Women's Health Commons^™

Expanding Services To Detect, Manage, And Prevent Pre-Eclampsia And Eclampsia In Tando Allahyar District Of Sindh Province, Pakistan, Ali M. Mir, Irfan Masood, Mumraiz Khan, Sharif M.I. Hossain, Tracy Mcclair, Pooja Sripad, Charlotte E. Warren

Reproductive Health

This endline report documents a USAID-supported implementation research project carried out by the Population Council in one district in Sindh province, as part of the global—Bangladesh, Ethiopia, Kenya, Nigeria, Pakistan—Ending Eclampsia initiative. This project assessed community midwives’ (CMWs) abilities to screen and detect pre-eclampsia/severe pre-eclampsia/eclampsia (PE/SPE/E) in pregnant and postnatal women and provide a loading dose of magnesium sulfate (MgSO4) to clients suffering from SPE/E and referrals to facilities for further management. This study also explored opportunities to enhance collaboration between CMWs and lady health workers (LHWs), encouraging LHWs to refer pregnant women for group antenatal care (ANC) and postnatal …

Post-Intervention Analysis Of Pre-Eclampsia And Eclampsia In Three Nigerian States, Salisu Mohammed Ishaku, Emmanuel Nwala, Gloria Adoyi, Charles Nwigwe, Solomon Kongyamba, Udochisom Anaba, Caroline Johnson, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but …

Assessing Quality Of Care And Outcomes For Women And Their Infants In Nigeria After Pregnancies Complicated By Hypertensive Disorders, Salisu Mohammed Ishaku, Gloria Adoyi, Innocent Agbo, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the leading cause of maternal mortality in Nigeria—now killing more women than postpartum hemorrhage. Various factors, including lack of capacity among lower-level health-care providers to detect, manage, and refer complications, have been indicated as reasons for most of these deaths. A landscape analysis of pre-eclampsia/eclampsia (PE/E) in Nigeria identified a lack of further information after delivery about the women who experienced HDPs. In this study, the Ending Eclampsia project recruited women with HDPs around the time of childbirth, and prospectively followed them for up to one year postpartum. The study evaluated the care these …

Hypertensive Disorders In Pregnancy: Assessing Postnatal Quality Of Care And Outcomes For Women And Their Infants In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Salma Rouf, Rabeya Akter, Shongkour Roy, Sumaiya Anwar, Karen Kirk, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages …

Assessing The Feasibility Of Primary Health Care Provider Prescription Of Anti-Hypertensive Medication To Pregnant Women In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Shongkour Roy, Pooja Sripad, Charlotte E. Warren

Reproductive Health

Hypertensive disorders of pregnancy (HDPs)—which are major contributors of maternal and newborn mortality, morbidity, and disability—are preventable. About 24 percent of maternal deaths in Bangladesh each year are due to pre-eclampsia and eclampsia (PE/E). A known cause of death in women with PE/E is cerebrovascular accident, which occurs due to rapidly increasing blood pressure (BP). Elevated BP associated with pregnancy should be detected and appropriately managed before onset of convulsions (eclampsia) and other life-threatening complications. For women presenting with severe PE/E, magnesium sulphate (MgSO4) is the recommended drug for convulsion management. Anti-hypertensive medicines are also recommended for control of high …

Strengthening Bauchi State College Of Nursing And Midwifery By Updating Its Training Curricula, Procedure Manuals And Student Handbooks, Ekechi Okereke, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

Many of Nigeria’s Nursing and Midwifery schools and colleges encounter challenges that include outdated training curricula, which can lead, in some cases, to loss of accreditation. In Bauchi state, a state College of Nursing and Midwifery was formally established in 2013. The Population Council engaged a curriculum expert who had worked with the Nursing and Midwifery Council of Nigeria (which stipulates minimum standards of compliance for accreditation) to assess the school’s training documents, including its training curriculum, procedure manual, and student handbook. The school is expected to secure full accreditation in 2019. The Population Council also supported the strengthening of …

Strengthening Cross River State Schools Of Nursing And Midwifery By Updating Their Training Curricula, Procedure Manuals And Student Handbooks, Ekechi Okereke, Godwin Unumeri, Aisha Jibril

Reproductive Health

Many of Nigeria’s Nursing and Midwifery schools and colleges encounter challenges that include outdated training curricula, which can lead, in some cases, to loss of accreditation. In Cross River state, in 2014 only one health training institution was accredited—provisionally. Five other institutions had lost their accreditations from the Nursing and Midwifery Council of Nigeria (NMCN) which stipulates minimum standards of compliance for accreditation. An assessment team led by the Director of Nursing of Calabar’s Ministry of Health visited the Cross River schools to determine the best ways of addressing the gaps in the accreditation team’s report. Through the HRH project …

Using Demographic And Health Surveys In The Campaign To End Fgm/C: A Kenyan Example, Dennis Matanda, Caroline W. Kabiru

Reproductive Health

In order to design effective interventions to end female genital mutilation/cutting (FGM/C), we need to map where FGM/C is practiced and what factors influence it. Data from the Demographic and Health Surveys (DHS), nationally representative surveys conducted in low- and middle-income countries every five years, give us the opportunity to explore how FGM/C is influenced by both individual and community-level factors. Where FGM/C prevalence is not uniform, various research and analysis techniques can be used to improve estimates and draw further information from DHS data. This brief shares insights from two studies carried out in Kenya using DHS data collected …

Discutiendo Desde El Interior: La Marginación De Los Hombres Trans Dentro Del Movimiento Por El Aborto Legal En Argentina / Arguing From Within: The Marginalization Of Trans Men Within The Movement For Legal Abortion In Argentina, Olivia Nichols

Independent Study Project (ISP) Collection

En la actualidad, el color verde lleva con ello una asociación casi indudable al movimiento por el aborto legal en Argentina. A pesar de este alto perfil del movimiento conocido como la marea verde, una recorrida por la historia del movimiento revela una gran brecha en el diálogo en relación con la inclusión de personas que no son mujeres cis, como los hombres trans que también abortan.

Informada por entrevistas con activistas trans argentinos y la observación de un encuentro de la Campaña Nacional por el Derecho al Aborto Legal, Seguro y Gratuito, esta investigación considera la inclusión (o falta …

The Challenges Of India’S Rising Breast Cancer Epidemic, Brigette Stickney

Independent Study Project (ISP) Collection

India is currently undergoing rapid urbanization, which is greatly impacting Indian citizens’ health. One of the rising concerns due to the drastic lifestyle and environmental changes that are results of urbanization is the issue of breast cancer. Breast cancer diagnosis rates are rising exponentially, and breast cancer has moved its way up to be the most common cancer in India. Breast cancer mortality rates in India are also some of the worst in the world. This paper analyses the social, mental, economic, geographic, and physical challenges that are present for women diagnosed with cancer in India. It assesses how they …

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …

What To Expect When You’Re Expecting: The Impacts China’S Maternal And Child Health Care Law Has Had On Tibetan Birthing Practices In The Diqing Tibetan Autonomous Prefecture, Hannah Mishriky

Independent Study Project (ISP) Collection

While childbirth is universal, it is undeniable that class, culture, ethnicity, and the scientific and political state of medicine all influence how women experienced it. The Tibetan ethnic minority of the People’s Republic of China (PRC) is a culture that exemplifies the uniqueness of each birth. Due to both their distinctive childbirth beliefs and practices, as well as the swift changes China has undergone, Tibetan birthing experiences are asking to be explored.

This study will focus on two major factors influencing Tibetan women's birthing experiences. To begin, research will be done to understand the Buddhist influences surrounding pregnancy and childbirth, …

Engaging Male Partners Of Adolescent Girls And Young Women In Hiv Services In Malawi: Findings From Dreams Implementation Science Research, Project Soar

HIV and AIDS

Important contributors to adolescent girls' and young women's (AGYWs') vulnerability to HIV are the power differentials in their sexual relationships with male partners. Therefore, engaging male partners of AGYWs is important in reducing HIV incidence among these women. Project SOAR, in collaboration with the Center of Reproductive Health at the University of Malawi College of Medicine, conducted qualitative research in the districts of Zomba and Machinga in Malawi to: 1) identify and locate the types of men who have sexual relationships with AGYW; 2) understand the challenges to and facilitators of accessing HIV services among AGYWs’ male partners; and 3) …

Female Sex Workers Living With Hiv In Tanzania Have Both A Need For Contraception And A Desire To Have Children In The Future, Project Soar

HIV and AIDS

HIV-positive women often have critical family planning (FP) needs in addition to HIV-related care, treatment, and prevention concerns. In sub-Saharan Africa, unintended pregnancy is common among HIV-positive women. At the same time, many women living with HIV want to have children some day, and there are various “safer conception” strategies available to help HIV-affected individuals and couples get pregnant while minimizing the risk of HIV transmission to seronegative partners and the baby. This brief describes the fertility-related needs and desires of female sex workers living with HIV in Tanzania, highlighting results indicating that health services should help women meet both …

Male Partners Of Adolescent Girls And Young Women: Relationship Characteristics And Hiv Risk—Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

Adolescent girls and young women (AGYW) in South Africa, as in many countries, are particularly vulnerable to HIV for a variety of reasons, including economic disadvantage and unequal power dynamics in sexual relationships with their male partners—many of whom are older and engage in high-risk behaviors. In an effort to learn more about men’s relationships with AGYW and how HIV services can better engage them, the Population Council is conducting implementation science research in KwaZulu-Natal Province. This brief reports findings from a 2017 baseline survey with nearly 1,000 men. An endline survey is planned for mid-late 2018, and will focus …

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Kenya? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Kenya to build needed evidence to inform community-based, girl-centered interventions. DREAMS programs in Kenya are implementing a core package of interventions in the highest HIV-burden areas to address HIV risk among adolescent girls and young women (AGYW)—a population in which AIDS is the leading cause of death in the region. This brief summarizes key findings from a survey of 1,778 AGYW, more than half of whom are enrolled in DREAMS programming.

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Zambia? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Zambia and other countries across sub-Saharan Africa to build needed evidence to inform community-based, girl-centered HIV-prevention programming. Critical to this process is understanding adolescent girls’ and young women’s (AGYWs’) knowledge, attitudes, sexual behaviors, and characteristics of their sexual partnerships that may put them at risk of HIV acquisition. This results brief summarizes key findings from a cross-sectional survey of 1,915 AGYW, half of whom were 15–19 years old and the other half 20–24 years old, residing in urban districts of Lusaka and Ndola. The findings in this brief were shared at …

Evaluating A Multidisciplinary Integrated Management Team Intervention To Improve Maternal And Child Outcomes And Hiv Service Uptake And Retention In Lesotho, Project Soar

HIV and AIDS

Pregnant and postpartum HIV-positive women face a particularly complex set of barriers to prevention of mother-to-child transmission of HIV (PMTCT) uptake at the policy, health facility, community, and individual levels. They are vulnerable to poor retention in care and adherence to treatment, especially in the first three months after initiation of treatment and the postpartum period. In addition, counseling and support for primary prevention among HIV-negative pregnant women is almost nonexistent in PMTCT programs. This brief describes the IMPROVE study—a multidisciplinary integrated management team intervention to increase maternal and child health and HIV service uptake and retention—that Project SOAR is …

Modeling The Expected Cost-Effectiveness And Impact Of Oral Pre-Exposure Prophylaxis In Uganda And Swaziland, Project Soar

HIV and AIDS

Clinical trials have shown that oral antiretrovirals (ARVs) containing tenofovir/emtricitabine used by HIV-negative individuals to prevent HIV acquisition, called oral pre-exposure prophylaxis (PrEP), are safe and effective in several populations. Prior modeling work has demonstrated that oral PrEP is most cost effective when targeted to populations at very high risk of infection, with risk dependent on a combination of individual behavior and epidemic contexts. This brief describes a study Project SOAR is conducting to assist Uganda and Swaziland in making critical decisions about oral PrEP introduction and scale up by modeling the expected cost effectiveness and impact of oral PrEP …

The Hold Me Tight Program For Couples Becoming Parents: A Mixed Methods Study, Debbie Wang

Theses and Dissertations (Comprehensive)

ABSTRACT

Attachment theory has made substantial contributions to the understanding of close relationships. The purpose of this study was to inquire whether an attachment-informed psychoeducational program is a feasible and effective intervention for couples expecting their first child. The overarching question was: Is an attachment-informed relationship enhancement program, such as Hold Me Tight^® (HMT), helpful to couples in strengthening their relationship and increasing their confidence in becoming first-time parents? The research question was addressed using a mixed-methods approach.

In the first phase, the Hold Me Tight^® program developed by Dr. Sue Johnson was modified for use with couples …

How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba

Reproductive Health

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this …

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson

Reproductive Health

Both the family planning sector and the environmental sector will be interested in this synopsis of findings from a study of the first four years of the Tuungane integrated population, health, and environment (PHE) project in Tanzania. The objectives of the Tuungane Project are to achieve healthier families, healthier forests, and healthier fisheries, using an integrated, cross-sectoral approach. Analyses of the 2011 baseline and 2016 midline quantitative data, and additional qualitative data from 2016, measured the project’s progress and shed light on the contribution of the project interventions to building resilience, and on the links between family planning and other …

Dynamics Of Injectable Contraceptive Use In India, The Evidence Project

Reproductive Health

This brief describes a research study by the Population Council, with support from USAID/India, whose purpose is to provide evidence that can be used to strengthen the family planning program and meet the needs of reversible contraceptive users who want to prevent pregnancy in India. Understanding the experiences of the small but growing population of women choosing the injectable is important as the Government of India continues to roll out injectable contraceptive methods in the public sector. The report’s key recommendations include: disseminating messaging about potential side effects of the injectable, institutionalizing quality of care in pre-service trainings for all …

Dynamics Of Interval Iud Use In India, The Evidence Project

Reproductive Health

The IUD is an important long-acting, reversible contraceptive method, and an alternative to permanent female sterilization that does not carry the risk of regret. In India, as the government aims to expand the basket of reversible method choice available to women, understanding the experiences of those who use the interval IUD is paramount. This brief describes a study by the Population Council, with support from USAID/India, which found that overall there is room to improve the quality of services clients receive. The report recommends disseminating messaging about potential side effects of the IUD, training frontline health workers on four domains …