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Public Health

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2014

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Articles 31 - 60 of 137

Full-Text Articles in Sociology

Cleft Lip And Palate In India: Determining The Socioeconomic Factors That Influence Quality Of Life And Treatment Received, With A Focus In Rural Nainital District, Uttarakhand State, Ellery Ward Apr 2014

Cleft Lip And Palate In India: Determining The Socioeconomic Factors That Influence Quality Of Life And Treatment Received, With A Focus In Rural Nainital District, Uttarakhand State, Ellery Ward

Independent Study Project (ISP) Collection

Cleft lip and cleft palate are birth defects that range in severity, and may cause serious physical and social challenges to those who are born with them. This project sought to determine the socioeconomic factors that influence the lives of people with cleft lip and or cleft palate in India, and the treatment, or lack thereof, which they receive. Specific focus was given to the rural and mountainous area of Nainital district in Uttarakhand state. This study was carried out with the assistance of the Aarohi organization located in the Satoli village in Nainital district. Interviews with one plastic surgeon …


Eating Disorders: Prevalence, Perceptions, And Treatments In Jordan, Brenda Gable Apr 2014

Eating Disorders: Prevalence, Perceptions, And Treatments In Jordan, Brenda Gable

Independent Study Project (ISP) Collection

This study examines the perceptions that young women in Jordan have regarding their bodies and eating disorders, in addition to their opinion regarding media and familial pressures to fit societal norms. The study further examines eating disorders as a mental disorder and the obstacles that individuals face when seeking treatment. This study was implemented by 95 surveys distributed to women in a first aid course at Jordan University and by interviewing professionals in the nutritional, mental health, and educational field. It was found that 86% of surveyed students believed that young women in Jordan struggled with body image and 72% …


Adolescent Perceptions Of Health Through Photovoice In Cato Manor, South Africa, Renee Lamoreau Apr 2014

Adolescent Perceptions Of Health Through Photovoice In Cato Manor, South Africa, Renee Lamoreau

Independent Study Project (ISP) Collection

This study will investigate how youth in Cato Manor perceive health in their community using photovoice as the primary methodology. Photovoice is a participatory action research method that gives participants the power to answer research questions through imagery. Participants take pictures in response to a question or prompt, and then describe a self-­‐selected number of pictures using the SHOWED process. This study will employ this methodology to answer the following questions: What objects, people, and events do youth associate with health? How do youth in Cato Manor define health and sickness? The following report will summarize the social and physical …


Mainecare Stage A Health Homes Year 1 Report: Implementation Findings And Baseline Analysis, Kimberley S. Fox Mpa, Carolyn E. Gray Mph, Katherine Rosingana, Deborah A. Thayer Mba Mar 2014

Mainecare Stage A Health Homes Year 1 Report: Implementation Findings And Baseline Analysis, Kimberley S. Fox Mpa, Carolyn E. Gray Mph, Katherine Rosingana, Deborah A. Thayer Mba

Population Health & Health Policy

In January 2013, Maine established Health Homes under federal authority pursuant to Section 2703 of the Affordable Care Act to improve care coordination for MaineCare members with chronic conditions. Stage A of the Health Homes initiative focuses on members with complex medical chronic conditions. Stage B, planned for early 2014, will focus on persons with severe and persistent mental health conditions and children with serious emotional disturbances. The Stage A demonstration builds off the State’s existing Maine multi-payer Patient Centered Medical Home (PCMH) Pilot project and Maine’s Medicare Advanced Primary Care Practice (MAPCP) Demonstration by providing add-on payments to primary …


Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand Mar 2014

Financial Security Scorecard: A State-By-State Analysis Of Economic Pressures Facing Future Retirees, Christian Weller, Nari Rhee, Carolyn Arcand

Public Policy and Public Affairs Faculty Publication Series

As Americans increasingly worry about their retirement prospects, states play an important and growing role in retirement security policy. States already manage long-term care programs for the elderly through Medicaid. Concerned about the impact of future elder poverty on state and local budgets and their local economies, a number of states are exploring the creation of low-cost and low-risk retirement savings plans for private sector workers who lack access to pensions or 401(k)s on the job. Some states have developed programs to help older workers find work.

This report presents the Financial Security Scorecard, designed to inform state-level stakeholders and …


Evaluation Of The Jewish Community Housing For The Elderly Memory Support Initiative, Joan Hyde Jan 2014

Evaluation Of The Jewish Community Housing For The Elderly Memory Support Initiative, Joan Hyde

Gerontology Institute Publications

Jewish Community Housing for the Elderly (JCHE) is a large, multi-campus organization that houses and serves 1,500 residents (80 market rate and 1,420 low income). The average age is 80 years old, with one-third of residents 85 and older. Three quarters of the residents are not native English speakers. Through HUD and other funding, JCHE offers a range of supports to these residents, including translators, interpreters and staff with language and cultural competence, meals, transportation and, through their Service Coordinators, facilitation of resident access to government benefits, home care and other services.

According to the Alzheimer’s Association’s 2012 special report …


Impacts Of The Criminalization On The Everyday Lives Of People Living In With Hiv In Canada, Barry D. Adam, Richard Elliott, Patrice Corriveau, Ken English Jan 2014

Impacts Of The Criminalization On The Everyday Lives Of People Living In With Hiv In Canada, Barry D. Adam, Richard Elliott, Patrice Corriveau, Ken English

Sociology, Anthropology, and Criminology Publications

As part of a study on the social consequences of the criminal justice system on people living with HIV or AIDS (PHAs) in Canada, this article focuses on how heightened public identification of HIV with criminal matters is having wide ranging effects on perceived personal security and in particular on negotiating potential romantic and sexual interactions. As articulated by the Supreme Court of Canada, the courts have been enforcing a requirement that HIV-positive people disclose their sero-status to prospective partners, relying on the notion that “through deterrence it [the Criminal Code] will protect and serve to encourage honesty, frankness and …


Prevention: Sexual Violence Against Adolescent And Young Adult Women, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar, Joav Merrick Jan 2014

Prevention: Sexual Violence Against Adolescent And Young Adult Women, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.


Adolescence And Sexuality, Joav Merrick, Ariel Tenenbaum, Hatim A. Omar Jan 2014

Adolescence And Sexuality, Joav Merrick, Ariel Tenenbaum, Hatim A. Omar

Pediatrics Faculty Publications

No abstract provided.


Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew Jan 2014

Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew

Reproductive Health

This research report presents a country profile of Kenya, and looks at differential access to and quality of family planning (FP) and abortion/post-abortion services to assess their current situation, as well the various financing and delivery mechanisms for these crucial services. Since 2000, Kenya has passed several new sexual and reproductive health (SRH) and population-related policies, including a new population and development policy that addresses rapid population growth. Results of this country profile highlight the need for further research on: 1) innovative ways through which SRH information can be brought to schools; 2) FP/SRH indicators in people living with disabilities; …


Postpartum Family Planning In Burkina Faso, Marina Daniele Jan 2014

Postpartum Family Planning In Burkina Faso, Marina Daniele

Reproductive Health

This is a formative study aiming to identify the main barriers to the provision and uptake of quality postpartum family planning (PPFP) services at the supply, access, demand, and policy levels in Burkina Faso. This study reveals that there are substantial shortfalls in the availability of quality PPFP at all these levels. Most of the difficulties observed in the provision of PPFP services are due to the failure to translate largely sound policies and guidelines into practice. This study contributes to identifying priority areas and makes recommendations for improvement in order to respond to unmet need for family planning in …


Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc Jan 2014

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report …


Research Gaps In Scale Up Of Family Planning And Reproductive Health Programming, The Evidence Project, E2a, Hpp, Measure Evaluation Jan 2014

Research Gaps In Scale Up Of Family Planning And Reproductive Health Programming, The Evidence Project, E2a, Hpp, Measure Evaluation

Reproductive Health

The Evidence Project, in collaboration with the Evidence to Action Project, the Health Policy Project, and MEASURE Evaluation convened a meeting to discuss research gaps related to scale-up. The meeting was held at the request of USAID’s Office of Population and Reproductive Health (OPRH) to help guide their research strategy. The meeting had four objectives: discuss scale-up experiences and the role of research and monitoring for strengthening program performance at scale; identify research gaps related to scale-up; prioritize the scale-up research gaps for OPRH; identify next steps for addressing these priority research gaps. This meeting generated a rich discussion about …


Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal Jan 2014

Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal

Reproductive Health

Social and behavior change communication (SBCC) interventions are now incorporated within state project implementation plans and increasing resources are being allocated for SBCC activities. A close monitoring of SBCC activities and an evaluation in terms of reach and effectiveness among intended audiences is thus necessary. This calls for a serious effort to build the capacity of monitoring and evaluation (M&E) personnel to monitor and evaluate performance of SBCC activities. FHI 360’s Improving Healthy Behaviors Program, funded by USAID, aims to provide technical assistance to strengthen the capacities of public program managers at the national, state, and district level to monitor …


Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council Jan 2014

Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Balochistan government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Balochistan—about 35 percent of the deaths in this age group are pregnancy-related. Approximately 3,000 women die each year in Balochistan due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The maternal …


Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council Jan 2014

Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family …


Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq Jan 2014

Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq

Reproductive Health

This report presents an argument for prioritizing family planning to achieve the maternal, child, and development goals of four major provinces in Pakistan, using the latest available provincial data, especially the Pakistan Demographic and Health Survey 2012-13. The analysis is based on provincial projections generated by the Population Council. Opportunities for enhancing family planning are identified, and the number of maternal, infant, and child lives that could be saved in each province through an accelerated family planning program is estimated. The analysis establishes that none of the provinces are on track to meet Millennium Development Goals 4 or 5. The …


Balika Fact Sheet: Highlight On Gender And Rights, Population Council Jan 2014

Balika Fact Sheet: Highlight On Gender And Rights, Population Council

Poverty, Gender, and Youth

Data presented in this Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Gender and Rights,” reveal that attitudes about gender equitability differ across domains and by the background characteristics of respondents in terms of education, marital status, and age. Those who are married, less educated, and young are less aware of gender equality and rights including domestic violence, autonomy, and confidence. The data suggest specific areas where interventions may produce positive outcomes. The BALIKA survey included a number of questions to measure the values held about gender equality in terms of marriage expectations, …


Adolescent Girls Empowerment Programme: Research And Evaluation Baseline Technical Report, Paul C. Hewett, Karen Austrian, Erica Soler-Hampejsek, Jere R. Behrman, Christine A. Kelly, Dela Kusi-Appouh, Fiammetta Bozzani, Barbara Mensch, Minyoi Maimbolwa Jan 2014

Adolescent Girls Empowerment Programme: Research And Evaluation Baseline Technical Report, Paul C. Hewett, Karen Austrian, Erica Soler-Hampejsek, Jere R. Behrman, Christine A. Kelly, Dela Kusi-Appouh, Fiammetta Bozzani, Barbara Mensch, Minyoi Maimbolwa

Poverty, Gender, and Youth

The theory of change behind the Adolescent Girls Empowerment Program (AGEP) posits that adolescent girls are empowered by acquiring social, health, and economic assets. Girls can draw on these assets to reduce vulnerabilities and expand opportunities, thereby increasing their likelihood of completing school, delaying sexual debut, and reducing the risk of early marriage, unintended pregnancy, acquisition of HIV, and so on. AGEP serves vulnerable adolescent girls in Zambia aged 10–19 in two age cohorts: 10–14-year-olds and 15–19-year-olds. AGEP operates in ten “master sites,” five urban and five rural, in four provinces of Zambia. The three core components of AGEP in …


Culture, Caregiving, And Health: Exploring The Influence Of Culture On Family Caregiver Experiences, Jennifer Pharr, Carolee Dodge Francis, Christine Terry, Michele Clark Jan 2014

Culture, Caregiving, And Health: Exploring The Influence Of Culture On Family Caregiver Experiences, Jennifer Pharr, Carolee Dodge Francis, Christine Terry, Michele Clark

Public Health Faculty Publications

Ethnic minorities are expected to experience a greater demand for family caregiving than non-Latino Whites due to their projected population growth. Although the consensus of researchers on caregiving and culture finds that the caregiving experience differs significantly among cultural/ethnic groups, the question remains as to how cultural values and norms influence the caregiver experiences. We conducted an interpretative, phenomenological qualitative analysis of focus group transcripts from four groups (African American, Asian American, Hispanic American, and European American) for cultural influences on caregiving. Data were collected in Nevada between December 7, 2009, and August 20, 2010. Thirty-five caregivers participated in this …


Strategies Employed By Inner-City Activists To Reduce Alcohol-Related Problems And Advance Social Justice, Laurie Drabble, Denise Herd Jan 2014

Strategies Employed By Inner-City Activists To Reduce Alcohol-Related Problems And Advance Social Justice, Laurie Drabble, Denise Herd

Faculty Publications

This study explored strategies employed by activists engaged in efforts to change policies and laws related to selling and promoting alcoholic beverages based on in-depth interviews with 184 social activists in seven U.S. major cities. Nine strategies aimed at improving local conditions and influencing policy were described by activists across regional contexts. Grassroots mobilization was central to all other strategies, which included the creation or enforcement of laws, meeting with elected officials, media advocacy, working with police/law enforcement, education and training, direct action, changing community norms, and negotiating with store owners.


Hiv Testing Implementation In Two Urban Cities: Practice, Policy, And Perceived Barriers., Camden J Hallmark, Jennifer Skillicorn, Thomas P Giordano, Jessica A Davila, Marlene Mcneese, Nestor Rocha, Avemaria Smith, Stacey Cooper, Amanda D. Castel Jan 2014

Hiv Testing Implementation In Two Urban Cities: Practice, Policy, And Perceived Barriers., Camden J Hallmark, Jennifer Skillicorn, Thomas P Giordano, Jessica A Davila, Marlene Mcneese, Nestor Rocha, Avemaria Smith, Stacey Cooper, Amanda D. Castel

Epidemiology Faculty Publications

BACKGROUND: Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.

METHODS: We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.

RESULTS: In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% …


Wonder Drugs To Hot New Diets: Knowledge Is Power! Adult Health Literacy, Adnan Ahmeduddin, Mary Grace Bowring, Kelly Davis, Indra Gomez, Sarah Halle, Courtney Middlebrook, Molly Sadowsky, Lauren Shauger, Lauren Violette Jan 2014

Wonder Drugs To Hot New Diets: Knowledge Is Power! Adult Health Literacy, Adnan Ahmeduddin, Mary Grace Bowring, Kelly Davis, Indra Gomez, Sarah Halle, Courtney Middlebrook, Molly Sadowsky, Lauren Shauger, Lauren Violette

ISCOPES Posters and Presentations

No abstract provided.


Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab Jan 2014

Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab

Reproductive Health

The gender profile of the HIV/AIDS epidemic has changed since it emerged 30 years ago when infections were concentrated in key populations of men such as injecting drug users and men who have sex with men. In 2012, women accounted for nearly 50 percent of the estimated 35.3 million people living with HIV/AIDS globally. In the Middle East and North Africa, 44 percent of infected adults are women. The past 30 years have also witnessed remarkable improvements in access to high-quality information and medical services, including services for prevention of mother-to-child transmission of the virus. With care and treatment for …


Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council Jan 2014

Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Khyber Pakhtunkhwa (KP) government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in KP—about 27 percent of the deaths in this age group are pregnancy-related. Approximately 1,700 women die each year in KP due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. …


An Evaluation Of Population Services Zimbabwe’S Mobile Outreach Model, Ravikanthi Rapiti, Saiqa Mullick Jan 2014

An Evaluation Of Population Services Zimbabwe’S Mobile Outreach Model, Ravikanthi Rapiti, Saiqa Mullick

Reproductive Health

This report documents a service evaluation of Population Services Zimbabwe’s (PSZ) mobile outreach program in four provinces of Zimbabwe. The evaluation was conducted by the Population Council between September and October 2013. It provides key findings on the quality of the PSZ outreach program in expanding choice and access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception, as well as recommendations for PSZ and other family planning programs to consider in scaling up and strengthening mobile outreach services. The evaluation, conducted by the Population Council, was designed to focus on various components of quality including adequate information …


Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Babacar Mane, Eva Burke, Nafissatou Diop, Kate Reiss, Thoai Ngo, Katharine Footman, Maaike Van Min Jan 2014

Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Babacar Mane, Eva Burke, Nafissatou Diop, Kate Reiss, Thoai Ngo, Katharine Footman, Maaike Van Min

Reproductive Health

In developing countries, postpartum hemorrhage and complications related to unsafe abortions are direct causes of maternal death. In Senegal, actions have been undertaken by the government to reduce this burden and significant advances have been made in these areas in recent years. However, progress is still necessary to achieve the Millennium Development Goals for the reduction of the maternal mortality rate to the target numbers by 2015. The objective of the study was to understand the knowledge about, availability of, and practices in the provision of misoprostol at pharmacies in Dakar, Senegal, to ensure correct delivery of the product. Pharmacists …


Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara Jan 2014

Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Although Kenya has made significant progress in ensuring its citizens’ right to reproductive health, many Kenyans still lack access to or fail to use contraceptives, in part because of the lack of quality family planning (FP) services. Through the STEP UP research program, the African Population and Health Research Center developed a comprehensive country profile report that outlines the status, causes, and consequences of unintended pregnancy in Kenya. One of the most prominent findings was how important public health facilities are to reducing unmet need for FP. In order to solidify gains achieved and make further progress, concerted commitment from …


Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian Jan 2014

Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian

Reproductive Health

A review of literature and analysis of large surveys were carried out with funding from the STEP UP consortium led by Population Council to build a coherent body of robust research-based evidence on the situation in India in the context of unmet need for family planning (FP) and safe abortion services. The study found that there is insufficient training of different cadres of health staff in the public health system on abortion provision, post-abortion care, FP counseling of young couples, emergency contraception, and IUD insertion/removal. Despite service delivery guidelines in India expecting providers to provide FP counseling during antenatal visits, …


Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Community-Based Workshops, Population Council Jan 2014

Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Community-Based Workshops, Population Council

Reproductive Health

The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Community-Based Workshops” is to orient community-health workers on the RMC concept. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal health in relation to RMC. Discuss rights-based approaches related to RMC. Discuss selected strategies that reduce disrespect and abuse (D&A). Discuss the role of the community in promoting RMC. Demonstrate knowledge and use of the Alternative Dispute Resolution mechanism. Develop action plans to support the implementation of RMC interventions at the community level. Summary: D&A deters facility-based childbirth and Skilled …