Women's Utilization Research Articles

Family Planning Methods Utilization in Women of Reproductive Age Group: Evidence from Regionally Representative Data from Karachi, Pakistan

Background: To assess the status of knowledge and practices about family planning utilization and its influencing factors among women of reproductive age group in Karachi, Pakistan. The study design was analytical cross-sectional study. The Place and Duration of Study was Combined Military Hospital, Malir Cantt from January to March 2021. Methods: Data was collected from 426 participants visiting outpatient department of a tertiary care hospital, using structured questionnaire. Nonprobability, convenient sampling technique was used to select study participants. Data was analyzed in Statistical Package of Social Sciences, version 23. Results: Family planning knowledge and practicing contraceptive methods utilization among women of reproductive age group was 73.94% and 55.16% respectively. Effectiveness of contraceptive methods was acknowledged by 57.27%. Family planning utilization practices were statistically associated with educational status, marriage duration, number of children, knowledge, availability, suitability and effectiveness of FP methods and husband support. Family planning centers and hospitals were the most common (41%) sources of information and desire to conceive was found to be the leading cause (54.2%) to attain family planning services. Conclusion: Overall the study revealed satisfactory knowledge about family planning with relatively low practices or utilization of contraceptive methods. Researches using qualitative approach are recommended to gain deep insight of women’s internal feeling regarding family planning. Besides, reasons for non-utilization of family planning services need to be explored further.

Effectiveness of Nursing Guidelines on Marital Outcomes of Women with Urinary Incontinence

Context: Urinary incontinence is an important multifactorial health problem that affects women's life quality negatively and is related significantly to age, education, occupation, marital status, and body mass index.
 Aim: To evaluate the effectiveness of nursing guidelines on marital outcomes of women with urinary incontinence.
 Methods: Quasi-experimental (pre/posttest, study/control) design was used. The study was conducted at the urogynecology unit at Ain Shams Maternity University Hospital on a purposive sample of 76 women attending the setting mentioned above. Sample inclusion criteria were women age <40 years, married, diagnosed with urinary tract infection, and free from chronic disease. The study tool included a structured interview questionnaire, Kings’ health questionnaire, women practice checklist.
 Results: Findings of the present study showed that 43.4% of the women were housewives, 27.6% completed preparatory school education. There were highly statistically significant differences between study and control groups regarding physical, social, sexual, and psychological dimensions of King's health outcomes post and followed up of guidelines implementation when the p-value was <0.001. The practice of the study group improved significantly than controls.
 Conclusion: The study revealed improvement in the total health outcomes and health practice among the study group compared to the controls with an increase in the total practice with the decrease in total health problems of king health, especially sexual problems. Recommendations: Performing training programs for improving women's awareness about urinary incontinence and sexual life. Replication of the study on a larger probability sample for generalizing the findings and studying the factors affecting women's utilization of urodynamic services.

Knowledge of pregnancy complications and utilization of antenatal care services in Rwanda.

While Rwanda's progress towards achieving the maternal health care targets of the Sustainable Development Goals is impressive, evidence of women's limited utilization of antenatal care (ANC) services in the context of an improved health care system provides an opportunity for exploring other essential but less highlighted factors that may shape ANC service utilization. In this study, we examined the association between women's knowledge of pregnancy complications and the utilization of maternal health services. We employed logistic regression analysis using the 2015 Rwanda Demographic and Health Survey data. Our analytical sample consisted of women (n=5883) in their reproductive ages (15-49years). Three maternal health care indicators, namely, timing of first ANC visit, number of ANC visits, and place of delivery, were explored. We controlled for the effects of socioeconomic and demographic characteristics, including marital status, place of residence and age. The results show that women with no knowledge of pregnancy complications were less likely to utilize ANC services within the first trimester (odds ratio [OR]=0.76, p<0.01), achieve the WHO recommended minimum of eight visits (OR=0.66, p<0.01), and deliver at a health facility (OR=0.77, p<0.10). Given these findings, we recommend restructuring existing maternal health care programs to include rigorous maternal health education.

Postpartum U.S. Women's Oral Health Knowledge, Attitudes, and Practices During Pregnancy.

The purpose of this study was to assess oral health knowledge, attitudes, and practices of women who had given birth in the United States within the past 2 years, and to evaluate factors affecting women's dental service utilization during pregnancy. This study used a descriptive, cross-sectional design and employed non-probability sampling methods. The 47-item questionnaire included: oral health behaviors (8), knowledge (5), attitudes (12), and practices during pregnancy (10), and demographic (12) questions. Participants were recruited through multiple postpartum support group forums on Facebook. Logistic regression was used to identify potential predictors of dental utilization during pregnancy. Ninety-one percent of the participants had at least an associate's degree, and 85.6% had dental insurance coverage during pregnancy. Approximately 56% knew the connection between poor oral health and pregnancy complications; however, only 11% obtained this information from their OBGYNs and 10% from their dental offices. Although women aware of the association were more likely to visit the dental office during pregnancy (64%, p < .001), the majority (74%) who experienced tooth or gum related issues during pregnancy reported not receiving any dental or gum treatment. Women, who had positive dental attitudes and awareness of an increased risk of pregnancy complications due to poor oral health, were more likely to receive dental care during pregnancy regardless of dental coverage. Medical and dental providers could play an active role in educating women on the importance of having good oral health, potential oral/systemic relationships, and the benefits of receiving dental care during pregnancy.

Mapping the Location of Health Centers in Relation to "Maternity Care Deserts": Associations With Utilization of Women's Health Providers and Services.

Background and Objectives:The aim was to explore the association between community health centers’ (CHC) distance to a “maternity care desert” (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors.Measures:Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff.Research Design:Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a “desert” were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234).Results:Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to “deserts” had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care.Conclusions:CHCs located closer to “deserts” and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.

Utilization of Women's Preventive Health Services During the COVID-19 Pandemic.

The association of the COVID-19 pandemic with women's preventive health care use is unknown. To describe utilization of women's preventive health services. Cross-sectional study of women aged 18 to 74 years enrolled in a commercial health maintenance organization in Michigan. COVID-19 pandemic (2019-2020). Adjusted odds ratios (AORs) of receiving breast cancer screening, cervical cancer screening, sexually transmitted infection (STI) screening, long-acting reversible contraception (LARC) insertions, and pharmacy-obtained contraception, adjusted for month, age, county, zip code characteristics (per-capita income, non-White percentage of population, non-English-proficient percentage of population), and plan designation (primary plan holder vs dependent). The study population included 685 373 women aged 18 to 74 years, enrolled for 13 000 715 person-months, of whom 10 061 275 person-months (77.4%) were among women aged 25 to 64 years and 8 020 215 (61.7%) were the primary plan holder, with mean zip code per capita income of $33 708, 20.2% mean zip code non-White population, and 3.4% mean zip code non-English-speaking population. For services requiring an in-person visit (breast cancer screening, cervical cancer screening, STI testing, and LARC insertions), utilization declined by 60% to 90% during the spring of 2020, with a nadir in April 2020, after which utilization for all services recovered to close to 2019 levels by July 2020. Claims for pharmacy-obtained hormonal contraceptives in 2020 were consistently 15% to 30% lower than 2019. The AORs of a woman receiving a given preventive service in 2020 compared with 2019 were significantly lower for breast cancer screening (AOR, 0.80; 95% CI, 0.79-0.80), cervical cancer screening (AOR, 0.80; 95% CI, 0.80-0.81), STI screening (AOR, 0.83; 95% CI, 0.82-0.84), LARC insertion (AOR, 0.87; 95% CI, 0.84-0.90), and pharmacy-obtained contraception (AOR, 0.73; 95% CI, 0.72-0.74) (all P < .001). In this cross-sectional study of women enrolled in a large US commercial health maintenance organization plan, the COVID-19 pandemic was associated with large but transient declines in rates of breast cancer screening, cervical cancer screening, STI screening, and LARC insertions, and moderate persistent declines in pharmacy-obtained hormonal contraceptives. The overall odds of a woman receiving a given preventive service in 2020 was 20% to 30% lower than 2019. Further research into disparities in access to care and the health outcomes of decreased use of these key health services is warranted.

Ruang Gender Haruskah Selalu dipisah? Ruang Kelola Wilayah Adat dan Pendekatan Ekologi Politik Feminis

Gender space generally separates space and place of land and natural resources management and utilization based on gender. The assumption these gender space segregation with firm boundary lines implicated demand to showing women's control, utilization, and management of the land and natural resources on the participatory mapping result that is mostly facilitated by JKPP in Indonesia. One of the purposes of this demand is to include women's interests over space in every decision-making process that has an impact on the women's production areas. In fact, not all places have separated the control, utilization, and management of the land and natural resources based on gender. In an agrarian society, like in Indonesia, most of the areas for control, utilization, and management of the land and natural resources are communal based, which is means that the land and natural resources are joint management by men and women. In one indigenous territory, at two different places and times, gender based management can undergo changes. Taking the case of the Balai Juhu in Hulu Sungai Tengah Regency, South Kalimantan, using a feminist political ecology framework, this article examines the complexities of gender segregation on indigenous territory

An Open Secret: The History of Unwanted Pregnancy and Abortion in Modern Bolivia

In An Open Secret, historian Natalie Kimball “wrestles with an uncomfortable and slippery notion—that of unwanted pregnancy (embarazo no deseado)” (p. 113). The book's thesis—that the material and affective conditions that lead a person to regard their pregnancy as unwanted often elude conventional categorization—destabilizes several assumptions around reproductive behavior in urban Bolivia between 1952 and 2010. Kimball's oral histories with El Alto and La Paz residents in the early 2000s demonstrate how few women reflect on their pregnancies in such circumscribed terms. The causes of reproductive behavior are quickly revealed as too nuanced for frameworks of choice and rights as well as some of the structural observations on which feminist scholars have typically relied. Rather, in Bolivia, where abortion remains almost completely illegal, bearing a child is tied as closely to interpersonal and financial networks as to legal and political systems. More familiar is Kimball's argument that pregnant people have always looked for ways to negotiate their reproductive lives and have utilized political openings to achieve expanded, though limited, access to reproductive health care.According to state data from 2008, over one-third of pregnancies in contemporary Bolivia are unwanted, and most of these are carried to term. Yet the majority of Kimball's interlocutors described continuing their pregnancies not as an outcome of choosing to do so but as an obligation or necessity. Moreover, those who went on to have children expressed ambivalence but not complete regret. These layered responses guide the organization of An Open Secret. After tracing the history of reproductive policy in Bolivia, Kimball examines accounts of reproduction and abortion from medical personnel, police, and religious officials—many of whom have maintained public disapproval of abortion—before assessing women's own complex perceptions of their pregnancies. The following two chapters probe women's experiences with reproductive health care after the 1952 national revolution and into the military dictatorship and the democratic opening, respectively, which while markedly different were not entirely distinct. After the revolution, women “pushed the boundaries” of the state's pronatalist policies by continuing to terminate pregnancies (p. 149). Following the democratic opening in 1982, Bolivian women's groups organized for reproductive health-care access. Their activism and increased international support for abortion care were impetuses for the extension of public health insurance to cover pregnancy loss and expanded access to biomedical contraceptive support. Chapter 6 examines how legal mechanisms have failed both to prosecute people who have obtained illegal abortions and to facilitate access to legal abortions.Kimball's primary contributions come with their use of oral history as both a source and a lens through which to view the archive. Their conversations with 121 Bolivian women and men highlight the state's ongoing interest in reproduction and the role of structural forces on women's reproductive behavior, their “perceptions of what future was desired or possible” (p. 7). Even more, Kimball demonstrates the power of the social and affective on reproductive behavior. Their fieldwork never assumes the primacy of the individual woman; rather, each interlocutor represents a network of people, commitments, and judgments that make terminating a pregnancy possible or not. Kimball illustrates how the disruptions and especially the continuities of these interpersonal and systemic webs have influenced Bolivian women's experiences of their own pregnancies over the past half century.Beyond contributing to the growing number of country studies of reproductive politics and governance in Latin America, An Open Secret adds to examinations of the lives of urban Indigenous peoples and medical pluralism during neoliberalism. Particular moral frameworks abound in the adjacent and “inextricably linked” El Alto and La Paz; the majority Indigenous and poor populations encounter more pronounced antiabortion stigma amid the religious and patriarchal dynamics of urban Bolivia than in the surrounding rural areas (p. 18). Moreover, Bolivia's recent incorporation of some Indigenous health-care methods into the national health system and women's continual utilization of Andean birth control and abortifacients offer a unique context in which to trace the relationship between biomedical and Indigenous health systems.An Open Secret makes a case for narrative accounts as essential data for interpreting statistical and archival studies about how individuals navigate the complex avenues of reproduction. Moreover, Kimball's use of oral history elevates the intimate experiences of women as explicitly political. The book's lack of concise conclusions is not so much a problem of the text as it is reflective of the realities of this still forward-thinking task. Kimball must err on the side of subject anonymity in a climate in which abortion is stigmatized and piece together stories that often must necessarily remain secret. Rather than detracting from the argument, these impasses add weight to a main point of Kimball's argument, that “women's experiences matter simply because they occur” (p. 3).

Women's Participation in Labor Force in Sub-Saharan Africa (SSA): A Review of Determinants and Impacts

Background: In the last few decades, there has been a significant increase in women's participation in gainful employment in Sub-Saharan Africa (SSA). This scooping review has primarily aimed at assessing the key determinants and effects of women's involvement in the labor force in SSA.&#x0D; Methods: The authors did the review based on 19 articles selected from PubMed and goggle search. The selection considered only those published in the last 15 years, conducted based on large sample from Sub-Saharan African countries, and those exclusively related to women’s Labor Force Participation (LFP). More than 80% of the reviewed studies (16 of the 19) employed a cross-sectional study design with quantitative approaches.&#x0D; Results: The review witnessed that women's labor force participation in SSA is determined by various individual, household, and community characteristics. Women with lower fertility, living in poor economic condition (low wealth quantiles), and those with above primary education were more likely to participate in gainful employment. Other demographic factors explaining why some women participate in the labor force more often than others include women's age, marital status, number of under-five children, household size, and headship. Among the community variables, living in areas with better infrastructure (transport and communication) increased the likelihood of women’s participation in gainful employment. Nearly all studies showed significant positive impacts of women's labor force participation on several domains of women's life and household well-being, such as on women's nutrition, childcare, and health service utilization.&#x0D; Conclusion: The review implies that despite concerns about some adverse impacts of women's participation in gainful employment (such as on childcare), most of the studies indicated positive effects of LFP on women's and children's health, nutrition, and overall household well-being in SSA.

Impact of educational intervention on cervical cancer screening uptake among reproductive age women

The objective of this review is to examine the efficacy of educational approaches in increasing women's adoption of cervical screening. A search was conducted through PubMed, Medline and Google Scholar. Articles that met the eligibility criteria were reviewed. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guided the data synthesis and reporting. We conducted a qualitative synthesis of evidence and pooled individual research results in meta-analyses using RevMan 5.3 review manager, where applicable. Heterogeneity has been estimated for total summary results of studies pooled together. Quality analysis of the papers was done using JADAD scale. This meta-analysis included a total of nine articles (n=2316). Statistical research findings indicate that the use of cervical cancer educational approaches substantially improved cervical cancer screening rates and screening acceptability by double folds 2.88. The results of this study support the use of educational intervention for cervical cancer to increase the acceptance of cervical cancer screening by women. We also recommend more research to assess the efficacy of various teaching approaches and the effect of intervention length on the rise in women's cervical cancer screening services utilization.

Comparing Postpartum Care Utilization from Medicaid Claims and the Pregnancy Risk Assessment Monitoring System in Wisconsin, 2011-2015.

To compare two data sources from Wisconsin-Medicaid claims and Pregnancy Risk Assessment Monitoring System (PRAMS) surveys-for measuring postpartum care utilization and to better understand the incongruence between the sources. We used linked Medicaid claims and PRAMS surveys of Wisconsin residents who delivered a live birth during 2011-2015 to assess women's postpartum care utilization. Three different definitions of postpartum care from Medicaid claims were employed to better examine bundled service codes and timing of care. We used one question from the PRAMS survey that asks women if they have had a postpartum checkup. Concordance between the two data sources was examined using Cohen's Kappa value. For women who reported having a postpartum checkup on PRAMS but did not have a Medicaid claim for a traditional postpartum visit, we determined the other types of health care visits these women had after delivery documented in the Medicaid claims. Among the 2313 women with a Medicaid-paid delivery and who completed a PRAMS survey, 86.6% had claims for a postpartum visit during the first 12weeks postpartum and 90.5% self-reported a postpartum checkup on PRAMS (percent agreement = 79.9%, Kappa = 0.015). The percent agreement and Kappa values varied based on the definition of postpartum care derived from the Medicaid claims data. There was slight agreement between Medicaid claims and PRAMS data. Most women had Medicaid claims for postpartum care at some point in the first 12weeks postpartum, although the timing of these visits was somewhat unclear due to the use of bundled service codes.

Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020.

Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race-ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010-2020) electronic database to identify most recently published national estimates by race-ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial-ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.

The relationship between religion, culture, cost, ethics, and husband perception with the decision of women's utilization of Assisted reproductive technology as method of infertility management

Context: Infertility is a global health problem characterized by inability of couple to achieve pregnancy after one year of regular unprotected sexual intercourse; or after 6 months if the woman is older than 35 years of age. Aims: To examine the effect of determinants on the Utilization of Assisted Reproductive Technology (ART) among women Setting and Design: This is a cross sectional survey design conducted on women at the Obstetrics, Gynaecology and Fertility clinics in university of Benin Teaching Hospital, Benin-City, Nigeria, 2020. Material and Methods: This study was conducted among 348 women, selected through stratified probability sampling method, and a self-structured questionnaire was designed, administered and same retrieved. Statistical Analysis Used: Data collected were analyzed using descriptive statistics, means, standard deviation (SD) and Pearson Correlation Coefficient at 0.05 significant levels. Results: The mean (SD) of the determinants: religion, culture, cost, ethics, and husband perception were as follows: 2.47 ± 1.28, 2.34 ± 1.20, 3.37 ± 1.25, 2.35 ± 1.09, 2.33 ± 1.13 respectively. The Pearson Correlation Coefficient, shows significant relationship (P= Conclusion: The cost of ART is a major factor, therefore, there is need for international efforts to facilitate globalization of ART services with special attention to manpower development, subsidization of the running cost and establishment a global partnership as obtained in the Sustainable Development Goals (SDGs).

Patterns of Help-seeking Strategies in Response to Intimate Partner Violence: A Latent Class Analysis.

Women engage in multiple strategies to cope with the impact of intimate partner violence (IPV). Prior research has focused predominantly on women's service utilization and help seeking as individual acts, yet it is likely that women engage in distinct patterns of multiple help-seeking strategies to achieve safety. As such, the current article examines patterns of service-related help-seeking strategies survivors employ. This article also investigates demographic factors, relationship characteristics, and mental and physical health effects of IPV associated with patterns of help seeking. Using a web-based survey, data were collected from service-engaged adult female IPV survivors (n = 369) in the Southwest region of the United States. Latent class analysis (LCA), a person-centered analytical approach, was used to identify survivors' patterns of help seeking. A 3-class LCA model was determined to be the best fit for the data. Among the sample, 50% of women broadly engaged formal and informal networks, 15% primarily engaged informal networks, and 35% broadly engaged networks but avoided legal systems while seeking other formal services. Findings indicated varying and significant associations between class membership and race/ethnicity, foreign-born status, number of children, IPV severity, and mental health symptoms. The findings reinforce the need for practitioners to be aware of the varied ways women choose or avoid seeking help and explore women's preferences. Comprehensive and collaborative service networks are necessary for early detection and holistic care. Addressing structural factors is imperative for expanding the range of viable support options available to IPV survivors, particularly women of color.

Are marital relationships a barrier to health care utilization in Southern Appalachia?: A dyadic examination of the link between marital quality and individual health care usage.

There are substantial health disparities in Appalachia partially due to the poor access and utilization of health care. Social support, especially in Appalachia, is consistently linked to the utilization of available health care. The present study aims to identify how on aspect of social support, relationship functioning, are associated with health care utilization for couples in Southern Appalachian. Individual and couple data (N = 147, individuals; n = 76, couples) were collected from participants interested in a brief couple interventions. Individuals and Dyadic Path analyses were conducted in Mplus using methods to account for the dependence in the data. Relational aggression was the only marital factor linked to health care utilization in multivariate analyses while constructive communication was only linked to health care utilization in bivariate correlations, r = .24, p < .05. Dyadic results indicate that men's health care utilization may benefit from partner's relational aggression while women's utilization may be negatively influenced by her own self-reported relational aggression. An individual's social context must be considered in order to completely understand barriers to health care utilization. Further, the inclusion of couple/dyadic level interventions should be considered in order to improve health care utilization in the Appalachian region and similarly rural regions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

”Little girl, where do you think you go with this method?”: shame and use of emergency contraception

Abstract Background In England in 2018, 45% of pregnancies were unplanned at the time of conception. In 2017, there were 192,900 abortions carried out for women residing in England and Wales, with the highest rate of abortion being for women aged 20-24 (28.2 per 1000 resident women). Aim To understand social and cultural influences which affect ethnic minority young women's utilization and experience of emergency contraception in the United Kingdom. Methods Qualitative in-depth interviews following an interview topic guide were conducted with seven young women currently living in the UK, whose parents were born outside the UK. Interviews were recorded, transcribed and input into NVivo version 11.4.3. Transcriptions were coded to identify themes and these themes were then analyzed to identify commonalities and establish connections to understand perceptions and experiences of the participants. The themes coded were “Knowledge of emergency contraception”, “relationships” “concerns about obtaining and using EC”, “balancing risks” and “religion and culture”. Results Participants were often not open with their parents about sexual health related topics. Cultural taboos still persist towards sex before marriage which could translate into guilt and shame about using EC. When asked about concerns surrounding EC, participants mentioned concerns relating to obtaining EC, generally involving privacy embarrassment or shame. Stigma and concern about what others may think was a fairly frequent theme throughout the interviews, with participants being worried about what friends, family or service providers would think about them. Conclusions cultural awareness in healthcare reiterate the need for interventions which take into consideration sociocultural contexts. This is essential to ensure that young women have access to emergency contraception in order to prevent unwanted pregnancy. Key messages Despite availability of emergency contraception, young women still face the risk of going through an unwanted pregnancy becuase of embarrasment and shame. Cultural taboos towards sex before marriage still persists and this is translated into guilt and shame about using emergency contraception.

ARE Wives of Migrants in Rural Bangladesh Really “Left behind”? A Nuanced Analysis of How Spousal Migration Affects Women’s Healthcare Utilization

Research ObjectiveLabor migration has a profound effect on the family at all levels, but evidence documenting the impact of migration on women "left behind" is still lacking. We analyze the effects of migration on healthcare utilization and outcomes of women "left behind," and consider the moderating effects of household structure on gender‐related barriers to healthcare utilization.Study DesignWe examine outcomes across 5 domains: healthcare utilization, mental health, self‐reported health, BMI, and gender equality. The primary independent variable is a categorical measure of the husband’s migration status, and the secondary predictor is the family context within which the women live, defined as their relationship to the household head. We conduct bivariate and regression analyses using linear, logistic, and multinomial models controlling for age, education, and geographic location.Population StudiedSince 1966, the International Center for Diarrheal Disease Research, Bangladesh (icddr,b), has implemented a Health and Demographic Surveillance System in the rural Matlab area of Bangladesh, collecting data monthly on nearly the entire population of around 200 000. In 1996, the widely utilized Matlab Health and Socioeconomic Survey (MHSS1) was conducted on a representative sample of 7% of households, followed by MHSS2 in 2012‐2014, which had unusually successful migrant tracking, capturing 92‐94% of surviving members of all key age‐sex cohorts. Our sample is drawn from MHSS2 and includes 6983 currently married women between the ages of 15 and 45.Principal FindingsMore than twice as many women who had a cohabitating spouse could not access health care when they needed it (20.8%), compared to women with international migrant spouses (10.2%, P &lt; .001). International spousal migration remained a significant predictor of women's ability to access healthcare primarily through a reduction in financial barriers (P &lt; .001), when controlling for age, education, relationship to household head, self‐reported health, depression, and geographic location. The barriers to healthcare access varied for women depending on the migration status of their spouse. Financial barriers decreased by 66% for wives of international migrants (P &lt; .001), but barriers related to mobility, autonomy, and family approval increased for this same group of women.Gains in access to health care are also explained by improvements women’s mobility and economic empowerment associated with husband’s domestic and international migration (P &lt; .001). However, these positive migration effects do not translate into significant differences in self‐reported health, BMI, or depression; and migration‐related improvements in economic empowerment and mobility are fully moderated for women who live with their parents or in‐laws.ConclusionsThe potential benefits of migration for women's healthcare utilization may be diluted by family structures that perpetuate unequal gender dynamics.Implications for Policy or PracticeDue to the dynamic and evolving nature of migration, a comprehensive approach is essential to understand the health impacts on women and their families and inform policies in both sending and receiving countries. These efforts also help to answer growing calls for attention to gender, including those in the newly adopted UN Global Compact for Migration, and take an important step toward understanding, not just where communities stand in relation to global targets, but through what mechanisms progress on women's access to healthcare is being made or hindered.Primary Funding SourceAgency for Healthcare Research and Quality.

Factors affecting rural women's utilisation of continuum of care services in remote or isolated villages or Pakistan – A mixed-methods study

IntroductionAn effective continuum of care for pregnancy and childbirth connects women and girls with essential reproductive and maternity care services. This study aimed to estimate the continuum of care utilisation rate of women who lived in remote and isolated regions of Pakistan and explored factors that influence women's utilisation of reproductive and maternity care services. MethodsA mixed-methods study was conducted in five rural villages of Sindh, Pakistan. A cross-sectional survey with 669 women who gave birth between July 2010 and September 2014 investigated women's maternity-care service utilisation during pregnancy, childbirth, and in the postpartum period. In-depth interviews with 15 women explored their maternity-care experiences with health providers. ResultsOnly 6.4% of 669 women participants reported to have completed the continuum of care for their last pregnancy. Skilled birth attendants, including health professionals, were used by 56.1% for antenatal care, 40.8% for both antenatal and childbirth, 22.3% for antenatal, childbirth and postnatal, and only 6.4% reported using all pregnancy-related and postpartum services. Limited knowledge about affordable health services, poor health literacy, and access to health services was associated with women's fragmented utilisation of maternity care. A lack of respectful maternity-care was also identified as a major barrier to women's utilisation of primary health care facilities, especially for childbirth. ConclusionThe existing primary health structure in Pakistan provides a good foundation to deliver continuity of care services; however, health services utilisation for reproductive and maternity care remains suboptimal in women who live in geographically remote regions of Pakistan.

The “Benevolent” Japan Self-Defense Forces and Their Utilization of Women

The “Benevolent” Japan Self-Defense Forces and Their Utilization of Women

A Quality Improvement Project to Increase Patient Portal Enrollment and Utilization in Women Living With HIV at Risk for Disengagement in Care.

Women living with HIV are less likely to be retained and engaged in consistent care than their male counterparts. The purpose of this quality improvement project was to increase the enrollment and utilization rate of a patient portal, an mHealth technology, by women living with HIV at risk of disengagement in care to improve their overall engagement and retention in care. At-risk women were identified, educated on, and enrolled in a patient portal system during routine clinic appointments. Engagement was measured using portal utilization rates and patient-initiated communication and analyzed using descriptive statistics. Paired 2-tailed Student t-tests were used to evaluate changes in adherence rates, viral loads, and CD4 T-cell counts from 90-day pre-enrollment to 90-day post-enrollment. Overall results indicate improved utilization and engagement through the use of a patient portal system are feasible in this population and promote engagement and retention in care.