Women's Health Commons^™

Prelacteal Feeding Practices In Pakistan: A Mixed-Methods Study, Muhammad Asim, Zarak Husain Ahmed, Mark D. Hayward, Elizabeth M. Widen

Community Health Sciences

Background: Prelacteal feeding, the feeding a newborn substances or liquids before breastfeeding, is a common cultural practice in Pakistan, but is associated with neonatal morbidity and mortality because it delays early initiation of breastfeeding. In this study, we sought to examine the social and cultural factors associated with prelacteal feeding in Pakistan.
Methods: This mixed-method study used data from the Pakistan Demographic and Health Survey (PDHS) 2012-13. Findings from the survey were complemented by qualitative interviews with mothers and healthcare providers. In a subset of PDHS dyads (n = 1361) with children (0-23 months), descriptive statistics and bivariate and multivariable …

Costs Of Maternity Leave To Support Breastfeeding; Brazil, Ghana And Mexico, Mireya Vilar-Compte, Graciela M. Teruel, Diana Flores-Peregrina, Grace J. Carroll, Gabriela S. Buccini, Rafael Perez-Escamilla

Department of Public Health Scholarship and Creative Works

Objective To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women’s weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given …

Laws Restricting Access To Abortion Services And Infant Mortality Risk In The United States, Roman Pabayo, Amy Ehntholt, Daniel M. Cook, Megan Reynolds, Peter Muennig, Sze Yan Liu

Department of Public Health Scholarship and Creative Works

Objectives: Since the US Supreme Court′s 1973 Roe v. Wade decision legalizing abortion, states have enacted laws restricting access to abortion services. Previous studies suggest that restricting access to abortion is a risk factor for adverse maternal and infant health. The objective of this investigation is to study the relationship between the type and the number of state-level restrictive abortion laws and infant mortality risk. Methods: We used data on 11,972,629 infants and mothers from the US Cohort Linked Birth/Infant Death Data Files 2008–2010. State-level abortion laws included Medicaid funding restrictions, mandatory parental involvement, mandatory counseling, mandatory waiting period, and …

Recommended Syphilis And Hiv Testing After Positive Sti Testing, Katherine Cayce Monaghan Rn, Bsn

Doctor of Nursing Practice Final Manuscripts

Background: Historically primary and secondary syphilis were seen primarily among men who have sex with men and rates among women remained low and rarely increased. Recent research shows that between 2013–2017, the primary and secondary syphilis rate increased 72.7% in the U.S. and 155.6% among women. Patients diagnosed with syphilis have a two to five fold increased risk of acquiring human immunodeficiency virus (HIV). Additionally, positive testing for other sexual transmitted infections (STI) might be indicators of high risk sexual behaviors and exposures that place a person at greater risk for acquiring syphilis and HIV. A southern California university student …

Black Women Survive Breast Cancer With Community-Based Care, Shelley I. White-Means, Jill Dapremont, Barbara D. Davis, Tronlyn Thompson

Faculty Presentations

PURPOSE Community-based breast cancer support agencies who address non-medical, social determinants of health needs that serve as barriers to maximizing breast health outcomes may play a vital role in mitigating breast cancer mortality. They share a common emphasis on addressing social, economic, and psychological needs of breast cancer survivors and those at risk of breast cancer. This paper is third in a series of papers exploring why the rate of breast cancer mortality is two times higher for African American women than white women in Memphis. We sought insights from community-based breast cancer support agencies because they have a close-up …

La Maestra’S Circle Of Care: Studying The Impact Of An Integrated Service Model On The Health And Well-Being Of Vulnerable Populations, Zara Marselian

Dissertations

ABSTRACT

There is an urgent need to reform the health care delivery system in the United States, as recognized through current bipartisan efforts. Society’s vulnerable populations especially need health care reform as health care outcomes are the poorest among disadvantaged populations. Moreover, vulnerable populations are twice as likely to develop chronic diseases than the general population and they remain ill due to other contextual, societal factors affecting their ability to achieve health and well-being. This population is subjected to adverse life events that suggest a more comprehensive approach to health and well-being is called for.

The Circle of Care is …

Black Pregnancy Matters: Racial Reproductive Bias In African American Maternal Mortality, Juhi Khemani

Master's Projects and Capstones

This semester-long research project uncovers how racial biases demonstrated in the reproductive health field, and specifically before, during, and after childbirth, affect the rate of maternal mortality and morbidity for African American mothers in the United States. The rate of maternal mortality for this specific racial group is four times greater as compared to Caucasian women and this discrepancy will be investigated and analyzed throughout this capstone thesis. Interviews were conducted with key figures in the obstetric and gynecological field as well as with Black mothers themselves in an effort to uncover what factors, aside from medical anomalies, are leading …

An Examination Of The Association Between State Medicaid Perinatal Services And Birth Outcomes, Joy Morgan Myers

Honors Theses

This thesis investigated the connection between socioeconomic status, healthcare coverage, and birth outcomes. The research question that was posed specifically looked at twenty perinatal services that states covered under Medicaid to varying degrees to see their association, if any, with premature birth rates and low birthweight rates. State-level and Mississippi county-level data were compiled regarding preterm birth rates, low birthweight rates, presumptive eligibility adoption, and coverage of twenty different perinatal services. Using these data, the correlation between state Medicaid expansion status and birth outcomes was first calculated in order to determine if variation in birth outcomes was associated with expanded …

The Impact Of Location On Healthcare Access For Individuals With Disabilities, Addison Kimber

Honors Scholar Theses

This paper analyzes healthcare access for individuals with disabilities living in rural areas. In current political discussion, we typically think of insurance coverage as the metric to analyze healthcare access. However, as demonstrated by studies of healthcare in the United Kingdom, people with disabilities continue to face barriers to health care even with universal healthcare systems. In particular, individuals in rural areas have less healthcare access than urban residents. This is due to factors including socioeconomic status, insurance coverage, access to competent care, and transportation. This study aims to understand if disability status exacerbates the issue of access in rural …

Mass Matters: Increasing Mammography Rates To Underserved Women, Ingrid N. Cooper

Evidence-Based Practice Project Reports

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

Do Recipients Of Cash Transfer Scheme Make The Right Decisions On Household Food Expenditure? A Study From A Rural District In Pakistan, Aminah Jahangir, Shehla Zaidi, Jai K. Das, Shifa Habib

Community Health Sciences

Objective: To assess spending by beneficiaries of Benazir Income Support Programme on monthly food commodities, and contribution of the cash grant programme on purchase of nutritious foods.
Methods: The descriptive cross-sectional survey of households enrolled in the Benazir Income Support Programme was conducted during July and August, 2013, in Matiari district of the Sindh province of Pakistan. Monthly household food expenditure on food commodities and use of the cash grant on type of food purchased was assessed through structured interviews of the beneficiaries. Results were computed in 2013 Pak rupees and converted to 2018 United States dollar. Women beneficiaries were …

Knowledge, Motivations And Concerns About Participation In Breast Cancer Clinical Trials In Puerto Rico, Marinilda Rivera-Díaz, Angélica N. García-Romero, Alelí M. Ayala-Marín, Camille Vélez-Alamo, Adrianna I. Acevedo-Fontánez, Mariana Arévalo, Vivian Colón-López

Journal of Health Disparities Research and Practice

Clinical trials (CT) in breast cancer have been crucial for new treatment discoveries. While participation in cancer CT is low, minorities are particularly underrepresented.This study aimed toidentify factors influencing the participation in CTs based on the experiences of Latina breast cancer survivors in Puerto Rico (PR), especially their CT knowledge, motivations, and concerns.Method:Focus groups (FG) were conducted by two social workers and the University of Puerto Rico/MD Anderson Community Health Educator. Participants were stratified into two subgroups: a) women with CT experience and b) those without CT experience. Seven FG were completed among breast cancer survivors (n=34) at …

Increasing Patient Adherence To Gestational Weight Gain Goals In Pregnancy, Annie Vining

Dissertations

Abstract

Problem: The inability to maintain healthy weight gain during pregnancy may contribute to multiple pregnancy-related complications. Nutritional education and support may improve nutrition and vitamin consumption, and recommendations for healthy gestational weight gains have been published. However, pregnant women have reported minimal advice regarding healthy weight gain during pregnancy. A personalized, nutritional counseling program was initiated in a Midwestern, suburban OB-GYN private practice.

Methods: A quality improvement descriptive, correlational design was used. A cohort of pregnant women first trimester through six-weeks postpartum received individual counseling and face-to-face interaction at an office visit each trimester.

Results: Twenty ( …

Safe Consumption Sites And The Perverse Dynamics Of Federalism In The Aftermath Of The War On Drugs, Deborah Ahrens

Dickinson Law Review (2017-Present)

In this Article, I explore the complicated regulatory and federalism issues posed by creating safe consumption sites for drug users—an effort which would regulate drugs through use of a public health paradigm. This Article details the difficulties that localities pursuing such sites and other non-criminal-law responses have faced as a result of both federal and state interference. It contrasts those difficulties with the carte blanche local and state officials typically receive from federal regulators when creatively adopting new punitive policies to combat drugs. In so doing, this Article identifies systemic asymmetries of federalism that threaten drug policy reform. While traditional …

Struggling With Long-Time Low Uptake Of Modern Contraceptives In Pakistan, Nasim Zahid Shah, Tazeen S. Ali, Imtiaz Jehan, Xaher Gul

Woman and Child Health

Background: Efforts to expand access to reproductive health care in Pakistan date as far back as the early 1950s. Despite such efforts, the fertility rate has declined at a slower pace compared to that in neighbouring countries.
Aims: To explore the underlying reasons and challenges for long-time low contraceptive use among female clients and key service providers of community-based family planning programmes in Pakistan.
Methods: A qualitative study was carried out with a total of 10 focus group discussions and 7 in-depth interviews with female clients and key service providers. The data were analysed using qualitative content analysis.
Results: The …

Two Implementation Models Of Workers' Health Education Programs In Egypt: What Works? What Doesn't Work?, Nahla G. Abdel-Tawab, Norhan Bader, Elizabeth Tobey, Aparna Jain

Reproductive Health

This brief presents findings from two models of workers’ health education programs implemented by the Evidence Project/Population Council in Egypt. The two interventions aimed to increase family planning (FP) service demand among young people aged 18–35 in Port Said and urban Souhag. In Port Said, male and female factory workers who were trained as peer educators shared family planning/reproductive health (FP/RH) information with fellow factory workers, distributed communication materials, and provided referrals to infirmary nurses trained in FP counseling. In Souhag, male and female peer educators were trained to provide integrated FP/RH and livelihood workshops to job seekers. Results of …

Evaluation Of The Impact Of Social Collaborations On Sexual And Reproductive Health Knowledge, Lucki Word, Jaila Campbell, Manar T. Edriss, Destiny Stroman, Jewel Evans, Melanie Hanna-Johnson, Md, Anil N. F. Aranha, Phd

Medical Student Research Symposium

Introduction: Developments in technology, such as the popularity of mobile devices and social media outlets, have enhanced the ability of individuals to communicate. Currently, search engines allow for easy exploration of information related to every topic of interest. Our study purpose was to evaluate the impact of technological and social collaborations on sexual and reproductive health knowledge (SRHK).

Methods: A 50-item survey instrument, integrating factors of sociodemographics, number/type of social collaborations, technological communication use, and SRHK, was developed to assess familiarity with sexual and reproductive health perceptions. The survey was provided to consenting patients in an ambulatory, primary care setting. …

Evaluating Implementation Effectiveness And Sustainability Of A Maternity Waiting Homes Intervention To Improve Access To Safe Delivery In Rural Zambia: A Mixed-Methods Protocol, Elizabeth G. Henry, Thandiwe Ngoma, Jeanette L. Kaiser, Rachel M. Fong, Taryn Vian, Davidson H. Hamer, Peter C. Rockers, Godfrey Biemba, Nancy A. Scott

Nursing and Health Professions Faculty Research and Publications

Background: In low-income countries such as Zambia, where maternal mortality rates are persistently high, maternity waiting homes (MWHs) represent one potential strategy to improve access to safe delivery, especially for women living in remote areas. The Maternity Homes Access in Zambia project (MAHMAZ) is evaluating the impact of a MWH model on women’s access to safe delivery in rural Zambia. There is a growing need to understand not only the effectiveness of interventions but also the effectiveness of their implementation in order to appropriately interpret outcomes. There is little evidence to guide effective implementation of MWH for both immediate uptake …

The Community Health System In Bangladesh: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Bangladesh. Bangladesh is divided into eight administrative divisions, 64 districts, and 545 subdistricts, known as upazilas. Each rural area within an upazila is divided into union parishads and mouzas, which are further divided into villages. The Ministry of Health and Family Welfare has an extensive health infrastructure that is pluralistic and follows the country’s administrative pattern. Union parishads are the smallest administrative unit in rural areas. At the lowest administrative level, traditional healers, nonqualified allopathic practitioners, and community health workers (CHWs) are typically the only providers available. This brief …

Implementation Process Brief: Integrated Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Charlotte E. Warren, Aparna Jain, Melsa Lutomia, Jane Loech, Elizabeth Washika

Reproductive Health

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those …

The Community Health System In Haiti: An Overview, Frontline Health Project

Reproductive Health

This brief provides an overview of the community health system in Haiti. In Haiti, the health system is overseen at the national level by the Ministry of Public Health and Population (Ministère de la Santé Publique et de la Population-MSPP) which provides policies and standards for service delivery at all levels, including the community level. Health service delivery is managed and coordinated across three levels: national (level III), health department (level II), and district and community levels (level I). The national level is guided by the MSPP and provides policy guidance for community-level service delivery. The Health Department level is …

Pharmacist-Prescribed Birth Control: A Policy Analysis, Brianna Full

UNO Student Research and Creative Activity Fair

Although unintended pregnancy in the United States has steadily decreased from 2008, rates are still unacceptably high as almost half (42%) of all pregnancies are not wanted or timed correctly (Finer & Zolna). In 2011, 2.8 million of the 6.1 million pregnancies in the United States each year were unintended. Public health professionals are worried about unintended pregnancy because research shows that unwanted or mistimed pregnancies come with associations to adverse maternal and child health outcomes, such as delayed prenatal care, premature birth, and negative physical and mental health effects for children (Frost, Frohwirth & Zolna, 2016). Also, two-thirds (68%) …

Unintended Pregnancy Among The Lgbtq+ Population, Kenna M. Barnes

UNO Student Research and Creative Activity Fair

Unintended births are related to adverse health outcomes for both parents and children (Mosher, et al., 2012). For the context of this research, unintended will include both mistimed (too early) and unwanted (wanted to avoid pregnancy) pregnancies. Non-heterosexual women, defined as anyone who has same-sex sexual behaviors, attractions, or identities, make up about 5.1% of the population according to Williams Institute (2019). The impact of unintended pregnancy among non-heterosexual individuals is not well understood, creating large disparities in the community. This has manifested in emotional, physical, and social wellness gaps compared to their heterosexual counterparts (Buchmueller & Carpenter, 2010; Everett …

Assessing Physical Activity In People With Mental Illness: 23-Country Reliability And Validity Of The Simple Physical Activity Questionnaire (Simpaq), S Rosenbaum, R Morell, A Abdel-Baki, M Ahmadpanah, T V. Anilkumar, L Baie, A Bauman, S Bender, Zahra Hoodbhoy, Romaina Iqbal, Ayesha Mian

Department of Paediatrics and Child Health

Background: Physical inactivity is a key contributor to the global burden of disease and disproportionately impacts the wellbeing of people experiencing mental illness. Increases in physical activity are associated with improvements in symptoms of mental illness and reduction in cardiometabolic risk. Reliable and valid clinical tools that assess physical activity would improve evaluation of intervention studies that aim to increase physical activity and reduce sedentary behaviour in people living with mental illness.
Methods: The five-item Simple Physical Activity Questionnaire (SIMPAQ) was developed by a multidisciplinary, international working group as a clinical tool to assess physical activity and sedentary behaviour in …

Medicaid Home Visitation And Maternal And Infant Care And Health: A Reassessment Of Program Effectiveness, Cristian Meghea, Zhiying You, Jennifer E. Raffo, Lee Anne Roman

Michigan Journal of Public Health

Introduction: The Maternal Infant Health Program, MIHP, is Michigan's largest home visiting program for Medicaid-eligible pregnant women and infants. Prior quasi-experimental propensity score matched MIHP evaluations were limited by the possibility of selection bias due to the limited available baseline characteristics. The purpose of this study was to assess the effectiveness of MIHP including previously unobserved baseline characteristics to mitigate the possibility of selection bias.

Methods: We analyzed health care and outcomes of mothers and their infants using linked administrative and screening data. All Medicaid pregnant women with a singleton birth in Michigan between 2009 and 2012 who were prenatally …

Rural Primary Care And The Diagnostic Resolution Of Abnormal Screening Mammograms: A Mixed Methods Study In Rural Missouri, Jean Hunleth, Julia Maki, Amanda Lee, Aimee James, Rebecca Lobb

Journal of Health Disparities Research and Practice

Rural health clinics (RHCs) and federally qualified health centers (FQHCs) play a vital role in initiating cancer screening in underserved, rural settings. Yet there is limited information about their involvement in diagnostic tests when a mammogram result is abnormal. Diagnostic resolution of abnormal mammograms varies widely by geographic location and resources, and timely resolution is important for addressing rural-urban cancer disparities. This mixed methods study in a rural region of Missouri with high rates of cancer mortality examined the roles of primary care providers during follow-up after an abnormal mammogram, the processes they used, and the clinic specific variations among …

Factors Contributing To Domestic Violence Among Hindu Asian Indian Immigrant Women In Allegheny County, Pennsylvania: A Feasibility Study, Chelsea Pallatino, Todd Bear, Martha A. Terry

Journal of Health Disparities Research and Practice

While there is research on survivors of domestic violence in India and the United States (U.S.), little is known about the sociocultural factors related to domestic violence among Hindu Asian Indian immigrant women (AIIW) in the U.S. The objectives of this study were to a) test the feasibility of conducting domestic violence research among Hindu AIIW; b) investigate domestic violence prevalence and correlations with other characteristics; and c) test the cultural appropriateness of completed measures on social support, acculturation status, and domestic violence. Over 50% of respondents had experienced abuse, often perpetrated by family. Participants had high levels of social …

Creating A Community-Based Protocol To Prevent Unintended Pregnancy In Homeless Women In Monongalia County, West Virginia, Jessica Eva Wukasch

Graduate Theses, Dissertations, and Problem Reports (ETD)

Background: At any given time, 10% of homeless women are pregnant, about twice the rate of all U.S. women of reproductive age (5%) (Healthcare for the Homeless, 2001). According to Healthcare for the Homeless Council ([HHC], 2012), approximately “73% of pregnancies among homeless women were unintended at the time of conception.” In addition, “about 12% of homeless children are placed in foster care compared to 1% of other children” (HHC, 2012). There is an evident need to address unintended pregnancy among homeless women.

Objective: The overall objective was to create an accessible and useful community-based protocol to reduce the rate …

A Rural Mother's Guide To Breastfeeding, Haley Tillett

Undergraduate Honors Theses

Breastfeeding is considered as the gold standard of infant health (CDC, n.d.). The benefits provided to both the baby and mother by breastfeeding are unmatched when compared to formula feeding. Recent studies have shown a disparity in rates of breastfeeding, primarily in rural areas. This may be due, in part, to the fact that mothers in rural areas may not have equal access to resources and support they need to successfully breastfeed due to geographic isolation. This guide will provide an overview of breastfeeding resources in rural communities with a focus on Kittitas Valley, Washington. Resources include but are not …