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Reproductive Health

Prevalence of Anxiety and Depression among Women with Polycystic Ovary Syndrome Living in War versus Non-war Zone Countries: A Randomized Controlled Trial Assessing a Pharmacist Intervention

Citation:

Alkoudsi, Kinda T., and Iman A. Basheti. 2020. "Prevalence of Anxiety and Depression among Women with Polycystic Ovary Syndrome Living in War versus Non-war Zone Countries: A Randomized Controlled Trial Assessing a Pharmacist Intervention.Research in Social and Administrative Pharmacy 16 (5): 689-98.

Authors: Kinda T. Alkoudsi, Iman A. Basheti

Abstract:

Background: Polycystic ovary syndrome (PCOS) is a serious health problem. In women experiencing PCOS, there are myriad physical and mental health consequences; anxiety/depression are commonly associated with this condition. Community pharmacists are in a pivotal position to identify and help women diagnosed with PCOS. Objectives: To investigate the prevalence/severity of anxiety/depression among females diagnosed with PCOS living in Syria (a war-zone country) and Jordan (a non-war zone country). Secondly, to evaluate the impact of a pharmaceutical care service delivered by a clinical pharmacist on participants’ anxiety/depression severity. 
 
Methods: Females, diagnosed with PCOS above the age of 16, were recruited into the study and randomly allocated into either the active or the control group. The active group participants received a PCOS pharmaceutical care service. This service involved the provision of verbal and written educational materials, with a special focus on diet and exercise. The control group participants received only standard counseling. Both groups were followed up for four months. All participants completed the Beck Anxiety Inventory and the Beck Depression Inventory at baseline and follow-up. 
 
Results: Data from study participants (n = 118) from both Syria (n = 60) and Jordan (n = 58) highlighted a high prevalence of anxiety (Syria = 95% vs. Jordan = 98%) and depression (Syria = 83% vs. Jordan = 65%). At follow-up, active group participants, from both countries, showed significant improvements in anxiety and depression mean scores (anxiety: Syria = 34.97 ± 14.8 vs. 30.47 ± 14.3, p < 0.001; Jordan = 26.93 ± 13.7 vs. 23.37 ± 15.2, p < 0.001; depression: Syria = 26.53 ± 12.6 vs. 22.93 ± 12.2, p < 0.001; Jordan = 17.70 ± 11.0 vs. 15.76 ± 11.1, p = 0.049). No significant improvements were evident for control group participants from either countries. 
 
Conclusion: Prevalence of anxiety/depression for females with PCOS living in Syria and in Jordan is high and calls for special attention by healthcare specialists and policymakers in both countries. Females, who received the PCOS pharmaceutical care service, showed significant improvements in anxiety/depression scores. Improvements were similar in both countries.

Keywords: polycystic ovary syndrome, war, anxiety, depression

Topics: Armed Conflict, Civil Wars, Gender, Women, Health, Mental Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Jordan, Syria

Year: 2020

Factors Associated with the Use of Maternal Health Services by Mothers in a Post-Conflict Area of Western Côte d'Ivoire in 2016

Citation:

Samba, Mamadou, Akissi Régine Attia-Konan, Abou Dramane Sangaré, Gotré Jules Youan, Luc Philippe Kouadio, and Ramata Bakayoko-Ly. 2020. "Factors Associated with the Use of Maternal Health Services by Mothers in a Post-Conflict Area of Western Côte d'Ivoire in 2016." BMC Health Services Research 20.

Authors: Mamadou Samba, Akissi Régine Attia-Konan, Abou Dramane Sangaré, Gotré Jules Youan, Luc Philippe Kouadio, Ramata Bakayoko-Ly

Abstract:

Background: In Côte d’Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d’Ivoire. 
 
Methods: We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted. 
 
Results: The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI95% = 1.4–7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI95% = 1.5–6.1). 
 
Conclusion: Improving the use of maternal health services in western Côte d’Ivoire requires taking into account women’s socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.

Keywords: determinants, Côte d'Ivoire, maternal health services, Accessibility

Topics: Gender, Women, Health, Reproductive Health, Post-Conflict Regions: Africa, West Africa Countries: Côte D'Ivoire

Year: 2020

Health in Conflict and Post-Conflict Settings: Reproductive, Maternal and Child Health in Colombia

Citation:

Jaraba, Sara Milena Ramos, Natalia Quiceno Toro, María Ochoa Sierra, Laura Ruiz Sánchez, Marlly Andrea García Jiménez, Mary Y. Salazar-Barrientos, Edison Bedoya Bedoya, Gladis Adriana Vélez Álvarez, Ana Langer, Jewel Gausman, and Isabel C. Garcés-Palacio. 2020. "Health in Conflict and Post-Conflict Settings: Reproductive, Maternal and Child Health in Colombia." Conflict and Health 14.

Authors: Sara Milena Ramos Jaraba, Natalia Quiceno Toro, María Ochoa Sierra, Laura Ruiz Sánchez, Marlly Andrea García Jiménez, Mary Y. Salazar-Barrientos, Edison Bedoya Bedoya, Gladis Adriana Vélez Álvarez, Ana Langer, Jewel Gausman, Isabel C. Garcés-Palacio

Abstract:

Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. 
 
Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. 
 
Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998–2004, 2005–2011 and 2012–2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998–2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. 
 
Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

Topics: Armed Conflict, Conflict, Gender, Women, Health, Reproductive Health, International Organizations, NGOs, Post-Conflict Regions: Americas, South America Countries: Colombia

Year: 2020

Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo

Citation:

Altare, Chiara, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, and Paul Spiegel. 2020. "Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo." Conflict and Health 14.

Authors: Chiara Altare, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, Paul Spiegel

Abstract:

Background: Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women’s and children’s health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. 
 
Methods: We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. 
 
Results: Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers’ regular payment, medicaments’ availability and facilities’ running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. 
 
Conclusions: Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.

Keywords: health services, health system, conflict, population displacement, North Kivu, South Kivu, Democratic Republic of Congo, maternal, newborn, child, reproductive health

Topics: Age, Youth, Conflict, Gender, Women, Girls, Boys, Health, Reproductive Health, International Organizations, NGOs, Sustainable Development Goals (SDGs) Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2020

Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics from Refugee, Conflict-Affected, and Australian-Born Backgrounds

Citation:

Rees, Susan J., Jane R. Fisher, Zachary Steel, Mohammed Mohsin, Nawal Nadar, Batool Moussa, Fatima Hassoun, Mariam Yousif, Yalini Krishna, Batoul Khalil, Jok Mugo, Alvin Kuowei, Louis Klein, and Derrick Silove. 2019. "Prevalence and Risk Factors of Major Depressive Disorder Among Women at Public Antenatal Clinics from Refugee, Conflict-Affected, and Australian-Born Backgrounds." JAMA Network Open 2 (5).

Authors: Susan J. Rees, Jane R. Fisher, Zachary Steel, Mohammed Mohsin, Nawal Nadar, Batool Moussa, Fatima Hassoun, Mariam Yousif, Yalini Krishna, Batoul Khalil, Jok Mugo, Alvin Kouwei Tay, Louis Klein, Derrick Silove

Abstract:

Importance: Pregnancy may increase the risk of depression among women who self-identify as refugees and have resettled in high-income countries. To our knowledge, no large systematic studies among women with refugee backgrounds in the antenatal period have been conducted.

Objectives: To compare the prevalence of major depressive disorder (MDD), trauma exposure, and other psychosocial risk factors among women who identify as refugees, women from the same conflict-affected countries, and women from the host nation and to test whether self-identification as a refugee indicates greater likelihood of prevalence and risk.

Design, Setting and Participants: This cross-sectional study was undertaken in 3 public antenatal clinics in Sydney and Melbourne, Australia, between January 2015 and December 2016. Overall, 1335 women (685 consecutively enrolled from conflict-affected backgrounds and 650 randomly selected from the host nation) participated. Data analysis was undertaken between June and September 2018.

Exposures: One-hour interviews covering mental health, intimate partner violence, and other social measures.

Main Outcome and Measures: World Health Organization measure for intimate partner violence and the Mini-International Neuropsychiatric Interview from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) for MDD. To make a diagnosis, 1 of 2 items relating to being consistently depressed for 2 weeks and 3 further symptoms that cause personal distress or psychosocial dysfunction were endorsed.

Results: Overall, 1335 women (84.8% overall response rate), comprising 685 (51.3%) from conflictaffected countries (women self-identifying as refugees: 289 [42.2%]) and 650 (48.7%) from the host nation, participated. The mean (SD) age was 29.7 (5.4) years among women from conflictaffected backgrounds and 29.0 (5.5) years among women born in the host nation. Conflict-affected countries included Iraq (260 [38.0%]), Lebanon (125 [18.2%]), Sri Lanka (71 [10.4%]), and Sudan (66 [9.6%]). Women who identified as refugees reported higher exposure to 2 to 3 (67 [23.2%]) and 4 or more (19 [6.6%]) general traumatic events compared with women from the host nation (103 [15.8%] and 21 [3.2%], respectively). Women who identified as refugees also reported higher exposure to 1 (147 [50.9%]) and 2 or more (97 [33.6%]) refugee-related traumatic events compared with women from the host nation (86 [13.2%] and 20 [3.1%], respectively). Women who identified as refugees reported higher rates of psychological intimate partner violence than women born in the host nation (124 [42.9%] vs 133 [20.5%]; P < .001). Women who identified as refugees were less likely to identify 5 or more supportive family or friends compared with women born in the host nation (36 [12.5%] vs 297 [45.7%]; P < .001). A greater proportion of women who identified as refugees reported experiencing 3 or more financial stressors compared with women born in the host nation (65 [22.5%] vs 41 [6.3%]; P < .001). Women who identified as refugees had the highest prevalence of MDD (94 [32.5%]), followed by women from other conflict-affected backgrounds (78 [19.7%]), and women born in the host nation (94 [14.5%]).

Conclusion and Relevance: Women identifying as refugees reported a higher prevalence of MDD and all the indicators of adversity related to that disorder. Even after risk factors were accounted for, refugee status was associated with risk of MDD. Assessing whether women attending an antenatal clinic self-identify as refugees may offer an important indicator of risk of MDD and a range of associated psychosocial adversities.

Topics: Displacement & Migration, Refugees, Conflict, Domestic Violence, Gender, Women, Health, Mental Health, Reproductive Health, Trauma Regions: Africa, MENA, East Africa, Asia, Middle East, South Asia, Oceania Countries: Australia, Iraq, Lebanon, Sri Lanka, Sudan

Year: 2019

Climate Shocks Constrain Human Fertility in Indonesia

Citation:

Sellers, Samuel, and Clark Gray. 2019. "Climate Shocks Constrain Human Fertility in Indonesia." World Development 117: 357-69.

Authors: Samuel Sellers, Clark Gray

Abstract:

Climate change is likely to induce a large range of household- and individual-level responses, including changes in human fertility behaviors and outcomes. These responses may have important implications for human and economic development and women's empowerment. Drawing on the literature linking climate conditions to rice cultivation in Indonesia, we use longitudinal household survey and high-resolution climate data to explore changes in childbearing intentions, family planning use, and births following community-level climate shocks from 1993 to 2015. We find that fertility intentions increase and family planning use declines in response to delays in monsoon onset occurring within the previous year, particularly for wealthier populations. However, women on farms are significantly more likely to use family planning and less likely to give birth following abnormally high temperatures during the previous five years. We also measure parallel shifts in household well-being as measured by rice, food, and non-food consumption expenditures. Our findings advance the environmental fertility literature by showing that longer duration environmental shocks can have impacts on fertility behaviors and outcomes. Collectively, our results illustrate human fertility responses to climate change in a country vulnerable to its effects, and demonstrate that in some cases, climate shocks can constrain human fertility.

Keywords: family planning, reproductive health, environmental shock, Indonesia, Southeast Asia

Topics: Environment, Climate Change, Gender, Women, Health, Reproductive Health, Households Regions: Asia, Southeast Asia Countries: Indonesia

Year: 2019

A Systematic Literature Review of Factors Affecting the Timing of Menarche: The Potential for Climate Change to Impact Women’s Health

Citation:

Canelón, Silvia P., and Mary Regina Boland. 2020. "A Systematic Literature Review of Factors Affecting the Timing of Menarche: The Potential for Climate Change to Impact Women’s Health." International Journal of Environmental Research and Public Health 17 (5).

Authors: Silvia P. Canelón, Mary Regina Boland

Abstract:

Menarche is the first occurrence of a woman’s menstruation, an event that symbolizes reproductive capacity and the transition from childhood into womanhood. The global average age for menarche is 12 years and this has been declining in recent years. Many factors that affect the timing menarche in girls could be affected by climate change. A systematic literature review was performed regarding the timing of menarche and four publication databases were interrogated: EMBASE, SCOPUS, PubMed, and Cochrane Reviews. Themes were identified from 112 articles and related to environmental causes of perturbations in menarche (either early or late), disease causes and consequences of perturbations, and social causes and consequences. Research from climatology was incorporated to describe how climate change events, including increased hurricanes, avalanches/mudslides/landslides, and extreme weather events could alter the age of menarche by disrupting food availability or via increased toxin/pollutant release. Overall, our review revealed that these perturbations in the timing of menarche are likely to increase the disease burden for women in four key areas: mental health, fertility-related conditions, cardiovascular disease, and bone health. In summary, the climate does have the potential to impact women’s health through perturbation in the timing of menarche and this, in turn, will affect women’s risk of disease in future.

Keywords: climate change, timing of menarche, women's health

Topics: Environment, Climate Change, Environmental Disasters, Gender, Women, Girls, Health, Mental Health, Reproductive Health

Year: 2020

Introspecting Climate Change from the Lens of Feminism

Citation:

Kalinga, Kirti. 2019. "Introspecting Climate Change from the Lens of Feminism." Journal of Energy Research and Environmental Technology 6 (3): 264-8.

Author: Kirti Kalinga

Abstract:

Climate change is a widespread problem whose ramifications are felt across sectors, economies and geo-spatial location. But the degree to which one will be affected depends on the power relations, social positioning and the cultural milieu. Though, there are limited studies exploring the nexus between climate change and gender but it is not difficult to discern that the ravaging effects of climate change will have disproportionate impact on women increasing their burden, hardship and vulnerability which will ultimately exacerbate gender inequalities. Therefore, climate justice is nothing without gender justice and feminist epistemologies and standpoint theories help to unravel the layers of climate injustice. Many studies have been conducted at the micro level that explores climate change related vulnerability. But they have been limited to either community level vulnerability or household level. This implies that there is a dearth of gender segregated data that will elucidate the gender specific impacts of climate change. The present paper looks at the vulnerabilities of women in climate change hotspot Satavaya village in Rajnagar block of Kendrapara district in Odisha. Satavaya is under constant threat of coastal erosion due to sea level rise. The research findings reflect that climate change has aggravated livelihood insecurity, thus, inducing a male dominated mass labour migration. As they leave behind their family, the entire responsibility of running the household remains with the women, who have to carry the “double burden” of care and earning responsibilities. Health risks, especially reproductive problems are very high for women in Satavaya. They are also confronted with water and food insecurities. Climate change induced extreme events further trap them in cycle of poverty and amplifies their vulnerabilities. There is a need to develop women centric coping and adaptation strategies. 

Keywords: climate change, gender inequality, vulnerability, Satavaya, feminism, migration

Topics: Displacement & Migration, Climate Displacement, Economies, Poverty, Environment, Climate Change, Feminisms, Gendered Power Relations, Gender Equality/Inequality, Health, Reproductive Health, Households, Livelihoods, Security, Food Security Regions: Asia, South Asia Countries: India

Year: 2019

The Evolving Role of Traditional Birth Attendants in Maternal Health in Post-Conflict Africa: A Qualitative Study of Burundi and Northern Uganda

Citation:

Chi, Primus Che, and Henrik Urdal. 2018. "The Evolving Role of Traditional Birth Attendants in Maternal Health in Post-conflict Africa: A Qualitative Study of Burundi and Northern Uganda." SAGE Open Medicine 6: 1-9. doi: 10.1177/2050312117753631.

Authors: Primus Che Chi, Henrik Urdal

Abstract:

Objectives: Many conflict-affected countries are faced with an acute shortage of health care providers, including skilled birth attendants. As such, during conflicts traditional birth attendants have become the first point of call for many pregnant women, assisting them during pregnancy, labour and birth, and in the postpartum period. This study seeks to explore how the role of traditional birth attendants in maternal health, especially childbirth, has evolved in two post-conflict settings in sub-Saharan Africa (Burundi and northern Uganda) spanning the period of active warfare to the post-conflict era.
Methods: A total of 63 individual semi-structured in-depth interviews and 8 focus group discussions were held with women of reproductive age, local health care providers and staff of non-governmental organisations working in the domain of maternal health who experienced the conflict, across urban, semi-urban and rural settings in Burundi and northern Uganda. Discussions focused on the role played by traditional birth attendants in maternal health, especially childbirth during the conflict and how the role has evolved in the post-conflict era. Transcripts from the interviews and focus group discussions were analysed by thematic analysis (framework approach).
Results: Traditional birth attendants played a major role in childbirth-related activities in both Burundi and northern Uganda during the conflict, with some receiving training and delivery kits from the local health systems and non-governmental organisations to undertake deliveries. Following the end of the conflict, traditional birth attendants have been prohibited by the government from undertaking deliveries in both Burundi and northern Uganda. In Burundi, the traditional birth attendants have been integrated within the primary health care system, especially in rural areas, and re-assigned the role of ‘birth companions’. In this capacity they undertake maternal health promotion activities within their communities. In northern Uganda, on the other hand, traditional birth attendants have not been integrated within the local health system and still appear to undertake clandestine deliveries in some rural areas.
Conclusion: The prominent role of traditional birth attendants in childbirth during the conflicts in Burundi and northern Uganda has been dwindling in the post-conflict era. Traditional birth attendants can still play an important role in facilitating facility and skilled attended births if appropriately integrated with the local health system.

Keywords: traditional birth attendants, post-conflict, maternal health, childbirth, health system

Topics: Health, Reproductive Health, Post-Conflict Regions: Africa, East Africa Countries: Burundi, Uganda

Year: 2018

“Provide Care for Everyone Please”: Engaging Community Leaders as Sexual and Reproductive Health Advocates in North and South Kivu, Democratic Republic of the Congo

Citation:

Steven, Victoria J., Julianne Deitch, Erin Files Dumas, Meghan C. Gallagher, Jimmy Nzau, Augustin Paluku, and Sara E. Casey. 2019. ““Provide Care for Everyone Please”: Engaging Community Leaders as Sexual and Reproductive Health Advocates in North and South Kivu, Democratic Republic of the Congo.” Reproductive Health 16. doi: 10.1186/s12978-019-0764-z.

Authors: Victoria J. Steven, Julianne Deitch, Erin Files Dumas, Meghan C. Gallagher, Jimmy Nzau, Augustin Paluku, Sara E. Casey

Abstract:

Background: Inadequate infrastructure, security threats from ongoing armed conflict, and conservative socio-cultural and gender norms that favour large families and patriarchal power structures contribute to poor sexual and reproductive health (SRH) outcomes in North and South Kivu provinces, Democratic Republic of the Congo (DRC). In order to expand contraceptive and post-abortion care (PAC) access in North and South Kivu, CARE, the International Rescue Committee and Save the Children provided technical support to the Ministry of Health and health facilities in these regions. Partners acknowledged that community leaders, given their power to influence local customs, could play a critical role as agents of change in addressing inequitable gender norms, stigma surrounding SRH service utilization, and topics traditionally considered taboo within Congolese society. As such, partners actively engaged with community leaders through a variety of activities such as community mapping exercises, values clarification and transformation (VCAT) activities, situational analyses, and education.
 
Methods: This manuscript presents findings from 12 key informant interviews (KIIs) with male political and non-political community leaders conducted in six rural health zones of North and South Kivu, DRC. Transcripts were analysed thematically to explore community leaders’ perceptions of their role in addressing the issue of unintended pregnancy in their communities.
 
Results: While community leaders in this study expressed overall positive impressions of contraception and strong support for ensuring access to PAC services following spontaneous and induced abortions, the vast majority held negative beliefs concerning women who had induced abortion. Contrasting with their professed opposition to induced abortion, leaders’ commitment to mediating interpersonal conflict arising between community members and women who had abortions was overwhelming.
 
Conclusion: Results from this study suggest that when thoughtfully engaged by health interventions, community leaders can be empowered to become advocates for SRH. While study participants were strong supporters of contraception and PAC, they expressed negative perceptions of induced abortion. Given the hypothesized link between the presence of induced abortion stigma and care-avoidance behavior, further engagement and values clarification exercises with leaders must be integrated into community mobilization and engagement activities in order to increase PAC utilization.

Keywords: abortion, contraception, community leader, post-abortion care, DRC, Qualitative, community mobilization

Topics: Armed Conflict, Gender, Gender Roles, Gendered Power Relations, Patriarchy, Health, Reproductive Health, Infrastructure, International Organizations Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2019

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