Maternal and Child Health Commons^™

Female Genital Cutting In Somaliland: Baseline Assessment, Katy Newell-Jones

Reproductive Health

This report summarizes research findings into the prevalence and attitudes around female genital cutting (FGC) in 20 communities across five regions of Somaliland. There was a specific focus on young people, who accounted for 47 percent of the interviewees, and also on the role of schools in promoting abandonment of cutting. This research found that the prevalence of FGC in the five regions studied is 98.9 percent across all age groups in city, semi-city, and village communities. The findings indicate that decisionmaking in relation to FGC has less to do with having accurate knowledge, and more to do with the …

Female Genital Mutilation/Cutting In Kenya: Is Change Taking Place? Descriptive Statistics From Four Waves Of Demographic And Health Surveys, Bettina Shell-Duncan, David Gathara, Zhuzhi Moore

Reproductive Health

Nationally representative survey data on female genital mutilation/cutting (FGM/C) in Kenya are available from four waves of Demographic and Health Surveys. These survey data provide a rich and detailed picture of when, where, and how FGM/C has been carried out, and trends in changes in the practice. National prevalence data from successive waves of surveys show a steady decrease in the prevalence of FGM/C among women aged 15–49. While the data reported here are descriptive, they provide useful insights on the progress of FGM/C abandonment at national and subnational levels. These findings are useful for policymakers in steering discussions on …

Female Genital Mutilation/Cutting In Nigeria: A Scoping Review, Blessing U. Mberu

Reproductive Health

This report’s overarching objective is the examination of key trends in the evidence base of female genital mutilation and cutting (FGM/C) and gaps in knowledge for Nigeria, building on a scoping review of peer-reviewed and "grey" literature along with quantitative analysis of relevant data. What is clear from prevalence levels identified over the last 15 years is how widespread different types of FGM/C are, in Nigeria’s different ethno-geographical zones, and the little change that has taken place over time, despite increased international, and renewed national, political commitment to eradicate the practice. The findings show that much work remains to be …

Florence: A Midwife Success Story, Amy Dempsey

Reproductive Health

Ebonyi State is one of three states in Nigeria where the Ending Eclampsia project provides trainings, mentoring, and supportive supervision focused specifically on pre-eclampsia/eclampsia (PE/E) detection, prevention, and treatment measures. This brief reports on the success of one nurse/midwife who attended an Ending Eclampsia–led training on proper detection of pre-eclampsia, administration of the magnesium sulphate for severe cases, and referral of PE/E patients to secondary facilities for management. When there are gaps in providers’ skill sets, partners like Ending Eclampsia, UNICEF, and UNFPA help to bring them up to standard by providing supportive supervision and on-the-job trainings that span a …

Knowledge And Practices For Pre-Eclampsia And Eclampsia Care In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

The Bangladesh Maternal Mortality Survey revealed that pre-eclampsia and eclampsia (PE/E) is the second most common direct cause of maternal deaths—between 1,000 and 1,200 maternal deaths (20 percent) each year. Early detection and treatment during antenatal care visits are instrumental in reducing deaths from PE/E. In Bangladesh, however, primary healthcare providers have limited knowledge of the condition, and in many cases are unaware of how to detect, manage, and treat it. This research brief presents the findings of a landscape analysis that was conducted to better understand service providers’ maternal health knowledge, attitudes, and practices, particularly around PE/E.

Increasing Access To Reproductive Health Care Through Improved Service Delivery, Gul Rashida, Iram Kamran, Muhammad Khalil, Zeba Tasneem, Rehan M. Niazi, Mumraiz Khan, Tahira Parveen

Reproductive Health

The study documented in this report examines the provision and utilization of public and private sector maternal and child health services in Punjab, Pakistan with a focus on family planning (FP) services. It is aimed at enabling a better understanding of the specific demand and supply dynamics leading to low contraceptive prevalence despite unmet need, and the opportunities that must be seized to enhance access to quality family planning services. The report is part of a larger project being implemented by the Population Council with the assistance of the Department for International Development, UK entitled “Sustaining Focus on Provincial Governments …

Knowledge Of Pre-Eclampsia And Eclampsia In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

In Bangladesh between 1,000 and 1,200 women die every year from pre-eclampsia and eclampsia (PE/E), contributing to 20 percent of maternal deaths. It is the country’s second leading direct cause of maternal mortality. In addition to the burden of maternal mortality, when a mother dies her baby is at increased risk of dying during the first year of life. To fully understand community perceptions of PE/E, the Population Council conducted a landscape analysis in 12 upazilas in four districts. This brief presents those research findings, and concludes that stronger awareness of the importance of early antenatal care and of seeking …

Landscape Analysis: Preventing And Managing Pre-Eclampsia And Eclampsia In Pakistan, Population Council

Reproductive Health

The Ending Eclampsia project conducted a landscape analysis to identify policy and program activities, as well as gaps and challenges around the prevention and treatment of PE/E and use of magnesium sulphate at the provincial and district levels in Pakistan. The analysis assessed the practices for PE/E prevention and treatment, prevalence of PE/E, associated complications, and contribution to maternal mortality and morbidity. This landscape analysis was a major study and one of the first of its kind in the country, blending multiple perspectives on provision of care through the public health system for pregnant women facing, or at risk of, …

Life-Saving Medicines And Equipment In Facilities In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

This research brief is a part of a larger landscaping analysis by Population Council, with support from USAID and the MacArthur Foundation. In Bangladesh, in 12 upazilas in four districts, it assessed the capacity of primary health facilities to manage pre-eclampsia and eclampsia (PE/E). This brief shares findings from 134 facilities on required infrastructure for providing maternal and newborn health (MNH) services, human resources, facility readiness, and MNH commodities and supplies. Facility readiness is vital to providing quality services to antenatal care (ANC) patients, especially to women with PE/E. Without functioning equipment, ANC/PNC registers, essential medicines, electricity, and running water, …

Modeling And Mapping Of Girls' Female Genital Mutilation/Cutting (Fgm/C) In The Context Of Economic, Social, And Regional Disparities: Kenya Demographic And Health Surveys 1998-2014, Ngianga-Bakwin Kandala, Damaris Kinyoki, Ahmed Sarki, David Gathara, Paul Komba, Bettina Shell-Duncan

Reproductive Health

The aim of this research study is analysis of successive household data for estimating and revealing trends, similarities, and differences in geographic patterns for the burden of female genital mutilation/cutting (FGM/C) and related risk factors among girls ages 14 and younger in Kenya. This Evidence to End FGM/C study, from a coalition led by the Population Council, is intended to contribute to a deeper understanding of the recent burden of FGM/C among the girls within this very young age group, and to enhance knowledge of the geographic distribution of this practice over time. The report will inform current elimination efforts …

Policies For Pre-Eclampsia And Eclampsia Prevention And Management In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

Bangladesh experiences between 5,000 and 6,000 maternal deaths each year. Of those deaths, 20 percent are from pre-eclampsia and eclampsia (PE/E), the second most common direct cause of maternal mortality in the country. In Bangladesh, best practices to prevent PE/E using aspirin and calcium and managing it through task sharing and use of magnesium sulphate and anti-hypertensive drugs have not been optimally examined. To appreciate the enormity of the problem, the Population Council conducted a landscape analysis in 12 upazilas in four districts. The study was cross sectional, and data collection activities included in-depth interviews (IDIs) with policymakers, development partners, …

Rapid Evidence Assessment: Quality Of Studies Assessing Interventions To Support Fgm/C Abandonment, Tammary Esho, Jamlick Karumbi, Carolyne Njue

Reproductive Health

The last decade has seen increased focus and investment in interventions to eliminate female genital mutilation/cutting (FGM/C), along with the need to accelerate its abandonment. The UK Department for International Development (DFID) commissioned the Evidence to End FGM/C: Research to Help Girls and Women Thrive project to: 1) assess the quality of studies that have evaluated different interventions for the prevention of FGM/C, and 2) describe the FGM/C interventions that were evaluated by high-quality studies. The quality of evidence on the effectiveness and impact of FGM/C interventions is generally moderate to low. In addition, few baseline surveys are conducted prior …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Ebonyi, Population Council

Reproductive Health

As a partner on the Fistula Care Plus (FC+) project, the Population Council is conducting implementation research that tests solutions to treatment barriers. Formative research in Nigeria’s Ebonyi State found that a lack of knowledge among lower-level providers and women and families of how the condition occurs, where treatment is available, and the signs and symptoms of obstetric fistula, as well as transportation costs, affect women’s access to screening and repair. Baseline data reveal the necessity of a comprehensive intervention to address fistula treatment barriers in Ebonyi. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Katsina, Population Council

Reproductive Health

As a partner on the Fistula Care Plus (FC+) project, the Population Council is conducting implementation research that tests solutions to treatment barriers. Formative research in Nigeria’s Katsina State found that a lack of knowledge among lower-level providers and women and families of how the condition occurs, where treatment is available, and the signs and symptoms of obstetric fistula, as well as transportation costs, affect women’s access to screening and repair. Baseline data reveal the necessity of a comprehensive intervention to address fistula treatment barriers in Katsina. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Uganda, Population Council

Reproductive Health

As a partner on the Fistula Care Plus (FC+) project, the Population Council is conducting implementation research that tests solutions to treatment barriers. Formative research in Uganda found that a lack of knowledge among lower-level providers and women and families of how the condition occurs, where treatment is available, and the signs and symptoms of obstetric fistula, as well as transportation costs, affect women’s access to screening and repair. Baseline data reveal the necessity of a comprehensive intervention to address fistula treatment barriers in Uganda. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and counseling, but …

Results From Systematic Literature Review On Pe/E In Bangladesh, Karen Kirk, Amy Dempsey

Reproductive Health

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal death from 550 per 100,000 live births in 1990, to 170 maternal deaths per 100,000 live births in 2015. Despite this progress, there are still between 5,000 and 6,000 maternal deaths every year in Bangladesh, where 20 percent are the result of pre-eclampsia and eclampsia (PE/E). This systematic review of peer-reviewed literature published between January 2000 and July 2016 identified interventions adopted to manage PE/E throughout Bangladesh. Specifically, it looked at issues around quality of care, gaps in the evidence, and barriers to …

Results From Systematic Literature Review On Pe/E In Nigeria, Amy Dempsey, Karen Kirk

Reproductive Health

Pre-eclampsia and eclampsia (PE/E), hypertensive disorders of pregnancy, are consistently cited as a leading cause of maternal and newborn morbidity and mortality in Nigeria. A recent, nationwide cross-sectional survey found that PE/E contributes to 28.2 percent of national maternal deaths. The other main contributors to maternal mortality are hemorrhage and pregnancy-related infection or sepsis. To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E, the Ending Eclampsia project conducted a systematic review of papers on PE/E in Nigeria published between 2000–15. The methods, results, and recommendations are discussed in this brief.

Transition Into Adult Care: Factors Associated With Level Of Preparedness Among Adolescents Living With Hiv In Cambodia, Siyan Yi, Chanrith Ngin, Khuondyla Pal, Vohith Khol, Sovannary Tuot, Sokunmealiny Sau, Penhsun Ly

Background: Preparing adolescents for transition into adult care and supporting their acquisition of self-health care management skills is a critical determinant of their post-transition HIV care outcomes. However, there is a scarcity of research on effective transition strategies. This study explores factors associated with adolescent preparedness for transition into adult care in Cambodia.

Methods: In August 2016, a cross-sectional study was conducted among 223 adolescents living with HIV aged 15–17, randomly selected from 11 antiretroviral therapy clinics, utilizing a structured questionnaire. The level of preparedness was determined using a pre-existing scale, and adolescents were categorized as having a …

Midwives’ And Patients’ Perspectives On Disrespect And Abuse During Labor And Delivery Care In Ethiopia: A Qualitative Study, Sahai Burrowes, Sarah Jane Holcombe, Dube Jara, Danielle Carter, Katheryn Smith

Background: It is increasingly recognized that disrespect and abuse of women during labor and delivery is a violation of a woman’s rights and a deterrent to the use of life-saving, facility-based labor and delivery services. In Ethiopia, rates of skilled birth attendance are still only 28% despite a recent dramatic national scale up in the numbers of trained providers and facilities. Concerns have been raised that women's perceptions of poor quality of care and fear of mistreatment might contribute to this low utilization. This study examines the experiences of disrespect and abuse in maternal care from the perspectives of …

A Systematic Review: The Prenatal And Postnatal Events Associated With Infant Mortality Rate (Imr), Ariel L. Thomas, Sarah A. Awwad, Briana E. Clark

Williams Honors College, Honors Research Projects

Infant mortality rate (IMR) is an indication of overall population health, maternal and child health, accessibility and quality of primary health care, and the availability of community resources. The current IMR in the United States is high despite advances made in the medical field. The purpose of our systematic review is to describe and critically appraise research about prenatal events, postnatal events, and increased infant mortality rate and to give nursing practice recommendations to help decrease the rate. We used CINAHL, Medline and PubMed to find 20 research articles. Overall, the research stated that going to prenatal visits had a …