Health

Citation:

Van Egmond, Kathia, Marleen Bosmans, Ahmad Jan Naeem, Patricia Claeys, Hans Verstraelen, and Marleen Temmerman. 2004. “Reproductive Health in Afghanistan: Results of a Knowledge, Attitudes and Practices Survey Among Afghan Women in Kabul.” Disasters 28 (3): 269–82. doi:10.1111/j.0361-3666.2004.00258.x.

Authors: Kathia Van Egmond, Marleen Bosmans, Ahmad Jan Naeem, Patricia Claeys, Hans Verstraelen, Marleen Temmerman

Abstract:

A reproductive-health knowledge, attitudes and practices (KAP) survey was carried out among 468 Afghan women of reproductive age. A convenience sample of women was selected from attendees in the outpatient departments of four health facilities in Kabul. Seventy-nine per cent of respondents had attended at least one antenatal consultation during their last pregnancy. Two-thirds (67 per cent) delivered their first child between 13 and 19 years. The Caesarean-section rate was low (1.6 per cent). Two-thirds (67 per cent) of deliveries occurred in the home. The contraceptive prevalence rate was 23 per cent (16 per cent modern and 7 per cent natural methods). Twenty-four per cent had knowledge of any STIs, although most of these women did not know correctly how to prevent them. Most of the women (93 per cent) needed authorization from their husband or a male relative before seeking professional health-care. In multivariate analysis, women's schooling was significantly associated with antenatal-care attendance (AOR 4.78), institutional delivery (AOR 2.29), skilled attendance at birth (AOR 2.07) and use of family planning (AOR 4.59). Reproductive-health indicators were noted to be poor even among these women living in Kabul, a group often considered to be the most privileged. To meet the reproductive-health needs of Afghan women, the socio-cultural aspects of their situation--especially their decision-making abilities -- will need to be addressed. A long-standing commitment from agencies and donors is required, in which the education of women should be placed as a cornerstone of the reconstruction process of Afghanistan.

Topics: Gender, Women, Health, Reproductive Health Regions: Asia, South Asia Countries: Afghanistan

Year: 2004

Citation:

Hyman, Batya. 2000. “The Economic Consequences of Child Sexual Abuse for Adult Lesbian Women.” Journal of Marriage and Family 62 (1): 199–211.

Author: Batya Hyman

Abstract:

This study is designed to extend the investigation of the long-term consequences of child sexual abuse (CSA) into the workplace and to consider the effects on the economic welfare of 1,925 lesbian women from the National Lesbian Health Care Survey. It seeks to develop a two-stage, least-squares model that considers simultaneously the effects of child sexual abuse on four spheres of a woman's life--her physical health, mental health, educational attainment, and economic welfare; and to investigate the differential impacts of diverse forms of child sexual abuse on the adult woman's functioning. The CSA survivors experienced adverse health and mental health consequences. The type of CSA experienced was also a significant predictor of a woman's educational attainment and annual earnings.

Topics: Economies, Women, Health, Mental Health, Trauma, LGBTQ, Livelihoods, Sexual Violence, Sexual Exploitation and Abuse

Year: 2000

Citation:

Warner, Faith R. 2007. “Social Support and Distress Among Q’eqchi’ Refugee Women in Maya Tecun, Mexico.” Medical Anthropology Quarterly 21 (2): 193–217.

Author: Faith R. Warner

Abstract:

This article addresses issues of vulnerability and distress through an analysis of the relationship between social support networks and traumatic stress in a Q'eqchi' refugee community in southern Mexico. The sociopolitical violence, forced displacement, and encampment of Guatemalan Mayan populations resulted in the breakdown and dispersal of kin and community groups, leaving many Q'eqchi' women with weakened social support networks. Research involving testimonial interviews and traumatic stress and social support questionnaires revealed that Q'eqchi' refugee women with weak natal kin social support networks reported greater feelings of distress and symptoms of traumatic stress than did women with strong networks. In particular, a condition identified as muchkej emerged as one of the most significant symptoms reported by women with weak natal kin support networks. I critically consider muchkej as an idiom of distress and argue that aid organizations should consider the relationship between social support and traumatic stress, as expressed through such idioms, when attempting to identify vulnerable members of a refugee population.

Topics: Displacement & Migration, IDPs, Refugee/IDP Camps, Gender, Women, Health, Mental Health, Violence Regions: Americas, North America Countries: Mexico

Year: 2007

Citation:

Caprioli, Mary. 2003. “Gender Equality and Civil Wars.” CPR Working Paper No. 8, Social Development Department, Environmentally and Socially Sustainable Development Network, World Bank, Washington, DC.

Author: Mary Caprioli

Abstract:

The research and paper on Gender Equality and Civil Wars was commissioned by the CPR Unit. It is part of an ongoing effort by the Unit to encourage original research on issues of gender and conflict, raise awareness inside the World Bank on what up to now has been a generally neglected dimension—both the conflict dimensions of gender and development, and the gender aspects conflict and development—and gradually contribute to improve the way we think about and address gender and its complex linkages with the causes and effects of violent conflict. Other elements of this effort currently under way include a comprehensive literature review on gender and conflict, a stocktaking of how the Bank has approached gender in conflict-affected countries, and an analysis of international experiences and conceptual framework to help us think about young men at risk and their deadly interplay with violence, conflict and other risky behavior such as HIV/AIDS transmission.

Topics: Armed Conflict, Civil Wars, Gender, Gendered Power Relations, Gender Equality/Inequality, Health, HIV/AIDS

Year: 2003

Citation:

Bosmans, Marleen, Dina Nasser, Umaiyeh Khammash, Patricia Claeys, and Marleen Temmerman. 2008. “Palestinian Women’s Sexual and Reproductive Health Rights in a Longstanding Humanitarian Crisis.” Reproductive Health Matters 16 (31): 103–11. doi:10.1016/S0968-8080(08)31343-3.

Authors: Marleen Bosmans, Dina Nasser, Umaiyeh Khammash, Patricia Claeys, Marleen Temmerman

Abstract:

This paper results from a study conducted in the Occupied Palestinian Territory in September 2002 to test the usefulness of a guide for a comprehensive approach to sexual and reproductive health rights and needs of refugee women. In-depth interviews with key informants from 19 organisations and two focus group discussions were carried out in the West Bank and Gaza. Three refugee camps were visited as well as five health facilities. The findings revealed that severe restrictions on mobility had reduced access to health facilities for both staff and patients in a significant way. For pregnant women, this had resulted in decreased access to antenatal and post-natal care and an increasing number of home deliveries, induced deliveries and deliveries at military checkpoints. Lack of donor interest and withdrawal of donor support were mentioned as hampering the implementation of the National Reproductive Health Guidelines, and the sustainability and quality of existing sexual and reproductive health services. Family planning had become a politically sensitive issue, and there were indications of increased gender-based violence. Lack of access to reproductive health services was the most visible aspect of the impact of the conflict on women's sexual and reproductive health. Little attention is paid to the less visible evidence that women's reproductive rights have been subordinated to the political situation.

Topics: Displacement & Migration, Refugees, Gender, Women, Gender-Based Violence, Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2008

Citation:

Hadi, A., T. Rahman, D. Khuram, J. Ahmed, and A. Alam. 2007. “Raising Institutional Delivery in War-Torn Communities: Experience of BRAC in Afghanistan.” Asia Pacific Family Medicine 6: 1–9.

Authors: A. Hadi , T. Rahman, D. Khuram, J. Ahmed, A. Alam

Abstract:

Aims: Although reproductive health services have been expanded in rural communities in Afghanistan in the last several years, no systematic attempt has been made to assess their contribution to promote safe delivery. This study assesses the effects of the Bangladesh Rural Advancement Committee (a non-government organisation) health programme in raising institutional delivery in post-conflict traditional communities in Afghanistan.

Methods: Data for this study came from two surveys conducted by Management Science of Health/United States Agency of International Development in 2004 and 2006 in the district of Paghman in Kabul province. A total of 180 randomly selected married women who gave birth in the last 2 years preceding the survey were interviewed.

Results: Findings reveal that institutional delivery in rural communities has been increasing even in post-conflict poor rural communities. The use of services was much higher if antenatal care was provided by midwives and physicians. Intensive community mobilization, provision of free services and transport facilities at night, incentives to health providers, maintaining privacy in the delivery room and the quality of services were the key factors in raising the number of institutional deliveries.

Conclusions: The provisions of free services and incentives for health providers worked well in raising the frequency institutional delivery. Given that Afghan communities are sparsely distributed in the countryside and largely inaccessible by most modern transport, the expansion of this approach to provide institutional delivery may not be feasible at this stage. This study argues for the promotion of new approaches to maternal health by testing the cost-effective intervention models. The study concludes that an integrated approach to address health services can significantly improve access to and the utilization of institutional delivery among poor and disadvantaged communities in Afghanistan.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health, International Organizations Regions: Asia, South Asia Countries: Afghanistan

Year: 2007

Citation:

Skokić, Fahrija, Selma Muratović, and Gordana Radoja. 2006. “Perinatal and Maternal Outcomes in Tuzla Canton during 1992-1995 War in Bosnia and Herzegovina.” Croatian Medical Journal 47 (5): 714–21.

Authors: Fahrija Skokić, Selma Muratović, Gordana Radoja

Abstract:

Aim: To compare perinatal and maternal outcomes in Tuzla Canton during the 1992-1995 war in Bosnia and Herzegovina with those before (1988-1991) and after (2000-2003) the war.

Methods: We retrospectively collected data on a total of 59 707 liveborn infants and their mothers from the databases of Tuzla University Department for Gynecology and Obstetrics and Tuzla Institute for Public Health. Data on the number of live births, stillbirths, early neonatal deaths, causes of death, gestational age, and birth weights were collected. We also collected data on the number of medically unattended deliveries, examinations during pregnancy, preterm deliveries, and causes of maternal deaths. Perinatal and maternal outcomes were determined for each study period.

Results: There were 23 194 live births in the prewar, 18 302 in the war, and 18 211 in the postwar period. Prewar perinatal mortality of 23.3 per 1000 live births increased to 25.8 per 1000 live births during the war (P<0.001), due to a significant increase in early neonatal mortality (10.3‰ before vs 15.1‰ after the war,P<0.001). After the war, both perinatal mortality (14.4‰) and early neonatal mortality (6.6‰) decreased (P<0.001 for both). The most frequent cause of early neonatal death during the war was prematurity (55.7%), with newborns most often dying within the first 24 hours after birth. During the war, there were more newborns with low birth weight (<2500 g), while term newborns had lower average body weight. Women underwent 2.4 examinations during pregnancy (5.4 before and 6.3 after the war, P<0.001 for both) and 75.9% had delivery attended by a health care professional (99.1% before and 99.8% after the war; P<0.001 for both). Maternal mortality rate of 65 per 100 000 deliveries during the war was significantly higher than that before (39 per 100 000 deliveries) and after (12 per 100 000 deliveries) the war (P<0.001 for both).

Conclusion: Perinatal and maternal mortality in Tuzla Canton were significantly higher during the war, mainly due to lower adequacy and accessibility of perinatal and maternal health care.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health Regions: Europe, Balkans, Eastern Europe Countries: Bosnia & Herzegovina

Year: 2006

Relevant Links: http://www.cmj.hr/default.aspx?id=26

Citation:

Epstein, Helen. 2006. "The Underground Economy of AIDS." Virginia Quarterly Review 82 (1): 53-63. 

Author: Helena Epstein

Abstract:

This article recounts the author's experience in Harare, Zimbabwe to observe the social and economic conditions of the women there and its relation to the spread of AIDS. It presents information on Shaping the Health of Adolescents in Zimbabwe program designed by University of California student Megan Dunbar. It describes the financial and social conditions of the women in the area. It emphasizes the significance of sex to a poor country.

Topics: Economies, Poverty, Gender, Women, Girls, Health, HIV/AIDS, Livelihoods Regions: Africa, Southern Africa Countries: Zimbabwe

Year: 2006

Citation:

Anema, Aranka, Michel R Joffres, Edward Mills, and Paul B. Spiegel. 2008. “Widespread Rape Does Not Directly Appear to Increase the Overall HIV Prevalence in Conflict-Affected Countries: So Now What?” Emerging Themes in Epidemiology 5 (1): 1–7. doi:10.1186/1742-7622-5-11.

Authors: Aranka Anema, Michel R Joffres, Edward Mills, Paul B. Spiegel

Abstract:

Sub-Saharan Africa (SSA) is severely affected by HIV/AIDS and conflict. Sexual violence as a weapon of war has been associated with concerns about heightened HIV incidence among women. Widespread rape by combatants has been documented in Burundi, Sierra Leone, Rwanda, Democratic Republic of Congo, Liberia, Sudan and Uganda. To examine the assertion that widespread rape may not directly increase HIV prevalence at the population level, we built a model to determine the potential impact of varying scenarios of widespread rape on HIV prevalence in the above seven African countries.

Topics: Armed Conflict, Gender, Women, Health, HIV/AIDS, Post-Conflict, Sexual Violence, Rape Regions: Africa, Central Africa, East Africa, West Africa Countries: Burundi, Democratic Republic of the Congo, Liberia, Rwanda, Sierra Leone, Sudan, Uganda

Year: 2008

Citation:

Doyle, P., N. Maconochie, and M. Ryan. 2006. “Reproductive Health of Gulf War Veterans.” Philosophical Transactions of the Royal Society of London B: Biological Sciences 361 (1468): 571–84.

Authors: P. Doyle, N. Maconochie, M. Ryan

Abstract:

In this review we summarize the scientific literature on reproductive health following deployment to the first Gulf war by armed service personnel. All the studies examined had methodological limitations, making interpretation difficult. Nonetheless we conclude that for male veterans there is no strong or consistent evidence to date for an effect of service in the first Gulf war on the risk of major, clearly defined, birth defects or stillbirth in offspring conceived after deployment. Effects on specific rare defects cannot be excluded at this stage since none of the studies had the statistical power to examine them. For miscarriage and infertility, there is some evidence of small increased risks associated with service, but the role of bias is likely to be strong. For female veterans, there is insufficient information to make robust conclusions, although the weight of evidence to date does not indicate any major problem associated specifically with deployment to the Gulf. None of the studies have been able to examine risk according particular exposures, and so possible associations with specific exposures for smaller groups of exposed veterans cannot be excluded. We suggest that the way forward to address the question of veterans' reproductive health with confidence in the future is prospective surveillance following deployment. Anything less will result in further problems of interpretation and continued anxiety for parents, as well as prospective parents, in the armed forces.

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, Reproductive Health, Military Forces & Armed Groups, Militaries

Year: 2006