Women's Health Commons^™

Prevalence And Determinants Of Fully Vaccinated Status For Covid-19 Among Pregnant Women In Brazil, Ghana, Kenya, And Pakistan, Vaishnavi Mathur, Jessica Schue, Berhaun Fesshaye, Prachi Singh, Emily Miller, Caroline Badzi, Emefa Modey, Marleen Temmerman, Ferdinand Okwaro, Renato Souza

Centre of Excellence in Women and Child Health

Maternal immunization provides essential maternal and fetal protection for several infectious diseases. The variability in vaccination guidelines for pregnant women across countries and through the course of the COVID-19 pandemic influenced the perception of both the general public and broader health care systems towards COVID-19 vaccination in pregnancy and moreover shaped the accessibility and decision-making trajectory of pregnant women to become fully vaccinated. As part of a larger multi-country, mixed-methods study, the purpose of this cross-sectional analysis is to assess what factors are associated with pregnant women being fully vaccinated for COVID-19 in Brazil, Ghana, Kenya, and Pakistan. In each …

Breastfeeding Support For Mothers Of Low Birthweight Infants In Hospitals In Rural Western Kenya: An Exploratory Study, Fiona Dickinson, Florence Were, Alloys K’Oloo, Iwaret Otiti, Linda Tindi, Mwanamvua Boga, Mary Kimani, Laura Kiige, Kathy Mellor, Helen Nabwera

Centre of Excellence in Women and Child Health

Background One in ten newborns in sub-Saharan Africa weigh < 2500 g (i.e. low birthweight [LBW]). Breastfeeding difficulties from birth are common among LBW infants. This study explored the use of trained peer mothers to deliver breastfeeding support to mothers of LBW infants in healthcare facilities in rural Kenya.

Methods Five trained peer mothers provided breastfeeding support to 23 mothers of LBW infants across eight healthcare facilities in Homa Bay County. Qualitative, semi-structured interviews were conducted with 11 mothers, 10 healthcare providers and 5 peer mothers prior to and during the breastfeeding support intervention. Inductive thematic analysis was used.

Results Three key themes were discovered: mothers valued the confidence the peer mothers gave them to breastfeed their LBW infants, peer mothers found that the training and their previous experience caring for LBW infants enabled them to work collaboratively with mothers …

Occupational Therapy For Maternal Pelvic Floor And Mental Health: A Holistic Approach To Recovery, Diana S. Theodore

Student Capstone Papers

Maternal pelvic floor dysfunction (PFD) is highly prevalent yet often underrecognized in occupational therapy practice, despite its significant impact on mental health, daily function, and quality of life. Many postpartum women experience symptoms such as urinary incontinence, pain with intimacy, and pelvic organ prolapse, which are frequently normalized or left untreated. Occupational therapy practitioners often have limited training in addressing the complex relationship between pelvic floor function and maternal mental health, contributing to gaps in care. The purpose of this capstone project was to develop a comprehensive handbook for occupational therapy students and practitioners integrating pelvic floor function and maternal …

Is Home Birth A Choice? Racial And Geographic Differences In Unintended Home Births In The U.S., Anna De La Paz

Population Health Research Brief Series

Home births that happen without planning or medical support (i.e., unintended home births) carry a higher likelihood of adverse outcomes, such as low birth weight, preterm birth, and hypothermia. This data slice summarizes findings using data from CDC WONDER (2017–2023) on racial, regional, and metropolitan status differences in home births among women ages 15–44 in the U.S. Findings show that unintended home births are disproportionately concentrated among non-Hispanic Black women, with rates varying substantially by region and metropolitan status.

The Mommy Wine Culture: A Scoping Review Using The Person-Environment-Occupational Model., Sabina Khan

Student Dissertations

Maternal alcohol use as a coping response to parenting-related stress has received growing attention in public health and psychology but remains underexplored within occupational therapy. This gap limits understanding of how daily role demands, environmental pressures, and individual vulnerabilities combine to shape drinking as a functional coping behavior. This dissertation aimed to identify and synthesize factors associated with maternal alcohol use in the context of parenting stress and interpret these determinants using the person–environment–occupation model. A scoping review was conducted following the Arksey and O’Malley framework and reported according to PRISMA-ScR guidelines. Five databases were systematically searched without date or …

Justice, Autonomy, Beneficence, And Non-Maleficence: The Global Failure To Heed Ethical Mandates In Birth Spaces, Julia Dees

Richard T. Schellhase Essay Prize in Ethics

Respectful and safe care in all birthing spaces has long been an ideal that global communities fail to meet. Birthing people are disrespected, physically or emotionally harmed, or left to completely fend for themselves during a period of extreme emotional and medical vulnerability. Historically, autonomy especially has been ignored in birthing spaces with medical trends like the twilight sleep, where women were drugged into a state of unconsciousness during birth (Taylor, 2023), demonstrating the desire of western medicine, in particular, to reduce birthing people to bystanders in their own birth. While birth trends and medical treatments have changed throughout time, …

A Comparative Analysis Of Group Care: Trust, Professional Identity, And Health System Structure In The United Kingdom And The Netherlands, Samantha J. Kohlmann

Senior Theses

Group prenatal care (Group Care) has been associated with improved maternal experiences and select clinical outcomes, yet less is understood about how it functions within high-resource health systems and what mechanisms underlie its impact. This study examines how Group Care is implemented in the United Kingdom and the Netherlands, with particular attention to professional roles, relational dynamics, and health system context.

I employed a qualitative, comparative design and conducted four semi-structured interviews with midwife researchers involved in Group Care implementation in both countries. Data were analyzed thematically, with attention to cross-context similarities and differences.

Findings indicate that Group Care operates …

Co-Designing An Adolescent Perinatal Mental Health Intervention In Kenya And Mozambique: The Inspire Project, Tatiana Salisbury, Fernando Chissale, Margrette Hanselmann, Evaline Langat, Sarah Kinja, Violet Naanyu, Mark Nyalumbe, Mellan Lilumbi, Lucy Nyaga, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background Interventions to support adolescent perinatal mental health are limited and largely developed for delivery in high-income countries. This study aimed to co-design an intervention to improve mental health outcomes among pregnant and post-partum adolescent girls in Mozambique and Kenya.

Methods 159 adolescent girls (aged 15–19 years) and young women (aged 20–24 years) with experience of a pregnancy during adolescence, their partners and family members, service providers and community influencers were recruited in Kilifi County, Kenya and Moatize District, Mozambique. Those who consented took part in individual interviews, focus group discussions, observations, and workshops to identify key priorities for supporting …

Maternal Infection At Delivery And Risk Of Stillbirth And Early Neonatal Death: Nested Case-Control Studies In East African Pregnancy Cohorts, Anna Seale, Meron Kebede, Rosanna Glazik, Mussie Brhane, Mulu Berihun, Zelalem Teklemariam, Dadi Marami, Joseph Oundo, Tadesse Gure, Angela Koech

Centre of Excellence in Women and Child Health

Background Stillbirths and early neonatal deaths remain common in low- and middle-income countries. Maternal infections are likely contributors, but data are extremely limited. We aimed to describe maternal infections at delivery and their association with perinatal death.

Methods We investigated maternal infections at delivery in two hospitals in East Africa: in Kilifi County Hospital (2011–2017), Kenya, and Hiwot Fana Comprehensive Specialised Hospital (2019–2020), Ethiopia. We compared 642 mothers delivering stillbirths/newborns dying in the first 24 h after birth (cases) and 855 mothers with newborns surviving ≥ 24 h (controls) from pregnancy cohorts. We tested maternal blood with molecular diagnostic panels …

Knowledgable Births: Advancing Informed Consent In Maternal Healthcare, Ella A. Forrester

Senior Theses

Background:

Informed consent is both a legal requirement and an ethical cornerstone of healthcare, ensuring that patients understand and voluntarily agree to medical treatments. However, evidence suggests that the informed consent process is often inadequately implemented in maternal healthcare settings, particularly during childbirth. While giving birth, women retain full decision-making capacity but are not consistently provided with sufficient information or support to exercise this right. Contributing factors include ineffective patient–provider communication, limited health literacy, and insufficient access to culturally responsive educational resources.

Methods:

This study aimed to address gaps in accessible prenatal education by developing an online resource platform, Know …

Beyond Parallel Programmes: A Roadmap For Operational Integration Of Family Planning And Nutrition In Low- And Middle-Income Countries, Marleen Temmerman, Samuel Ojong

Centre of Excellence in Women and Child Health

No abstract provided.

Beyond Parallel Programmes: A Roadmap For Operational Integration Of Family Planning And Nutrition In Low- And Middle-Income Countries, Marleen Temmerman, Samuel Ojong

Centre of Excellence in Women and Child Health

No abstract provided.

Daily Outdoor Pm2.5 Exposure Characterization And Road Edge Effect During A 2022 - 2023 Monitoring Campaign In Gambia, Kenya And Mozambique, Terence Mushore, Handsome Nyoni, Laura Munthali, Sibusisiwe Makhanya, Laurine Chikoko, Anotida Chapunza, Stanley Luchters, Matthew Chersich, Marleen Temmerman, Angela Koech

Centre of Excellence in Women and Child Health

Air pollution is a major contributor to mortality and adverse health outcomes, particularly in pregnant women and children, with vehicular emissions as a key source. This study aimed to characterize long-term exposure to fine particulate matter (PM2.5), evaluate potential health risks, and quantify the contribution of road transport and proximity to roads in The Gambia, Kenya, and Mozambique. Multi-temporal personal exposure data were interpolated into continuous spatial surfaces and aggregated into daily averages, which were then compared with World Health Organization (WHO) guidelines to assess potential health impacts. Multi-distance buffers at 10 m intervals up to 1000m from major roads …

Prevalence And Determinant Factors Of Depression Among Pregnant Women In Poned Health Center In Tangerang City Area, Dian Geumala Hayati, Sudijanto Kamso, Popy Yuniar, Yuli Puspita Devi

Jurnal Epidemiologi Kesehatan Indonesia

According to World Health Organization (WHO), approximately 10% of pregnant women experience mental disorders, with depression being particularly prevalent. In developing countries, this rate is was even higher, reaching 19.8% after childbirth and 15.6% during pregnancy. Various studies conducted in Indonesia show that the prevalence of depression among pregnant women ranges widely, from 21.4% to 26.2%.This study aimed to determine the prevalence and risk factors associated with depression during pregnancy in pregnant women at the PONED Community Health Center in Tangerang City Area. A facility-based cross-sectional study was conducted with 105 pregnant women attending antenatal check-ups at the 17 PONED …

Maternal Respiratory Syncytial Virus Vaccination And Preterm Birth A Utah Statewide Retrospective Cohort Study, Amy Solsman, Torri Metz, Josh Benton, Shana Godfred-Cato

Knowledge and Creativity Expo

We conducted a statewide, retrospective cohort study to evaluate the association between maternal receipt of the respiratory syncytial virus (RSV) vaccine and preterm birth. All individuals who delivered a singleton neonate in Utah and were between 32 0/7 and 36 6/7 weeks of gestation from September 2023 to February 2024 were included and followed up until delivery. Overall, 2,733 of 24,213 individuals (11.3%) received the vaccine. Vaccine receipt was associated with lower odds of preterm birth (5.5% vaccinated group vs 6.8% unvaccinated group, adjusted odds ratio 0.80, 95% CI, 0.67–0.95). Receipt of the RSV vaccine was not associated with any …

Conjoined Twins And Abortion Restrictions: Navigating 'Ban State' Challenges, A Case Report, Beau Morgan Nrp

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

This case report highlights an unusual scenario of a conjoined twin pregnancy resulting from intrauterine insemination in a state with restrictive abortion laws. Despite a diagnosis deemed not compatible with life, the patient faced legal barriers preventing termination within their home state. Forced to seek care out-of-state, the patient underwent a successful termination at ten weeks and three days after lengthy and expensive travel. This case stresses the complex challenges posed by restrictive abortion laws, impacting patient access to essential medical interventions. The case demonstrates the critical intersections between medical care, medical ethics, legal constraints, and patient outcomes in managing …

A Physician Survey On Research And Implementation Priorities For Caffeine Citrate Use In Newborn Care In Sub-Saharan Africa, Olufunke Bolaji, Osayame Ekhaguere, Franck Houndjahoue, Nicholas Embleton, Helen Nabwera

Centre of Excellence in Women and Child Health

Background:Evidence on caffeine citrate (CC) for apnoeaof prematurity (AOP) originate from high-income countries. This study aimed to develop consensus on research design for evidence in sub-Saharan Africa (SSA).

Methods:We surveyed physicians in newborn units across SSA to assess their opinions on CC research and their preferred study designs.

Participants rated four study designs:a) an observational before-and-after study; a randomized controlled trial (RCT) of b) caffeine versus placebo; c) caffeine versus aminophylline; d) a traditional or stepped wedge cluster trial.  They  assessed  each  design  using  a  Likert  scale  for  evidence, feasibility, and ethics considerations.

Results:Ninety-two   newborn   physicians …

Bridging Ipv And Sud For Pregnant And Postpartum Women: A Case Report Of Interdisciplinary Programming In Mississippi, Catherine Poehling, Masoumeh Karimi, Chinedu Chukwu, Jerome R. Kolbo, Xiaoshan Gordy, Saijun Zhang, Matthew Morris, Andrew Voluse, Erin Dehon, Michelle Brassfield, Danielle Lahn, Lisa Slade, Deanna Howington, Kathleen Rhodes, Tearsanee Davis, Sonja Fuqua, Mary M. Wesley, Lei Zhang

Journal of Public Health in the Deep South

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) adolescents in the U.S. South experience disproportionately high rates of bullying, discrimination, depression, and suicidality. Supportive and inclusive school climates are identified as key protective factors that can mitigate these risks and function as primary prevention against violence. This systematic narrative review synthesizes peer-reviewed research and high-quality survey reports published between 2015 and 2024 that assess school climate, mental health, and violence-related outcomes among LGBTQ+ youth with representation from Southern states, including Mississippi, Alabama, and Louisiana. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 1,167 records …

Racial Disparities Among Pregnant Women Of Color And Their High Risk For Developing Periodontal Disease, Darrylnn Mayo

Pacific Journal of Health

This qualitative study explored the oral health experiences of four women of color during their pregnancies. Data was collected through interviews and presented as case studies. Although existing literature indicated that pregnant women of color are at a higher risk for developing periodontal disease, the participants in this case study reported actively engaging with their dental care providers, daily intake of prenatal vitamins with practice of self-oral care, and compliance with oral hygiene instructions. Further studies should investigate larger sample populations with broader minority ethnic groups to help explore the determinants of racial disparities and strategize ways to reduce barriers …

A Qualitative Analysis Of Progress, Successes, And Challenges Among Indiana Recipients As Part Of A National Initiative To Reduce Covid-19–Related Health Disparities, Marla Winters, Lily Darbishire

Purdue Journal of Service-Learning and International Engagement

In light of the COVID-19 pandemic, the Centers for Disease Control and Prevention (CDC) provided funding to states as part of the CDC Disparities Grant initiative. The aim of the funding was to reduce chronic disease and COVID-19–related health disparities among vulnerable communities through four unique strategies. Funding was awarded to the Indiana Department of Health (IDOH) to begin an Indiana chapter of this initiative, called Indiana Healthy Opportunities for People Everywhere (I-HOPE). From 2021 to 2023, the IDOH provided I-HOPE funding to local communities (subgrantees) to support the design and implementation of programs to improve community health. For example, …

Early Neonatal Admissions With Feeding Difficulties To Acute Paediatric Services At A Tertiary Paediatric Hospital In England: Sequential Audits Pre-Covid-19 And During The Covid-19 Pandemic, Kalvin Lee, Thomas Frederick Dunne, Mary Masoud, Hayley Gleig, Heidi Stott, Helen Nabwera, Halina Kamarova

Centre of Excellence in Women and Child Health

Introduction: Our objective was to describe the population of infants < 7 days of age admitted to the acute general paediatric services at Alder Hey Children’s Hospital and ascertain the proportion with feeding difficulties amenable to community-based support.

Methods: Sequential retrospective audits of all infants < 7 days of age admitted to acute paediatrics at Alder Hey Children’s Hospital, Liverpool, England, from March to September 2019 (pre-COVID-19) and March to September 2020 (during COVID-19). All the infants were born and discharged from maternity units in Merseyside, Northwest England. Anonymised data were extracted from the electronic clinical records by three members of the clinical team.

Results: Pre-COVID-19, 38.6% (93) of the 241 admissions to acute general paediatric services had feeding difficulties. 31.2% (29) presented solely with feeding difficulties and 31.2% (29) were exclusively breastfed. However, during COVID-19, although there were fewer admissions (104), more than half (51%, 54) had feeding difficulties and for 54% (29), this was the only reason for admission. Over half (53.7%, 29) were exclusively breastfed.

Conclusion: Our audits showed that at least a third of infants < 7 days of age admitted with feeding difficulties did not have any other features of severe illness. These admissions unnecessarily expose infants to hospital-acquired infections while disrupting the opportunity for families to build close and loving relationships that enhance the establishment of breastfeeding. Co-designing infant feeding strategies with the mothers and stakeholders will be a crucial next step to enhance infant feeding support, particularly in impoverished communities in the region.

“Now That The Baby Is Out, I Can Be Vaccinated”: A Qualitative Study On Covid-19 Vaccine Hesitancy In Pregnant Women In Kilifi, Kenya, Angela Koech, Onesmus Wanje, Grace Mwashigadi, Geoffrey Katana, Richmond Mdindi, Peter Mwangome, Rachel Craik, Marianne Vidler, Mai-Lei Kinshella, Marleen Temmerman

Centre of Excellence in Women and Child Health

COVID-19 vaccines are safe and effective in pregnancy, but vaccine hesitancy limits uptake and effectiveness. This study explored COVID-19 vaccine hesitancy in pregnancy in Kilifi, coastal Kenya, to elicit reasons for vaccine hesitancy and acceptance, and to compile misconceptions around vaccination in pregnancy. Twenty-three in-depth interviews were conducted with pregnant women, mothers who had given birth in the previous 2 years and health workers (community health promoters, nurses, and supervisors). Data were analyzed using thematic template analysis based on the Vaccine Hesitancy Determinants Matrix. Concern about vaccine safety for the unborn baby was a major driver of hesitancy. Many pregnant …

Qualitative Exploration Of Factors Associated With Covid-19 Vaccination Among Pregnant Women In Kenya, Violet Naanyu, Ferdinand Okwaro, Ingrid Gichere, Mandeep Sura, Prachi Singh, Berhaun Fesshaye, Marleen Temmerman

Centre of Excellence in Women and Child Health

The COVID-19 pandemic significantly disrupted societies worldwide, and COVID-19 vaccination has been identified as instrumental in the fight against the pandemic. While studies have examined uptake of COVID-19 vaccination, more research is needed to gain a better understanding of the factors influencing pregnant women’s decisions to get vaccinated. In this study, we used a cross-sectional descriptive qualitative study to explore the attitudes, beliefs, and behaviors related to COVID-19 vaccination during pregnancy in Kenya. A total of 50 in-depth interviews were conducted between October 2023 to March 2024 with a purposively drawn sample of 25 pregnant and 25 postpartum women during …

Advancing Screening For Intimate Partner Violence In Pregnant Individuals Throughout The Perinatal Period To Prevent Adverse Pregnancy And Maternal Outcomes, Emilia R. Valdez

Nursing | Senior Theses

Background: Intimate Partner Violence experienced by pregnant individuals contributes to adverse pregnancy outcomes and maternal health. A mother’s exposure to Intimate Partner Violence (IPV) can affect their ability to carry a healthy pregnancy to term (38 – 40 weeks gestational age) and places them at risk for comorbidities including; Preterm birth, Intrauterine Growth Restriction, Low Birth Weight/ Small for Gestational Age, Premature Rupture of Membranes and Miscarriage. The incidence of IPV screening is not accessible to all pregnant individuals due to healthcare providers lack of education, time constraints in the workplace, bias and discomfort towards IPV. The implementation of IPV …

Location Of Births By Health Facility Type: A Time Trend Analysis From 1995 To 2023 In 130 Low- And Middle-Income Countries, Anna Gage, Madeleine Conrad, Chiara Sumich, Wes Warriner, Aduragbemi Banke-Thomas, Corinne Bintz, Kelly Bienhoff, Jessica Bishai, Abdu Mohiddin, Marleen Temmerman

Centre of Excellence in Women and Child Health

Background: With major increases in facility births in low- and middle-income countries (LMICs) since 1995, a key question is what types of facilities met the increased demand. Understanding the evolving delivery landscape is crucial to informing debates about optimal models for balancing access, quality, and equity. We studied the distribution of delivery location by health facility level and sector (private versus public) in 130 LMICs from 1995 to 2023.

Methods: We used 745 data sources with delivery location information in our analysis. We first categorised births as in-facility or not, then further classified facility births by level (hospital …

"It's A Dance": Examining Midwives As Choreographers Of Reproduction In Maine, Annie Goldstein

Honors Theses

This thesis examines the contemporary work of community-based Maine midwives through the theoretical framework of choreography. In the context of this work, choreography can be understood as the well-thought-out, purposeful undertaking of a process during which negotiation, coordination, and improvisation are required to adapt to constantly changing circumstances. Using choreography, this thesis attempts to understand how Maine midwives navigate global market processes and practice under authoritative forms of biomedicine, ultimately linking them to other midwives across various global sites. Situated within Maine’s maternal health landscape that is characterized by the ongoing closure of labor and delivery units and rural hospitals, …

From Coverage To Care: Evaluating The Effects Of Aca Medicaid Expansion On Birth Outcomes, Bailey R. Lengfelder

Economics Honors Projects

I examine the impact of the Affordable Care Act’s Medicaid expansion on maternal and fetal health outcomes using National Center for Health Statistics Natality data from 2006 to 2023. I exploit staggered state adoption as a quasi-experiment, and the staggered differences-in-differences estimates indicate an increase in the share of Medicaid births but broadly no impact on maternal prenatal care, maternal health, and fetal health. The absence of statistically significant effects is consistent across heterogeneity groups. These null findings indicate that expanded insurance access through the Affordable Care Act may be insufficient to improve health outcomes. I do find a statistically …

Creating An Abortion Safe Harbor Using The Doctrine Of Double Effect, Evelyn M. Tenenbaum

American University Journal of Gender, Social Policy & the Law

[INTRODUCTION] In the three years since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization (Dobbs) holding that women no longer have a constitutional right to an abortion, many family physicians, obstetricians, and gynecologists have refrained from—or delayed—providing abortion services to pregnant women, even when that restraint created a substantial risk of causing serious injury or death. This reluctance to provide care is labeled physician hesitancy, which is defined as physicians acting in their own professional or personal interest to deny or delay care that would otherwise be provided under the prevailing standard of care.

It …

Civil Rights In Theory, Health Disparities In Practice: Affordable Care Act Section 1557 And The Maternal Mortality Crisis, Grace Hall

American University Journal of Gender, Social Policy & the Law

[INTRODUCTION] On a hot Fourth of July in 2021, Harmony Ball-Stribling spent her final day laughing with her husband, hours before preeclampsia killed her. Harmony was eight months pregnant and living in Belzoni, Mississippi, where she celebrated the holiday with her church congregation. Her congregation prayed over her and her baby for a safe delivery, as she was scheduled to have a cesarean section in five days.

Later that evening, Harmony woke in agony, vomited, and complained of chest pain to her husband, Mr. Stribling. Harmony’s husband put his wifein their car and began the more than thirty-mile drive to …

Improving Maternal Health: Investigating The Early Impacts Of Medicaid Coverage Of Doulas In Oregon, Miriam Akhmetshin

Scripps Senior Theses

While the U.S. spends more per-capita than any country on healthcare, we experience the worst maternal health outcomes of high-income nations. In addition to hefty healthcare bills, an overwhelming majority of mothers experience pregnancy-related health issues that decrease productivity and utility. Thus, it is critical to research cost-effective solutions that can improve maternal health and promote equitable outcomes. Doulas are trained non-medical professionals who support mothers and families before, during and after birth. As a growing body of medical literature points to the role of doulas in decreasing costly medical interventions, insurance companies have begun covering their services. In 2014, …