Health Care Services For Women Research Articles

(092) Mental and Sexual Health Outcomes Associated with Female Genital Mutilation/Cutting in Africa: A Systematic Narrative Synthesis

Abstract Introduction There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. Objective This study's objective was to collate evidence on mental and sexual health outcomes associated with female genital mutilation/cutting in Sub-Saharan Africa Methods The study employed a scoping review and narrative synthesis approach and conducted a systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Results Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. Conclusions The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Amref International University and Aga Khan University Hospital.

Health care for women during pregnancy, childbirth and the postpartum period as well as for newborns financed from public funds

Purpose – the aim of the article is to describe health care services for women during pregnancy, childbirth and the postpartum period, including newborn care, provided in the period 2017–2021.Method – the analyses included data from the Council of Ministers’ reports on the implementation and effects of the application of the Act on Family Planning, Protection of the Human Foetus and Conditions for Termination of Pregnancy, as well as demographic data published by the Statistics Poland.Results – it was shown that in the period 2017– 2021, the number of women who received the service specified in the advice given during pregnancy decreased. However, the share of births registered as coordinated care for pregnant women I (KOC I) [pl. Koordynowana Opieka nad Ciężarną] in the total number of births increased, although ultimately they constituted a small percentage of the number of births in the country. Births carried out as KOC II/III had a higher and growing share in the number of births each year. The number of patients receiving coordinated children's care, perinatal palliative care services, and the number of pregnant participants in the Prenatal Testing Program also increased. At the same time, access to the above-mentioned services depended on the place of residence of the potential patient, since relevant service providers were available only in some voivodships, or, as in the Prenatal Testing Program, obtaining the service depended on meeting strict conditions.Conclusion – it is necessary to increase the availability of the analysed services by introducing service providers in voivodeships where they are lacking. It is also necessary to enable all interested pregnant women to participate in the Prenatal Testing Program without having to meet additional conditions.

Provider-Reported Barriers in Sexual Health Care Services for Women With Upstream Barriers: The Case of Syphilis and Congenital Syphilis in Southern Colorado, 2022.

Syphilis and congenital syphilis rates have increased sharply in Colorado in the past 5 years. Congenital syphilis is passed during pregnancy in utero and can cause lifelong physical, developmental, and neurologic problems for the child, or can lead to miscarriage, stillbirth, or early infant death. Congenital syphilis is easily prevented if the mother receives timely testing, treatment, and prenatal care. Providers can play a key role in preventing congenital syphilis for women with social vulnerabilities, who have a higher likelihood of syphilis and/or congenital syphilis infection. We surveyed 23 and interviewed 4 health care providers in southern Colorado in 2022 to record their experiences in providing sexual health care services. We asked providers with direct care experience about perceived barriers in effectively treating syphilis. The most significant barriers reported in the survey were the cost of treatment (26%) and the loss to follow-up (22%). Interviews revealed further challenges, including discretionary testing procedures, delays in screening results, treatment referral issues, and stigma around substance use and sexual activity. Elevated syphilis and congenital syphilis rates pose significant public health challenges. Coordinated interventions are necessary to effectively reduce the transmission of syphilis and congenital syphilis among women with upstream barriers. Potential care solutions include expanding rapid, point-of care testing and treatment options, supporting bicillin delivery or web-based inventory systems, offering anti-stigma training for providers, offering mental and behavioral health resources at providers' clinics, and expanding partnerships with syringe access programs.

Reproductive Health Problems and Health Care Services Offered to Female Inmates of Women Jail Multan

Background: Women prisoners’ health is one of the major challenges among public health issues since the increasing incarceration rate has a direct impact on prisoners’ health status. Female prisoners often face many health issues in which most important are reproductive health problems. The prison services regarding reproductive health needs of female inmates vary in every jail. Unfortunately, in many prisons, health care services for women are still not adequate. 
 Objectives: The objectives of the study are to determine the frequency of reproductive health problems of female inmates and to assess the health care services offered to female inmates of Women Jail Multan. 
 Method: It was cross-sectional descriptive study in which 118 female inmates of reproductive age group were included. Data was collected through questionnaire which was entered in to computer using SPSS 20.0. Frequencies and percentages were calculated and data was presented in tables. Means, Standard Deviations and Correlation were calculated. ANOVA was applied to test significance and Chi-square test was applied. Level of significance was kept at p ≤ 0.05. 
 Results: Among 118 female inmates, 33.9% were 31-40 years old, 87.3% were married and 78.0% were illiterate. The length of incarceration of 42.4% female inmates was upto 12 months. 35.0% had 1-2 children and 16.5% were living in jail with their children. Majority (92.4%) had gynecological problem and 82.2% had medical problems while 11.0% had experienced sexual violence by jail staff. Only 2 females were pregnant. 100.0% female inmates had availability of lady doctor or LHV for antenatal check-up.100.0% female inmates were provided proper diet and food supplements and the quality of food was satisfactory. 
 Conclusion: Study revealed that health care services for reproductive problems including obstetric and gynecological issues was satisfactory however prevalence of gynecological issues was high. Sexual violence of female inmates faced by jail staff during imprisonment was noticed for which strict legislative measures should be taken.

Mass Media and Promotion of Women’s Health in Capital of Jharkhand

This abstract provides an overview of a comprehensive strategy to promote women's health in the capital of Jharkhand, Ranchi, through mass media. Women's health in this region faces unique challenges, including issues related to maternal health, reproductive health, nutrition, and mental health. This abstract outline a strategic plan to address these challenges effectively. The strategy begins with identifying key health issues and collaborating with local healthcare providers, NGOs, and government agencies to gather accurate information and statistics. Educational content is then developed, encompassing articles, videos, infographics, and podcasts, which are translated into local languages for accessibility. Various media channels are leveraged, including television, radio, print media, and social media, to disseminate this content. Special attention is given to community outreach, with the organization of health camps and workshops to engage directly with the local population. The strategy aims to promote healthy behaviors, challenge cultural stigmas, and advocate for policy changes that enhance women's healthcare services, Television/print media highlighting the issues of women health and seafty. Collaboration with local influencers and the empowerment of women with knowledge about their rights and healthcare options are additional components of the plan. Continuous monitoring and evaluation ensure the impact of mass media campaigns is measured, and the sustainability of these initiatives is addressed through a long-term strategy. By adopting this comprehensive approach, mass media can become a powerful tool in promoting women's health in Ranchi, Jharkhand, leading to improved healthcare awareness, behavior, and outcomes among women in the region.

THE GUIDELINE FOR MAKING NEW WOMEN ENTREPRENEUR : A CASE STUDY OF HOME HEALTH CARE SERVICES

The objectives of this research were to study the pattern of home health care services and provide the guidelines for creating new women entrepreneurs in Sansai District, Chiang Mai Province, using the Business Model Canvas. The researcher used qualitative research and used purposive sampling method. A semi-structured interview was used to collect data through in-depth interviews. The informants consisted of ten healthcare and elderly care entrepreneurs, six healthcare workers working in the hospital, five healthcare workers working in promoting hospitals, four rescue workers, and five public health officers in Sansai Chiang Mai, a total of 30 persons. The results show that home health care services for women entrepreneurs could be divided into three types: 1) nursing homes, 2) elderly transportation services, and 3) home elderly care services. In addition, the results reveal that new women entrepreneurs should understand the basic concept of business operations. It consists of the following elements for consideration: 1) Determine the service model. 2) Determine the target customers. 3) Determine the key activities. 4) Identify the key resources. 5) Finding the network. 6) Consideration of the revenue. 7) Understand the cost structure. 8) Use appropriate communication tools. 9) Maintain customer relationships.

Terrorist attacks against women's healthcare facilities 1970-2018.

Targeted acts of violence against women's healthcare facilities and healthcare providers are a continued threat to the safety and well-being of those seeking reproductive care as well as those who provide it around the world. This study aims to review and analyze terrorist attacks against facilities and providers who offer women's healthcare services globally. A thorough analysis of data coming from the Global Terrorism Database (GTD) was performed. This database is run by the National Consortium for the Study of Terrorism and Responses to Terrorism. Two hundred and seventy-one incidents registered in the GTD between 1970 and 2018 were found to be terrorist attacks on women's healthcare facilities, the majority of which occurred in the United States. The method of attack or weapons used varied greatly. While the majority of these attacks targeted facilities, a number of attacks focused on individuals, namely, healthcare providers. Facilities and providers associated with women's healthcare services, particularly reproductive health, remain at risk of terror attack. Although carried out by a variety of groups and with diverse methods, these attacks appear most prevalent, or most reported, in Western society and threaten essential reproductive healthcare.

A scoping review of Aotearoa New Zealand women's experiences of substance use, alcohol and drug services

INTRODUCTION: The experiences with healthcare services of women who use substances (WWUS)—especially when pregnant or parenting—are largely missing from research in Aotearoa. This scoping review was conducted to inform doctoral research on a new, integrated parenting and substance-use residential-treatment facility in Auckland: Te Whare Taonga. APPROACH: Two objectives of the review were to: 1) collate insights from experiences of women who use substances; and 2) synthesise strengths and weaknesses within current healthcare and alcohol or other drug (AOD) services to understand what works to support WWUS, particularly those who are pregnant or parenting. Peer-reviewed studies, grey literature, and theses published between 1992–2022 exploring the perspectives and views of WWUS and their experiences of substance use, healthcare services, and AOD-treatment providers in Aotearoa New Zealand, were scoped in multiple databases. FINDINGS: The review evidenced a need for gender-specific or gender-sensitive services that are non-stigmatising, accessible to pregnant or parenting women, and culturally appropriate. Holistic care tailored to individual need was considered important. Barriers to treatment included stigma, wait times, negative experiences of healthcare workers, and a lack of appropriate services to meet women’s needs. CONCLUSIONS: There is a lack of AOD services available to WWUS, and, subsequently, research is limited. However, the findings provide an understanding of how healthcare and treatment providers, social workers, whānau (extended family, family group, can include friends with no kinship ties), community, and funders can provide informed and empathetic support to WWUS, including those who are pregnant and parenting.

Perspectives of VA healthcare from rural women veterans not enrolled in or using VA healthcare.

Women Veterans have unique healthcare needs and often experience comorbid health conditions. Despite this, many women Veterans are not enrolled in the Veterans Health Administration (VHA) and do not use VHA services. Underutilization of VHA services may be particularly prevalent among rural women Veterans, who may experience unique barriers to using VHA care. Nonetheless, knowledge of rural women Veterans and their experiences remains limited. We sought to understand rural women Veterans' perceptions and needs related to VHA healthcare, including barriers to enrolling in and using VHA services, and perspectives on how to communicate with rural women Veterans about VHA services. Rural women Veterans were recruited through community engagement with established partners and a mass mailing to rural women Veterans not enrolled in or using VHA healthcare. Ten virtual focus groups were conducted with a total of twenty-nine rural women Veterans (27 not enrolled in VHA care and 2 who had not used VHA care in the past 5 years) in 2021. A thematic inductive analytic approach was used to analyze focus group transcripts. Primary themes regarding rural women Veterans' perceptions of barriers to enrollment and use of VHA healthcare included: (1) poor communication about eligibility and the process of enrollment; (2) belief that VHA does not offer sufficient women's healthcare services; and (3) inconvenience of accessing VHA facilities. Although VHA has substantially expanded healthcare services for women Veterans, awareness of such services and the nuances of eligibility and enrollment remains an impediment to enrolling in and using VHA healthcare among rural women Veterans. Recommended strategies include targeted communication with rural women Veterans not enrolled in VHA care to increase their awareness of the enrollment process, eligibility, and expansion of women's healthcare services. Creative strategies to address access and transportation barriers in rural locations are also needed.

What women want: A mixed-methods study of women's health priorities, preferences, and experiences in care in three Rwandan rural districts.

To explore Rwandan women's experiences, priorities, and preferences in accessing health care for non-pregnancy-related conditions and inform development of healthcare services related to these conditions among women of reproductive age at district hospitals and health centers in Rwanda. We used a mixed-methods, exploratory sequential design. Semi-structured qualitative interviews were conducted with Rwandan women and coded thematically. A cross-sectional quantitative survey based on the qualitative data was administered to women attending health centers. Seventeen interviews and 150 surveys were conducted. Women identified conditions including back pain, gynecologic cancers, and abnormal vaginal bleeding as concerns. They generally reported positive experiences while accessing health care and knowledge of accessing health care. Barriers to care were identified, including transportation costs and inability to miss work. Women expressed a desire for more control over their care and the importance of maintaining their dignity while accessing health care. These findings provide useful insights to inform development of non-pregnancy-related healthcare services for women in Rwanda according to their priorities and preferences. The reported end-user health concerns, barriers to care, and diminished control over their care point to a need to evolve health systems around user-tailored needs and design interventions optimizing access whilst promoting dignified care.

Availability of priority maternal and newborn health indicators: Cross-sectional analysis of pregnancy, childbirth and postnatal care registers from 21 countries.

Data from national health information systems are essential for routinely tracking progress, programmatic decision-making and to improve quality of services. Understanding the data elements captured in patient registers which are building blocks of national HMIS indicators, enables us to standardize data collection and measurement of key indicators for tracking progress towards achieving maternal and newborn health goals. This analysis was done through a review of antenatal care (ANC), childbirth and postnatal care (PNC) registers from 21 countries across five geographic regions. Between July and October 2020, country-based maternal and newborn experts, implementing agencies, program managers, and ministry of health personnel were asked to share the registers in use. Both paper-based and electronic registers were obtained. Twenty ANC registers, eighteen childbirth and thirteen PNC were available and analyzed. Both longitudinal and cross-sectional ANC and PNC registers were obtained, while the childbirth registers included in the analysis were all cross-sectional. Fifty-five percent (11/20) ANC registers and 54% (7/13) PNC registers were longitudinal. In four countries, the registers were electronic, while the rest were paper-based (17 countries). Sub-analysis of registers from four countries (Ghana, Kenya, Nigeria, and Zambia) where the 2017/2018 and 2019/2020 registers were available showed that the latest versions included 21/27 (78%) of data elements that are critical in the computation of key maternal and newborn care indicators. This analysis highlights some areas in where there are data gaps in data on pregnancy and childbirth. Program managers and health workers should use data gathered routinely to monitor the performance of their national health system and to guide the continuous improvement of health care services for women and newborns. The findings can help to inform the standardization of pregnancy and childbirth registers, and provide information for other countries seeking to introduce indicators in their health systems.

“It Wasn’t Until I Took the Reins and Said….” Power and Advocacy in Canadian Women’s Narratives of Polycystic Ovary Syndrome Diagnosis and Treatment*

Gaps in health-care services for women with polycystic ovary syndrome (PCOS) are not isolated incidents. They are systemic and disadvantage women. In this study, we explored the juxtaposition of power and agency in diagnosis narratives collected from 72 Canadian women diagnosed with PCOS. Using Braun and Clarke’s inductive codebook thematic analysis, three themes of power were constructed: physicians as gatekeepers, oppression as intersectional, and antagonistic provider communications, leading to emotional and cognitive impacts. Themes of agency centered on education, active resistance strategies, and collective action. Implications for these findings are discussed in relation to women’s health equity.

Women\u2019s decision-making power in a context of free reproductive healthcare and family planning in rural Burkina Faso

BackgroundIn 2016, the national user fee exemption policy for women and children under five was introduced in Burkina Faso. It covers most reproductive healthcare services for women including prenatal care, delivery, and postnatal care. In subsequent years, the policy was gradually extended to include family planning. While studies have shown that user fee abolition policies increase visits to health centers and improve access to reproductive healthcare and family planning, there are also indications that other barriers remain, notably women’s lack of decision-making power. The objective of the study is to investigate women’s decision-making power regarding access to reproductive health and family planning in a context of free healthcare in rural Burkina Faso.MethodsA descriptive qualitative study was carried out in rural areas of the Cascades and Center-West regions. Qualitative data were collected using individual semi-structured interviews (n = 20 participants) and focus groups (n = 15 participants) with Burkinabe women of childbearing age, their husbands, and key informants in the community. Data was analyzed using thematic analysis.ResultsA conceptual framework describing women’s participation in the decision-making process was built from the analysis. Results show that the user fee exemption policy contributes to improving access to reproductive care and family planning by facilitating the negotiation processes between women and their families within households. However, social norms and gender inequalities still limit women’s decision-making power.ConclusionIn light of these results, courses of action that go beyond the user fee exemption policy should be considered to improve women’s decision-making power in matters of health, particularly with regard to family planning. Interventions that involve men and community members may be necessary to challenge the social norms, which act as determinants of women’s health and empowerment.

The role of telemedicine in gynecologic healthcare: A narrative review.

This article offers a comprehensive narrative literature review on telemedicine use in gynecologic healthcare analyzing current telemedicine integration in the field and outlining innovative and best practices. Telemedicine use in contraceptive care, sexually transmitted infections, acute and chronic gynecologic conditions, and education are discussed. NPs are in a unique position to offer these services to patients in need of women's healthcare services. Barriers, facilitators, clinical implications, and future research are addressed.

Are Essential Women's Healthcare Services Fully Covered? A Comparative Analysis of Policy Documents in Shanghai and New York City from 1978-2017.

This study aimed to analyze the changes in the 10 major categories of women’s healthcare services (WHSs) in Shanghai (SH) and New York City (NYC) from 1978 to 2017, and examine the relationship between these changes and maternal mortality ratio (MMR). Content analysis of available public policy documents concerning women’s health was conducted. Two indicators were designed to represent the delivery of WHSs: The essential women’s healthcare service coverage rate (ESCR) and the assessable essential healthcare service coverage rate (AESCR). Spearman correlation was used to analyze the relationship between the two indicators and MMR. In SH, the ESCR increased from 10% to 90%, AESCR increased from 0% to 90%, and MMR decreased from 24.0/100,000 to 1.01/100,000. In NYC, the ESCR increased from 0% to 80%, the AESCR increased from 0% to 60%, and the MMR decreased from 24.7/100,000 to 21.4/100,000. The MMR significantly decreased as both indicators increased (p < 0.01). Major advances have been made in women’s healthcare in both cities, with SH having a better improvement effect. A common shortcoming for both was the lack of menopausal health service provision. The promotion of women’s health still needs to receive continuous attention from governments of SH and NYC. The experiences of the two cities showed that placing WHSs among policy priorities is effective in improving service status.

Use of Antenatal Services among Women in Farming Communities in Kogi State

This study examined the use of antenatal services among women in farming communities in Kogi State, Nigeria. A multi-stage sampling technique was employed to collect primary data from 150 randomly selected farmers through the use of structured questionnaire. The data was analysed using descriptive statistics and logit regression model. Analysis of socio-economic variable revealed that majority (73.4%) of the respondents were below the age 40 years, with a mean household size of 6 members. About 94.7% of the respondents used antenatal care services covering an average distance of 4km in getting to nearest health facility. The study also revealed that majority (92.7%) of the respondents were aware of healthcare facilities availability and they mostly got their information from family members and friends. The use of antenatal care services among women was high and majority (95.3%) of the respondents had the knowledge of where antenatal centre is located. Also majority of the respondents visited those centres in their last pregnancy with frequency of visit between 1- 4 times. Previous visits, nearness to ANC centres and formal education positively influence the use of ANC services among women in the study area. High cost of antenatal services and poor level of information were found to be the most significant challenges facing women access to antenatal care services. We recommend that government should subsidize health care services for women in order to improve their affordability.

The Focus They Deserve: Improving Women Veterans' Health Care Access.

Veterans Health Administration (VHA) initiatives aim to provide veterans timely access to quality health care. The focus of this analysis was provider and staff perspectives on women veterans' access in the context of national efforts to improve veterans' access to care. We completed 21 site visits at Veterans Health Administration medical facilities to evaluate the implementation of a national access initiative. Qualitative data collection included semistructured interviews (n=127), focus groups (n=81), and observations with local leadership, administrators, providers, and support staff across primary and specialty care services at each facility. Deductive and inductive content analysis was used to identify barriers, facilitators, and contextual factors affecting implementation of initiatives and women veterans' access. Participants identified barriers to women veterans' access and strategies used to improve access. Barriers included a limited availability of providers trained in women's health and gender-specific care services (e.g., women's specialty care), inefficient referral and coordination with community providers, and psychosocial factors (e.g., childcare). Participants also identified issues related to childcare and perceived harassment in medical facility settings as distinct access issues for women veterans. Strategies focused on increasing internal capacity to provide on-site women's comprehensive care and specialty services by streamlining provider training and credentialing, contracting providers, using telehealth, and improving access to community providers to fill gaps in women's services. Participants also highlighted efforts to improve gender-sensitive care delivery. Although some issues affect all veterans, problems with community care referrals may disproportionately affect women veterans' access owing to a necessary reliance on community care for a range of gender-specific services.

Utilization of maternal healthcare services in women experiencing spousal violence in Pakistan: A comparative analysis of 2012-13 and 2017-18 Pakistan Demographic Health Surveys.

BackgroundPakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two important indicators ‘spousal violence’ and ‘maternal health care utilization’ to improve maternal health and achieve Sustainable Development Goals (SDGs) for these nations.ObjectiveThe objective of this study is to compare the data from the latest two Demographic Health Surveys of Pakistan to identify trends in prevalence of various forms of spousal violence and maternal healthcare utilization and to determine the predictive role of spousal violence in poor maternal health.MethodsWe conducted a retrospective analysis of nationally representative data from the 2012–13 and 2017–18 PDHS. The data used in this analysis is from the domestic violence module and core women’s questionnaire. Spousal violence and sociodemographic background were predictor variables. Terminated pregnancy, number of pregnancy losses, number of antenatal visits for last birth and institutional delivery for last birth were taken as indicators of maternal health. Logistic regression analysis was conducted to test for association between maternal health indicators and various forms of spousal violence after controlling for sociodemographic variables.ResultsAlmost one quarter of women experienced physical and emotional violence as revealed by both surveys. Binary analysis revealed that all forms of spousal violence significantly associate with maternal health variables in both surveys. The comparison of results on logistic regression analysis showed that odd ratios were relatively higher for 2012–13 as compared to 2017–18 PDHS. Logistic regression analysis from 2017–18 data showed that experience of less severe physical violence (OR = 1.26; 95% CI, 1.08–1.47), severe physical violence (OR = 1.41; 95% CI, 1.09–1.83), sexual violence (OR = 1.39; 95% CI, 1.02–1.89), physical violence during pregnancy (OR = 1.37; 95% CI, 1.07–1.76) augment the risk of terminated pregnancy. Emotional violence decreases the likelihood for institutional delivery (OR = 0.64; 95% CI, 0.45–0.93) and above than four antenatal visits (OR = 0.54; 95% CI, 0.37–0.79).ConclusionsStrategies to prevent spousal violence should be at the core of maternal health programs because health sector provides a platform to challenge social norms and promote attitudes that disapprove spousal violence which are essential for promoting gender equality, women empowerment (SDG 3) and improve maternal health (SDG 5).

Building trust and enhancing localization to improve access to women’s health services in Afghanistan

Abstract Background Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care. Methods Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services. Results Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p &amp;lt; 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p &amp;lt; 0.001). Time trend and qualitative analyses is ongoing. Conclusions Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan. Key messages Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.

COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition

ABSTRACTCoronavirus disease 2019 (COVID-19) continues to ravage health and economic metrics globally, including progress in maternal and child nutrition. Although there has been focus on rising rates of childhood wasting in the short term, maternal and child undernutrition rates are also likely to increase as a consequence of COVID-19 and its impacts on poverty, coverage of essential interventions, and access to appropriate nutritious foods. Key sectors at particular risk of collapse or reduced efficiency in the wake of COVID-19 include food systems, incomes, and social protection, health care services for women and children, and services and access to clean water and sanitation. This review highlights key areas of concern for maternal and child nutrition during and in the aftermath of COVID-19 while providing strategic guidance for countries in their efforts to reduce maternal and child undernutrition. Rooted in learnings from the exemplars in Global Health's Stunting Reduction Exemplars project, we provide a set of recommendations that span investments in sectors that have sustained direct and indirect impact on nutrition. These include interventions to strengthen the food-supply chain and reducing food insecurity to assist those at immediate risk of food shortages. Other strategies could include targeted social safety net programs, payment deferrals, or tax breaks as well as suitable cash-support programs for the most vulnerable. Targeting the most marginalized households in rural populations and urban slums could be achieved through deploying community health workers and supporting women and community members. Community-led sanitation programs could be key to ensuring healthy household environments and reducing undernutrition. Additionally, several COVID-19 response measures such as contact tracing and self-isolation could also be exploited for nutrition protection. Global health and improvements in undernutrition will require governments, donors, and development partners to restrategize and reprioritize investments for the COVID-19 era, and will necessitate data-driven decision making, political will and commitment, and international unity.