Women Of Low Socioeconomic Status Research Articles

Socioecological factors influencing the risk of developing hypertensive disorders of pregnancy in India: a rapid review

BackgroundThe prevalence of hypertensive disorders of pregnancy (HDPs) in India is 11%, which is one of the highest rates globally. Existing research on HDPs in India primarily focuses on biological risk factors, with minimal research on how socioecological factors combine to increase risk of HDPs. We conducted a rapid review using Bronfenbrenner’s Ecological Model to understand the social and cultural factors associated with HDPs among Indian pregnant women to identify possible intervention targets that may uniquely improve health in this population. Bronfenbrenner’s Ecological Model is a framework that can be used to understand the complex relationship between multiple influences on health.MethodsWe reviewed studies published between January 2010 and January 2024 using PubMed, Science Direct, and Scopus databases. Search terms included variants of hypertension, pregnancy, and India. Inclusion criteria were: (1) peer-reviewed journal article; (2) published between January 2010 to January 2024; (3) participants consisted of Indian women living in India; (4) studies evaluated socioecological risk factors associated with HDPs. One independent reviewer performed searches, screening, data extraction, and quality assessment. Each included study was then organized within Bronfenbrenner’s Ecological Model.ResultsA total of 921 studies were generated from the initial search, with 157 exclusions due to duplicates. Following screening for inclusion and exclusion criteria at the title/abstract and full text levels, 17 studies remained in the final review. Socioecological risk factors of HDPs were identified at each level, with the most commonly identified influences including: low socioeconomic status (SES), lacking community education and knowledge on HDP management and prevention, and lacking prenatal HDP screening.ConclusionThis study determined that the high risk for HDPs in India is influenced by many intertwined socioecological factors. Women in rural and low SES areas need more health education on HDP management and prevention. There also needs to be more adequate prenatal HDP screening, with at least 4 and ideally 8 prenatal visits. Prenatal screenings should be accompanied with culturally appropriate patient education, especially for low SES women who have limited literacy, so that they can effectively make individual and microsystemic lifestyle decisions aimed at either managing or preventing HDPs.

College Women’s Establishing of Peer Social-relationships and Communicating about Pandemic-related Political Identities and Topics

This mixed-methods study examines two research areas concerning whether U.S. women college students, compared with men, enrolled in online classes during the pandemic suffered from stress regarding their ability to socialize and negotiate a community/national political issue(s) affecting them negatively academically in terms of their grade point average and course outcomes, as well as whether the women would experience a sense of belonging and camaraderie with classmates by discussing topics impacting their identities and circumstances in terms of their individual and communal, social-relational, health, and financial pandemic contexts, which might also influence them negatively academically as stressors linked to their course outcomes and progress. Conducted in a rural, geographically marginalized area, the study implements survey and short-answer question instruments and utilizes an exploratory case-study design and a convergent-parallel strategy assessing 188 women and 188 men participants, including racial/ethnic minority and low socio-economic status (SES) women, with women’s median age of 23. of women and men surveyed, the former reported statistically significantly higher stress levels than men connected to the women’s need to socialize and tackle pandemic-oriented community and national political issues affecting their lives and statuses, which subsequently influenced their academic progress. Overall, the pandemic damaged women, especially racial/ethnic minorities, more than men, with women having higher stress rates revolving around their need for socializing (59% versus 33%) and addressing political issues (54% versus 32%), stressors hampering the women’s academic outcomes and status, as well as some experiencing additional stress regarding health and financial concerns. In response to these settings, 21% of women (n = 40) desired to discuss controversial topics, such as their pandemic stressors and related experiences in the classroom, including the pandemic’s political consequences for themselves, to promote self-expression, forge bonds, and seek and provide assistance in addressing all classmates’ academic, personal, and community needs.

Prediction of delayed breastfeeding initiation among mothers having children less than 2 months of age in East Africa: application of machine learning algorithms.

Delayed breastfeeding initiation is a significant public health concern, and reducing the proportion of delayed breastfeeding initiation in East Africa is a key strategy for lowering the Child Mortality rate. However, there is limited evidence on this public health issue assessed using advanced models. Therefore, this study aimed to assess prediction of delayed initiation of breastfeeding initiation and associated factors among women with less than 2 months of a child in East Africa using the machine learning approach. A community-based, cross-sectional study was conducted using the most recent Demographic and Health Survey (DHS) dataset covering the years 2011 to 2021. Using statistical software (Python version 3.11), nine supervised machine learning algorithms were applied to a weighted sample of 31,640 women and assessed using performance measures. To pinpoint significant factors and predict delayed breastfeeding initiation in East Africa, this study also employed the most widely used outlines of Yufeng Guo's steps of supervised machine learning. The pooled prevalence of delayed breastfeeding initiation in East Africa was 31.33% with 95% CI (24.16-38.49). Delayed breastfeeding initiation was highest in Comoros and low in Burundi. Among the nine machine learning algorithms, the random forest model was fitted for this study. The association rule mining result revealed that home delivery, delivered by cesarean section, poor wealth status, poor access to media outlets, women aged between 35 and 49 years, and women who had distance problems accessing health facilities were associated with delayed breastfeeding initiation in East Africa. The prevalence of delayed breastfeeding initiation was high. The findings highlight the multifaceted nature of breastfeeding practices and the need to consider socioeconomic, healthcare, and demographic variables when addressing breastfeeding initiation timelines in the region. Policymakers and stakeholders pay attention to the significant factors and we recommend targeted interventions to improve healthcare accessibility, enhance media outreach, and support women of lower socioeconomic status. These measures can encourage timely breastfeeding initiation and address the identified factors contributing to delays across the region.

Determinants of the optimal uptake of sulfadoxine–pyrimethamine doses for intermittent treatment of malaria in pregnancy in urban Nigeria

Malaria is a leading cause of maternal and child mortality in urban Nigeria. Intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp–SP) during pregnancy can prevent malaria but uptake is suboptimal. This cross-sectional study analyzed secondary data on 1159 urban Nigerian women from the 2015 Malaria Indicator Survey using descriptive statistics and logistic regression. The primary outcome was optimal IPTp–SP uptake (≥ 3 doses). 67% of women took any SP during pregnancy but only 39% took ≥ 3 IPTp–SP doses as recommended. Region and wealth index significantly predicted optimal IPTp–SP uptake while education did not. Women from lower-income regions in the urban areas were less likely to receive optimal IPTp–SP. Strategies to increase IPTp–SP uptake in urban Nigeria should target low-income regions and women of lower socioeconomic status. Logistic regression identified actionable factors for improving antenatal malaria prevention. Optimal IPTp–SP uptake remains suboptimal across urban Nigeria, threatening maternal and child health.

Male support for cervical cancer screening in Debre Berhan City Ethiopia a community based cross sectional survey

Male partner involvement strongly influences a woman's decision to undergo cervical cancer screening. Women of low socioeconomic status are disproportionately affected by cervical cancer. Women living in low-and middle-income countries often encounter resistance from their partners regarding participation in cervical cancer screening. The lack of men's support for sexual and reproductive health programs, including cervical cancer screening, creates a barrier to women's utilization of health services. To assess Ethiopian men's awareness, knowledge, perceptions, and attitudes toward cervical cancer screening and their support to their female partners during screening. A community-based cross-sectional survey was conducted from June 20, 2023, to August 04, 2023. A multistage sampling procedure was used to recruit 614 male survey participants. Descriptive statistics were used to summarize sociodemographic data. Univariate and multivariate regression analyses were performed to measure the associations between the dependent and independent variables. A p-value of less than 0.05 was considered statistically significant. In this survey, 58.5% (359) of participants supported their partners for cervical cancer screening. More than half 55.9% (343) of the participants had an awareness of cervical cancer disease and 47.2% (290) participants knew the risk factors associated with the development of cervical cancer. In addition to that, 66.8% (410) of men have a positive attitude towards screening and encourage their wives to get screened if they notice symptoms of cervical cancer. Regarding the perceptions of cervical cancer, 37.0% (227) of male participants believed that their female partners were at risk of developing the disease, while 38.3% (235) of men believed that cervical cancer screening was only necessary if the woman showed symptoms. Completion of higher education (AOR = 3.75, 95% CI 1.60–8.79, p = 0.002), living with other people (AOR = 0.09, 95% CI 0.03–0.29, p < 0.0001), not being tested for HIV (AOR = 0.26, 95% CI 0.10–0.74, p = 0.011), and having information about cervical cancer (AOR = 3.33, 95% CI 1.36–8.15, p = 0.009) were statistically significantly associated with men’s support for their partners in cervical cancer screening. Men’s awareness, knowledge, and perceptions of cervical cancer screening were low. On the other hand, men have a positive attitude towards screening and encourage their wives to get screened if they notice symptoms of cervical cancer. This survey will serve as a basis for the development of further strategies and action plans to promote and support male participation in cervical cancer screening in Ethiopia. This can be achieved through the development of strategic plans, including public campaigns, raising awareness among social and community leaders, involving non-governmental organizations focusing on women's health, and community education.

Fruits and Vegetable Consumption and Risk of Cholecystectomy in Young Women of Low Socioeconomic Status

Fruits and Vegetable Consumption and Risk of Cholecystectomy in Young Women of Low Socioeconomic Status

Abstract PO3-09-09: Interventions to improve adherence to oral endocrine therapy for prevention or treatment of breast cancer in African American women of low socioeconomic status

Abstract Introduction: Adherence to oral endocrine therapy (OET) for the prevention and treatment of hormone receptor-positive breast cancer (BC) is important as they reduce the risk of new or recurrent BC. OET adherence is greatly compromised in women of lower socioeconomic status (SES). We have recently reported that patients belonging to the African American race, with longer time on OET, and using OET in the prevention setting are more likely to be non-adherent to OET. Therefore, our study aims to design unique patient-centered interventions and pilot test their feasibility, acceptability, and effectiveness in improving OET adherence in African American women of low SES. Patients and Methods: This prospective study includes adult, African American women on OET for either the prevention or treatment of BC at Harris Health System in Houston, Texas, serving the underserved patient population with low SES. The first intervention is a motivational interviewing (MI) based telephone intervention consisting of an initial phone call followed by five monthly follow-up calls with an MI-trained pharmacy student. The second intervention is a theatre-based educational video with a script developed by a local African American playwright, featuring African American women. Three African American BC survivors with experience in taking OET consulted with the study team to convey their BC journey and explain challenges with taking OET. They provided feedback on the script and production of the educational video. Informed consent was obtained verbally via phone in the MI intervention and electronically for the educational video intervention. Individuals in both intervention groups were compensated with Walmart eGift cards. Pre- and post-intervention adherence was measured using the proportion of days covered (PDC) over 6-12 months and compared using a paired t-test. Participants also complete a survey at the end of the interventions to determine their acceptability. The survey responses were summarized descriptively. Results: For the MI intervention initiated in 20 patients, the median age and BMI of study participants was 61 years (range: 49-71) and 30.8 (range: 22.3-57.8) respectively. All participants identified their ethnicity as non-Hispanic or Latino. The majority of participants had hypertension (n=13, 65%) and/or hyperlipidemia (n=11, 55%) with depression (n=3, 15%) and diabetes (n=8, 40%) being less common. The most common stage of BC cancer was stage I (n=9, 45%), followed by stage II (n=4, 20%), stage 0 (n=3, 15%) and then stage III (n=2, 10%) and IV (n=2, 10%). Letrozole was the most common OET (n=13, 65%), followed by tamoxifen (n=3, 15%), anastrozole (n=2, 10%) and exemestane (n=2, 10%). Most participants were not on a CDK 4/6 inhibitor (n=18, 90%). The median number of years on therapy was 2.8 (0.6-4.5). The median pre-intervention PDC for OET was 0.7 (range: 0.2-0.9). The MI intervention is expected to be complete by October 2023 for all patients. For the educational video intervention, 7 out of the anticipated 25 participants have been enrolled in the intervention. All patients were taking OET for BC treatment and not prevention. Letrozole (n=3, 43%) and anastrozole (n=3, 43%) were the most utilized OET, followed by exemestane (n=1, 14%). While 5 participants (71%) in this intervention reported not missing any OET doses in the past week, 2 patients (29%) reported missing all 7 doses within the past week. After watching the educational video, most participants (n=6, 86%) reported that they strongly agreed to take their OET regularly. The recruitment of study participants for this intervention is ongoing. Conclusion: In this study, we report that MI and educational video interventions are feasible. The interventions and analysis of their effectiveness and acceptability are ongoing. Citation Format: Camille Johnson, Ann Adigwe, Nicole Ekezie, Bilqees Fatima, Zahra Majd, Keith Houk, Tejal Patel, Rob Shimko, Onyebuchi Ononogbu, Susan Abughosh, Meghana Trivedi. Interventions to improve adherence to oral endocrine therapy for prevention or treatment of breast cancer in African American women of low socioeconomic status [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-09-09.

“You take my place; let’s switch!” What It Means to Be a Woman Powerlifter in Parasport

Gendered disability in elite sport has emerged as a pertinent area of inquiry in sport psychology. However, qualitative research aimed at amplifying the voices of marginalized subgroups is notably sparse. Employing a phenomenological approach, we examined the lived experience of a Filipina para powerlifter, probing the intersection of gender, disability, and socioeconomic status in shaping how the participant made sense of life and identity, both within and outside the realm of sport. Three personal experiential themes were generated from the interview data's interpretative phenomenological analysis: “survival of the fittest,” “the voices in my head did not allow me to give up,” and “I am deeply human with a heart.” Narrating the trials she surpassed from childhood to adulthood as an athlete/person with disability (A/PWD), she realized the environmental, socioeconomic, and cultural conditions that handicap her more than her physical impairment alone. Despite bouts with self-pity and disempowerment, the participant drew strength from internal resilience and external support systems, ultimately achieving recognition as her country's first bemedaled Paralympian. This journey fostered profound compassion for her fellow athletes/persons with disabilities. Notwithstanding the limitations of a single-participant study, this research asserts its significant contribution to the scholarly discourse on cultural sport psychology, particularly concerning women of low socioeconomic status in sport for A/PWD. Upholding that the viewpoints and agency of marginalized individuals are heard and respected confirms their position as active participants in knowledge generation within the discipline.

Evaluating the relationship between conditional cash transfer programme on preterm births: a retrospective longitudinal study using the 100 million Brazilian cohort

BackgroundPreterm births increase mortality and morbidity during childhood and later life, which is closely associated with poverty and the quality of prenatal care. Therefore, income redistribution and poverty reduction initiatives may be valuable in preventing this outcome. We assessed whether receipt of the Brazilian conditional cash transfer programme - Bolsa Familia Programme, the largest in the world - reduces the occurrence of preterm births, including their severity categories, and explored how this association differs according to prenatal care and the quality of Bolsa Familia Programme management.MethodsA retrospective cohort study was performed involving the first live singleton births to mothersenrolled in the 100 Million Brazilian Cohort from 2004 to 2015, who had at least one child before cohort enrollment. Only the first birth during the cohort period was included, but born from 2012 onward. A deterministic linkage with the Bolsa Familia Programme payroll dataset and a similarity linkage with the Brazilian Live Birth Information System were performed. The exposed group consisted of newborns to mothers who received Bolsa Familia from conception to delivery. Our outcomes were infants born with a gestational age < 37 weeks: (i) all preterm births, (ii) moderate-to-late (32–36), (iii) severe (28–31), and (iv) extreme (< 28) preterm births compared to at-term newborns. We combined propensity score-based methods and weighted logistic regressions to compare newborns to mothers who did and did not receive Bolsa Familia, controlling for socioeconomic conditions. We also estimated these effects separately, according to the adequacy of prenatal care and the index of quality of Bolsa Familia Programme management.Results1,031,053 infants were analyzed; 65.9% of the mothers were beneficiaries. Bolsa Familia Programme was not associated with all sets of preterm births, moderate-to-late, and severe preterm births, but was associated with a reduction in extreme preterm births (weighted OR: 0.69; 95%CI: 0.63–0.76). This reduction can also be observed among mothers receiving adequate prenatal care (weighted OR: 0.66; 95%CI: 0.59–0.74) and living in better Bolsa Familia management municipalities (weighted OR: 0.56; 95%CI: 0.43–0.74).ConclusionsAn income transfer programme for pregnant women of low-socioeconomic status, conditional to attending prenatal care appointments, has been associated with a reduction in extremely preterm births. These programmes could be essential in achieving Sustainable Development Goals.

Association of Depressive and Anxiety Symptoms With Risk of Cardiovascular Disease in Middle-Aged and Older Chinese Women.

The objective of this study was to estimate the association of depressive and anxiety symptoms with the risk of cardiovascular disease (CVD) in middle-aged and older Chinese women and to further evaluate whether the association was influenced by sociodemographic factors. This cross-sectional study included 9544 women aged 40 to 70 years from the eastern, central, and western regions of China in 2018. Logistic regression models were utilized to examine odds ratios (ORs) and their 95% confidence intervals (CIs) for depressive and anxiety symptoms with CVD risk. Depressive (OR = 1.89) and anxiety symptoms (OR = 1.55) were independently associated with an increased risk of CVD after adjusting for potential confounders. Stratified analyses found that depressive symptoms were only significantly associated with higher risk of CVD in women aged over 50 years and with lower levels of education and household income, whereas anxiety symptoms were only significantly associated with an elevated risk of CVD in women aged 60 to 70 years, and living in rural areas, and with lower levels of education and household income. Our findings emphasize the improvement of recognizing and managing depressive and anxiety symptoms to reduce the risk of CVD in middle-aged and older women, particularly in older women of low socioeconomic status.

Personal Care Products, Socioeconomic Status, and Endocrine-Disrupting Chemical Mixtures in Black Women.

Personal care products (PCPs) are sources of exposure to endocrine-disrupting chemicals (EDCs) among women, and socioeconomic status (SES) may influence these exposures. Black women have inequitable exposure to EDCs from PCP use, but no study has investigated how exposure to EDCs through PCPs may vary by SES, independent of race. Using data from the Study of Environment, Lifestyle, and Fibroids, a cohort of reproductive-aged Black women (n = 751), we quantified associations between PCPs and urinary biomarker concentrations of EDC mixtures (i.e., phthalates, phenols, parabens) within SES groups, defined using k-modes clustering based on education, income, marital status, and employment. Information about PCP use and SES was collected through questionnaires and interviews. We used principal component analysis to characterize the EDC mixture profiles. Stratified linear regression models were fit to assess associations between PCP use and EDC mixture profiles, quantified as mean differences in PC scores, by SES group. Associations between PCP use and EDC mixture profiles varied by SES group; e.g., vaginal powder use was associated with a mixture of phenols among lower SES women, whereas this association was null for higher SES women. Findings suggest that SES influences PCP EDC exposure in Black women, which has implications for public health interventions.

Demographic and socioeconomic factors associated with cervical cancer screening among women in Serbia.

Effective reduction of cervical cancer incidence and mortality requires strategic measures encompassing the implementation of a cost-effective screening technology. Serbia has made significant strides, introducing organized cervical cancer screening in 2012. However, various impediments to screening implementation persist. The aim of the study was to estimate the socioeconomic factors associated with cervical cancer screening among women in Serbia. Data from 2019 National Health Survey of the population of Serbia were used in this study. The study is cross sectional survey on a representative sample of the population of Serbia. Present total number of participants analyzed in survey 6,747. In Serbia, 67.2% of women have done a Pap test at any time during their lives, of which 46.1% of women have undergone cervical cancer screening in the past 3 years. About a quarter of women have never undergone a Pap test in their life (24.3%). The probability of never having a Pap test have: the youngest age group (15-24 years) is 1.3 times more likely than the oldest age group (OR = 1.31), unmarried women 0.3 times more often than married women (OR = 0.37), respondents with basic education 0.9 times more often than married women (OR = 0.98), the women of lower socioeconomic status 0.5 times more often than respondents of high socioeconomic status (OR = 0.56). Enhancement of the existing CCS would be the appropriate public health approach to decrease the incidence and mortality of cervical cancer in the Republic of Serbia.

Occupational Rehabilitation or Self-Change? Practices for Self-Change in an Occupational Rehabilitation Group for Ultra-Orthodox Low-SES Women in Israel

This article is based on ethnographies in an occupational rehabilitation group for unemployed and underemployed Jewish ultra-Orthodox low socioeconomic status women in Israel. The ethnographies tracked the cross-cultural encounter between ultra-Orthodox women and an organization that uses neoliberal practices in its occupational rehabilitation. The findings revealed the implications of practices promoting autonomy and freedom to choose, psychologizing structural barriers, and simulating the occupational world in a group setting. They also demonstrated ultra-Orthodox women’s agentic solutions for dealing with the discursive clash they experienced between the collectivist and neoliberal discourses. They used collectivization—familiar to them from their ultra-Orthodox culture—to respond to the demands for individualism and freedom to choose, which enabled them to proceed on their own terms. This article discusses intercultural encounters in the context of occupational rehabilitation for minority groups and the importance of designing culturally sensitive facilitation practices that include cultural translation.

Sex differences in chronic obstructive pulmonary disease characteristics: the Korea National Health and Nutrition Examination Survey 2007-2018.

Chronic obstructive pulmonary disease (COPD) is less prevalent in females than males, but it affects mortality in females. There may be sex differences in the clinical characteristics of COPD. We analyzed the Korea National Health and Nutrition Examination Survey dataset from 2007 to 2018. We compared the clinical characteristics and comorbidities in subjects with COPD according to sex. We adjusted the multivariate logistic regression of lung cancer prevalence according to COPD and sex by age and smoking amount. Females with COPD tended to be older than males with COPD (64.1 ± 0.4 yr vs. 62.3 ± 0.2 yr, respectively, p < 0.001). Approximately 89% of males with COPD had a smoking history, while 86% of females with COPD were non-smokers (p < 0.001). Household income was lower (p < 0.001) and asthma and overall malignancy were more prevalent in females with COPD than males with COPD (25.5 vs. 11.6%, respectively, p < 0.001; (6.3 vs. 5.4%, respectively, p < 0.001). However, lung cancer was more common in males with COPD than females with COPD (0.9 vs. 0.1%, respectively, p < 0.001). Lung cancer prevalence increased in males with moderate COPD compared to subjects without COPD (OR, 4.409; 95% CI, 1.741-9.419). Females with COPD had a lower smoking rate, household income, and lung cancer prevalence than males with COPD. More active COPD screening is needed for women of low socioeconomic status, even if they do not smoke.

Superwoman Schema and self-rated health in black women: Is socioeconomic status a moderator?

BackgroundThe Superwoman Schema (SWS) construct elucidates Black women's socialization to be strong, suppress their emotions, resist vulnerability, succeed despite limited resources, and help others at their own expense. Drawing from intersectionality and social psychological research on self-schemas, this study examined the extent to which SWS was associated with Black women's self-rated health. We also investigated whether socioeconomic status (SES) moderated the association between SWS, its five dimensions, and self-rated health. MethodsData were from the Mechanisms Underlying Stress and Emotions (MUSE) in African-American Women's Health Study, a cohort of African American self-identified women. SWS was assessed using Giscombé’s 35-item Superwoman Schema Scale. Socioeconomic status was measured by household income and educational attainment. Ordered logistic regression models were used and statistical interactions were run to test for moderation (N = 408). ResultsFirst, SWS dimension “obligation to help others” was associated with worse self-rated health (p < .05). Second, household income, but not education, moderated the association between SWS and self-rated health (p < .05): SWS overall was associated with worse self-rated health among higher income women but better self-rated health among lower income women. Third, income moderated the association between SWS dimension “obligation to present an image of strength” and self-rated health (p < .05): presenting strength was associated with better self-rated health for lower income women only. Fourth, moderation results revealed that SWS dimension “obligation to help others” was inversely associated with self-rated health particularly among higher income women. ConclusionsFindings speak to the complex interplay between SES and SWS dimensions as they relate to Black women's perceived health.

Use of opioids among pregnant women 1997–2016: A Danish drug utilization study

ObjectiveUse of opioids in pregnancy is of concern yet little is known on opioid prescription patterns in Denmark. The aim of this drug utilization study was to describe prescription patterns for opioids during pregnancy in Denmark from 1997 to 2016. Study designUsing the nationwide health care registers, we obtained information on all women with a registered pregnancy in the period 1 January 1997 to 31 December 2016. Opioids were grouped in four: opioids (N02A except codeines), opioid dependency medications (N07BC), cough medications (R05DA except codeines), and codeines (N02AJ06, N02AJ07, N02BA75, and R05DA04). We used logistic regression analyses to identify factors associated with opioid use in pregnancy and cumulative oral morphine equivalent (OMEQ) to estimate volume of use in pregnancy. ResultsPrescription patterns were similar for women with live births, non-live births, and terminations. Total use of opioids among women with live born deliveries remained stable at 19.8 per 1000 pregnancies from 1997 to 2016. Codeine use declined from 2008 onwards, while use of other opioids increased from 2007 onwards. This was dominated by a threefold increase in tramadol use (2.0–7.6 per 1000 pregnancies with live births). Codeine was the most used opioid, followed by tramadol and codeine combined with paracetamol. The number of women, who used opioids before pregnancy and continued into their pregnancy, was reduced as the pregnancy progressed. The cumulative oral morphine equivalent during pregnancy was stable until 2007, after which, use prior to pregnancy and during the first two trimesters increased. The odds ratios for opioid use were higher in pregnancies of women of lower socioeconomic status or older age. For live births, odds ratios for opioid use in pregnancy were higher among women with obesity or smoking. ConclusionsOverall use of opioids was stable from 2007 to 2016. This covers a decline in the use of codeine, but a 3-fold increase in tramadol. The number of pregnant women who continued use throughout pregnancy decreased, while OMEQ among persistent users increased. The real-world data suggest an unmet need of specific focus in local Danish Outpatient Clinics and Multidisciplinary Pain Centers both pre-conceptionally and during pregnancy.

Can a cash crop be a women's crop?: Examining gender norms, relations and equity around lentil commercialization in Ethiopia

The benefits of subsistence-crop commercialization may depend on gender norms and relations. In sub-Saharan Africa, crop commercialization has been shown to often have unequal outcomes for women and men due to pre-existing social hierarchies and norms around farm roles, asset ownership, control over crops and income, and local farming practices. Using qualitative methods, this article examines gender norms and relations around lentil commercialization in the Amhara and Oromia regions of Ethiopia, to understand whether the benefits of market-orientated lentil production accrue to women and men farmers equitably. The findings reveal that despite naming lentils a women's crop, women remain marginalized from the sale and use of lentil. The study also found that lentil commercialization is often accompanied by labour commercialization, which has exclusionary effects on farmers of low socioeconomic status and unmarried women. Some policy recommendations are suggested based on these findings.

Observation of Demographic Factors, Labor Characteristics, and Outcomes in Vesicovaginal Fistula

Introduction: Vesicovaginal fistula (VVF) is a significant public health issue, particularly in areas with inadequate access to quality emergency obstetric care. This study aimed to examine the demographic and obstetric factors associated with VVF in a specific population and to evaluate the outcomes of VVF surgery. Methods: This cross-sectional study was conducted at the Dhaka Medical College Fistula Centre from April to July 2013. From a total of 47 admissions, 27 patients were selected based on specific inclusion criteria. Data were collected on demographic factors, obstetric history, cause of VVF, and surgery-related characteristics. The primary outcome was the success or failure of VVF surgery. Result: The study included women with an average age of 33.78 years and an average height of 144.67 cm. Majority were classified as poor (66.67%). Most had primary education (62.96%) and were housewives (92.59%). Vaginal deliveries were most common (59.26%). Stillbirths accounted for the majority of outcomes (77.78%). Obstetrical causes were the primary reason for vesicovaginal fistula (VVF) (70.37%). Local repair was the most common mode of surgical repair (59.26%), and the majority of surgeries were successful (85.19%). Conclusion: The study highlights the significant burden of VVF among women of lower socioeconomic status and educational level. It underscores the need for improved surgical techniques and decision-making in obstetric and gynecological care, and the importance of access to quality obstetric care. Further research is needed to develop and implement effective strategies to prevent and treat VVF, particularly in resource-limited settings.

Influenza and pertussis vaccine coverage in pregnancy in Australia, 2016-2021.

Vaccination in pregnancy is the best strategy to reduce complications from influenza or pertussis infection in infants who are too young to be protected directly from vaccination. Pregnant women are also at risk of influenza complications preventable through antenatal vaccination. Both vaccines are funded under the National Immunisation Program for pregnant women in Australia, but coverage is not routinely reported nationally. We reviewed all reported Australian maternal influenza and pertussis vaccine coverage data for the period 2016-2021, to identify gaps and information needs. Maternal influenza vaccine coverage was suboptimal at < 58% for 2016-2018, with higher coverage of 62-75% reported in two states (Victoria and Western Australia) for 2019-2021. Maternal pertussis vaccine coverage from 2016 was generally higher than for influenza at > 70%, with the highest jurisdictional coverage of 89% reported in Western Australia in 2020. Vaccination rates were often suboptimal among First Nations pregnant women and up to 20% lower than among non-First Nations Australian women; while data were limited, coverage was low among culturally and linguistically diverse women and among women of lower socio-economic status. Jurisdictional perinatal data collections were the best source of information on antenatal vaccine coverage but were only available for a minority of the population; a nationally consistent systematic approach is lacking. Timely and comprehensive data are needed to provide feedback to improve maternal vaccination coverage, particularly among groups with higher risk and/or low uptake, and as new vaccines are recommended, including COVID-19 vaccination.

Uterine rupture; An obstetric tragedy still with us. A six year review of cases in a specialist hospital, NorthWest Nigeria

Background: Uterine rupture is a major cause of perinatal and maternal morbidity and mortality, it usually has a devastating outcome if not promptly attended to. The study determined the trends, risk factors, feto-maternal outcomes following uterine rupture as seen at ASYBSH.&#x0D; Method: The study was a retrospective review of cases of uterine rupture managed at the ASYBSH between March 2015 and February 2021. Records of the theatre and labour wards were searched and the folders of patients with uterine rupture were retrieved. Relevant information such as socio- demographic variables, booking status, clinical presentations were retrieved and entered into a structured profoma.&#x0D; Results: Deliveries in the hospital during the period were eleven thousand four hundred and twenty (11,420), out of which one hundred and fifty-six (156) were complicated by uterine rupture giving an overall incidence of 1.36 percent or one in every seventy-four (74) deliveries. Uterine rupture occurred mainly among women of low socio-economic status and high parity. The major predisposing factors were injudicious use of oxytocin (62.8%) prolonged obstructed labour (19.8%), previous caesarean section scar (8.5%), use of misoprostol (5.3%), fundal pressure (2.4%) and unexplained factors (1.2%)&#x0D; Conclusion: Uterine rupture remains a devastating obstetric calamity with a high incidence. Injudicious use of oxytocin, prolonged obstructed labour and previous caesarean section scar were the three leading predisposing factors identified in this study.