Women's Health Policy Research Articles

The Sociology of South Asian Women’s Health

In this lucidly written book, The Sociology of South Asian Women’s Health, Sara Rizvi Jafree, emphasises how health policies have left out the cultural knowledge about the unique circumstances and experiences of South Asian women. The author deftly explored the importance of re-conceptualising health policy development with a culturally and socially appropriate background for women in South Asia. In the introductory chapter of the book, Jafree starts by giving a concise structural description of how South Asian women’s health behaviour and health outcomes are affected by social systems of family, gender, faith, culture, government, schooling, and the media. Sara Rizvi Jafree aims to connect health policy efforts with knowledge of socio-environment and structural factors to propose better health policies for women. The book consists of nine chapters that are co-authored by different scholars with Jafree.

Experiences of Women with Visual and Orthopedic Disabilities in Obstetrics and Gynecology Units: A Phenomenological Study

Experiences of women with visual and orthopedic disabilities in obstetrics and gynecology units: A Phenomenological Study
 
 ABSTRACT
 Objective: This research was conducted to understand the core/base of the experiences, thoughts, and feelings of women with visual and orthopedic disabilities about health care services related to obstetrics and gynecology units. 
 Bu araştırmanın amacı, görme ve ortopedik engelli kadınların obstetri ve jinekoloji birimleri ile ilgili yaşadıkları deneyimlerini, düşüncelerini ve hislerini anlamaktır.
 Methods: A descriptive phenomenological design was used in this study. This study was conducted with women with 10 visual and 12 orthopedic disabilities registered to physical disability associations in Izmir, western Turkey, between May 2020 and November 2020. Data were collected by in-depth interview method using semi-structured questions. All transcripts were evaluated by two researchers and codes were created. The codes formed the sub-themes in terms of similarities and differences, themes were created as a result of combining sub-themes. 
 Results: The data obtained consists of two main themes: 1) 'Challenges and Problems' 2) 'Health Professionals'. 'Challenges and Problems' has 10 sub-themes: Social pressure, dependence on others-helplessness, problems with gynecology/obstetrics examination chairs, transportation problems, poor physical conditions, financial problems, procrastination/disregard, obscurity-uneasiness, privacy-shame-hesitate, and discourses in the past. 'Health Professionals' and it has four positive sub-themes and eight negative sub-themes. Positive sub-themes; introducing-describing the physical environment, helping, giving information before the procedure, being understanding and relevant. Negative sub-themes; not taking enough time-disinterest, exclusion- stigma, violence, maltreatment from female healthcare professionals, communication problems, lack of privacy, helplessness, and lack of education/awareness. 
 Conclusion: In the study, it was concluded that women with visual and orthopedic disabilities experienced problems, negative thoughts and feelings related to the attitudes and behaviors of individual, environmental, social, institutional, economic, information and health professionals related to obstetrics and gynecology units.Therefore, women health policies should concentrate on problems experienced by women with visual and orthopedic disabilities and health professionals in obstetrics and gynecology units.
 Keywords: Disability; visual disabilities; orthopedic disabilities; obstetrics and gynecology units; phenomenology.
 Financing
 All persons listed as authors participated sufficiently in this study to accept public responsibility for the manuscript content. This article did not receive any funding from public or private entities.

Reproductive Health Policy in the United States: An American College of Physicians Policy Brief.

The legal landscape around access to reproductive health care services was substantially altered after the Supreme Court decision in Dobbs v Jackson Women's Health Organization. In the aftermath of the decision, some state governments have begun to impose stringent restrictions and complete bans on the provision of abortion, whereas others have sought to protect and expand access. Some have gone as far as imposing criminal and civil penalties on physicians and other clinicians who provide evidence-based, clinically indicated reproductive health care services and information that is guided by biomedical ethics and provided in the best interest of the patient's health and well-being. In several states, lawmakers have attempted and successfully used new approaches to enforcing and achieving these prohibitions, including prohibitions on crossing state lines to obtain abortion care, prohibitions on the mailing of medication abortion, and the authorization of third-party civil lawsuits. In this policy brief, the American College of Physicians (ACP) updates and expands on its previous public policy positions on abortion from its 2018 policy paper, "Women's Health Policy in the United States," to reflect this new reality. The College also offers policymakers and payers recommendations to promote equitable access to reproductive health care services and safeguard maternal health. ACP reaffirms its opposition to undue and unnecessary governmental interference in the patient-physician relationship that criminalizes the provision of health care made in the physician's clinical judgment and based on clinical evidence and the standard of care.

Transnationalism, intersectionality and activism in health policy for women

Resumo: Propomos, neste artigo, a análise do desenho da Rede Cegonha e da resposta à epidemia do vírus Zika, desde a perspectiva das políticas de saúde para as mulheres no Brasil. Construímos essa análise à luz de uma tríade de fatores que influenciam o desenho das políticas públicas: a mobilização de narrativas transnacionais; a interseccionalidade dos determinantes sociais de saúde e a mobilização da sociedade civil, em particular os movimentos de mulheres e feministas. Por meio de pesquisa em documentos produzidos por autoridades de saúde pública e de entrevistas com mulheres ativistas em saúde, reconstruímos a trajetória das políticas de saúde para as mulheres e discutimos que a dimensão transnacional presente nessas ações e programas ainda é pouco considerada pela literatura quando analisamos o ciclo dessas políticas, sobretudo no que tange às narrativas apresentadas por governos e sociedade civil.

Analyzing factors associated with time to age at first marriage among women in Ethiopia: log logistic-gamma shared frailty model

ObjectiveThe main objective of this study is to fit Log logistic-Gamma shared frailty model for the determinant of time to age at first marriage among women in Ethiopia.MethodsThe data set in this study were obtained from Demography and Health survey conducted in Ethiopia in 2016. In this study, we used Log logistic-Gamma shared frailty model to account for the loss of independence that arises from the clustering of women in region of Ethiopia. A total of 12,066 women aged 15–49 in Ethiopia were included in this study.ResultsOf all 12,066 women aged 15–49, 9466 (78.45%) were married and the median & mean age at first marriage for women living in Ethiopia were 17.2 years and 17.5 years respectively, while the minimum and maximum age at first marriage observed were 8 years and 49 years respectively.ConclusionThe most significant contributing factors to delaying time to age at first marriage of women aged 15–49 in Ethiopia were increased education level of women, increased education level of the head, increased income, residing in urban and being followers of religion other than orthodox, catholic, protestant & Muslim. The heterogeneity of age at first marriage for women aged 15–49 among regions in Ethiopia was observed. The government of Ethiopia and the concerned bodies should revise the women's health policy and practice to reduce early marriage and give attention to women; illiterate, live in rural areas, and have illiterate and poor heads.

Moe Kura: a longitudinal study of mother and child sleep and well-being in Aotearoa New Zealand

ABSTRACT Moe Kura is a longitudinal study focused on the role of sleep in the health and well-being of mothers and children in Aotearoa New Zealand (NZ). The leadership, design and conduct of the study is informed by Kaupapa Māori research principles and is positioned within a broader rights-based approach to health, recognising that inequities in health must be identified and understood to improve the health of wāhine Māori and tamariki. In late pregnancy 418 Māori women and 768 non-Māori women were recruited and data collected at four waves (35–37 weeks gestation, 4–6 weeks postpartum, 11–13 weeks postpartum and when the Moe Kura child was 3–4 years of age) with linkage to birth records and national administrative datasets and associated qualitative research. Findings demonstrate substantial inequities in sleep health, infant and maternal health, and maternal employment between Māori and non-Māori, along with the important role of sleep in perinatal health and maternal mental health outcomes. The research philosophy that underpins the study, the primary focus on women, and the detailed measurement of sleep during the childbearing years has provided new and important findings that contribute to intervention development and health policy for women and children in NZ.

UTERUS CANCER PROFILE IN WOMEN RESIDENTS IN MONTES CLEAR, MINAS GERAIS

Introduction: Cervical cancer is one of the most frequent in the female population, it is related to HPV infection, multiple partners, unfavorable socioeconomic conditions, among other factors. Objective: To know the profile of cervical cancer in women living in Montes Claros, Minas Gerais, Brazil. Methods: This is a descriptive study with a quantitative approach using data from patients diagnosed with cervical cancer available in hospital records of the José Alencar Gomes da Silva National Cancer Institute (INCA). Results and discussion: In the period analyzed, 555 cervical cancer diagnoses were registered in the database of the José Alencar Gomes da Silva National Cancer Institute (INCA) in the municipality investigated. Conclusion: The data available in the INCA database in relation to women residing in Montes Claros, Minas Gerais indicated adult, married, brown women, with a low level of education and occupations with low wages. Coordinated actions from all public spheres of planning and execution of women's health policy are needed to intensify early diagnosis and treatment.

Promoting Military Women's Health Policy Development through the Lens of the Social Ecological Model for Military Women's Health.

The goal of this supplemental issue of Women's Health Issues is to present the evidence on seven topics that are pertinent to the health of active duty military women (unplanned pregnancy, cervical cancer, sexually transmitted infections, adjustment disorders, obstetrics, breastfeeding, and sleep) as revealed by scoping review methods. The findings of each scoping review were synthesized within the framework of a social ecological model for military women's health (SEM-MWH), which allowed the authors to identify potential areas of research and local, organizational, or national policies that could improve the health of military women.

Reproductive Injustice at the Southern Border and Beyond: An Analysis of Current Events and Hope for the Future.

Reproductive Injustice at the Southern Border and Beyond: An Analysis of Current Events and Hope for the Future.

The relationship between body image and quality of life in postmenopausal women: A correlational cross-sectional study

The relationship between body image (BI) and quality of life (QoL) among postmenopausal women was assessed in this study. This correlational cross-sectional study was conducted on 320 postmenopausal women in Tehran-Iran. The subjects were selected using a multistage sampling method. Data was collected using the WHOQOL-BREF questionnaire, the Fisher’s body image questionnaire, and a socio-demographic questionnaire. Total score and score of all domains of QoL had a significant positive correlation with total score and score of all dimensions of BI and BI was a predictor of QoL (p < 0.001). Therefore, women health policies should concentrate on BI improvement for promoting QoL during menopause.

Maternal Morbidity and Mortality.

Maternal Morbidity and Mortality.

Prevalence and factors associated with morbidity among postmenopausal women in a rural area in Kozhikode District

Introduction: The focus of women's health researchers and health policy planners has also shifted toward postmenopausal women since recent trends suggest an increase in their number and life expectancy. In general, women have more complex and stressful aging process as men do, as a consequence of hormonal changes that occur during menopausal transition. Objectives: The objective of this study is to estimate the prevalence of postmenopausal symptoms among women in a rural area of Kozhikode and study factors associated with it. Material and Methodology: A cross-sectional study was conducted among postmenopausal women aged 40–55 years in Nanminda panchayat, a rural area in Kozhikode district. This 1-year study was conducted from June 2015 to June 2016, had 245 participants with informed consent. There are 17 wards (17 clusters) in Nanminda panchayat area from which 6 wards were selected. The prevalence of postmenopausal symptoms and associated factors such as sociodemographic profile, morbidity details, diet supplements, anthropometric, clinical, and reproductive components was assessed using the pretested semistructured questionnaire. Results: A total of 245 postmenopausal women were studied. The prevalence of postmenopausal symptoms was found to be 64%. The mean age of the study population was 50.87 years. Age, education, marital status, menopausal age, and duration of menopause were found to be significantly associated with the presence of postmenopausal symptoms. Intake of Calcium supplements was found to be having protective effect against menopausal symptoms. Binary logistic regression revealed that age, educational status, marital status, and dietary intake of calcium supplements are significantly associated with postmenopausal symptoms. Conclusion: Women with early age of menopause and less duration since menopause had more risk of having postmenopausal symptoms. The prevalence of symptoms was found to be less if calcium supplements were taken.

Idiosyncratic ambivalence: A three-dimensional interpretative model to understand the non-adhesion of women to breast and cervical cancer screening

Health programs offer screening activities for the early detection of cancer in vulnerable population, but record very low participation rates. The authors have a theoretical framework to investigate the complexity of the phenomenon, in the psychodynamic and ethical dimensions, specific to women. In this study, the authors used semi-structured interviews and interpretative phenomenological analysis to explore the meaning-making processes of women who do not practice breast and cervical cancer prevention in Southern Italy neither in the public health-care system, nor in private health facilities. Three superordinate themes have emerged: taking care of oneself would be to love oneself; difficult contact with a sexual body;at the end, the fate decides . We highlight three levels in the psychism that underlie the behavior of not doing prevention: body-> affects-> thought. Understanding these psychic level mechanisms permits to support women's health policy, reducing costs and promoting health.

Does menstrual hygiene management and water, sanitation, and hygiene predict reproductive tract infections among reproductive women in urban areas in Ethiopia?

Reproductive tract infections (RTIs) are a public health concern in Ethiopia. However, the relationship between menstrual hygiene management (MHM) and water, sanitation, and hygiene (WASH) factors to RTIs have not been well addressed. A community-based cross-sectional study was conducted from January to March 2019 among 602 systematically selected reproductive-age women aged 15-49 years in Dessie City. Data were collected using a questionnaire and a direct observation checklist. RTIs were identified by the presence during one year before data collection of one or more signs of vaginal discharge, itching/irritation or ulcers/lesions around the vulva, pain during urination and sexual intercourse, and lower abdominal pain and lower back pain. Data were analyzed using multivariable logistic regression analysis with 95%CI (confidence interval). The self-reported prevalence of RTIs was 11.0%(95%CI:8.5-13.7%) during one year prior to the survey. The most commonly reported symptoms of RTI were burning micturition (9.1%) and vaginal discharge (6.1%). Three-fourths 443(75.0%) of households used traditional pit latrines and the majority of the study participants 527(89.2%) did not meet the basic access requirement of 20 liters of water per capita per day. The majority 562(95.1%) of the study participants did not have multiple sexual partners during the last year and 97.8% did not practiced sexual intercourse during menstruation. The most common type of blood-absorbent material used was a sanitary pad 497(84.8%) followed by cloth 89(15.2%). Factors significantly associated with RTIs were using unclean latrines (AOR: 4.20; 95%CI:2.00-8.80), not washing hands with soap before touching the genital area (AOR: 3.94; 95%CI:1.49-10.45), history of symptoms of RTIs in the past year (AOR: 5.88; 95%CI:2.30-14.98), having multiple sexual partners in the past year (AOR: 4.46; 95%CI:1.59-12.53), changing absorbent material only once per day (AOR: 8.99; 95%CI:4.51-17.92), and washing the genital area only once per day during menstruation (AOR: 5.76; 95%CI:2.07-16.05). The self-reported prevalence of RTI showed that one women experienced RTI among ten reproductive-age women. Designing a women's health policy that focuses on ensuring availability of WASH facilities and improving MHM at the community level is key for sustainably preventing RTIs.

Development and validation of a claims-based measure of abortion services.

Data on abortion services are critical for monitoring trends in access and utilization, evaluating policies, and examining a wide range of research questions. Accurate and timely data, however, can be difficult to obtain for abortion services. Oregon is one of several states that use state funds to finance abortion services in their Medicaid programmes. Oregon's Medicaid programme contracts with managed care plans that receive global budgets to provide care. Abortion services, however, must be billed directly to the state through fee-for-service (FFS) billing to ensure that federal funds are not used. In this study, we identify possible abortions using Medicaid insurance claims data from Oregon and categorize identified abortions as high, medium, or low confidence according to convergent validity analysis of FFS billing. We used individually linked Medicaid eligibility and claims data from women ages 15 to 44 enrolled in Oregon's Medicaid programme from 2008 to 2013. Abortion-related Medicaid claims were identified and categorized based on diagnosis, procedure, and drug codes. These categories were assessed for convergent validity by examining FFS billing for possible abortions to women enrolled in managed care plans. In total, 23 763 possible abortions obtained by 18 518 women were classified with high (n = 21 450), medium (n = 562), and low (n = 1751) confidence. Among managed care abortions, more than 99% of high confidence abortions were billed on an FFS basis compared with 72% of medium confidence and <1% of low confidence abortions. The majority of high confidence abortions were to urban-residing (89%) white (73%) women. Research on abortion services using insurance claims has important implications for women's health care and public health policy. A high-quality claims-based measure can facilitate monitoring the provision of abortion services within health systems and evaluation of initiatives to increase equitable abortion access.

Perfil epidemiológico de gestantes/puérperas soropositivas para o HIV em uma maternidade de referência em Belém-PA

Objetivo: Descrever o perfil epidemiológico de gestantes/puérperas soropositivas para o HIV atendidas em uma maternidade pública de referência em gestação de alto risco- no município de Belém-Pará. Métodos: Trata-se de um estudo transversal, observacional de caráter descritivo com abordagem quantitativa. Realizado em uma maternidade de referência em Belém-PA. Resultados: Faixa etária predominante foi de 21 a 25 anos (48,0%), 80% se declarou de cor parda, metade é da região metropolitana de Belém e outra do interior do estado, 70% exercem atividades do lar, 48% tinham o ensino fundamental incompleto, 70% vivem em união estável, e 72% possuem renda familiar de 1 a 3 salários mínimos. Quanto aos hábitos de vida: 12% fumaram, 18 % consumiram bebidas alcóolicas e apenas 4 % usaram drogas ilícitas/injetável nesta gestação. Conclusão: Conclui-se que o perfil das gestantes puérperas soropositivas se assemelha com os descritos na literatura, por vezes existindo peculiaridades da nossa região. Necessidade de ampliação do diagnóstico de infecção para todas as mulheres jovens, de acordo com as políticas de saúde da mulher.

Continuing Streams of Policy Consciousness to Advance Global Health

Continuing Streams of Policy Consciousness to Advance Global Health

Foundations for the development and implementation of a women's and perinatal health information model for management in Latin AmericaFundamentos do desenvolvimento e implementação de um modelo de informação em saúde da materna e perinatal orientado à gestão na América Latina

RESUMENObjetivoEl Sistema Informático Perinatal (SIP) ha marcado un hito en el uso de información sistematizada en la Región de las Américas. Lo que se ha aprendido ha contribuido al desarrollo de un modelo basado en un conjunto mínimo de indicadores (CMI). El objetivo del estudio fue describir el proceso histórico y metodológico de desarrollo, implementación y escalamiento territorial de un CMI para monitorizar y evaluar políticas, programas y servicios de salud de la mujer y perinatal orientado a la gestión (SIP-GESTIÓN).MétodosEl estudio se llevó a cabo en dos etapas: 1) validación en cuatro fases de un CMI en una red de hospitales: a) construcción del modelo teórico de indicadores, b) implementación de la investigación operativa, c) selección final de indicadores, y d) definición de patrones de referencia, y 2) escalamiento territorial.ResultadosSe identificaron 17 modelos de indicadores. El modelo inicial incluyó 177 indicadores agrupados en siete dimensiones (contexto, hábitos, accesibilidad, uso de servicios, calidad de cuidados, impacto materno-fetal, e impacto materno-neonatal) que se redujeron a 21 tras tres rondas Delphi. El modelo final (SIP-GESTIÓN) incluyó 40 indicadores. Se analizaron 240 021 partos (79,1%) de un total de 303 559 atendidos en las 122 maternidades seleccionadas en 24 Jurisdicciones (100%) de Argentina. La información se presenta a nivel nacional y desagregada por región sanitaria, provincia y hospital.ConclusionesEste modelo permitió alcanzar altos niveles de cobertura y calidad de la información y escalamiento territorial y es útil para la gestión, la investigación y la reorientación de programas y políticas.

Exposure to intimate partner violence and malnutrition among young adult Bangladeshi women: cross-sectional study of a nationally representative sample.

This study explores the relationship between malnutrition and intimate partner violence (IPV) among 1,086 young adult Bangladeshi women aged 15-24 years using a cross-sectional data from the 2007 Bangladesh Demographic Health Survey (BDHS). About one-third (33.4%) young adult women experienced physical and/or sexual IPV, 14.5% experienced only sexual IPV and 29% experienced only physical IPV by husbands. About 32.6% young adult women were reported as being underweight (BMI < 18.5) and 6.2% were overweight (BMI ≥ 25). Underweight women experienced more physical IPV (OR = 1.39; 95%CI: 1.09-2.71) and physical and/or sexual IPV (OR = 1.48; 95%CI: 1.12-2.75) than normal range women. Results also indicate a positive association between being overweight/obese and all the forms of IPV. The study findings indicate that the IPV experience plays a significant role in underweight and overweight/obese young adult women and support that younger women's health and nutrition program and policies need to address IPV.

American College of Physicians' Position on U.S. Women's Health Policy

Women typically live longer than men and exhibit differences in disease expression and reaction to medications; thus, women can be particularly