Health

Use of Facility Assessment Data to Improve Reproductive Health Service Delivery in the Democratic Republic of the Congo

Citation:

Casey, Sara E., Kathleen T. Mitchell, Immaculée Mulamba Amisi, Martin Migombano Haliza, Blandine Aveledi, Prince Kalenga, and Judy Austin. 2009. “Use of Facility Assessment Data to Improve Reproductive Health Service Delivery in the Democratic Republic of the Congo.” Conflict and Health 3: 12.

Authors: Sara Casey, Kathleen T. Mitchell, Immaculée Mulamba Amisi, Martin Migombano Haliza, Blandine Aveledi, Prince Kalenga, Judy Austin

Abstract:

Background:

Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).

Methods:

Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities.

Results:

None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC.

Conclusions:

Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2009

Female Solider’s Gynecological Healthcare in Operation Iraqi Freedom

Citation:

Nielsen, Peter. 2009. “Female Solider’s Gynecological Healthcare in Operation Iraqi Freedom.” Military Medicine 174 (11): 1172–6.

Author: Peter Nielsen

Abstract:

OBJECTIVE: To describe female soldiers' predeployment gynecologic healthcare screening, common symptoms, and availability of gynecologic care during Operation Iraqi Freedom.

METHODS: A questionnaire distributed to U.S. military females presenting to outpatient facilities in level 3 echelon of care between August 2005 and March 2006.

RESULTS: Three-hundred ninety seven of 401 surveys (99%) were returned. Ten percent of deployed females (40) had no cervical cytology screening 1 year before deployment and 27% of the 399 required additional treatments for abnormal cervical cytology during deployment. Thirty-five percent reported a gynecologic problem and 44% received care at their base. Irregular bleeding was the most common gynecologic problem. Forty-four percent of women used some form of hormonal contraception; however, 43% changed methods because of unavailability. One-third of soldiers received pre-deployment menses regulation counseling, with 48% of those using continuous oral contraceptive pills for cycle control.

CONCLUSION: Gaps remain in predeployment gynecologic screening and counseling. These critical predeployment medical evaluations must remain a priority for all female soldiers to ensure unit readiness.

Topics: Combatants, Female Combatants, Gender, Women, Health, Reproductive Health Regions: Americas, North America Countries: United States of America

Year: 2009

The Unequal Burden of War: The Effect of Armed Conflict on the Gender Gap in Life Expectancy

Citation:

Plumper, Thomas, and Eric Neumayer. 2006. “The Unequal Burden of War: The Effect of Armed Conflict on the Gender Gap in Life Expectancy.” International Organization 60: 723–54.

Authors: Thomas Plumper, Eric Neumayer

Abstract:

Globally, the consequences of wars are drastic as they are coupled with social, economic and political instability. It is well known to all of us today that thousands of civilians are faced with horrendous physical, mental and psychological pains, and some die from the consequences of the wars that are being fought amidst villages, towns and homes. The violence between the warring faction has not only affected human beings, but has completely destroyed the infrastructure, leaving the population in ill hygienic conditions with no social services to address their plight. The history of impunity that has not been checked by most of our leaders has made the rule of the gun become one of the methods of clinging or/and coming to power. The increasing costs incurred to sustain these cycles of conflict has resulted to decrease in economic production and hence, cutting down on social service budgets. The most affected sector particularly in Africa has been the health sector. This paper is drawn from the experiences of women in situations of armed conflict, as documented by Isis-WICCE, an international women’s organisation that exist to promote women’s human rights by recording and exposing the atrocities committed to women. In addition, Isis-WICCE carries out annual institutes, where women human rights activists from networks worldwide, are facilitated to have adequate skills to record their own stories for advocacy and accountability to women’s human right.

Topics: Armed Conflict, Gender, Women, Health, Rights, Human Rights, Women's Rights

Year: 2006

Prolonged Grief Disorder and Depression in Widows due to the Rwandan Genocide

Citation:

Schaal, Susanne, Thomas Elbert, and Frank Neuner. 2009. “Prolonged Grief Disorder and Depression in Widows due to the Rwandan Genocide.” Omega 59 (3): 203–19.

Authors: Susanne Schaal, Thomas Elbert, Frank Neuner

Abstract:

Should pathological grief be viewed as a nosological category, separate from other forms of mental diseases? Diagnostic criteria for "Prolonged Grief Disorder" (PGD) have recently been specified by Prigerson and her coworkers. We interviewed a total of 40 widows who had lost their husbands during the Rwandan genocide in 1994. We assessed Major Depression using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and prolonged grief reactions with the PG-13. In order to examine the distinctiveness of the two syndromes we performed a multitrait correlational matrix analysis using modified versions of Generalized Proximity Functions (GPFs). 12.5% (n = 5) of the sample fulfilled the criteria for a diagnosis of PGD; 40% (n = 16) met criteria for Major Depressive Episode. The two syndromes were strongly associated. No discriminant validity was found between the two constructs suggesting that PGD may rather be an appearance of depression than a separate nosological entity.

Topics: Gender, Women, Genocide, Health, Mental Health, Trauma Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2009

A New Generation of Women Veterans: Stressors Faced by Women Deployed to Iraq and Afghanistan

Citation:

Street, Amy, Dawne Vogt, and Lissa Dutra. 2009. “A New Generation of Women Veterans: Stressors Faced by Women Deployed to Iraq and Afghanistan.” Clinical Psychological Review 29 (8): 685–94.

Authors: Amy Street, Dawne Vogt, Lissa Dutra

Abstract:

The extent of female service members' involvement in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), in terms of both the number of women deployed and the scope of their involvement, is unprecedented. While many of the mental health readjustment issues of female service members are likely to mirror those of the majority male Veteran population, this newest generation of women Veterans may also face unique threats to their mental health. The goal of this review it to highlight emerging issues relevant to the development of posttraumatic stress disorder (PTSD) among women deployed to Iraq and Afghanistan by reviewing the existing literature on gender-relevant issues among this cohort, as well as raising theoretically important issues that are worthy of further empirical investigation. Topics addressed include gender differences in combat experiences and in PTSD following combat exposure; sexual assault, sexual harassment and other interpersonal stressors experienced during deployment; women Veterans' experiences of premilitary trauma exposure; and unique stressors faced by women Veterans during the homecoming readjustment period. Given that most models of the impact of war zone deployment on PTSD are predicated on the experiences of male service members, women's expanding role in combat operations presents both an opportunity and a challenge to adapt these models to more effectively capture the experiences of female service members.

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, Mental Health, PTSD, Trauma, Military Forces & Armed Groups, Militaries, Post-Conflict, Sexual Violence Regions: Americas, North America Countries: United States of America

Year: 2009

The Gendering of Human Rights: Women and the Latin American Terrorist State

Citation:

Hollander, Nancy Caro. 1996. “The Gendering of Human Rights: Women and the Latin American Terrorist State.” Feminist Studies 22 (1): 40–80.

Author: Nancy Caro Hollander

Topics: Gender, Women, Governance, Health, Trauma, Military Forces & Armed Groups, Militaries, Militarization, Rights, Human Rights, Sexual Violence, Rape, SV against Women, Terrorism Regions: Americas, Central America, South America Countries: Argentina, Chile, El Salvador, Guatemala

Year: 1996

Congo Ceasefire Brings Little Relief for Women

Citation:

Truscott, Amanda. 2008. “Congo Ceasefire Brings Little Relief for Women.” CMAJ: Canadian Medical Association Journal 179 (2): 133–4.

Author: Amanda Truscott

Topics: Gender, Women, Gender-Based Violence, Health, Reproductive Health, Trauma, Sexual Violence, Male Perpetrators, Rape, SV against Women Regions: Africa, Central Africa Countries: Congo-Brazzaville

Year: 2008

Observations from a Maternal and Infant Hospital in Kabul, Afghanistan - 2003

Citation:

Williams, Jennifer, and Brian McCarthy. 2005. “Observations from a Maternal and Infant Hospital in Kabul, Afghanistan - 2003.” Journal of Midwifery & Women's Health 50 (4): 31-5.

Authors: Jennifer Williams , Brian McCarthy

Abstract:

Afghanistan is believed to have one of the highest infant and maternal mortality rates in the world. As a result of decades of war and civil unrest, Afghan women and children suffer from poor access to health services, harsh living conditions, and insufficient food and micronutrient security. To address the disproportionately high infant and maternal mortality rates in Afghanistan, the US Department of Health and Human Services pledged support to establish a maternal health facility and training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected because this hospital admits approximately 36,000 patients and delivers more than 14,000 babies annually. This article reports the initial observations at Rabia Balkhi Hospital and describes factors that influenced women's access, the quality of care, and the evaluation health care services. This observational investigation examined areas of obstetric, laboratory and pharmacy, and ancillary services. The investigators concluded that profound changes were needed in the hospital's health care delivery system to make the hospital a safe and effective health care facility for Afghan women and children and an appropriate facility in which to establish an Afghan provider training program for updating obstetric skills and knowledge.

Topics: Armed Conflict, Gender, Women, Girls, Boys, Health, Reproductive Health Regions: Asia, South Asia Countries: Afghanistan

Year: 2005

Safe Abortion: A Right for Refugees?

Citation:

Lehmann, Aimee. 2002. “Safe Abortion: A Right for Refugees?” Reproductive Health Matters 10 (19): 151–5.

Author: Aimee Lehmann

Abstract:

Thanks to initiatives since 1994, most reproductive health programmes for refugee women now include family planning and safe delivery care. Emergency contraception and post-abortion care for complications of unsafe abortion are recommended, but provision of these services has lagged behind, while services for women who wish to terminate an unwanted pregnancy are almost non-existent. Given conditions in refugee settings, including high levels of sexual violence, unwanted pregnancies are of particular concern. Yet the extent of need for abortion services among refugee women remains undocumented. UNFPA estimates that 25-50% of maternal deaths in refugee settings are due to complications of unsafe abortion. Barriers to providing abortion services may include internal and external political pressure, legal restrictions, or the religious affiliation of service providers. Women too may be pressured to continue pregnancies and are often unable to express their needs or assert their rights. Abortion advocacy efforts should highlight the specific needs of refugee women and encourage provision of services where abortion is legally indicated, especially in cases of rape or incest, and risk to a woman's physical and mental health. Implementation of existing guidelines on reducing the occurrence and consequences of sexual violence in refugee settings is also important. Including refugee women in international campaigns for expanded access to safe abortion is critical in addressing the specific needs of this population.

Topics: Displacement & Migration, Refugees, Gender, Women, Health, Reproductive Health

Year: 2002

Growing up in Guerrilla Camps: The Long-Term Impact of Being a Child Soldier in El Salvador’s Civil War

Citation:

Dickson-Gómez, Julia. 2002. “Growing up in Guerrilla Camps: The Long-Term Impact of Being a Child Soldier in El Salvador’s Civil War.” Ethos 30 (4): 327–56.

Author: Julia Dickson-Gómez

Abstract:

Many recent wars are characterized by high levels of civilian casualties, a large proportion of whom are women and children. Furthermore, an estimated 300,000 children are actively participating in 36 ongoing or recently ended conflicts around the world. However, there is a dearth of reseearch on the long-term effects of war trauma experienced in childhood or children's active participation in armed conflicts. This article explores the long-term effectives of children's active participation in the war in El Salvador by examining four young adults who fought with the guerrilla army as children and adolescents. Comparing these four cases with member of the community who joined and fought with the guerrilla as adults, it will be argued that traumatic experiences were even more devestating when they occurred in early childhood as they destroyed the ability to establish basic trust in competent and nurturing caretakers. Becoming a soldier created additional conflicts as these adolescent soldiers behaved in ways they felt were morally incorrect. Adolescent soldiers were also not given the opportunity to develop autonomy and learn adult peace-time roles. Both the psychological trauma suffered as children as well as continued economic scarcity and violence contribute to these campesinos' difficulties in creating meaningful lives as adults.

Topics: Age, Youth, Armed Conflict, Civil Wars, Combatants, Child Soldiers, Gender, Girls, Boys, Health, Mental Health, Trauma, Military Forces & Armed Groups, Non-State Armed Groups Regions: Americas, Central America Countries: El Salvador

Year: 2002

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