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  • A comprehensive reproductive health program for vulnerable adolescent girls
    Reprod. Health (IF 2.295) Pub Date : 2020-01-23
    Razieh Pourkazemi; Mojgan Janighorban; Zahra Boroumandfar; Firoozeh Mostafavi

    Reproductive health of vulnerable adolescent girls is a top priority in global programs. Alcohol consumption, drug abuse, high risk sexual behaviors, sexually transmitted diseases, sexual assault, escape from home, unrestrained sex in the family, history of robbery, imprisonment and living in drug hangouts expose adolescents to different sorts of damage and injury. These adolescent girls are at risk of AIDS and other STDs, unwanted pregnancies, illegal and unsafe abortions, unplanned pregnancy and childbirth, and unsafe motherhood. Therefore, assessing these girls’ reproductive health needs and designing programs to improve their sexual and reproductive health seem to be essential. This study will be conducted to design a comprehensive program for improving the reproductive health of vulnerable adolescent girls. The present study is an exploratory sequential mixed methods study (Qual-Quan) designed in three phases. In the first phase, a qualitative study will be used to describe the reproductive health needs of vulnerable adolescent girls, identify facilitating and inhibiting factors, and explain the strategies of reproductive health programs for these girls. Participants will be selected in this phase using purposive sampling method, and the data will be collected through semi-structured interviews. The obtained data will be analyzed using conventional qualitative content analysis. In the second phase, through a quantitative study, the strategies obtained from the qualitative study and review of the literature will be provided to reproductive health care providers, experts, policymakers, and planners to prioritize and select the best strategies. In the third phase, the initial draft of the program will be formulated based on prioritized strategies and will be proposed in a panel comprised of specialists in the areas of reproductive and sexual health, health promotion, social injuries and a psychiatrist. Finally, the final program will be developed and presented after obtaining the agreement and approval of the panel members. Designing a program based on a qualitative study, review of the existing evidence and programs, and using the opinions of experts in different areas can lead to different aspects of reproductive and sexual health of vulnerable adolescent girls. On the other hand, taking into account all cultural sensitivities and taboos as well as political, economic and social barriers, the development of such a program can provide the appropriate possibility of presenting comprehensive reproductive and sexual health services to vulnerable adolescent girls and achieve the goals agreed universally.

    更新日期:2020-01-23
  • A mental health program for infertile couples undergoing oocyte donation: protocol for a mixed methods study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-22
    Shohre Ghelich-Khani; Ashraf Kazemi; Malek Fereidooni-Moghadam; Mousa Alavi

    The psychological consequences of infertility in couples undergoing oocyte donation differ culturally, racially, religiously, and legally from other infertile couples undergoing assisted reproductive treatments. Therefore, the inclusion of a mental health program in assisted reproductive services is essential for these couples. As such, the aim of this study is to develop a program for improving the mental health of these couples. This study is designed using an exploratory mixed method and the program based on Talbot and Verrinder model. Different steps of this research include determination of a specific topic for planning (needs assessment), initial design of the program, finalization of the program (using the views of experts in this area), implementation of the program, monitoring of the implementation of the program and evaluation of the program. To perform the first step of Talbot’s program, the first phase of the study will be conducted. At first, through a qualitative study, the items of the questionnaire are designed and then its psychometric steps will be performed by a cross-sectional study. In the second and third steps, the classic Delphi technique will be used in four-round for initiation and finalization of the program, and the second phase will be completed. The fourth, fifth and sixth steps of the program including implementation, monitoring of the implementation and evaluation of the program in the future will be performed. Designing an appropriate program based on the documentations of the qualitative study and evidence can improve the mental health and quality of life of the couples undergoing oocyte donation. The program, based on the measurement of needs, will be implemented using a tool designed specifically for the target population and can be useful in the processes of treatment, education, policymaking and legislation as well as research.

    更新日期:2020-01-23
  • Non-communicable diseases and reproductive health in sub-Saharan Africa: bridging the policy-implementation gaps
    Reprod. Health (IF 2.295) Pub Date : 2020-01-23
    Sanni Yaya; K. Srikanth Reddy; José M. Belizán; Verónica Pingray

    Sub-Saharan Africa (SSA) region is a home for over one billion population distributed in 46 different countries. Over the decades, this region has confronted with high disease burden accounting around 24% of the global disease burden [1]. Traditionally, communicable diseases such as HIV, TB, and Malaria have long been the most prominent contributors to the disease burden. However, in the last two decades, the region has witnessed an epidemiological transition to non-communicable diseases (NCDs) [2]. Around 80% of all NCDs deaths occur in low and middle-income countries. It is projected that by 2020, NCDs will account for 27% of mortality in SSA [3]. Majority of NCDs related deaths can be prevented by addressing the common modifiable risk factors for NCDs include tobacco use, physical inactivity, the harmful use of alcohol, and unhealthy diet [4]. The NCDs and reproductive health morbidity and mortality, has become a significant part of the disease burden in the region requiring a rethink on policy prioritisation and implementation to minimise the burden. The WHO defines reproductive health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and its functions and processes.” This implies that people are able to have a satisfying and safe sex life and that they can reproduce and the freedom to decide if, when, and how often to do so [5]. However, reproductive health among women was often constrained by socio-cultural and economic factors across the societies, particularly in SSA. The access to abortion and contraception are severely restricted, contributing to high maternal mortalities and poor sexual and reproductive health outcomes [6,7,8,9]. Reproductive and maternal morbidities increase the risk of maternal mortality, stillbirth, neonatal death. Women facing pregnancy related complications are predisposed to immediate and long-term disabilities and infertility as well as adverse psychological and socio-economic consequences. SSA region faces high burden of maternal mortality, stillbirth and neonatal mortality rates [10]. In 2015, two-thirds of all maternal deaths worldwide occurred in SSA (546 maternal deaths per 100,000 live births [11]. SSA women in reproductive age (15–49 years) have low contraceptive prevalence rate (28%), and about half of them do not receive four or more antenatal check-ups (54%), and do not give birth in health facilities (52%). Further, adolescent girls and young women in the region face high risk of unintended pregnancies, sexually transmitted infections, HIV, and exposure to violence [12]. Further, 244,000 infants in the region annually become infected with HIV during pregnancy and delivery (115,000) or breast-feeding (129,000) [13]. The unmet needs of sexual and reproductive health services among SSA women are coupled with the rising burden of non-communicable diseases. NCDs account for almost 65% of women’s deaths globally, and the majority of these deaths occur in LMICs and are premature. In recent years, NCDs among women of reproductive age has doubled in many African countries [14]. Also, there are established linkages between NCDs and reproductive health. Several NCDs risk factors adversely affect the reproductive health of women. For example, obesity, CVDs, hypertension, hyperglycemia, and gestational diabetes predispose pregnant women at higher risk of menstrual problems, hypertension in pregnancy, caesarean sections, post-natal complications and maternal mortality [10]. Obesity also increases the odds of developing CVDs and cancers in women [15, 16]. In a recent study, the prevalence of obesity across 32 Sub-Saharan African countries ranged from 1.1% in Madagascar to 23.0% in Swaziland [17]. A study shows that that women at the beginning of pregnancy 73.7% and 60.2% women in South Africa and Zimbabwe, respectively started their pregnancy with BMI above normal (BMI ≥ 25) [18]. Epidemiological, clinical and animal studies have shown the modelling effect of fetal life on NCDs diseases of adult life, like hypertension, coronary heart disease and diabetes [19]. Furthermore, nutrients restriction during fetal life have shown higher blood pressure in the progeny. Animal studies have shown that protein restriction and calcium restriction during pregnancy involved hypertension of the progeny [20]. In humans, calcium supplementation during pregnancy involved a reduction of hypertension of children whose mothers were supplemented in comparison with a placebo group [21]. In a previous mentioned study done in South Africa and Zimbabwe the prevalence of inadequate micronutrient intake from food sources was high in both countries. For the most basic micronutrients like iron, calcium, folate and zinc, the percentage of women below requirements was above 90% in both countries [18]. Further, research suggests that obesity is linked to polycystic ovary syndrome (PCOS) in women. Moreover, obese women with PCOS have worse metabolic and reproductive outcomes [22]. The hypertensive disorders of pregnancy is one of the major cause of maternal deaths and stillbirths in the region [10]. African Union (AU) is at the forefront of shaping the national health priorities including women and child health. The AU, despite being the first to develop African Charter of Human and People’s Rights on the Rights of Women in Africa that mandates state provision of comprehensive reproductive and sexual health services, is yet to be a reality and achieve the objective [23]. Building on Millennium Development Goal’s (MDGs) progress on reducing maternal and child mortality and malnutrition, combating infectious diseases, an updated Global Strategy for Women’s and Children’s Health (2016–2030) was launched in 2016 [24, 25]. This universal and equity-based strategy aims to end preventable deaths among women by reducing global maternal mortality to less than 70 per 100,000 live births and reduce by one-third premature mortality from NCDs and promote mental health and well-being. The reproductive health policies must be in alignment with this global strategy to minimize the mortalities due to NCDs risk factors linked to reproductive health. And also, to optimize better sexual and reproductive health in the SSA. At the individual level, prevention and continuum of care approach through “life-course” are essential for the prevention of NCDs. While most NCD related health outcomes cause morbidity and mortality during adulthood, exposure to risk factors begins early in life, and these behaviours often get established for the lifetime. WHO recommends that NCD prevention and control measures to consider health and social needs and reduce exposure to risk factors at all stages of the life course. Similarly, improving reproductive health outcomes calls for a comprehensive understanding of women’s health throughout the life course. The global strategy for women’s health adopts an integrated life course approach and underscores the need for investment in child and adolescent health and development [24]. At the systemic level, a comprehensive approach requires multipronged strategies focussing on prevention within primary care through community-based programs, health promotion, and cost-effective policies that target the whole population as well as high-risk individuals. Both NCDs and reproductive health thus needs to be addressed through both “population-based” and “high-risk individual” based approaches to empower individuals and populations to make healthier choices and access to health services. The global strategy recommends integrating NCDs prevention and treatment with women’s, children’s, and adolescents’ health care [24, 25]. The population-level approaches include increasing awareness, creating a conducive environment and instituting public health policies while high-risk individual-level approaches include early diagnosis and management and treatment of disease and need to integrate into the health systems in SSA. At the policy level, various bodies have emphasised the need for a collective response towards addressing health issues as it cuts across the sectors. The WHO has emphasized that effective NCD prevention and control require “health-in-all policies and whole-of-government approaches” across sectors, involving a range of ministries outside health such as health, agriculture, communication, education, employment, social welfare, social and economic development, sports, trade and industry transport, urban planning and others. Similarly, Global Strategy for Women’s and Children’s Health also emphasise the adoption of a multi-sectoral approach to develop and monitor interventions outside the health sector and asserts the countries to build governance mechanisms and capacity to facilitate multisector actor and cross-sector collaborations [25]. Most risk behaviours for NCDs and reproductive health are modifiable, and the related morbidity and mortality is preventable. Yet, the progress is largely determined by socioeconomic, demographic, political factors. Strengthening national policies, health systems, country-level surveillance, and monitoring systems, and creating sustainable partnerships and advocacy are key strategies towards addressing these health issues. However, implementation gaps remain contributing not only NCDs mortality, but also reproductive health. Identification of common risk factors and linkages among the NCDs and reproductive, would help intersectoral action and integration of health care services for the prevention of mortalities in respective sub-Saharan African counties. Such an effort, while contributing to better health outcome in region, also help accelerating the Sustainable Development Goals and targets, particularly SDG 3.4, 3.6, 3.7 and SDG11.2. Therefore, the journal encourages global public health scholars, particularly from sub-Saharan African countries to reflect upon these considerations and submission of manuscripts. 1. International Finance Corporation. World Bank Group. Health and Education. 2019; Available at: https://www.ifc.org/wps/wcm/connect/REGION__EXT_Content/IFC_External_Corporate_Site/Sub-Saharan+Africa/Priorities/Health+and+Education/. Accessed 30 Dec 2019. 2. Gouda HN, Charlson F, Sorsdahl K, Ahmadzada S, Ferrari AJ, Erskine H, et al. Burden of non-communicable diseases in sub-Saharan Africa, 1990-2017: results from the global burden of disease study 2017. Lancet Glob Health. 2019;7(10):e1375–87. Article Google Scholar 3. Juma PA, Mohamed SF, Matanje Mwagomba BL, Ndinda C, Mapa-Tassou C, Oluwasanu M, et al. Non-communicable disease prevention policy process in five African countries. BMC Public Health. 2018;18(Suppl 1):961-018-5825-7. Google Scholar 4. World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: World Health Organization; 2018. Google Scholar 5. World Health Organization. Health topics: Reproductive health. 2019; Available at: http://origin.who.int/topics/reproductive_health/en/. Accessed 30 Dec 2019. Google Scholar 6. Hall KS, Manu A, Morhe E, Dalton VK, Challa S, Loll D, et al. Bad girl and unmet family planning need among sub-Saharan African adolescents: the role of sexual and reproductive health stigma. Qual Res Med Healthc. 2018;2(1):55–64. Article Google Scholar 7. Alemayehu B, Addissie A, Ayele W, Tiroro S, Woldeyohannes D. Magnitude and associated factors of repeat induced abortion among reproductive age group women who seeks abortion Care Services at Marie Stopes International Ethiopia Clinics in Addis Ababa, Ethiopia. Reprod Health. 2019;16(1):76-019-0743-4. Article Google Scholar 8. Harries J, Orner P, Gabriel M, Mitchell E. Delays in seeking an abortion until the second trimester: a qualitative study in South Africa. Reprod Health. 2007;4:7–4755-4-7. Article Google Scholar 9. Vallely LM, Homiehombo P, Kelly-Hanku A, Whittaker A. Unsafe abortion requiring hospital admission in the Eastern Highlands of Papua New Guinea--a descriptive study of women's and health care workers' experiences. Reprod Health. 2015;12:22–015-0015-x. Article Google Scholar 10. Alliance for Maternal and Newborn Health Improvement (AMANHI) mortality study group. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297–308. Article Google Scholar 11. World Health Organization. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. ISBN 978 92 4 156514 1. 2015. Google Scholar 12. Naidoo K, Adeagbo O, Pleaner M. Sexual and reproductive health needs of adolescent girls and young women in sub-saharan africa: research, policy, and practice. SAGE Open. 2019;9(3):1-3. Article Google Scholar 13. Singh S, Darroch J, Vlassoff M, Nadeau J. Adding It Up: The Benefits of Investing in Sexual and Reproductive Health Care. New York: The Alan Guttmacher Institute and the United Nations Population Fund; 2004. p. 30. 14. Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Socioeconomic inequalities in the risk factors of noncommunicable diseases among women of reproductive age in sub-saharan Africa: a multi-country analysis of survey data. Front Public Health. 2018;6:307. Article Google Scholar 15. Kapur A. Links between maternal health and NCDs. Best Pract Res Clin Obstet Gynaecol. 2015;29(1):32–42. Article Google Scholar 16. Nkoka O, Ntenda PAM, Senghore T, Bass P. Maternal overweight and obesity and the risk of caesarean birth in Malawi. Reprod Health. 2019;16(1):40-019-0700-2. Article Google Scholar 17. Yaya S, Ekholuenetale M, Bishwajit G. Differentials in prevalence and correlates of metabolic risk factors of non-communicable diseases among women in sub-Saharan Africa: evidence from 33 countries. BMC Public Health. 2018;18(1):1168-018-6085-2. Article Google Scholar 18. Cormick G, Betran AP, Harbron J, Dannemann Purnat T, Parker C, Hall D, et al. Are women with history of pre-eclampsia starting a new pregnancy in good nutritional status in South Africa and Zimbabwe? BMC Pregnancy Childbirth. 2018;18(1):236–018-1885-z. Article Google Scholar 19. Barker DJ, Winter PD, Osmond C, Margetts B, Simmonds SJ. Weight in infancy and death from ischaemic heart disease. Lancet. 1989;2(8663):577–80. CAS Article Google Scholar 20. Langley-Evans SC, Phillips GJ, Jackson AA. In utero exposure to maternal low protein diets induces hypertension in weanling rats, independently of maternal blood pressure changes. Clin Nutr. 1994;13(5):319–24. CAS Article Google Scholar 21. Belizan JM, Villar J, Bergel E, del Pino A, Di Fulvio S, Galliano SV, et al. Long-term effect of calcium supplementation during pregnancy on the blood pressure of offspring: follow up of a randomised controlled trial. BMJ. 1997;315(7103):281–5. CAS Article Google Scholar 22. Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obes Rev. 2013;14(2):95–109. CAS Article Google Scholar 23. Ngwena CG. Protocol to the African charter on the rights of women: implications for access to abortion at the regional level. Int J Gynaecol Obstet. 2010;110(2):163–6. Article Google Scholar 24. Kuruvilla S, Bustreo F, Kuo T, Mishra CK, Taylor K, Fogstad H, et al. The global strategy for women's, children's and adolescents' health (2016-2030): a roadmap based on evidence and country experience. Bull World Health Organ. 2016;94(5):398–400. Article Google Scholar 25. High-Level Working Group on the Health and Human Rights of Women, Children and Adolescents. World Health Organization. Leading the realization of human rights to health and through health. Report of the High-Level Working Group on the Health and Human Rights of Women, Children and Adolescents. Geneva: World Health Organization; 2017. Google Scholar Download references Affiliations School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada Sanni Yaya The George Institute for Global Health, The University of Oxford, Oxford, UK Sanni Yaya Bruyere Research Institute, University of Ottawa, Ottawa, Canada K. Srikanth Reddy Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica PingrayAuthors Search for Sanni Yaya in: PubMed • Google Scholar Search for K. Srikanth Reddy in: PubMed • Google Scholar Search for José M. Belizán in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions SY and KSR conceptualized and wrote the initial draft. JB and VP provided comments and edits. All authors commented on the first draft and signed off on the final version. Corresponding author Correspondence to Sanni Yaya. Competing interests Sanni Yaya and José M. Belizán are Editors-in-Chief of Reproductive Health. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Yaya, S., Reddy, K.S., Belizán, J.M. et al. Non-communicable diseases and reproductive health in sub-Saharan Africa: bridging the policy-implementation gaps. Reprod Health 17, 8 (2020). https://doi.org/10.1186/s12978-020-0857-8 Download citation Published: 23 January 2020 DOI: https://doi.org/10.1186/s12978-020-0857-8

    更新日期:2020-01-23
  • Retraction Note: Factors associated with induced abortion in Nepal: data from a nationally representative population-based cross-sectional survey
    Reprod. Health (IF 2.295) Pub Date : 2020-01-21
    Suresh Mehata; Jamie Menzel; Navaraj Bhattarai; Sharad Kumar Sharma; Mukta Shah; Erin Pearson; Kathryn Andersen

    The authors have retracted this article [1] because it contains significant conceptual and textual overlap with unpublished work from another group. Suresh Mehata, Jamie Menzel, Erin Pearson and Kathryn Andersen agree with this retraction. Navaraj Bhattarai, Sharad Kumar Sharma and Mukta Shah did not respond to correspondence regarding this retraction.

    更新日期:2020-01-22
  • Every woman in the world must have respectful care during childbirth: a reflection
    Reprod. Health (IF 2.295) Pub Date : 2020-01-22
    José M. Belizán; Suellen Miller; Caitlin Williams; Verónica Pingray

    Every woman has the right to the highest attainable standard of health, which includes the right to respectful maternity care [1]. We—as pregnant and birthing individuals and the care providers, public health professionals, and researchers serving them—know instinctually what constitutes dignified treatment. Yet the systems and structures within which we birth and work are not designed to ensure respectful, evidence-based care. To help the reader see this more clearly, we invite you to do a thought experiment. Imagine you are a woman in labour. You come to a facility in order to receive quality obstetric care. What type of treatment would you expect? Timely attention? Clear and detailed information from a caring health provider about what to expect and why? Recognition of your role as an active decision-maker and protagonist in your own birthing experience, with the choice to consent to or refuse any procedures once you understand them and their implications? Perhaps having a chosen companion with you at all times or deciding on birth position(s) based on your own comfort? Or maybe having the privacy to experience your newborn’s first hours without sharing a bed with a stranger? What other expectations would you have? Viewed in this way, conceptualizing dignified treatment is simple. Yet such timely, respectful and consensual obstetric care is not the norm in many healthcare settings across the globe. There is a wide-spread belief that ensuring safe birth requires placing the needs and priorities of health providers over those of birthing women. This sets up and perpetuates a power imbalance, privileging providers and contributing to obstetric violence. The power imbalance between women and providers is echoed and exacerbated by similar power dynamics between providers (across cadre and seniority) that can produce counterproductive and even toxic interactions between members of the care team, undermining quality of care and contributing to provider burnout [2]. It is critical that we all reflect individually on these issues, because we—collectively as society—create the written and unwritten rules and norms that govern institutions (be they health facilities; schools of medicine, midwifery, and nursing; or safe motherhood initiatives); therefore, we can also be the driving force to change them. Clear your mind of the idea that the power dynamics in the institutions under which we live are natural. They are not; and making such a dangerous mistake misleads us into believing that we are exempt from acting. In the Millennium Development Goal-era push to reduce maternal and newborn mortality and morbidity, strong recommendations and actions were taken to reduce home births and encourage women to instead give birth in health facilities. Unfortunately, there was a large missing element. While we have seen rates of facility delivery increase dramatically, we have not seen a concomitant improvement in women’s experience of childbirth. The shift from birthing at home to birthing in facilities helped increase access to life-saving care for complications, but also introduced new challenges, including overcrowding of facilities, an excess of procedures, and over-medicalization of birth. In fact, we now know that facility birth does not on its own lead to improved outcomes; these rely on quality, respectful, evidence-based care [3]. The foundations for the contemporary focus on respectful care were laid in Latin America in the 1970s and 1980s. The publication (in Spanish) of Physiological and Psychological Bases for the Humanized Management of Natural Birth by Roberto Caldeyro-Barcia in the Latin American Centre for Perinatology, along with the jointly-led WHO and PAHO 1985 Fortaleza Declaration foregrounded the importance of dignified treatment [4, 5]. Subsequent work focused this new global attention on centring maternal satisfaction with the birthing process, uplifting positive traditional and indigenous practices, and identifying the health system conditions that contribute to mistreatment [6,7,8]. Within the last decade, respectful care in childbirth has garnered renewed attention, this time among a broader range of global health actors. For example, in Latin America, advocates pushed for legal frameworks addressing the issue [9]. The articles published in the Respectful Care series of this Journal reflect this, documenting the lack of dignified treatment in many countries: Tunisia, Nigeria, Guinea, Brazil, Tanzania, Ethiopia, India, South Africa, the United States, and among Romani women in Europe [10,11,12,13,14,15,16,17,18,19]. Yet today we find ourselves at an inflection point: it is time for us to move from merely documenting the problem towards engaging women, their families, and communities in jointly designing and testing effective, meaningful interventions. It is imperative that we provide the most respectful, humane, careful, friendly, effective, evidence-based childbirth care in our health facilities. At Reproductive Health, we are eager to receive and publish manuscripts to help achieve such care. Contributions from women and their families would be greatly appreciated, such as submissions describing their vision for respectful care and experiences, as well as offering suggestions for increasing respectful care in facilities. We welcome manuscripts from health facility staff from all levels—administration, nursing, midwifery, medicine, program managers, and decision makers—as well as manuscripts from social scientists on interventions to help providers change their attitudes and practices, and to encourage communities to demand their right to respectful care. We also seek articles from human rights activists and policymakers on actions to protect the right to respectful care during childbirth. As is stated in one of the articles published in the Journal’s Respectful Care Series: “The compassion and evidence based medicine agenda in healthcare is interconnected with human rights in healthcare, feeding into the principles of decision making and patient centred care” ( [20], abstract). As disrespect and abuse in childbirth has gained public traction, an interesting global semiotic discussion has arisen on the terminology that best defines it. For this series, we have selected the use of Respectful Care over the negative terms (“disrespect and abuse”, “mistreatment during childbirth”, or “obstetric violence”), in order to focus on the positive aspects of care and caring as a broader concept that encompasses all of what pregnant and childbearing people and their families deserve, and not just the absence of mistreatment [21]. By employing the term respectful care, we intend to set a shared goal for all actors, from lay individuals and health providers to researchers and policymakers. We expect that by joining efforts we can achieve a change in the delivery of dignified obstetric care. The Chilean writer, Isabel Allende, thoroughly narrates in her book De Amor y de Sombra, Digna’s first experience giving birth in a hospital, after having had five home deliveries: “Digna had gone to Los Riscos Hospital, where she felt she had been treated worse than a criminal. When she entered a numbered band was strapped around her wrist, they shaved her private parts, bathed her with cold water and antiseptic, (…) and placed her beside a woman in the same condition on a bed without sheets. After poking around, without her permission, in all her bodily orifices, they made her give birth beneath a bright lamp in full view of anyone who might happen by. She bore it all without a sigh, but when she left that place carrying a baby that was not hers in her arms and with her unmentionable places painted red like a flag, she swore that for the rest of her life she would never again set foot in a hospital.” (Translation by Margaret Sayer Peden) ( [22], p., 20). In order to continue efforts to improve maternal and newborn health, it is our responsibility to ensure that no woman in the world leaves a health facility feeling like Digna. We call on all readers to work together to achieve universal respectful care for every woman, everywhere. 1. The White Ribbon Alliance for Safe Motherhood. Respectful maternity care: The universal rights of childbearing women. White Ribb Alliance Safe Mother [Internet]; 2011. p. 1–6. Available from: http://whiteribbonalliance.org/wp-content/uploads/2013/10/Final_RMC_Charter.pdf Google Scholar 2. Sadler M, Santos MJ, Ruiz-Berdún D, Rojas GL, Skoko E, Gillen P, et al. Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence. Reprod Health Matt. 2016;24(47):47–55. Article Google Scholar 3. Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: A pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388:2176–219. Article Google Scholar 4. Caldeyro-Barcia R. Bases fisiológicas y psicológicas Para el manejo humanizado del parto normal [physiological and psychological bases for the humanized management of normal birth]. Centro Latinoamericano de Perinatologia y Desarollo Humano: Montevideo; 1979. Google Scholar 5. World Health Organization. Appropriate technology for birth. Lancet. 1985;326:436–7. Article Google Scholar 6. Misago C, Umenai T, Onuki D, Haneda K, Wagner M. Humanised maternity care. Lancet. 1999;354:1391–2. CAS PubMed Article Google Scholar 7. Belizán J, Villar J, Belizán M, Garrote N. Care of pregnant women in prenatal services in public maternity hospitals of Rosario, Argentina. Bol Of Sanit Panam. 1979;86:121–30. Google Scholar 8. Jewkes R, Abrahams N, Mvo Z. Why do nurses abuse patients? Reflections from south African obstetric services. Soc Sci Med. 1998;47(11):1781–95. CAS PubMed Article Google Scholar 9. Williams CR, Jerez C, Klein K, Correa M, Belizán JM, Cormick G. Obstetric violence: a Latin American legal response to mistreatment during childbirth. BJOG An Int J Obstet Gynaecol. 2018;125:1208–11. CAS Article Google Scholar 10. Amroussia N, Hernandez A, Vives-Cases C, Goicolea I. “Is the doctor God to punish me?!” An intersectional examination of disrespectful and abusive care during childbirth against single mothers in Tunisia. Reprod Health. 2017;14(1):32. PubMed PubMed Central Article Google Scholar 11. Bohren MA, Vogel JP, Tunçalp Ö, Fawole B, Titiloye MA, Olutayo AO, et al. Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers. Reprod Health. 2017;14(1):239–44. Article Google Scholar 12. Balde MD, Bangoura A, Diallo BA, Sall O, Balde H, Niakate AS, et al. A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea. Reprod Health. 2017;14(1):1045–9. Google Scholar 13. Mesenburg MA, Victora CG, Serruya SJ, De León RP, Damaso AH, Domingues MR, et al. Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort. Reprod Health. 2018;15(1):1–8. Article Google Scholar 14. Ratcliffe HL, Sando D, Lyatuu GW, Emil F, Mwanyika-Sando M, Chalamilla G, et al. Mitigating disrespect and abuse during childbirth in Tanzania: an exploratory study of the effects of two facility-based interventions in a large public hospital. Reprod Health. 2016;13(1):79. PubMed PubMed Central Article Google Scholar 15. Sheferaw ED, Bazant E, Gibson H, Fenta HB, Ayalew F, Belay TB, et al. Respectful maternity care in Ethiopian public health facilities. Reprod Health. 2017;14(1):60. PubMed PubMed Central Article Google Scholar 16. Sharma G, Penn-Kekana L, Halder K, Filippi V. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study. Reprod Health. 2019;16(7):1–16. Google Scholar 17. Oosthuizen SJ, Bergh A, Pattinson RC, Grimbeek J. It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa. Reprod Health. 2017;14(151):1–11. Google Scholar 18. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(77). 19. Watson HL, Downe S. Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review. Reprod Health. 2017;14(1):1. PubMed PubMed Central Article Google Scholar 20. Lokugamage AU, Pathberiya SDC. Human rights in childbirth, narratives and restorative justice: a review. Reprod Health. 2017;14(17):1–8. Google Scholar 21. Shakibazadeh E, Namadian M, Bohren MA, Vogel JP, Rashidian A, Pileggi VN. Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis. BJOG An Int J Obstet Gynaecol. 2018;125:932–42. CAS Article Google Scholar 22. Allende I. De Amor y de Sombra. Editorial Sudamericana; 1984. p. 336. Google Scholar Download references We wish to thank writer Isabel Allende, for her kind provision of the translation of the paragraph of her book. Affiliations Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica Pingray Safe Motherhood Program, University of California, San Francisco, USA Suellen Miller Department of Maternal & Child Health Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA Caitlin WilliamsAuthors Search for José M. Belizán in: PubMed • Google Scholar Search for Suellen Miller in: PubMed • Google Scholar Search for Caitlin Williams in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions All authors read and approved the final manuscript. Corresponding author Correspondence to José M. Belizán. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Belizán, J.M., Miller, S., Williams, C. et al. Every woman in the world must have respectful care during childbirth: a reflection. Reprod Health 17, 7 (2020) doi:10.1186/s12978-020-0855-x Download citation Published: 22 January 2020 DOI: https://doi.org/10.1186/s12978-020-0855-x

    更新日期:2020-01-22
  • Respectful maternity care and its related factors in maternal units of public and private hospitals in Tabriz: a sequential explanatory mixed method study protocol
    Reprod. Health (IF 2.295) Pub Date : 2020-01-20
    Khadije Hajizadeh; Maryam Vaezi; Shahla Meedya; Sakineh Mohammad Alizadeh Charandabi; Mojgan Mirghafourvand

    Disrespect and abuse (D&A) can violate human rights, affect women’s decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) assess the status of D&A and respectful maternity care (RMC) during childbirth and their relationships with childbirth experience, socio-demographic and obstetrics characteristics; b) explain women’s perceptions of various RMC aspects and determinants during childbirth; and c) present a guideline for promoting of RMC. A mixed methods sequential explanatory design will be used to conduct this study in 3 phases. The first phase is a quantitative study with a longitudinal descriptive-analytical design to identify any D&A and RMC and their relationships with childbirth experience among 334 women who have given birth in public and private hospitals in Tabriz, Iran. The sample will be selected proportional to each population. The second phase is a qualitative study to explore women’s perceptions of various RMC aspects and their determinants during childbirth. The conventional content analysis approach will be used to analyze the data. The third phase is focused on developing a guideline to improve the quality of maternity care. The literature review, findings of phase one and two, and focus group discussion (FGDs) with staff in the labour ward and using a Delphi technique will be used to complete the final phase. Considering the vulnerability of women during labor and delivery and the effect of D&A on cesarean section rates, a supportive guideline can improve the quality of maternity care and reduce D&A during childbirth, and improve women’s childbirth experiences. IR.TBZMED.REC.1398.202.

    更新日期:2020-01-21
  • A mental health intervention program for the oocyte donors: protocol for a mixed methods study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-20
    Elham Adib Moghaddam; Ashraf Kazemi; Gholamreza Kheirabadi; Seyyed Mehdi Ahmadi

    Oocyte donation is one of the assisted reproductive techniques that can undermine the mental health of the women donor. As such, the aim of this study is to design a mental health promotion program for oocyte donors. This is an exploratory mixed methods study (qualitative-quantitative) that consists of three phases. In the first phase, a qualitative study will be conducted to identify the needs and strategies of the mental health promotion program for the women donors. In this phase, the participants will be selected using purposeful sampling method and the data will be collected through semi-structured interviews. In the second phase, the initial draft of the program is designed and validated in the panel of experts and using the classic Delphi technique and, then, the program is finalized. In the third phase, the designed program will be implemented as a quasi-experimental study in two groups of program recipients (intervention) and control, and the effectiveness of the intervention program will be evaluated. In order to design a documentation-based mental health promotion program for the oocyte donors, their experience during the process of oocyte donation should be evaluated. Doing so, the program will be developed based on the specific circumstances of the target population and their social and cultural context and, hence, will have the highest impact.

    更新日期:2020-01-21
  • Identifying the needs and problems of those left behind, and working with them to address inequities in sexual and reproductive health: a key focus of Reproductive Health for 2020
    Reprod. Health (IF 2.295) Pub Date : 2020-01-21
    José M. Belizán; Suellen Miller; Venkatraman Chandra-Mouli; Verónica Pingray

    One of the key messages of the Sustainable Development Goals is to ensure that no one is left behind in development efforts, and to focus these efforts on those who are most likely to be left behind [1]. We are well aware that there are enormous inequalities and inequities in sexual and reproductive health [2]. The huge differences in the rates of maternal mortality between and within countries, speak to this [3]. What this means is that some individuals, families, groups, communities, and countries are much more likely than others to experience sexual and reproductive health problems, and when they do are less likely to be able to obtain the health and social services they need to overcome these problems and to get back to good health. These inequalities and inequities exist in situations of peace and security, even in high-income countries [4,5,6,7]. However, in situations of conflict and natural disasters, they are greatly exacerbated [8,9,10,11,12,13,14]. The editorial team of the Reproductive Health Journal wants to contribute to efforts to shed light on the sexual and reproductive health needs and problems of the most vulnerable, those most likely to be left behind, and on efforts being made to address inequalities and inequities. Given this, the Journal will prioritize articles that describe efforts addressing such population groups. We are convinced that solutions must come from the most affected populations and from those who work with and for them. That is why we will welcome articles that articulate the needs and problem, hopes and expectations, fears and concerns, by members of these populations themselves, and the solutions that they propose. We also welcome articles from individuals who work directly with these populations. Two other areas will be prioritized in the Reproductive Health journal. One is Adolescent Sexual and Reproductive Health and Rights (ASRHR). Adolescents were largely neglected in the context of the Millennium Development Goals [15]. In the context of the Sustainable Development Goals, they are receiving the attention they deserve [16, 17]. Our journal wants to contribute to sharing and learning between adolescents and with researchers, programmers, policy makers, and funders together, and thereby help ensure that focus is put to the best possible use. The second area is the delivery of interventions in the pre-conception period. In an Editorial published in Reproductive Health introducing a Supplement on Preconception Care we stated: "The preconception window has been recognized as one of the earliest sensitive windows of human development, and interventions that focus on this period have the potential to affect not only pregnancy but long term outcomes as well" [18]. Given that the preconceptual period has been identified as a critically important stage that influences maternal and perinatal health, interventions that are being developed to improve the coverage of preconceptual care, such as family planning, contraception, nutrition, lifestyle factors (e.g. smoking, alcohol, caffeine, weight) vaccinations, reduction of harmful exposures, prevention and treatment of chronic and infectious diseases, and environmental exposures are of interest [18,19,20]. We will continue with the two special sections on Female Genital Mutilation/Cutting and on Respectful Care during Childbirth at Health Facilities, as we believe that these issues reflect great inequality and inequity, with powerful implications for reproductive health. Health providers must have an active role to end female genital mutilation/cutting and achieving a respectful care, by adapting or creating behavioral change strategies including their own evaluation of their behavior and its change [21, 22]. As previously stated, these two sections will prioritize the needs, problems, and the solutions developed and implemented to improve them. In summary, as we move towards the start of the third decade of the twenty-first century, the priority of the Reproductive Health journal is to publish contributions highlighting the plight of those who are worst affected by sexual and reproductive health problems, and showcasing actions taken by those affected and those who work with them to overcome this unacceptable situation of inequality and inequity. 1. United Nations Committee for Development Policy. Leaving no one behind. Report on records of the Economic and Social Council. 2018. Supplement No 13. Available from: https://undocs.org/pdf?symbol=en/E/2018/33 Google Scholar 2. World Health Organization. State of inequality: reproductive, maternal, newborn and child health I. World Health Organization Report. 2015. Available from: https://www.who.int/docs/default-source/gho-documents/health-equity/state-of-inequality/state-of-inequality-reproductive-maternal-new-born-and-child-health.pdf?sfvrsn=f4034289_2 Google Scholar 3. UNFPA, World Health Organization, UNICEF, World Bank Group, the United Nations Population Division. Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. World Health Organization Report. 2019. Available from: https://www.unfpa.org/featured-publication/trends-maternal-mortality-2000-2017 ISBN: 978–92–4-151648-8. Google Scholar 4. Shaw D, Guise JM, Shah N, et al. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet. 2016;388:2282–95. Available from: https://www.ncbi.nlm.nih.gov/pubmed/27642026. https://doi.org/10.1016/S0140-6736(16)31527-6.Epub. Article PubMed Google Scholar 5. Thomson K, Hillier-Brown F, Todd A, et al. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018;18(1):869. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30005611. https://doi.org/10.1186/s12889-018-5677-1. Article PubMed PubMed Central Google Scholar 6. WHO Regional Office for Europe. Women’s health and well-being in Europe: beyond the mortality advantage: World Health Organization; 2016. Report Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/318147/EWHR16_interactive2.pdf?ua=1 ISBN 978 92 890 5191 0 7. Knight M, Nair M, Tuffnell D, Shakespeare J, Kenyon S, Kurinczuk JJ. Saving lives, improving mothers’ care - lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2013–15. Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2017. Available from: https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACE-UK%20Maternal%20Report%202017%20-%20Web.pdf Google Scholar 8. Askew I, Khosla R, Daniels U, et al. Sexual and reproductive health and rights in emergencies. Bull World Health Organ. 2016;94:311. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850544/. https://doi.org/10.2471/BLT.16.173567. Article PubMed PubMed Central Google Scholar 9. Davis JR, Wilson S, Brock-Martin A, Glover S, Svendsen E. The impact of disasters on populations with health and health care disparities. Disaster Med Public Health Prep. 2010;1:30–8. Article Google Scholar 10. Shalash A, Alsalman HM, Hamed A, et al. The range and nature of reproductive health research in the occupied Palestinian territory: a scoping review. Reprod Health. 2019;16:41. Article Google Scholar 11. Sami S, Kerber K, Kenyi S, et al. State of newborn care in South Sudan’s displacement camps: a descriptive study of facility-based deliveries. Reprod Health. 2017;14:161. Article Google Scholar 12. Ivanova O, Rai M, Mlahagwa W, et al. A cross-sectional mixed-methods study of sexual and reproductive health knowledge, experiences and access to services among refugee adolescent girls in the Nakivale refugee settlement, Uganda. Reprod Health. 2019;16:35. Article Google Scholar 13. Roxo U, Mobula ML, Walker D, Ficht A, Yeiser S. Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda. Reprod Health. 2019;16(Suppl 1):57. Article Google Scholar 14. Bartels SA, Michael S, Roupetz S, et al. Making sense of child, early and forced marriage among Syrian refugee girls: a mixed methods study in Lebanon. BMJ Glob Health. 2018;3:e000509. Available from: https://gh.bmj.com/content/3/1/e000509. https://doi.org/10.1136/bmjgh-2017-000509. Article PubMed PubMed Central Google Scholar 15. United Nations Development Programme. From the MDGs to Sustainable Development for All: Lessons from 15 years of practice. United Nations Development Programme. 2016. Report. Available from: https://www.undp.org/content/dam/undp/library/SDGs/English/From%20the%20MDGs%20to%20SD4All.pdf Google Scholar 16. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development. Nations Development Programme. 2015 Main Committee Report A/70/L.1. Available from: https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for%20Sustainable%20Development%20web.pdf Google Scholar 17. Chandra-Mouli V, Plesons M, Barua A, Mohan A, Melles-Brewer M, Engel D. Adolescent sexual and reproductive health and rights: a stock-taking and call-to-action on the 25th anniversary of the international conference on population and development. Sexual Reprod Health Matter. 2009;27:1 Available from: https://www.ncbi.nlm.nih.gov/pubmed/31701814. Google Scholar 18. Mumford SL, Michels KA, Salaria N, Valanzasca P, Belizán JM. Preconception care: it's never too early. Reprod Health. 2014;11:73. Article Google Scholar 19. Dean SV, Lassi ZS, Imama AM, Bhutta ZA. Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reprod Health. 2014;11(Suppl 3):S1. Article Google Scholar 20. Preconception Interventions. Reproductive health supplement. 2014. Available from: https://reproductive-health-journal.biomedcentral.com/articles/supplements/volume-11-supplement-3 Google Scholar 21. Doucet M, Pallitto C, Groleau D. Understanding the motivations of health-care providers in performing female genital mutilation: an integrative review of the literature. Reprod Health. 2017;14:46 Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5364567/. Article Google Scholar 22. Bohren MA, Mehrtash H, Fawole B, et al. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet. 2019; (published online Oct 8). Available from: https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2931992-0. Download references Affiliations Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina José M. Belizán  & Verónica Pingray Safe Motherhood Program, University of California, San Francisco, USA Suellen Miller Department for Reproductive Health Research, World Health Organization, Geneva, Switzerland Venkatraman Chandra-MouliAuthors Search for José M. Belizán in: PubMed • Google Scholar Search for Suellen Miller in: PubMed • Google Scholar Search for Venkatraman Chandra-Mouli in: PubMed • Google Scholar Search for Verónica Pingray in: PubMed • Google Scholar Contributions All authors read and approved the final manuscript. Corresponding author Correspondence to José M. Belizán. Competing interests The authors declare that they have no competing interests. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Reprints and Permissions Cite this article Belizán, J.M., Miller, S., Chandra-Mouli, V. et al. Identifying the needs and problems of those left behind, and working with them to address inequities in sexual and reproductive health: a key focus of Reproductive Health for 2020. Reprod Health 17, 6 (2020) doi:10.1186/s12978-020-0856-9 Download citation Published: 21 January 2020 DOI: https://doi.org/10.1186/s12978-020-0856-9

    更新日期:2020-01-21
  • Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal
    Reprod. Health (IF 2.295) Pub Date : 2020-01-17
    Alex Harsha Bangura; Isha Nirola; Poshan Thapa; David Citrin; Bishal Belbase; Bhawana Bogati; Nirmala B.K.; Sonu Khadka; Lal Kunwar; Scott Halliday; Nandini Choudhury; Ryan Schwarz; Mukesh Adhikari; S. P. Kalaunee; Sharon Rising; Duncan Maru; Sheela Maru

    Access to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes. The study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process. A total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics. Group antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system. ClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

    更新日期:2020-01-17
  • Knowledge of obstetric danger signs and associated factors: a study among mothers in Shashamane town, Oromia region, Ethiopia
    Reprod. Health (IF 2.295) Pub Date : 2020-01-16
    Biresaw Wassihun; Berhanu Negese; Hunduman Bedada; Solomon Bekele; Agegnehu Bante; Tomas Yeheyis; Agere Abebe; Duro uli; Merima Mohammed; Salasebish Gashawbez; Emebet Hussen

    Child birth which is a special moment for parents, families and communities is also a time of intense vulnerability. In many developing countries including Ethiopia, maternal morbidity and mortality still pose a substantial burden. Raising awareness of women about the danger signs of pregnancy and childbirth is the first essential step in appropriate and timely obstetric care. To assess the knowledge of obstetric danger signs among mothers and associated factors in Shashamane town, oromia region, Ethiopia. A community based cross sectional study design was employed. All kebeles were included in study; the number of households was determined using proportionate-to-population size then systematic random sampling technique to select 422 women who gave birth in Shashamane town between April and May 2018. A structured questionnaire was used to collect data. Data was checked and entered into Epi data version 3.1 then exported to Statistical Package for Social Science version 23 for analysis. Univariate, bivariate and multivariable analysis with 95% CI was carried out. Women who spontaneously mentioned at least two danger signs of pregnancy from eight items were considered to have good knowledge of the obstetric danger signs. A total of 422 mothers were involved in the study. The mean age of the respondent was 25 with a standard deviation of 4.3 year. 59.5% of the respondents were found to have poor knowledge of obstetric danger signs. Majority of respondents mentioned vaginal bleeding (64.7%) as a danger sign of pregnancy. According to the result of the multivariable analysis, antenatal care was significantly associated with the knowledge of obstetric danger sign. Respondents who attended antenatal care were 1.26 times more likely to have good knowledge of obstetric danger signs than those who had no antenatal care [AOR = 1.26, 95%CI (1.08–1.85)]. Respondents who gave birth at health center were 3.57 time more likely to have good knowledge of obstetric danger signs than those who gave birth at home [AOR = 3.57, 95%CI (1.23–10.39)]. According to this study, the knowledge of obstetric danger signs was poor. Some of the factors associated with this knowledge were antenatal care attendance and place of delivery; therefore, it is recommended that mothers should have at least four antenatal visits; this may create good relationship with the providers and enhance their knowledge. In addition to this providing compassionate and respectful maternity care in health facility is also crucial steps to attract more women to health facilities, and to reduce home deliveries.

    更新日期:2020-01-16
  • Using the theory of planned behavior to explain birth in health facility intention among expecting couples in a rural setting Rukwa Tanzania: a cross-sectional survey
    Reprod. Health (IF 2.295) Pub Date : 2020-01-13
    Fabiola V. Moshi; Stephen M. Kibusi; Flora Fabian

    According to the theory of planned behavior, an intention to carry out a certain behavior facilitates action. In the context of birth in health facility, the intention to use health facilities for childbirth may better ensure better maternal and neonatal survival. Little is known on the influence of the domains of theory of planned behavior on birth in health facility intention. The study aimed to determine the influence of the domains of theory of planned behavior on birth in health facility intention among expecting couples in the rural Southern Highlands of Tanzania. A community based cross-sectional study targeting pregnant women and their partners was performed from June until October 2017. A three-stage probability sampling technique was employed to obtain a sample of 546 couples (making a total of 1092 study participants). A structured questionnaire based upon the Theory of Planned Behavior was used. The questionnaire explored three main domains of birth in health facility intentions. These three domains included; 1) attitudes towards maternal services utilization, 2) perceived subjective norms towards maternal services utilization and 3) perceived behavior control towards maternal services utilization. The vast majority of study participants had birth in health facility intention. This included 499(91.2%) of pregnant women and 488(89.7%%) of their male partners partner. Only perceived subjective norms showed a significant higher mean score among pregnant women (M = 30.21, SD = 3.928) compared to their male partners (M = 29.72, SD = 4.349) t (1090) = − 1.965 at 95% CI = -0.985 to − 0.002; p < 0.049. After adjusting for the confounders, no intention to use health facility for childbirth decreased as the attitude [pregnant women (B = − 0.091; p = 0.453); male partners (B = − 0.084; p = 0.489)] and perceived behavior control [pregnant women (B = − 0.138; p = 0.244); male partners (B = − 0.155; p = 0.205)] scores increase among both pregnant women and their male partners. Despite the fact that majority of study respondents had birth in health facility intention, the likelihood of this intention resulting into practice is weak because none of the domains of theory of planned behavior showed a significant influence. Innovative interventional strategies geared towards improving domains of intention is highly recommended in order to elicit strong intention to use health facilities for childbirth.

    更新日期:2020-01-14
  • Exploring women and traditional birth attendants’ perceptions and experiences of stillbirths in district Thatta, Sindh, Pakistan: a qualitative study
    Reprod. Health (IF 2.295) Pub Date : 2020-01-13
    Sanam Zulfiqar Mcnojia; Sarah Saleem; Anam Feroz; Kausar S. Khan; Farnaz Naqvi; Shiyam Sunder Tikmani; Elizabeth M. McClure; Sameen Siddiqi; Robert L. Goldenberg

    Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women’s and Children’s Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman‘s body and uterus. Further women are advised to conceive soon so that they get rid of infections. Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.

    更新日期:2020-01-14
  • Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia
    Reprod. Health (IF 2.295) Pub Date : 2020-01-08
    Chama Mulubwa; Anna-Karin Hurtig; Joseph Mumba Zulu; Charles Michelo; Ingvild Fossgard Sandøy; Isabel Goicolea

    Community-based sexual reproductive interventions are key in attaining universal health coverage for all by 2030, yet adolescents in many countries still lack health services that are responsive to their sexual reproductive health and rights’ needs. As the first step of realist evaluation, this study provides a programme theory that explains how, why and under what circumstances community-based sexual reproductive health interventions can transform (or not) ‘ordinary’ community-based health systems (CBHSs) into systems that are responsive to the sexual reproductive health of adolescents. This realist approach adopted a case study design. We nested the study in the full intervention arm of the Research Initiative to Support the Empowerment of Girls trial in Zambia. Sixteen in-depth interviews were conducted with stakeholders involved in the development and/or implementation of the trial. All the interviews were recorded and analysed using NVIVO version 12.0. Thematic analysis was used guided by realist evaluation concepts. The findings were later synthesized using the Intervention−Context−Actors−Mechanism−Outcomes conceptualization tool. Using the retroduction approach, we summarized the findings into two programme theories. We identified two initial testable programme theories. The first theory presumes that adolescent sexual reproductive health and rights (SRHR) interventions that are supported by contextual factors, such as existing policies and guidelines related to SRHR, socio-cultural norms and CBHS structures are more likely to trigger mechanisms among the different actors that can encourage uptake of the interventions, and thus contribute to making the CBHS responsive to the SRHR needs of adolescents. The second and alternative theory suggests that SRHR interventions, if not supported by contextual factors, are less likely to transform the CBHSs in which they are implemented. At individual level the mechanisms, awareness and knowledge were expected to lead to value clarification’, which was also expected would lead to individuals developing a ‘supportive attitude towards adolescent SRHR. It was anticipated that these individual mechanisms would in turn trigger the collective mechanisms, communication, cohesion, social connection and linkages. The two alternative programme theories describe how, why and under what circumstances SRHR interventions that target adolescents can transform ‘ordinary’ community-based health systems into systems that are responsive to adolescents.

    更新日期:2020-01-08
  • Perceptions of isolation during facility births in Haiti - a qualitative study
    Reprod. Health (IF 2.295) Pub Date : 2019-12-27
    Alka Dev; Chelsey Kivland; Mikerlyne Faustin; Olivia Turnier; Tatiana Bell; Marie Denise Leger

    Haiti’s maternal mortality, stillbirth, and neonatal mortality rates are the highest in Latin America and the Caribbean. Despite inherent risks, the majority of women still deliver at home without supervision from a skilled birth attendant. The purpose of this study was to elucidate factors driving this decision. We conducted six focus group discussions with women living in urban (N = 14) or rural (N = 17) areas and asked them questions pertaining to their reasons for delivering at a facility or at home, perceptions of staff at the health facility, experiences with or knowledge of facility or home deliveries, and prior pregnancy experiences (if relevant). We also included currently pregnant women to learn about their plans for delivery, if any. All of the women interviewed acknowledged similar perceived benefits of a facility birth, which were a reduced risk of complications during pregnancy and access to emergency care. However, many women also reported unfavorable birthing experiences at facilities. We identified four key thematic concerns that underpinned women’s negative assessments of a facility birth: being left alone, feeling ignored, being subject to physical immobility, and lack of compassionate touch/care. Taken together, these concerns articulated an overarching sense of what we term “isolation,” which encompasses feelings of being isolated in the hospital during delivery. Although Haitian women recognized that a facility was a safer place for birthing than the home, an overarching stigma of patient neglect and isolation in facilities was a major determining factor in choosing to deliver at home. The Haitian maternal mortality rate is high and will not be lowered if women continue to feel that they will not receive comfort and compassionate touch/care at a facility compared to their experience of delivering with traditional birth attendants at home. Based on these results, we recommend that all secondary and tertiary facilities offering labor and delivery services develop patient support programs, where women are better supported from admission through the labor and delivery process, including but not limited to improvements in communication, privacy, companionship (if deemed safe), respectful care, attention to pain during vaginal exams, and choice of birth position.

    更新日期:2019-12-30
  • Domestic violence related disclosure among women and girls in Ethiopia: a systematic review and meta-analysis
    Reprod. Health (IF 2.295) Pub Date : 2019-12-23
    Berhanu Boru Bifftu; Berihun Assefa Dachew; Bewket Tadesse Tiruneh; Lemma Derseh Gezie; Yonas Deressa Guracho

    Domestic violence is common public health problem. Domestic violence related disclosure is an important first step in the process of prevention, control and treatments of domestic violence related adverse effect. Thus, this systematic review and meta-analysis aimed to determine the pooled prevalence of domestic violence related disclosure and synthesize its associated factors. We followed the PRISMA Guidelines to report the results of the finding. Databases including PubMed, Cochrane Library and Web of Sciences were searched. The heterogeneity between studies was measured by the index of heterogeneity (I2 statistics) test. Funnel plots and Egger’s test were used to determine publication bias. Moreover, sensitivity analysis was carried out. To calculate the pooled prevalence, a random effects model was utilized. Twenty one eligible studies were included in this systematic review and meta-analysis. The pooled prevalence of domestic violence related non-disclosure was found to be 36.2% (95% CI, 31.8–40.5%). Considering violence as normal or not serious, shame, embarrassment and fear of disclosure related consequences were the common barriers for non-disclosure. More than one third of women and girls were not disclosed their experience of domestic violence. The finding of this study suggests the need of evaluation and strengthening of the collaborative work among different sectors such as: policy-makers, service providers, administrative personnel and community leaders including the engagement of men partner. This study also suggests the needs of women empowerments against the traditional belief, attitude, and practice.

    更新日期:2019-12-23
  • Adherence of iron and folic acid supplementation and determinants among pregnant women in Ethiopia: a systematic review and meta-analysis
    Reprod. Health (IF 2.295) Pub Date : 2019-12-21
    Melaku Desta; Bekalu Kassie; Habtamu Chanie; Henok Mulugeta; Tadesse Yirga; Habtamu Temesgen; Cheru Tesema Leshargie; Yoseph Merkeb

    Iron and folic acid deficiency anaemia are one of the global public health challenges that pose 1.45% of all disability-adjusted life-years. It is recognized as a cause for an unacceptably high proportion of maternal and perinatal morbidity and mortality. Adherence to iron and folic acid supplementation during the antenatal period is paramount to reduce anaemia and its associated morbidities. Although several studies have been conducted across the country, their reports were inconsistent and inconclusive for intervention. Therefore, this systematic review and meta-analysis were aimed to estimate the pooled national level adherence to iron and folic acid supplementation and its determinants among pregnant women in Ethiopia. This systematic review and meta-analysis were pursued the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 guideline. An extensive search of databases including, PubMed, Google Scholar, and African Journals Online were conducted to access articles. The Newcastle- Ottawa quality assessment tool was used to assess the quality of each study and meta-analysis was conducted using a random-effects model. I2 test and Egger’s test were used to assess the heterogeneity and publication bias respectively. The meta-analysis of estimating national level adherence were done using STATA version 11 with 95% CI. Twenty studies with a total of 16,818 pregnant women were included in this meta-analysis. The pooled national level iron and folic acid supplementation’s adherence were 46.15% (95%CI:34.75,57.55). The highest adherence was observed in Addis Abeba, 60% (95%CI: 55.93, 64.07) followed by Tigray, 58.9% (95% CI: 33.86, 84.03). Women who received supplemental information [OR = 2.34, 95%CI: 1.05, 5.24], who had good knowledge [OR = 2.2, 95%CI: 1.05, 5.24], began the ANC visit before 16 weeks [OR = 2.41, 95%CI: 1.76, 3.29], and had ≥4 ANC visits [OR = 2.59, 95% CI: 1.09, 6.15] were more likely adhere to the supplementation. Fear of side effects (46.4, 95% CI: 30.9 61.8) and forgetfulness (30.7, 95% CI: 17.6, 43.8) were the major barriers of adherence of the supplementations. More than four of nine pregnant women have adhered to the iron and folic acid supplementation. This meta-analysis revealed that receiving supplemental counselling, knowledge of the supplement; early registration and frequent ANC visit were significantly associated with the adherence of the iron and folic acid supplementation. Therefore, provision of strengthened supplemental counselling service, antenatal care services, and improving the knowledge of the supplementation is a crucial strategy to increase the adherence among pregnant women in Ethiopia. Besides, addressing the barriers of the adherence of the supplement mainly counseling or managing of side effects and reducing of forgetfulness to take the tablet through getting family support or male involvement during visit is mandatory.

    更新日期:2019-12-21
  • “I feel myself incomplete, and I am inferior to people”: experiences of Sudanese women living with obstetric fistula in Khartoum, Sudan
    Reprod. Health (IF 2.295) Pub Date : 2019-12-21
    Salma A. E. Ahmed; Viva C. Thorsen; Salma A. E. Ahmed

    Obstetric fistula is among the most devastating maternal morbidities that occur as a result of prolonged, obstructed labor. Usually, the child dies in a large number of the cases. Moreover, some of the women become infertile while the majority suffer physical, psychosocial and economic challenges. Approximately 5000 new cases of obstetric fistula occur in Sudan each year. However, their experiences are under documented. Therefore, this study aimed to shed light on their daily lives living with obstetric fistula and how they cope. Using a qualitative study design, 19 women living with obstetric fistula were interviewed. The study took place in the fistula ward located in Khartoum hospital and the fistula re-integration center in Khartoum, Sudan. Thematic analysis approach was employed. Stigma and coping theories guided the data collection, analysis, and discussion of the findings. Women in our study suffered a challenging physical life due to leakage of urine. In addition, they encountered all forms of stigmatization. Women used both emotion-focused and problem-focused coping techniques to mitigate the consequences of obstetric fistula. The study findings underscore the importance of obstetric fistula prevention programs and the urgency of repair surgeries to alleviate women’s suffering. Community sensitization, rehabilitation and re-integration of women back to their communities are also important strategies on their journey to wholeness.

    更新日期:2019-12-21
  • The impact of adding community-based distribution of oral contraceptives and condoms to a cluster randomized primary health care intervention in rural Tanzania
    Reprod. Health (IF 2.295) Pub Date : 2019-12-19
    Mallory C. Sheff; Elizabeth F. Jackson; Almamy M. Kanté; Asinath Rusibamayila; James F. Phillips

    Efforts to expand access to family planning in rural Africa often focus on the deployment of community health agents (CHAs). This paper reports on results of the impact of a randomized cluster trial of CHA deployment on contraceptive uptake among 3078 baseline and 2551 endline women of reproductive age residing in 50 intervention and 51 comparison villages in Tanzania. Qualitative data were collected to broaden understanding of method preference, reasons for choice, and factors that explain non-use. Regression difference-in-differences results show that doorstep provision of oral contraceptive pills and condoms was associated with a null effect on modern contraceptive uptake [p = 0.822; CI 0.857; 1.229]. Discussions suggest that expanding geographic access without efforts to improve spousal and social support, respect preference for injectable contraceptives, and address perceived risk of side-effects offset the benefits of adopting contraceptives provided by community-based services. The results of this study demonstrate that increasing access to services does not necessarily catalyze contraceptive use as method choice and spousal dynamics are key components of demand for contraception. Findings attest to the importance of strategies that respond to the climate of demand. Controlled-Trial.com ISRCTN96819844. Retrospectively registered on 29.03.2012.

    更新日期:2019-12-19
  • Protocol for cluster randomized evaluation of reaching married adolescents - a gender-synchronized intervention to increase modern contraceptive use among married adolescent girls and young women and their husbands in Niger
    Reprod. Health (IF 2.295) Pub Date : 2019-12-18
    Sneha Challa; Stephanie M. DeLong; Nicole Carter; Nicole Johns; Holly Shakya; Sabrina C. Boyce; Ricardo Vera-Monroy; Sani Aliou; Fatouma A. Ibrahima; Mohamad I. Brooks; Caitlin Corneliess; Claire Moodie; Abdoul Moumouni Nouhou; Illa Souley; Anita Raj; Jay G. Silverman

    Early marriage and early childbearing are highly prevalent in Niger with 75% of girls married before age 18 years and 42% of girls giving birth between ages 15 and 18 years. In 2012, only 7% of all 15–19-year-old married adolescents (male and female) reported use of a modern contraceptive method with barriers including misinformation, and social norms unsupportive of contraception. To meet the needs of married adolescents and their husbands in Niger, the Reaching Married Adolescents (RMA) program was developed with the goal of improving modern contraceptive method uptake in the Dosso region of Niger. Using a four-arm cluster randomized control design, the RMA study seeks to assess whether household visits only (Arm 1), small group discussions only (Arm 2), or a combination of both (Arm 3), as compared to controls (no intervention – Arm 4), improve modern contraceptive method use among married adolescent girls and young women (AGYW), age 13–19 years-old, in three districts of the Dosso region. Intervention conditions were randomly assigned across the three districts, Dosso, Doutchi, and Loga. Within each district, eligible villages were assigned to either that intervention condition or to the control condition (12 intervention and 4 control per district). Across the three intervention conditions, community dialogues regarding modern contraceptive use were also implemented. Data for the study was collected at baseline (April – June 2016), at 24 months post-intervention (April – June 2018), and a final round of data collection will occur at 40 months post-intervention (October – December 2019). The RMA intervention is a gender-synchronized and community-based program implemented among married adolescent girls and their husbands in the context of rural Niger. The intervention is designed to provide education about modern contraception and to promote gender equity in order to increase uptake of modern contraceptive methods. Results from this cluster randomized control study will contribute to the knowledge base regarding the utility of male engagement as a strategy within community-level approaches to promote modern contraceptive method use in the high need context of West Africa. Registered October 2017 - ClinicalTrials.gov NCT03226730.

    更新日期:2019-12-19
  • Women’s costs for accessing comprehensive sexual and reproductive health services: findings from an observational study in Johannesburg, South Africa
    Reprod. Health (IF 2.295) Pub Date : 2019-12-16
    Naomi Lince-Deroche; Kaitlyn M. Berry; Cheryl Hendrickson; Tembeka Sineke; Sharon Kgowedi; Masangu Mulongo

    Evaluating progress towards the Sustainable Development Goal of universal access to sexual and reproductive (SRH) services requires an understanding of the health needs of individuals and what constitutes access to services. We explored women’s costs of accessing SRH services in Johannesburg, South Africa and contextualized costs based on estimates of household income. We conducted an observational study of women aged 18–49 at a public HIV treatment site and two public primary health care facilities from June 2015 to August 2016. Interviews assessed women’s SRH needs (for contraception, fertility problems, menstrual problems, menopause symptoms, sexually transmitted infections (STI), experiences of intimate-partner violence (IPV), and cervical and breast cancer screening) and associated costs. We calculated average and total costs (including out-of-pocket spending, lost income, and estimated value of time spent) for women who incurred costs. We also estimated the total and average costs of meeting all SRH needs in a hypothetical “full needs met” year. Finally, we contextualize SRH spending against a measure of catastrophic expenditure (> 10% of household income). Among the 385 women who participated, 94.8% had at least one SRH need in the prior 12 months; 79.7% incurred costs for accessing care. On average, women spent $28.34 on SRH needs during the prior year. Excluding one HIV-negative woman who spent 112% of her annual income on infertility treatment, HIV-positive women spent more on average annually for SRH care than HIV-negative women. Sixty percent of women reported at least one unmet SRH need. If all participants sought care for all reported needs, their average annual cost would rise to $52.65 per woman. Only two women reported catastrophic expenditure – for managing infertility. SRH needs are constants throughout women’s lives. Small annual costs can become large costs when considered cumulatively over time. As South Africa and other countries grapple with increasing access to SRH services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to SRH services. Literature on women’s financial and economic costs for accessing comprehensive sexual and reproductive health care in low- and middle-income countries is extremely limited, and existing literature often overlooks out-of-pocket costs associated with travel, child care, and time spent accessing services. Using data from a survey of 385 women from a public HIV treatment site and two public primary health care facilities in Johannesburg, we found nearly all women reported at least on sexual and reproductive health need and more than 75% of women incurred costs related to those needs. Furthermore, more than half of women surveyed reported not accessing services for their sexual and reproductive health needs, suggesting a total annual cost of more than $50 USD, on average, to access services for all reported needs. While few women spent more than 10% of their total household income on sexual and reproductive health services in the prior year, needs are constant and costs incur throughout a woman’s life suggesting accessing services to meet these needs might still result in financial burden. As South Africa grapples with increasing access to sexual and reproductive health services under the rubric of universal access, it is important to remember that individuals incur costs despite free care at the point of service. Policies that address geographic proximity and service quality would be important for reducing costs and ensuring full access to services.

    更新日期:2019-12-17
  • Improving pregnant women’s knowledge on danger signs and birth preparedness practices using an interactive mobile messaging alert system in Dodoma region, Tanzania: a controlled quasi experimental study
    Reprod. Health (IF 2.295) Pub Date : 2019-12-12
    Theresia J. Masoi; Stephen M. Kibusi

    Unacceptably high maternal and perinatal mortality remain a major challenge in many low income countries. Early detection and management of danger signs through improved access to maternal services is highly needed for better maternal and infant outcomes. The aim of this study was to test the effectiveness of an interactive mobile messaging alert system on improving knowledge on danger signs, birth preparedness and complication readiness practices among pregnant women in Dodoma region, Tanzania. A controlled quasi experimental study of 450 randomly selected pregnant women attending antenatal care was carried in Dodoma municipal. Participants were recruited at less than 20 weeks of gestation during the first visit where 150 were assigned to the intervention and 300 to the control group. The intervention groups was enrolled in an interactive mobile messaging system and received health education messages and were also able to send and receive individualized responses on a need basis. The control group continued receiving usual antenatal care services offered at the ANC centers. Pregnant women were followed from their initial visit to the point of delivery. Level of knowledge on danger signs and birth preparedness were assessed at baseline and a post test was again given after delivery for both groups. Analyses of covariance, linear regression were employed to test the effectiveness of the intervention. The mean age of participants was 25.6 years ranging from 16 to 48 years. There was significant mean scores differences for both knowleadge and birth preparedness between the intervention and the control group after the intervention (p < .001). The mean knowleadge score was (M = 9.531,SD = 2.666 in the intervention compared to M = 6.518,SD = 4.304 in the control, equivalent to an effect size of 85% of the intervention. Meanwhile, the mean score for IBPACR was M = 4.165,SD = 1.365 for the intervention compared to M = 2.631,SD = 1.775 in the control group with an effect size of 90% A multivariate linear regression showed a positive association between the intervention (p < 0.001) and level of knowledge (B = 2.910,95%CI = 2.199–3.621) and birth preparediness (B = 1.463,95%CI = 1.185–1.740). The Interactive mobile messaging alert system demonstrated to be effective in increasing women’s knowledge on danger signs and improving their birth preparedness practices.

    更新日期:2019-12-13
  • Family planning counseling and its associations with modern contraceptive use, initiation, and continuation in rural Uttar Pradesh, India
    Reprod. Health (IF 2.295) Pub Date : 2019-12-12
    Nabamallika Dehingia; Anvita Dixit; Sarah Averbach; Vikas Choudhry; Arnab Dey; Dharmendra Chandurkar; Priya Nanda; Jay G. Silverman; Anita Raj

    We examine the association between the quality of family planning (FP) counseling received in past 24 months, and current modern contraceptive use, initiation, and continuation, among a sample of women in rural Uttar Pradesh, India. This study included data from a longitudinal study with two rounds of representative household survey (2014 and 2016), with currently married women of age 15–49 years; the analysis excluded women who were already using a permanent method of contraceptive during the first round of survey and who reported discontinuation because they wanted to be pregnant (N = 1398). We measured quality of FP counseling using four items on whether women were informed of advantages and disadvantages of different methods, were told of method(s) that are appropriate for them, whether their questions were answered, and whether they perceived the counseling to be helpful. Positive responses to every item was categorized as higher quality counseling, vs lower quality counseling for positive response to less than four items. Outcome variables included modern contraceptive use during the second round of survey, and a variable categorizing women based on their contraceptive use behavior during the two rounds: continued-users, new-users, discontinued-users, and non-users. Around 22% had received any FP counseling; only 4% received higher-quality counseling. Those who received lower-quality FP counseling had 2.42x the odds of reporting current use of any modern contraceptive method (95% CI: 1.56–3.76), and those who received higher quality FP counseling at 4.14x the odds of reporting modern contraceptive use (95% CI: 1.72–9.99), as compared to women reporting no FP counseling. Women receiving higher-quality counseling also had higher likelihood of continued use (ARRR 5.93; 95% CI: 1.97–17.83), as well as new use or initiation (ARRR: 4.2; 95% CI: 1.44–12.35) of modern contraceptives. Receipt of lower-quality counseling also showed statistically significant associations with continued and new use of modern contraceptives, but the effect sizes were smaller than those for higher-quality counseling. Findings suggest the value of FP counseling. With a patient-centered approach to counseling, continued use of modern contraceptives can be supported among married women of reproductive age. Unfortunately, FP counseling, particularly higher-quality FP counseling remains rare.

    更新日期:2019-12-13
  • Understanding mistreatment during institutional delivery in Northeast Nigeria: a mixed-method study
    Reprod. Health (IF 2.295) Pub Date : 2019-12-02
    Nasir Umar; Deepthi Wickremasinghe; Zelee Hill; Umar Adamu Usman; Tanya Marchant

    Improving quality of care including the clinical aspects and the experience of care has been advocated for improved coverage and better childbirth outcomes. This study aimed to explore the quality of care relating to the prevalence and manifestations of mistreatment during institutional birth in Gombe State, northeast Nigeria, an area of low institutional delivery coverage. The frequency of dimensions of mistreatment experienced by women delivering in 10 health facilities of Gombe State were quantitatively captured during exit interviews with 342 women in July–August 2017. Manifestations of mistreatment were qualitatively explored through in-depth interviews and focus groups with 63 women living in communities with high and low coverage of institutional deliveries. The quantitative data showed that at least one dimension of mistreatment was reported by 66% (95% confidence interval (CI) 45–82%) of women exiting a health facility after delivery. Mistreatment related to health system conditions and constraints were reported in 50% (95% CI 31–70%) of deliveries. In the qualitative data women expressed frustration at being urged to deliver at the health facility only to be physically or verbally mistreated, blamed for poor birth outcomes, discriminated against because of their background, left to deliver without assistance or with inadequate support, travelling long distances to the facility only to find staff unavailable, or being charged unjustified amount of money for delivery. Mistreatment during institutional delivery in Gombe State is highly prevalent and predominantly relates to mistreatment arising from both health system constraints as well as health worker behaviours, limiting efforts to increase coverage of institutional delivery. To address mistreatment during institutional births, strategies that emphasise a broader health systems approach, tackle multiple causes, integrate a detailed understanding of the local context and have buy-in from grassroots-level stakeholders are recommended.

    更新日期:2019-12-02
  • Prevalence of common mental disorder and associated factors among pregnant women in South-East Ethiopia, 2017: a community based cross-sectional study
    Reprod. Health (IF 2.295) Pub Date : 2019-11-28
    Ashenafi Mekonnen Woldetsadik; Abebaw Nigussie Ayele; Adem Esmael Roba; Genet Fikadu Haile; Khan Mubashir

    Mothers suffering from common mental disorder (CMD), such as anxiety and depression may not be able to function properly, which could adversely affect the mother-infant bond and even result in increased infant morbidity and mortality. The purpose of this study was to assess the prevalence of CMD and its determinants among pregnant women in Southeast Ethiopia. Data was collected from 743 pregnant women via interview-administered, standardised questionnaires during Dec–Jan 2017. The WHO Self-Reported Questionnaire (SRQ) was used to screen CMD. Multivariate logistic regression was conducted and ORs and 95% confidence intervals were calculated. The prevalence of CMD during pregnancy was 35.8% (95% CI: 34–38%) and the main determinants of CMD were: illiteracy, presence of health risk, financial instability, physical or emotional abuse, having sexual intercourse without her willingness, family history of psychiatric illness and history of chronic medical illness. CMD prevalence during pregnancy was high, indicating a need to regularly screen pregnant women for CMD and its determinants as part of routine obstetric care.

    更新日期:2019-11-29
  • Prevalence and determinants of menstrual regulation among ever-married women in Bangladesh: evidence from a national survey
    Reprod. Health (IF 2.295) Pub Date : 2019-08-14
    Juwel Rana; Kanchan Kumar Sen; Toufica Sultana; Mohammad Bellal Hossain; Rakibul M. Islam

    Despite the remarkable reduction of maternal mortality, unsafe and untimely menstrual regulation (MR) remains a major maternal health problem in Bangladesh. This study aimed to determine the prevalence and identify determinants of MR among ever-married women in Bangladesh. Data for this study have been extracted from Bangladesh Demographic and Health Survey (BDHS) 2014. The survey followed a two-stage stratified sampling procedure and the study used a sub-sample of 8084 ever-married women aged 15 to 49 years extracted from survey sample of 17,863. Univariate and multivariate mixed-effect logistic regression analyses were used to identify risk factors for MR accounting for potential between-clusters variations. The weighted prevalence of MR was 12.3% (95% CI: 11.1–13.4%) among (991/8084) ever-married women. Women were less likely to have MR if they were from Chittagong (AOR 0.74, 95% CI: 0.57–0.96; p = 0.026) and Sylhet (AOR 0.53, 95% CI: 0.36–0.77; p = 0.001) divisions. Women were more likely to have MR if they were from high (AOR 1.47, 95% CI: 1.18–1.83; p = 0.001) and the highest (AOR 1.62, 95% CI: 1.27–2.05; p < 0.001) socioeconomic status (SES) group; being employed (AOR 1.35, 95% CI: 1.16–1.56; p < 0.001), having one or two children (AOR 1.73, 95% CI: 1.24–2.40: p = 0.001) and ≥ 3 children (AOR 2.56, 95% CI: 1.82–3.58; p < 0.001), and having membership of non-government organization (NGO) (AOR 1.18, 95% CI: 1.02–1.38; p = 0.030). MR is prevalent among Bangladeshi women and independently associated with geographic location, SES, parity, employment and NGO membership status. Health policy should prioritize in reducing spatial and socioeconomic inequalities in relation to MR services by ensuring accessibility and availability of MR services, especially in suburban divisions. Furthermore, abortion should be legalized in Bangladesh that will ultimately reduce the morbidity and mortality associated with unsafe abortion.

    更新日期:2019-11-28
  • Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial
    Reprod. Health (IF 2.295) Pub Date : 2019-08-15
    Ibrahim Yakubu; Gholamreza Garmaroudi; Roya Sadeghi; Azar Tol; Mir Saeed Yekaninejad; Adadow Yidana

    Adolescent pregnancy is a worldwide problem because of its health, social, economic and political repercussions on the globe. Even though the rates of adolescent pregnancy have declined over the decade, there is still unacceptably high rates especially in lower and middle-income countries including Ghana. Although the problem has been widely investigated, there is little information on the effectiveness of different methods to improve adolescent sexual abstinence based on theoretical models. This study is aimed to assess an educational intervention program on sexual abstinence based on the Health Belief Model (HBM) among adolescent girls in Northern Ghana. A cluster randomized control trial was conducted in Ghana from April to August 2018. Participants within the ages of 13–19 years were enrolled voluntarily from six randomly selected Senior High Schools (3 for intervention and 3 for control). A total of 363 adolescent were enrolled. A self-structured questionnaire was administered to both groups of participants at baseline and endpoint of the study. Control participants received their normal classes whiles the intervention group additionally received comprehensive sexuality education for 1 month. Qualified midwives conducted the health education program. At least two sessions were conducted for each participating class weekly. The lessons focused on perceived susceptibility, perceived severity of adolescent pregnancy, perceived benefits, perceived barriers to adolescent pregnancy prevention, personal and family values, perceived self-efficacy and knowledge of contraceptives. Educational strategies such as discussions, demonstrations, role-play and problem solving techniques were used to deliver the lessons. Sexual abstinence was the outcome variable of the study and it was measured after 3 months of the intervention. Binary logistic regression was used to assess the impact of the intervention on sexual abstinence practice. At baseline, there was no difference between control and intervention groups. The mean score of Knowledge and attitude for control were (58.17 and 139.42) and intervention (60.49 and 141.36) respectively. Abstinence practice was 69.4% for control and 71.6% in the intervention group. However, after the intervention, the mean score of knowledge and attitude for control were (87.58 and 194.12) respectively. Sexual abstinence in the control was 84.4% and intervention was 97.3% respectively. The educational interventions resulted in a significant difference in sexual abstinence between intervention and control groups (OR = 13.89, 95% Confidence Interval (2.46–78.18, P < 0.003). Educational intervention, which was guided by HBM, significantly improved sexual abstinence and the knowledge of adolescents on pregnancy prevention among the intervention group. Provision of comprehensive sex education guided by behavioural theories to adolescents at Senior High Schools in Ghana is recommended. This trial was retrospectively registered in Protocol Registration and Results System (PRS) with trial number NCT03384251 .

    更新日期:2019-11-28
  • The family planning quotient and reproductive life index (FPQ/RepLI) tool: a solution for family planning, reproductive life planning and contraception counseling
    Reprod. Health (IF 2.295) Pub Date : 2019-08-19
    Jessica M. Madrigal; Kelly Stempinski-Metoyer; Amy E. McManus; Lindsay Zimmerman; Ashlesha Patel

    Access to comprehensive and culturally appropriate reproductive life planning is essential to women’s health. Although many strategies and tools exist, few are designed for longitudinal use or provide visual aids. Our objective is to present the Family Planning Quotient (FPQ) and Reproductive Life Index (RepLI) (FPQ/RepLI) tool we created to facilitate the discussion of family planning and reproductive life goals between patients and providers and to provide a summary our evaluation of the tool. This tool was developed as a response to the Centers for Disease Control and Prevention’s charge of developing a tool that could help facilitate reproductive life planning by giving the patient a better understanding of their reproductive goals and trajectory. This cross-sectional evaluation of our tool took place with patients and providers at an urban, public hospital in Chicago. Patients spoke with a health educator about their sexual, gynecological, and obstetric history to complete the FPQ/RepLI tool. Our primary objective was to measure the proportion of women who indicated the tool was helpful and that they would use it to track their reproductive goals. Patients and providers completed an evaluation survey rating their satisfaction with the tool. Survey responses were summarized using frequencies and percentages. During the study, 790 patients completed the evaluation.. Most patients (n = 725, 91.9%) agreed that the tool was helpful and that they would use it to track their reproductive goals. Fifty-five (83.5%) providers agreed that there is a need for reproductive health tools in clinical practice. Most agreed that the tool helped the patient communicate goals, aided in educating about contraception, and facilitated the discussion and decision-making process about available contraceptives. The tool gives patients a resource for family and reproductive goal planning. Broad dissemination amongst other medical specialties beyond obstetrics and gynecology may make reproductive life planning accessible to more women.

    更新日期:2019-11-28
  • Discrepancy in perception of infertility and attitude towards treatment options: Indonesian urban and rural area
    Reprod. Health (IF 2.295) Pub Date : 2019-08-19
    Achmad Kemal Harzif; Victor Prana Andika Santawi; Stephanie Wijaya

    In Indonesia infertility affects 10–15% of reproductive-age couples. In addition to medical problem, infertility in Indonesia poses significant social problem. Childlessness is often stigmatized as a failure which victimizes couples, moreover the females. Despite the high prevalence, there is no fertility awareness education which further passes down the common myth, misperception, and negative attitude towards infertility treatment in Indonesian society. This study aims to reveal the knowledge, myth, and attitude towards infertility, likewise acceptance towards infertility treatment options. Cross-sectional study using standardized questionnaire was done to 272 individuals consisted of two parallel groups: Jakarta and Sumba representing urban and rural population respectively. Participants were all outpatients above 18 years old who visited the healthcare centers from February 2017 to June 2017. Knowledge on biological and lifestyle risk factors of infertility among Jakarta and Sumba groups were comparable. However, belief in supernatural causes of infertility is remarkable in Sumba population. There is a common misconception on the use of contraception as risk factors of infertility in both groups. Half respondents from both groups think infertility is a disease. In Jakarta 93.4% respondents consider both female and male should be investigated for infertility; in Sumba only 55.4% agree while 33.1% consider only female should be investigated. Infertility is an acceptable reason for polygamy for 41.3% respondents in Sumba, with 34.7% blaming maternal side for childlessness. Most respondents from both groups accept the use of Assisted Reproductive Technology and fertility enhancing drugs as treatment options. Lack of understanding, misleading myths, and negative attitude towards infertility have been illustrated in the sample population.

    更新日期:2019-11-28
  • Sexuality and contraceptive knowledge in university students: instrument development and psychometric analysis using item response theory
    Reprod. Health (IF 2.295) Pub Date : 2019-08-22
    Sebastian Sanz-Martos; Isabel M. López-Medina; Cristina Álvarez-García; Carmen Álvarez-Nieto

    As a consequence of biological, psychological and social changes during puberty, youth is a period characterized by impulsiveness and risk-taking. Members of this population often feel invulnerable and have a strong motivation to explore their identity. A good level of knowledge is necessary to allow young people to experience their sexuality in a healthy way, without associated risks. In our environment there is currently no valid Spanish-language tool to measure the level of knowledge about sexuality and contraception. This study sought to develop and test the psychometric properties of a new sexuality and contraception knowledge instrument. This is a cross-sectional study to validate the sexuality and contraception knowledge instrument. The validation process followed four phases: (1) development of the instrument, (2) content validation by an expert panel, (3) pilot test and (4) psychometric analysis of the instrument using item response theory according to the Rasch model. The validation process took place from September 2017 to February 2018. The sample included 387 students enrolled at the Nursing and Law degrees from the University of Jaen. The final instrument was made up of 15 items. All of the items presented good adaptation values with respect to the model. The scale showed good fit and reliability: 0.99 for items and 0.74 for people. The temporal stability of the scale was calculated using test–retest, obtaining a value of 0.81 (CI 0.692–0.888). The construct validity showed the one-dimensionality of the construct, while the discriminant validity obtained good results, so the scale appears to be able to differentiate between participants with low or high levels of knowledge. The results suggest the Sexuality and Contraception Knowledge Instrument is psychometrically valid and reliable for measuring the knowledge level concerning sexuality and contraceptive methods in young university students.

    更新日期:2019-11-28
  • Challenges to access health information during pregnancy in Iran: a qualitative study from the perspective of pregnant women, midwives and obstetricians
    Reprod. Health (IF 2.295) Pub Date : 2019-08-22
    Marzieh Javanmardi; Mahnaz Noroozi; Firouzeh Mostafavi; Hasan Ashrafi-rizi

    Appropriate health information seeking behavior can play an effective role in self-care and promotion of women’s quality of life during pregnancy. However, different barriers can impede pregnant women while accessing health information. The aim of this research was to explain challenges to access health information during pregnancy. The present qualitative study was carried out on 28 participants who were selected using the purposeful sampling technique. Data were collected through in-depth interviews, field notes, and daily notes; data were analyzed using conventional content analysis. The main barriers to access health information during pregnancy were as follows: many duties of women at home as well as out-of-home education and employment, inability to make distinction between correct and incorrect information, insufficient interactions between women and healthcare providers, failure to access to various information resources, common complaints of pregnancy, and stress and anxiety of confronting the problems during pregnancy. Based on the results, pregnant women experienced personal, social, and structural barriers when accessing health information. Therefore, policymakers and health planners should remove the barriers, encourage self-care, and enhance the quality of life for pregnant women, thus, promoting their health status in the end.

    更新日期:2019-11-28
  • Fertility and family planning in Uttar Pradesh, India: major progress and persistent gaps
    Reprod. Health (IF 2.295) Pub Date : 2019-08-23
    Shiva S. Halli; Damaraju Ashwini; Bidyadhar Dehury; Shajy Isac; Antony Joseph; Preeti Anand; Vikas Gothalwal; Ravi Prakash; B. M. Ramesh; James Blanchard; Ties Boerma

    Uttar Pradesh (UP) is the most populous state in India with historically high levels of fertility rates than the national average. Though fertility levels in UP declined considerably in recent decades, the current level is well above the government’s target of 2.1. Fertility and family planning data obtained from the different rounds of Sample Registration System (SRS) and the National Family Health Survey (NFHS). We analyzed fertility and family planning trends in India and UP, including differences in methods mix, using SRS (1971–2016) and NFHS (1992–2016). Bivariate and multivariate regression analyses were used. From 2000, while the total fertility rate (TFR) declined in UP, it is still well above the national level in 2015–16 (2.7 vs 2.18, respectively). The demand for family planning satisfied increased from 52 to 72% during 1998–99 to 2015–16 in UP, compared to an increase from 75 to 81% in India. Traditional methods play a much greater role in UP than in India (22 and 9% of the demand satisfied respectively), while use of sterilization was relatively low in UP when compared to the national averages (18.0 and 36.3% of current married women 15–49 years in UP and India, respectively in 2015–16). Within UP, district fertility ranged from 1.6 to 4.4, with higher fertility concentrated in districts with low female schooling, predominantly located in north-central UP. Fertility declines were largest in districts with high fertility in the late nineties (B = 7.33, p < .001). Among currently married women, use of traditional methods increased and accounted for almost one-third of users in 2015–16. Use of sterilization declined but remained the primary method (ranging from 33 to 41% of users in high and low fertility districts respectively) while condom use increased from 17 and 16% in 1998–99 to 23 and 25% in 2015–16 in low and high fertility districts respectively. Greater reliance on traditional methods and condoms coupled with relatively low demand for modern contraception suggest inadequate access to modern contraceptives, especially in district with high fertility rates. Family planning activities need to be appropriately scaled according to need and geography to ensure the achievement of state-level improvements in family planning programs and fertility outcomes.

    更新日期:2019-11-28
  • Mistreatment of women in public health facilities of Ethiopia
    Reprod. Health (IF 2.295) Pub Date : 2019-08-27
    Ephrem D. Sheferaw; Young-Mi Kim; Thomas van den Akker; Jelle Stekelenburg

    Recent evidence suggests that mistreatment of women during childbirth is a global challenge facing health care systems. This study seeks to explore the prevalence of mistreatment of women in public health facilities of Ethiopia, and identify associated factors. A two-stage cross sectional sampling design was used to select institutions and women. The study was conducted in hospitals and health centers across four Ethiopian regions. Quantitative data were collected from postpartum women. Mistreatment was measured using four domains: (1) physical abuse, (2) verbal abuse, (3) failure to meet professional standards of care, and (4) poor rapport between women and providers. Percentages of mistreatment and odds ratios for the association between its presence and institutional and socio demographic characteristics of women were calculated using bivariate and multivariable logistic regression modeling. A total of 379 women were interviewed, of whom 281 (74%) reported any mistreatment. Physical and verbal abuse were reported by 7 (2%) and 31 (8%) women interviewed respectively. Failure to meet professional standards of care and poor rapport between women and providers were reported by 111 (29%) and 274 (72%) women interviewed respectively. Multivariable logistic regression analysis revealed that the odds of reporting mistreatment were higher among women with four or more previous births (aOR = 3.36 95%CI 1.22,9.23, p = 0.019) compared to women with no previous childbirth, Muslim women (aOR = 3.30 95%CI 1.4,7.77, p = 0.006) and women interviewed in facilities with less than 17 births per MNH staff in a month (aOR = 3.63 95%CI 1.9,6.93, p < 0.001). However, the odds of reporting mistreatment were lower among women aged 35 and older (aOR = 0.22 95%CI 0.06, 0.73, p = 0.014) and among women interviewed between 8 and 42 days after childbirth (aOR = 0.37 95%CI 0.15, 0.9, p = 0.028). Mistreatment during childbirth in Ethiopia is commonly reported. Health workers need to consider provision of individualized care for women and monitor their experiences in order to adjust quality of their services.

    更新日期:2019-11-28
  • Contraceptive discontinuation: frequency and associated factors among undergraduate women in Brazil
    Reprod. Health (IF 2.295) Pub Date : 2019-08-29
    Christiane Borges do Nascimento Chofakian; Caroline Moreau; Ana Luiza Vilela Borges; Osmara Alves dos Santos

    In Brazil, high contraceptive prevalence rates coexist with high rates of unintended pregnancies. Contraceptive discontinuation may explain this context, but few studies have focused on highly educated young women in countries with low unmet need for modern contraception. This paper explores frequency and associated factors of contraceptive discontinuation among undergraduate students in Brazil within 12-months. This retrospective cohort study was conducted among a probability sample of 1679 undergraduates of São Paulo University. Data were collected online using a contraceptive calendar. We examined factors related to monthly discontinuation of oral pills and male condoms using Generalized Estimating Equation models. Altogether, 19% of oral pill users and 48% of male condom users discontinued their method for method-related reasons within 12-months, and 18% of oral pill users and 15% of male condom users abandoned/or switched to less effective methods. Women in casual relationships were at increased odds of oral pill (OR = 1.4 [1.1–1.8]) and male condom discontinuation (OR = 1.3 [1.0–1.7]), and at increased odds of switching from oral pill to less effective or no method (OR = 1.4 [1.1–1.7]). Other associated factors were method specific. Women from lower socioeconomic status or who had multiple lifetime partners were more likely to discontinue or abandon the oral pill, while more sexually experienced women were less likely to discontinue the male condom. Frequent method discontinuation in Brazil calls for greater attention to the difficulties women face when using short acting methods. Discontinuation was associated with type of partner and sexual experience highlighting the changing contraceptive needs of women at the early stages of their professional careers.

    更新日期:2019-11-28
  • Pilot randomized trial of short-term changes in inflammation and lipid levels during and after aspirin and pravastatin therapy
    Reprod. Health (IF 2.295) Pub Date : 2019-09-02
    Kerry S. Flannagan; Lindsey A. Sjaarda; Micah J. Hill; Matthew T. Connell; Jessica R. Zolton; Neil J. Perkins; Sunni L. Mumford; Torie C. Plowden; Victoria C. Andriessen; Jeannie G. Radoc; Enrique F. Schisterman

    Inflammation and elevated blood lipids are associated with infertility. Aspirin and statin therapy may improve infertility treatment outcomes among overweight and obese women with systemic inflammation, but little is known about the short-term effects of statins in this population. We conducted a pilot study of aspirin, pravastatin, or combined treatment among a group of overweight and obese, reproductive-aged women. Our goal was to characterize short-term changes in inflammatory and lipid biomarkers during and after treatment. In this open-label trial, women aged 18–40 years with a body mass index ≥25 kg/m2 were randomized to receive either 162 mg aspirin, 40 mg pravastatin, or both. The study medication was taken daily for 2 weeks, and participants were then followed for a two-week washout period. Participants provided blood samples at baseline, after the intervention period, and after the washout period. The outcomes were changes in biomarkers of inflammation and lipids measured in blood components at each timepoint. Nine, 8, and 8 women were randomized to the aspirin, pravastatin, and combined arms, respectively. Analyses were conducted among 8, 7, and 7 women in the aspirin, pravastatin, and combined arms for whom biomarker data was available at baseline. High-sensitivity C-reactive protein (hsCRP) levels were lower after treatment in all arms and continued to decrease after washout in the pravastatin and combined arms. Results were consistent between the whole sample and women with baseline hsCRP between 2 and 10 mg/L. Low-density lipoprotein (LDL) cholesterol was lower after treatment in the pravastatin and combined arms and rose slightly after washout. Our results provide preliminary evidence that short-term aspirin and pravastatin therapy reduces hsCRP and LDL cholesterol among overweight and obese women of reproductive age, including those with low-grade inflammation. Because of these short-term effects, these drugs may improve infertility treatment outcomes in this population, which we will assess in a future randomized trial.

    更新日期:2019-11-28
  • Prevalence of unwanted pregnancy in Iranian women: a systematic review and meta-analysis
    Reprod. Health (IF 2.295) Pub Date : 2019-09-04
    Rostam Jalali; Masoud Mohammadi; Aliakbar Vaisi-Raygani; Akram Ghobadi; Nader Salari

    Unwanted pregnancies are considered as one of the most important public health risks. Regarding the importance of the unwanted pregnancy in the country and helping health policy-makers obtain more accurate information on this issue, this study aims to provide a systematic review and meta-analytical on the prevalence of unwanted pregnancies in Iran. The present study was carried out using meta-analysis. Articles related to the topic were obtained through SID, Magiran, Scopus, PubMed, and ScienceDirect and Google Scholar databases from 2001 to 2017, Articles written based on cross-sectional studies were included in the study and other overviews, case-control, cohort, and interventional studies were excluded from the list of articles. Heterogeneity of studies was investigated using I2 index and data analysis was performed in Comprehensive Meta-Analysis software (Version 3). In 23 articles, the prevalence of unwanted pregnancy in Iranian women was 27.9% (95%CI: 24–32.1%). The meta-regression analysis was used in two sample sizes and years of study. It was reported that as the sample size and Years increases, the prevalence of the unwanted pregnancy decrease, this difference was also statistically significant (P = 0.000). Considering that the prevalence of unwanted pregnancy is high in Iran, it is necessary that health policy makers take effective measures to enhance the awareness of couples and public information about the risks of the unwanted pregnancy.

    更新日期:2019-11-28
  • Protocol for a prospective mixed-methods longitudinal study to evaluate the dynamics of contraceptive use, discontinuation, and switching in Kenya
    Reprod. Health (IF 2.295) Pub Date : 2019-09-05
    Susan Ontiri; Lilian Mutea; Maxwell Muganda; Peter Mutanda; Carolyne Ajema; Stephen Okoth; Solomon Orero; Ruth Odhiambo; Regien Biesma; Jelle Stekelenburg; Mark Kabue

    More women are accessing modern contraceptive use in Kenya, however, contraceptive discontinuation has stagnated over the decades. Any further increase in contraceptive use will most likely be from past users, hence understanding the dynamics of discontinuation while addressing quality of family planning services offered at health facilities and communities is critical for increasing the contraceptive prevalence rate and reducing the unmet need of family planning. The paper presents a study protocol that intends to evaluate the dynamics of contraceptive use, discontinuation, and switching among women of reproductive age initiating use of a contraceptive method. This longitudinal mixed-methods study is being conducted in Migori and Kitui counties, Kenya. A formative assessment using Interviews with adolescents, older women, heterosexual couples, health care workers, and community health volunteers explored barriers to contraceptive continuation and perspectives on discontinuation utilizing a qualitative cross sectional study design. Following the formative assessment, a client-centered intervention focusing on improving quality of family planning services, including counseling, will be implemented in 10 health facilities. A 24-month prospective cohort study among women of reproductive age initiating contraception with follow-up at 3, 6, 12, and 24 months will then be undertaken to assess the discontinuation rates, examine the dynamics of contraceptive use, discontinuation and switching, and further explore barriers and enablers for contraceptive continuation and switching among the study population. In sub-Saharan Africa, contraceptive discontinuation studies have mainly been based on survey data that is collected retrospectively. By implementing a longitudinal mixed-methods study, we gain deeper insights into the contraceptive dynamics influencing the decision to continue, discontinue, and even switch following implementation of a client-centered intervention that enhances quality of care. Additionally, the study will shed more light on the profile of women discontinuing contractive use and further explore individual and couple-level dynamics influencing decision-making on continuation and discontinuation. The findings of this study will provide information that can be used to develop and implement human-centered interventions that focus on improving quality of family planning services and consequently improved continuation rates and overall satisfaction with method. The study is registered with the Clinical Trials Registry, NCT03973593 .

    更新日期:2019-11-28
  • A qualitative assessment of perspectives on getting pregnant: the Social Position and Family Formation study
    Reprod. Health (IF 2.295) Pub Date : 2019-09-05
    Meredith G. Manze; Dana Watnick; Diana Romero

    Intentions-oriented approaches to measuring pregnancy do not necessarily align with how people view and approach pregnancy. Our objective was to obtain an in-depth understanding of the notions women and men hold regarding pregnancy. We conducted semi-structured in-depth interviews with 176 heterosexual women and men ages 18–35, in the United States. Data were analyzed using grounded theory methodology. Participants described notions of getting pregnant in one of three ways. One group of participants used language that solely described pregnancy as a deliberate process, either premeditated or actively avoided. Another described pregnancy as a predetermined phenomenon, due to fate or something that ‘just happens.’ The third group represented a blending of both notions. Our findings underscore the need to shift the current paradigm of deliberate intentions to one that recognizes that pregnancy can also be viewed as predetermined. These findings can be used to improve measurement, health services, and better direct public health resources.

    更新日期:2019-11-28
  • Stigma related to contraceptive use and abortion in Kenya: scale development and validation
    Reprod. Health (IF 2.295) Pub Date : 2019-09-06
    Marlene Makenzius; Grace McKinney; Monica Oguttu; Ulla Romild

    Stigma related to abortion and contraceptive use is a serious public health threat for young people, and validated scales to measure this stigma are scarce. The purposes of the study were to validate a newly constructed scale to measure the stigma of contraceptive use and to adapt a scale to measure the stigma of abortion. A study nested in a cluster-randomised trial. In 2017, data was collected from 633 secondary school youths, in a semi-urban setting in western Kenya. A qualitative pre-phase (face-validity) were initially utilised to draft and validate a seven-item scale to capture contraceptive use stigma (CUS) and to adapt the Stigmatizing Attitudes, Beliefs and Actions (SABA) scale (18 items), which captures aspects of abortion stigma. Statistical tests used included test-retest reliability analysis, Pearson’s correlation coefficients, Wilcoxon signed-rank test, Factor Analysis, Principal Component Analysis, interclass correlation and Cronbach’s alpha. For the CUS scale, paired t-test and Wilcoxon signed-rank test showed no significant score changed between time points (p = 0.64; 0.67). CUS had similar patterns between time points, with two relevant components: promiscuity and lack of autonomy. Cronbach’s alpha indicated acceptable internal consistency between time points (0.71;0.7). The confirmatory factor loadings for each item in the modified three subscales of SABA had a similar pattern to the original SABA scale, in particularly regarding negative stereotyping and, excluding and discriminating factors. The Cronbach’s alpha was adequate, although lower for the modified SABA (0.74) as compared to the original SABA (0.9). The SABA scale was renamed into Adolescents Stigmatizing Attitudes, Beliefs and Action (ASABA) scale. The CUS scale is considered valid and reliable for measuring contraceptive use stigma, and the ASABA scale was rated as reliable for capturing abortion stigma based on negative stereotyping and excluding and discriminating factors. The CUS, up to date the first ever proposed CUS scale, and the ASABA scale can be used to measure effects of stigma reduction interventions with the aim of preventing unintended pregnancies, motherhood and unsafe abortion among adolescents in Kenya and similar low-resource settings.

    更新日期:2019-11-28
  • The reliability and validity of the Patient Health Questionnaire-9 (PHQ-9) and PHQ-2 in patients with infertility
    Reprod. Health (IF 2.295) Pub Date : 2019-09-09
    Saman Maroufizadeh; Reza Omani-Samani; Amir Almasi-Hashiani; Payam Amini; Mahdi Sepidarkish

    Depression in patients with infertility often goes undiagnosed and untreated. The Patient Health Questionnaire-9 (PHQ-9) and its ultra-brief version (i.e. PHQ-2) are widely used measures of depressive symptoms. These scales have not been validated in patients with infertility. The aim of the present study was to examine the reliability and validity of the PHQ-9 and PHQ-2 in patients with infertility. In this cross-sectional study, a total of 539 patients with infertility from a referral infertility clinic in Tehran, Iran completed the PHQ-9, along with other relevant scales: the WHO-five Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS), and the Generalized Anxiety Disorder-7 (GAD-7). Factor structure and internal consistency of PHQ-9 were examined via confirmatory factor analysis (CFA) and Cronbach’s alpha, respectively. Convergent validity was evaluated by relationship with WHO-5, HADS and GAD-7. The mean total PHQ-9 and PHQ-2 scores were 8.47 ± 6.17 and 2.42 ± 1.86, respectively, and using a cut-off value of 10 (for PHQ-9) and 3 (for PHQ-2), the prevalence of depressive symptoms was 38.6 and 43.6%, respectively. The Cronbach’s alphas for PHQ-9 and PHQ-2 were, respectively, 0.851 and 0.767, indicating good internal consistency. The CFA results confirmed the one-factor model of the PHQ-9 (χ2/df = 4.29; CFI = 0.98; RMSEA = 0.078 and SRMR = 0.044). Both PHQ-9 and PHQ-2 showed moderate to strong correlation with the measures of WHO-5, HADS-depression, HADS-anxiety, and the GAD-7, confirming convergent validity. In univariate analysis, female sex, long infertility duration, and unsuccessful treatment were significantly associated with depression symptoms. Both PHQ-9 and PHQ-2 are brief and easy to use measures of depressive symptoms with good psychometric properties that appear suitable for routine use in patients with infertility.

    更新日期:2019-11-28
  • Perceptions and intervention preferences of Moroccan adolescents, parents, and teachers regarding risks and protective factors for risky sexual behaviors leading to sexually transmitted infections in adolescents: qualitative findings
    Reprod. Health (IF 2.295) Pub Date : 2019-09-10
    Hicham El Kazdouh; Abdelghaffar El-Ammari; Siham Bouftini; Samira El Fakir; Youness El Achhab

    Sexual choices and practices of adolescents living in conservative societies, including Morocco, can be influenced either positively or negatively by the prevailing contextual and social norms. These norms not only limit the access to reproductive health information and services but also lead to abstinence among devout adolescents. Thus, identifying contextual risks and protective factors of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents, as well as exploring perceptions of adolescents, parents and teachers regarding effective intervention preferences could improve the sexual health of adolescents. We conducted a qualitative study using focus group discussions (FGDs) based on the socio-ecological model as a theoretical framework. Sample groups of adolescents, parents, and teachers were selected from two public middle schools (disadvantaged and advantaged according to socio-economic level) in Taza city, Morocco, from May to July 2016. Participants were polled on protective factors and perceived facilitators of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents as well on their perception of intervention preferences to reduce the risks. Three sets of data were initially formed, coded, and analyzed using thematic analysis. Seventeen FGDs were conducted, including 8 groups of adolescents (28 boys and 28 girls, 14–16 years old), 5 groups of parents (21 males and 5 females), and 4 groups of teachers (13 males and 5 females). Five overall themes seemed to influence risky sexual behaviors in adolescents: (1) risky sexual practices and STIs; (2) the adolescent’s social domain; (3) the role of school; (4) media, including internet and social media; and (5) socio-cultural norms. Participants also suggested a number of possible interventions to improve the sexual health of adolescents and to reduce the risk of STIs, which could be applied at multiple levels. Successful intervention programs should target the multifaceted factors affecting the adolescent’s sexual behaviors, from the individual to the societal level. Allowing parents, teachers, and adolescents to work together could help reduce the socio-cultural and personal barriers that prevent effective communication about sexuality. Furthermore, schools can play a vital role in reducing risky sexual behaviors and STI acquisition rates in adolescents by promoting sex education in school curriculum and encouraging adolescents to engage in extracurricular activities and awareness campaigns.

    更新日期:2019-11-28
  • Childhood mortality, intra-household bargaining power and fertility preferences among women in Ghana
    Reprod. Health (IF 2.295) Pub Date : 2019-09-10
    Jacob Novignon; Nadege Gbetoton Djossou; Ulrika Enemark

    Continuing population growth could be detrimental for social and economic wellbeing. Understanding the factors that influence family planning decisions will be important for policy. This paper examines the effect of childhood mortality and women’s bargaining power on family planning decisions. Data was from the 2014 Ghana Demographic and Health Survey (DHS). A sample of 3313 women in their reproductive age were included in this study. We created variables on women’s exposure to and experience of child mortality risks. Three different indicators of women’s bargaining power in the household were also used. Probit models were estimated in accordance with the nature of the dependent variable. Results from the probit models suggest that child mortality has a positive association with higher fertility preference. Also, child mortality risks and woman’s bargaining power play important roles in a woman’s fertility choices in Ghana. Women with higher bargaining power were likely to prefer fewer children in the face of child mortality risks, compared to women with lower bargaining power. In addition to public sensitization campaigns on the dangers of high fertility and use of contraceptives, the findings of this study emphasize the need to focus on reducing child mortality and improving women bargaining power in developing countries.

    更新日期:2019-11-28
  • Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities
    Reprod. Health (IF 2.295) Pub Date : 2019-09-11
    Violeta Alarcão; Miodraga Stefanovska-Petkovska; Ana Virgolino; Osvaldo Santos; Sofia Ribeiro; Andreia Costa; Paulo Nogueira; Patrícia M. Pascoal; Sónia Pintassilgo; Fernando Luís Machado

    The existing knowledge on the interplay between reproductive and sexual health, migration and acculturation is recent and inconsistent, particularly on the sociocultural motives and constraints regarding fertility. Therefore, sexual and reproductive health (SRH) surveys are needed to provide accurate and comparable indicators to identify and address SRH inequalities, with specific focus on under researched aspects, such as the interrelation between migration and gender. FEMINA (FErtility, MIgratioN and Acculturation) aims to investigate intersectional SRH inequalities among Cape Verdean immigrant and Portuguese native families and how they impact on fertility in Portugal. This study will use a comprehensive approach exploring simultaneously the components of SRH, namely regarding identities, perceptions and practices of both women and men among lay people and relevant experts and stakeholders. The project has three main goals: 1) to identify social determinants of SRH among Cape Verdean immigrant and Portuguese native men and women of reproductive age; 2) to gain understanding of the diversity of the sexual and reproductive experiences and expectations of Cape Verdean immigrant and Portuguese native men and women of reproductive age, considering the singularities of their migratory, social and family dynamics; and 3) to produce recommendations for policy makers, employers and service providers on how to better address the SRH needs of Portuguese-born and immigrant populations. The study will address these goals using a mixed methods approach, including: a cross-sectional telephone survey with a probabilistic sample of 600 Cape Verdean immigrant and 600 Portuguese native women and men (women aged 18 to 49 and men aged 18 to 54), residents of the Greater Lisbon Area; a qualitative research through in-depth interviews with a subsample of 30 Cape Verdean immigrants and 30 Portuguese native men and women; and a Delphi technique for finding consensus on good practices in SRH for the entire population with a special emphasis on immigrants, namely extra-EU migrants. Data will be used to produce a comprehensive set of indicators to monitor SRH in Portugal, to foster a greater understanding of its specificities and challenges to policy and decision makers, and to provide targeted recommendations to promote inclusive and migrant sensitive SRH services.

    更新日期:2019-11-28
  • Socio-cultural contextual factors that contribute to the uptake of a mobile health intervention to enhance maternal health care in rural Senegal
    Reprod. Health (IF 2.295) Pub Date : 2019-09-12
    Margaret E. MacDonald; Gorgui Sene Diallo

    Although considerable progress has been made in reducing maternal mortality over the past 25 years in Senegal, the national maternal mortality ratio (MMR), at 315 deaths per 100,000 live births, is still unacceptably high. In recent years a mobile health (mHealth) intervention to enhance maternal health care has been introduced in rural and remote areas of the country. CommCare is an application that runs on cell phones distributed to community health workers known as matrones who enroll and track women throughout pregnancy, birth and the post-partum, offering health information, moral support, appointment reminders, and referrals to formal health care providers. An ethnographic study of the CommCare intervention and the larger maternal health program into which it fits was conducted in order to identify key social and cultural contextual factors that contribute to the uptake and functioning of this mHealth intervention in Senegal. Ethnographic methods and semi-structured interviews were used with participants drawn from four categories: NGO field staff (n = 16), trained health care providers (including physicians, nurses, and midwives) (n = 19), community level health care providers (n = 13); and women belonging to a community intervention known as the Care Group (n = 14). Data were analyzed using interpretive analysis informed by critical medical anthropology theory. The study identified five socio-cultural factors that work in concert to encourage the uptake and use of CommCare: convening women in the community Care Group; a cultural mechanism for enabling pregnancy disclosure; constituting authoritative knowledge amongst women; harnessing the roles of older women; and adding value to community health worker roles. We argue that, while CommCare is a powerful tool of information, clinical support, surveillance, and data collection, it is also a social technology that connects and motivates people, transforming relationships in ways that can optimize its potential to improve maternal health care. In Senegal, mHealth has the potential not only to bridge the gaps of distance and expertise, but to engage local people productively in the goal of enhancing maternal health care. Successful mHealth interventions do not work as ‘magic bullets’ but are part of ‘assemblages’ – people and things that are brought together to accomplish particular goals. Attention to the social and cultural elements of the global health assemblage within which CommCare functions is critically important to understand and develop this mHealth technology to its full potential.

    更新日期:2019-11-28
  • Prevalence and patterns of cigarette smoking before and during early and late pregnancy according to maternal characteristics: the first national data based on the 2003 birth certificate revision, United States, 2016
    Reprod. Health (IF 2.295) Pub Date : 2019-09-13
    Anthony J. Kondracki

    The objective of this study was to examine the prevalence of smoking by intensity status before pregnancy and during early (first and second trimester) and late (third trimester) pregnancy according to race/ethnicity, age, and educational attainment of women who gave birth in the United States in 2016. This cross-sectional study was based on the 2016 National Center for Health Statistics (NCHS) Natality File of 3,956,112 live births, the first year that it became 100% nationally representative. Self-reported smoking data were used to create new seven smoking intensity status categories to capture natural variability in smoking patterns during pregnancy and to identify maternal smokers by race/ethnicity, age, and educational attainment. The risk of smoking at low and high intensity in early pregnancy was estimated in multivariable logistic regression analyses. Nearly 9.4% of women reported smoking before pregnancy and 7.1% during pregnancy, both at high and low intensity, and smoking rates were higher in the first trimester (7.1%) than in the second (6.1%) or the third (5.7%) trimester. Non-Hispanic White women, women 20–24 years old, and women with less than a high school education were the strongest predictors of smoking anytime during pregnancy. The odds of smoking in early pregnancy at high intensity were 88% lower (aOR 0.12, 95% CI: 0.11, 0.13) for Hispanic women, compared to non-Hispanic White women; 16% higher (aOR 1.16, 95% CI: 1.12, 1.21) for women 20–24 years old and 16% lower (aOR 0.84, 95% CI: 0.80, 0.89) for women ≥35 years old, compared to women 25–29 years old; as well as 13% higher (aOR 1.13, 95% CI: 1.09, 1.18) for women with less than a high school education and 92% lower (aOR 0.08, 95% CI: 0.08, 0.09) for women with a bachelor’s degree or higher, compared to women with a high school diploma. Despite the high prevalence of high intensity smoking before and during pregnancy, future intervention strategies need to focus on the proportion of low intensity quitters and reducers, who are ready to stop smoking. Continual monitoring of trends in smoking intensity patterns is necessary, including neonatal outcomes over time.

    更新日期:2019-11-28
  • “That’s a woman’s problem”: a qualitative analysis to understand male involvement in maternal and newborn health in Jigawa state, northern Nigeria
    Reprod. Health (IF 2.295) Pub Date : 2019-09-18
    Vandana Sharma; Jessica Leight; Nadège Giroux; Fatima AbdulAziz; Martina Bjorkman Nyqvist

    Maternal and newborn mortality continue to be major challenges in Nigeria. While greater participation of men in maternal and newborn health has been associated with positive outcomes in many settings, male involvement remains low. The objective of this analysis was to investigate male involvement in maternal and newborn health in Jigawa state, northern Nigeria. This qualitative study included 40 event narratives conducted with families who had experienced a maternal or newborn complication or death, in-depth interviews with 10 husbands and four community leaders, and four focus group discussions with community health workers. The interviews focused on understanding illness recognition and care seeking as well as the role of husbands at each stage on the continuum of maternal and newborn health. Data were transcribed, translated to English, and coded and analyzed using Dedoose software and a codebook developed a priori. This paper reports low levels of knowledge of obstetric and newborn complications among men and limited male involvement during pregnancy, childbirth and the post-partum period in Jigawa state. Men are key decision-makers around the location of the delivery and other decisions linked to maternal and newborn health, and they provide crucial resources including nutritious foods and transportation. However, they generally do not accompany their wives to antenatal visits, are rarely present for deliveries, and do not make decisions about complications arising during delivery and the immediate post-partum period. These gendered roles are deeply ingrained, and men are often ridiculed for stepping outside of them. Additional barriers for male involvement include minimal engagement with health programs and challenges at health facilities including a poor attitude of health providers towards men and accompanying family members. These findings suggest that male involvement is limited by low knowledge and barriers related to social norms and within health systems. Interventions engaging men in maternal and newborn health must take into account these obstacles while protecting women’s autonomy and avoiding reinforcement of gender inequitable roles and behaviors.

    更新日期:2019-11-28
  • Adult and young women communication on sexuality: a pilot intervention in Maputo-Mozambique
    Reprod. Health (IF 2.295) Pub Date : 2019-09-18
    Mónica Frederico; Carlos Arnaldo; Kristien Michielsen; Peter Decat

    Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into account that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context. The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions. The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex. By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality.

    更新日期:2019-11-28
  • Contextual-relationship and stress-related factors of postpartum depression symptoms in nulliparas: a prospective study from Ljubljana, Slovenia
    Reprod. Health (IF 2.295) Pub Date : 2019-09-18
    Polona Rus Prelog; Marijana Vidmar Šimic; Tanja Premru Sršen; Maja Rus Makovec

    For a significant proportion of women, postpartum depression (PPD) is the first mood episode in their lives, yet its aetiology still remains unclear. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aimed to gain further insight into the risk factors for postpartum depression symptoms (PPDS) of nulliparas in Slovenia and to examine vulnerability to developing depressive symptoms, with an emphasis on contextual and stress-related characteristics. The sample consisted of 156 nulliparas in the third trimester of pregnancy enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Postpartum Depression Scale (EPDS), the Zung Anxiety Scale and a question battery designed by the research team including questions about emotional support and work-related stress. Logistic regression was used to test the association between demographic, social, environmental, personality and attachment variables and PPD of nulliparas (EPDS ≥10), controlling for baseline (prepartum) depression score. A multivariable linear regression model was built with the postpartum EPDS continuous score as a dependent variable. 28/156 (17,9%) were evaluated as being at risk for depression (EPDS≥10) in the last trimester and 25/156 (16%) at six weeks postpartum. The results of the logistic regression model controlled for prepartum depression score showed that increased risk for developing PPDS was associated with anxiety level postpartum, intimate-partner-attachment anxiety postpartum, and elevated stress due to loss of employment or an unsuccessful search for employment in the previous year. The results of the multivariable regression model, however, showed the association with education and postpartum anxiety with PPDS continuous score; EPDS after giving birth was higher for more educated and more anxious primiparas. Our findings demonstrate the importance of anxiety symptoms and higher education level in assessments of nulliparas’ mental health. The results of our study show and confirm the results of previous research that anxiety symptoms in the immediate postpartum period are likely to be associated with depressive symptoms in nulliparas. The results also suggest that higher level of education of first-time mothers might not be a protective factor, especially for nulliparas with the university level of education. Further studies on larger samples should be considered.

    更新日期:2019-11-28
  • Potential excess of vaginal examinations during the management of labor: frequency and associated factors in 13 Peruvian hospitals
    Reprod. Health (IF 2.295) Pub Date : 2019-10-10
    Jessica Hanae Zafra-Tanaka; Renee Montesinos-Segura; Pamela D. Flores-Gonzales; Alvaro Taype-Rondan

    A high number of vaginal examinations (VEs) may lead to a higher risk of infections, as well as discomfort/dissatisfaction with intrapartum care. To determine the frequency of potential excess of vaginal examinations (PEVE) during the management of labor and identify its associated factors, in Peruvian hospitals. Secondary analysis of the data collected in the DisrespEct and abuse during ChIlDbirth in pEru (DECIDE) study, held between April and May 2016. In this study, women hospitalized in Peruvian hospitals right after giving birth were surveyed by trained personnel. PEVE, the main outcome, was considered as five or more vaginal examinations (VEs) performed during the management of labor. Poisson regression models with robust variance were performed to calculate crude and adjusted prevalence ratios (cPR and aPR) as well as their 95% confidence intervals (95% CI). One thousand four hundred twenty registries of 13 hospitals from 8 Peruvian cities were evaluated. The number of women studied at each hospital ranged between 100 and 129. The median age was 26 years (interquartile rank: 22–31). The median number of VEs was 3 (interquartile rank: 2–5). The proportion of women who underwent PEVE was 33.9%, this ranged from 0.9 to 69.9% at the studied hospitals. The frequency of PEVE was higher in women who attended > 2 obstetric psychoprophylaxis sessions, compared to those who attended ≤ 2 sessions (aPR: 1.78 95% CI: 1.01–3.12); and among women who gave birth between 18:00 h and 23:59 h, compared to those who did it between 7:00 and 17:59 h (aPR: 1.28 95% CI: 1.04–1.57). Around one in three women underwent a PEVE, although this frequency varied widely across the evaluated hospitals. Women with more psychoprophylaxis sessions, and who gave birth between 18:00 h and 23:59 h, had a higher PEVE frequency. Future studies should assess in depth the causes and consequences of this high frequency.

    更新日期:2019-11-28
  • Improving the quality of maternal and newborn health outcomes through a clinical mentorship program in the Democratic Republic of the Congo: study protocol
    Reprod. Health (IF 2.295) Pub Date : 2019-10-10
    Xu Xiong; Rebecca Carter; Paul-Samson Lusamba-Dikassa; Elvis C. Kuburhanwa; Francine Kimanuka; Freddy Salumu; Guy Clarysse; Baudouin Kalume Tutu; Sylvain Yuma; Alain Mboko Iyeti; Julie H. Hernandez; Jeffrey G. Shaffer; Susie Villeneuve; Alain Prual; Lee Pyne-Mercier; Assaye Nigussie; Pierre Buekens

    The Democratic Republic of the Congo (DRC) boasts one of the highest rates of institutional deliveries in sub-Saharan Africa (80%), with eight out of every ten births also assisted by a skilled provider. However, the maternal and neonatal mortality are still among the highest in the world, which demonstrates the poor in-facility quality of maternal and newborn care. The objective of this ongoing project is to design, implement, and evaluate a clinical mentorship program in 72 health facilities in two rural provinces of Kwango and Kwilu, DRC. This is an ongoing quasi-experimental study. In the 72 facilities, 48 facilities were assigned to the group where the clinical mentorship program is being implemented (intervention group), and 24 facilities were assigned to the group where the clinical mentorship program is not being implemented (control group). The groups were selected and assigned based on administrative criteria, taking into account the number of deliveries in each facility, the coverage of health zones, accessibility, and ease of implementation of a clinical mentorship program. The main activities are organizing and training a national team of mentors (including senior midwives, obstetricians, and pediatricians) in clinical mentoring, deploying them to mentor all health providers (mentees) performing maternal and newborn health (MNH) services, and providing in-service training in routine and Emergency Obstetrical and Newborn Care (EmONC) to the mentees in health facilities over an 18-month period. Baseline and endline assessments are carried out to evaluate the effectiveness of the clinical mentorship program on the quality of MNH care and the effective coverage of key interventions to reduce maternal and neonatal mortality. Findings will be disseminated nationwide and internationally, as scientific evidence is scarce. A national strategy, guidelines, and tools for clinical mentorship in MNH will be developed for replication in other provinces, thus benefitting the entire country. This is the largest project on clinical mentorship aimed to improving the quality of MNH care in Africa. This program is expected to generate one of the first pieces of scientific evidence on the effectiveness of a clinical mentorship program in MNH on a scientifically designed and sustainable model.

    更新日期:2019-11-28
  • Reasons for nonuse of contraceptive methods by women with demand for contraception not satisfied: an assessment of low and middle-income countries using demographic and health surveys
    Reprod. Health (IF 2.295) Pub Date : 2019-10-11
    Laísa Rodrigues Moreira; Fernanda Ewerling; Aluisio J. D. Barros; Mariangela Freitas Silveira

    Nonuse of contraceptive methods by women in need of contraception may impact their sexual and reproductive health. The aim of this study was to describe the reasons for nonuse of contraception among women with demand for contraception not satisfied in low and middle-income countries (considering both overall countries and various subgroups of women). We used the latest Demographic and Health Survey data from 47 countries. A descriptive analysis of the reasons for nonuse of contraceptive methods was performed among sexually active women with demand for contraception not satisfied. The prevalence of each reported reason was also evaluated according to marital status, woman’s age and schooling, area of residence, wealth index, and parity. Wealth-related absolute inequality for each reason was also evaluated using the Slope Index of Inequality. A pro-rich inequality pattern means that the reason is more prevalent among the richest women while a pro-poor means the reason is more common among the poorest ones. On average, 40.9% of women in need of contraception were not using any contraceptive methods to avoid pregnancy. Overall, the most prevalent reasons for nonuse of contraceptives were “health concerns” and “infrequent sex,” but the prevalence of each reason varied substantially across countries. Nonuse due to “opposition from others” was higher among married than unmarried women; in turn, the prevalence of nonuse due to “lack of access” or “lack of knowledge” was about two times higher in rural areas than in urban areas. Women with less schooling more often reported nonuse due to “lack of access.” Pro-rich inequality was detected for reasons “health concerns,” “infrequent sex,” and “method-related”, while the reasons “other opposed,” “fatalistic,” “lack of access,” and “lack of knowledge” were linked to patterns of pro-poor inequality. Family planning promotion policies must take into account the different reasons for the nonuse of contraceptive methods identified in each country as well as the contextual differences regarding women of reproductive age (such as social norms and barriers that prevent women from accessing and using contraceptives).

    更新日期:2019-11-28
  • Validation of three mental health scales among pregnant women in Qatar
    Reprod. Health (IF 2.295) Pub Date : 2019-10-16
    Katherine A. Roof; Laurie James-Hawkins; Hanan F. Abdul Rahim; Kathryn M. Yount

    The objective of this study is to validate three mental health scales in a targeted sample of pregnant Arab women living in Qatar: the Kuwait University Anxiety Scale, the Perceived Stress Scale, and the Edinburgh Postnatal Depression Scale. Random split-half exploratory factor analysis and confirmatory factor analyses (n = 336; n = 331), conducted separately, were used to evaluate scale dimensionality, factor loadings, and factor structure of the KUAS, the PSS, and the EPDS. Fit statistics for the three scales suggested adequate fit to the data and estimated factor loadings were positive, similar in magnitude, and were significant. The final CFA model for the KUAS supported a 19-item, two factor structure. CFA models also confirmed 8- and 10-item, single-factor structures for the PSS and EPDS, respectively. The validation of scales for these aspects of mental health in Arab pregnant women is critical to ensure appropriate screening, identification, and treatment to reduce the risk of sequelae in women and their children. Findings offer a useful comparison to mental-health scale validations in other Arab contexts.

    更新日期:2019-11-28
  • The power of peers: an effectiveness evaluation of a cluster-controlled trial of group antenatal care in rural Nepal
    Reprod. Health (IF 2.295) Pub Date : 2019-10-22
    Poshan Thapa; Alex Harsha Bangura; Isha Nirola; David Citrin; Bishal Belbase; Bhawana Bogati; B. K. Nirmala; Sonu Khadka; Lal Kunwar; Scott Halliday; Nandini Choudhury; Al Ozonoff; Jasmine Tenpa; Ryan Schwarz; Mukesh Adhikari; S. P. Kalaunee; Sharon Rising; Duncan Maru; Sheela Maru

    Reducing the maternal mortality ratio to less than 70 per 100,000 live births globally is one of the Sustainable Development Goals. Approximately 830 women die from pregnancy- or childbirth-related complications every day. Almost 99% of these deaths occur in developing countries. Increasing antenatal care quality and completion, and institutional delivery are key strategies to reduce maternal mortality, however there are many implementation challenges in rural and resource-limited settings. In Nepal, 43% of deliveries do not take place in an institution and 31% of women have insufficient antenatal care. Context-specific and evidence-based strategies are needed to improve antenatal care completion and institutional birth. We present an assessment of effectiveness outcomes for an adaptation of a group antenatal care model delivered by community health workers and midwives in close collaboration with government staff in rural Nepal. The study was conducted in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized, cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allowed for iterative improvement in design by making changes to improve the quality of the intervention. We evaluated effectiveness through a difference in difference analysis of institutional birth rates between groups prior to implementation of the intervention and 1 year after implementation. Additionally, we assessed the change in knowledge of key danger signs and the acceptability of the group model compared with individual visits in a nested cohort of women receiving home visit care and home visit care plus group antenatal care. Using a directed content and thematic approach, we analyzed qualitative interviews to identify major themes related to implementation. At baseline, there were 457 recently-delivered women in the six village clusters receiving home visit care and 214 in the seven village clusters receiving home visit care plus group antenatal care. At endline, there were 336 and 201, respectively. The difference in difference analysis did not show a significant change in institutional birth rates nor antenatal care visit completion rates between the groups. There was, however, a significant increase in both institutional birth and antenatal care completion in each group from baseline to endline. We enrolled a nested cohort of 52 participants receiving home visit care and 62 participants receiving home visit care plus group antenatal care. There was high acceptability of the group antenatal care intervention and home visit care, with no significant differences between groups. A significantly higher percentage of women who participated in group antenatal care found their visits to be ‘very enjoyable’ (83.9% vs 59.6%, p = 0.0056). In the nested cohort, knowledge of key danger signs during pregnancy significantly improved from baseline to endline in the intervention clusters only (2 to 31%, p < 0.001), while knowledge of key danger signs related to labor and childbirth, the postpartum period, and the newborn did not in either intervention or control groups. Qualitative analysis revealed that women found that the groups provided an opportunity for learning and discussion, and the groups were a source of social support and empowerment. They also reported an improvement in services available at their village clinic. Providers noted the importance of the community health workers in identifying pregnant women in the community and linking them to the village clinics. Challenges in birth planning were brought up by both participants and providers. While there was no significant change in institutional birth and antenatal care completion at the population level between groups, there was an increase of these outcomes in both groups. This may be secondary to the primary importance of community health worker involvement in both of these groups. Knowledge of key pregnancy danger signs was significantly improved in the home visit plus group antenatal care cohort compared with the home visit care only group. This initial study of Nyaya Health Nepal’s adapted group care model demonstrates the potential for impacting women’s antenatal care experience and should be studied over a longer period as an intervention embedded within a community health worker program. ClinicalTrials.gov Identifier: NCT02330887 , registered 01/05/2015, retroactively registered.

    更新日期:2019-11-28
  • Associations between dietary micronutrient intake and molecular-Bacterial Vaginosis
    Reprod. Health (IF 2.295) Pub Date : 2019-10-22
    Susan Tuddenham; Khalil G. Ghanem; Laura E. Caulfield; Alisha J. Rovner; Courtney Robinson; Rupak Shivakoti; Ryan Miller; Anne Burke; Catherine Murphy; Jacques Ravel; Rebecca M. Brotman

    Bacterial vaginosis (BV), a clinical condition characterized by decreased vaginal Lactobacillus spp., is difficult to treat. We examined associations between micronutrient intake and a low-Lactobacillus vaginal microbiota as assessed by molecular methods (termed “molecular-BV”). This cross-sectional analysis utilized data collected at the baseline visit of the Hormonal Contraception Longitudinal Study, a cohort of reproductive-aged women followed over 2 years while initiating or ceasing hormonal contraception (HC). The Block Brief 2000 Food Frequency Questionnaire was administered and micronutrient intakes were ranked. Vaginal microbiota composition was assessed using 16S rRNA gene amplicon sequencing and clustered into community state types (CSTs) based on the types and relative abundance of bacteria detected. Associations between the lowest estimated quartile intake of nutrients and having a low-Lactobacillus CST (molecular-BV) were evaluated by logistic regression. Separate models were built for each nutrient controlling for age, body mass index, behavioral factors, HC use and total energy intake. We also conducted a literature review of existing data on associations between micronutrient intakes and BV. Samples from 104 women were included in this analysis. Their mean age was 25.8 years (SD 4.3), 29.8% were African American, 48.1% were using HC, and 25% had molecular-BV. In adjusted multivariable analyses, the lowest quartile of betaine intake was associated with an increased odds of molecular-BV (aOR 9.2, p value < 0.01, [CI 2.4–35.0]). This is the first study to assess the association between estimated micronutrient intake and molecular-BV. Lower energy-adjusted intake of betaine was associated with an increased risk of molecular-BV. Betaine might have direct effects on the vaginal microenvironment or may be mediated through the gut microbiota. Additional research is needed to determine reproducibility of this finding and whether improved intake of select micronutrients such as betaine decreases the risk of BV and its sequelae.

    更新日期:2019-11-28
  • Healthcare system indicators associated with modern contraceptive use in Ghana, Kenya, and Nigeria: evidence from the Performance Monitoring and Accountability 2020 data
    Reprod. Health (IF 2.295) Pub Date : 2019-10-26
    Ibitola Asaolu; Velia Leybas Nuño; Kacey Ernst; Douglas Taren; John Ehiri

    Public health literature is replete with evidence on individual and interpersonal indicators of modern contraceptive use. There is, however, limited knowledge regarding healthcare system indicators of modern contraceptive use. This study assessed how the healthcare system influences use of modern contraceptive among women in Ghana, Kenya, and two large population states in Nigeria. This study used data from Phase 1 of the Performance Monitoring and Accountability 2020. The analytical sample was limited to women with a need for contraception, defined as women of reproductive age (15 to 49 years) who wish to delay or limit childbirth. Therefore, this analysis consisted of 1066, 1285, and 1955 women from Nigeria, Ghana, and Kenya respectively. Indicators of healthcare assessed include user-fees, visit by health worker, type of health facility, multiple perinatal services, adolescent reproductive healthcare, density of healthcare workers, and regularity of contraceptive services. All analyses were conducted with SAS (9.4), with statistical significance set at p < 5%. The prevalence of modern contraceptive was 22.7, 33.2, and 68.9% in Nigeria, Ghana, and Kenya respectively. The odds of modern contraceptive use were higher among Nigerian women who lived within areas that provide adolescent reproductive healthcare (OR = 2.05; 95% C.I. = 1.05—3.99) and Kenyan women residing in locales with polyclinic or hospitals (OR = 1.91; 1.27—2.88). Also, the odds of contraceptive use were higher among Kenyan women who lived in areas with user-fee for contraceptive services (OR = 1.40; 1.07–1.85), but lower among Ghanaian women residing in such areas (OR = 0.46; 0.23—0.92). Lastly, the odds of modern contraceptive use were higher among women visited by a health-worker visit among women in Ghana (OR = 1.63; 1.11—2.42) and Nigeria (OR = 2.97; 1.56—5.67) than those without a visit. This study found an association between country-specific indicators of healthcare and modern contraceptive use. Evidence from this study can inform policy makers, health workers, and healthcare organizations on specific healthcare factors to target in meeting the need for contraception in Ghana, Kenya, and Nigeria.

    更新日期:2019-11-28
  • Evaluating the effectiveness of a combined approach to improve utilization of adolescent sexual reproductive health services in Kenya: a quasi-experimental design study protocol
    Reprod. Health (IF 2.295) Pub Date : 2019-10-29
    Lilian Mutea; Susan Ontiri; Sheila Macharia; Meital Tzobotaro; Carolyne Ajema; Vincent Odiara; Francis Kadiri; Solomon Orero; Mark Kabue; Kristien Michielsen; Peter Gichangi

    Access to and utilization of adolescent sexual and reproductive health (ASRH) services remains poor. ASRH services in Kenya are primarily offered in health facilities and include counselling, information, and services on family planning, sexually transmitted infections, and HIV and basic life skills. The Ministry of Education also provides age-appropriate sexual and reproductive health information in schools. This paper presents a study protocol that will evaluate the effectiveness of a combined approach toward improving utilization of ASRH services. This will be a quasi-experimental study utilizing qualitative and quantitative methods. During the formative phase, data will be collected through focus group discussions, in-depth interviews, and key informant interviews to explore the barriers and facilitators of provision and utilization of ASRH services. A quantitative design will be used to obtain baseline and endline data through household surveys and client exit interviews. Following the formative and baseline household and client exit assessments, an intervention focusing on provision of ASRH service package targeting boys and girls will be implemented for 18 months. The package will include contextualized ASRH services, including counselling and age-appropriate, comprehensive sexual education for behavior change with an aim to increase utilization of ASRH services. An analysis of the primary outcome (utilization of ASRH services) will be undertaken to establish the difference in difference between the control and intervention arm, before the intervention (using the baseline survey data) and after the intervention (using the endline survey data). Adolescents have now been included in the World Health Organization’s Global strategy for women’s, children’s and adolescents’ health (2016–2030), acknowledging the unique health challenges facing young people and their pivotal role as drivers of change in the post-2015 era. This study will generate evidence on whether a combined school, facility, and community approach works toward improving utilization of ASRH services. The information generated from the study will be beneficial for programming as it will identify underlying reasons for low utilization of ASRH services. Results will help to shape ASRH programs and reduce teenage pregnancy within Kenya and other similar low middle-income countries. The study is registered at http://www.pactr.org/ , registration number PACTR201906738029948.

    更新日期:2019-11-28
  • A systematic review and meta-analysis of postpartum contraceptive use among women in low- and middle-income countries
    Reprod. Health (IF 2.295) Pub Date : 2019-10-29
    Rubee Dev; Pamela Kohler; Molly Feder; Jennifer A. Unger; Nancy F. Woods; Alison L. Drake

    Short birth intervals increase risk for adverse maternal and infant outcomes including preterm birth, low birth weight (LBW), and infant mortality. Although postpartum family planning (PPFP) is an increasingly high priority for many countries, uptake and need for PPFP varies in low- and middle-income countries (LMIC). We performed a systematic review and meta-analysis to characterize postpartum contraceptive use, and predictors and barriers to use, among postpartum women in LMIC. PubMed, EMBASE, CINAHL, PsycINFO, Scopus, Web of Science, and Global Health databases were searched for articles and abstracts published between January 1997 and May 2018. Studies with data on contraceptive uptake through 12 months postpartum in low- and middle-income countries were included. We used random-effects models to compute pooled estimates and confidence intervals of modern contraceptive prevalence rates (mCPR), fertility intentions (birth spacing and birth limiting), and unmet need for contraception in the postpartum period. Among 669 studies identified, 90 were selected for full-text review, and 35 met inclusion criteria. The majority of studies were from East Africa, West Africa, and South Asia/South East Asia. The overall pooled mCPR during the postpartum period across all regions was 41.2% (95% CI: 15.7–69.1%), with lower pooled mCPR in West Africa (36.3%; 95% CI: 27.0–45.5%). The pooled prevalence of unmet need was 48.5% (95% CI: 19.1–78.0%) across all regions, and highest in South Asia/South East Asia (59.4, 95% CI: 53.4–65.4%). Perceptions of low pregnancy risk due to breastfeeding and postpartum amenorrhea were commonly associated with lack of contraceptive use and use of male condoms, withdrawal, and abstinence. Women who were not using contraception were also less likely to utilize maternal and child health (MCH) services and reside in urban settings, and be more likely to have a fear of method side effects and receive inadequate FP counseling. In contrast, women who received FP counseling in antenatal and/or postnatal care were more likely to use PPFP. PPFP use is low and unmet need for contraception following pregnancy in LMIC is high. Tailored counseling approaches may help overcome misconceptions and meet heterogeneous needs for PPFP.

    更新日期:2019-11-28
  • Factors influencing decision-making power regarding reproductive health and rights among married women in Mettu rural district, south-west, Ethiopia
    Reprod. Health (IF 2.295) Pub Date : 2019-10-29
    Afework Tadele; Amanuel Tesfay; Alemi Kebede

    Women’s decision-making power regarding reproductive health and rights (RHR) was the central component to achieve reproductive well-being. Literatures agree that a women having higher domestic decision-making power regarding their health care were more likely to utilize health services. More than 80% of women in Ethiopia reside in rural areas where they considered as the subordinates of their husbands. This would restrict women to fully exercise their RHR. Thus, this study aims to determine the factors influencing the women’s decision-making power regarding RHR in Mettu rural district, South West Ethiopia. A community based cross-sectional study was done among 415 by using randomly selected married women of reproductive age from March to April 2017. Data was entered by using Epi-data manger 1.4 and analyzed by SPSS version 21. Descriptive and multivariate logistic regression analysis was carried out. One hundred sixty-eight (41.5%) of the women had greater decision-making power regarding RHR. Woman’s primary education AOR 2.62[95% C. I 1.15, 5.97], secondary (9+) education AOR 3.18[95% C. I 1.16, 8.73] and husband’s primary education AOR 4.0[95% C. I 1.53, 10.42], secondary (9+) education AOR 3.95 [95% C. I 1.38, 11.26], being knowledgeable about RHR AOR 3.57 [95% C. I 1.58, 8.09], marriage duration of more than 10 years AOR 2.95 [95% C. I 1.19, 7.26], access to micro-credit enterprises AOR 4.26[95% C. I 2.06, 8.80], having gender equitable attitude AOR 6.38 [95% C. I 2.52, 12.45] and good qualities of spousal relation AOR 2.95 [95% C. I 1.30, 6.64] were positively influencing women’s decision-making power regarding RHR. More than four in ten rural women had greater decision-making power regarding RHR. External pressures (qualities of spousal relation, gender equitable attitude) and knowledge about RHR were found to influence women’s decision-making power. Public health interventions targeting women’s RHR should take into account strengthening rural micro-credit enterprises, qualities of spousal relations and priority should be given to women with no formal education of husband or herself and marriage duration of < 5 years.

    更新日期:2019-11-28
  • Correction to: Preference of specimen collection methods for human papillomavirus detection for cervical cancer screening: a cross-sectional study of high-risk women in Mombasa, Kenya
    Reprod. Health (IF 2.295) Pub Date : 2019-10-30
    Griffins O. Manguro; Linnet N. Masese; Kishor Mandaliya; Susan M. Graham; R. Scott McClelland; Jennifer S. Smith; Vernon Mochache

    Following publication of the original article [1], we have been notified that another author should be added to the team of authors. The Name and affiliation details are below.

    更新日期:2019-11-28
  • Community-based maternal and child health project on 4+ antenatal care in the Democratic Republic of Congo: a difference-in-differences analysis
    Reprod. Health (IF 2.295) Pub Date : 2019-11-01
    Hocheol Lee; Sung Jong Park; Grace O. Ndombi; Eun Woo Nam

    Despite efforts to achieve the Millennium Development Goals, the maternal mortality ratio in the Democratic Republic of Congo was 693 per 100,000 in 2015—the 6th highest in the world and higher than the average (547 per 100,000) in sub-Saharan Africa. Antenatal care (ANC) service is a cost-effective intervention for reducing the maternal mortality ratio in low-income countries. This study aimed to identify the intervention effect of the maternal and child health care (MCH) project on the use of four or more (4+) ANC services. The MCH project was implemented using the three delays model in Kenge city by the Ministry of Public Health (MoPH) of the DRC with technical assistance from Korea International Cooperation Agency (KOICA) and the Yonsei Global Health Center from 2014 to 2017. Furthermore, Boko city was selected as the control group. A baseline and an endline survey were conducted in order to evaluate the effectiveness of this project. We interviewed 602 and 719 participants in Kenge, and 150 and 614 participants in Boko in the baseline and endline surveys, respectively. We interviewed married reproductive-aged women (19–45 years old) in both cities annually. The study instruments were developed based on the UNICEF Multiple Indicator Cluster Surveys. This study used the homogeneity test and the binary logistic regression difference-in-differences method of analysis. The odds of reproductive-aged women’s 4+ ANC service utilization at the intervention site increased 2.280 times from the baseline (OR: 2.280, 95% CI: 1.332–3.902, p = .003) as compared to the control site. This study showed that the KOICA MCH project effectively increased the 4+ ANC utilization by reproductive-aged women in Kenge. As the 4+ ANC services are expected to reduce maternal deaths, this project might have contributed to reducing maternal mortality in Kenge. In the future, we expect these findings to inform MCH policies of the MoPH in the DRC.

    更新日期:2019-11-28
  • Debating medicalization of Female Genital Mutilation/Cutting (FGM/C): learning from (policy) experiences across countries
    Reprod. Health (IF 2.295) Pub Date : 2019-11-01
    Els Leye; Nina Van Eekert; Simukai Shamu; Tammary Esho; Hazel Barrett

    Although Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach. The purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C. More research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030.

    更新日期:2019-11-28
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