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Reproductive Health

Perinatal and Maternal Outcomes in Tuzla Canton during 1992-1995 War in Bosnia and Herzegovina

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

Reproductive Health of Gulf War Veterans

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

Women’s Health, Changes and Challenges in Health Policy Development in Lithuania

Citation:

Kalediene, Ramune, and Ruta Nadisauskiene. 2002. “Women’s Health, Changes and Challenges in Health Policy Development in Lithuania.” Reproductive Health Matters 10 (20): 117-26.

Authors: Ramune Kalediene, Ruta Nadisauskiene

Abstract:

Health is a sensitive mirror of social circumstances. This paper looks at the situation of women's health in Lithuania in the context of the social, political and economic transition in the country following independence in 1990, and reforms to the health system. Data since 1990 show that considerable social and demographic inequalities in the health of women exist in Lithuania, with low-educated women and those living in rural areas in the most unfavourable situation, including in relation to reproductive health. Reproductive health issues have received some recognition in recent years, with the main attention and resources directed to the development of a Maternal and Child Health Programme, especially perinatal care and the organisation of neonatology services, which has resulted in a notable decrease in maternal, perinatal and infant mortality. Services for family planning, abortion, infertility, cervical and breast cancer, and violence against women are under-developed. Non-governmental organizations are beginning to be formed to advocate for increased resources and services for reproductive health. Improvements in the health status of Lithuanian women can be expected if attention is paid to social determinants of health.

Topics: Armed Conflict, National Liberation Wars, Gender, Women, Girls, Boys, Health, Mental Health, Reproductive Health, Post-Conflict Regions: Europe, Baltic states, Northern Europe Countries: Lithuania

Year: 2002

Maternal and Child Health in the Occupied Palestinian Territory

Citation:

Rahim, H. F. A., L. Wick, S. Halileh, S. Hassan-Bitar, H. Chekir, G. Watt, and M. Khawaja. 2009. “Maternal and Child Health in the Occupied Palestinian Territory.” Lancet 373 (9667): 967–77.

Authors: H. F. A. Rahim, L. Wick, S. Halileh, S. Hassan-Bitar, H. Chekir, G. Watt, M. Khawaja

Abstract:

The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age ≤1 year) and children younger than 5 years have changed little, and the prevalence of stunting in children has increased. Living conditions have worsened since 2006, when the elected Palestinian administration became politically and economically boycotted, resulting in unprecedented levels of Palestinian unemployment, poverty, and internal conflict, and increased restrictions to health-care access. Although a political solution is imperative for poverty alleviation, sustainable development, and the universal right to health care, women and children should not have to wait. Urgent action from international and local decision makers is needed for sustainable access to high-quality care and basic health entitlements.

Topics: Armed Conflict, Displacement & Migration, Economies, Poverty, Gender, Women, Girls, Boys, Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2009

Maternal Care under Minimal Conditions during the War in Croatia

Citation:

Habek, Dubravko. 2009. “Maternal Care under Minimal Conditions during the War in Croatia.” International Journal of Gynecology & Obstetrics 107 (1): 60–1.

Author: Dubravko Habek

Abstract:

The Medical Corps Unit (MCU) of the 105th Croatian Army Brigade from Bjelovar, Croatia, provided medical care for military personnel wounded in action and civilians living close to the frontline and some distance from civilian medical facilities. Medical treatment was provided in the conflict areas of Novska, East Slavonia, and Posavlje during the 1991–1992 conflict and in 1995 during the Flash and Storm military actions. The MCU was structured as a mobile surgical unit for primary surgical management with an inpatient clinic and complete surgical and resuscitation facilities.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health, Military Forces & Armed Groups, Militaries Regions: Europe, Balkans, Eastern Europe Countries: Croatia

Year: 2009

Accessing Maternal Health Services in Eastern Burma

Citation:

Douoguih, Macaya. 2008. “Accessing Maternal Health Services in Eastern Burma.” PLoS Medicine 5 (12): 1645-6.

Author: Macaya Douoguih

Topics: Gender, Women, Health, Reproductive Health Regions: Asia, Southeast Asia Countries: Myanmar

Year: 2008

Maternal Health, War, and Religious Tradition: Authoritative Knowledge in Pujehun District, Sierra Leone

Citation:

Jambai, Amara, and Carol MacCormack. 1996. “Maternal Health, War, and Religious Tradition: Authoritative Knowledge in Pujehun District, Sierra Leone.” Medical Anthropology Quarterly 10 (2): 270–86. doi:10.1525/maq.1996.10.2.02a00090.

Authors: Amara Jambai, Carol MacCormack

Abstract:

In Sierra Leone constraints to ideal maternal health require a primary health care approach that includes collaboration with traditional midwives. They are authoritative figures embedded within local political structures and a powerful women's religion. The local causes of maternal risk are described, including civil war and refugee camp life. Traditional midwives provide vital services in the camp, are respected for their social status, and learn additional skills. Biomedical and traditional systems of authoritative knowledge, based on different kinds of legitimacy to heal, are in a complementary relationship.

Topics: Armed Conflict, Civil Wars, Displacement & Migration, Refugees, Refugee/IDP Camps, Gender, Women, Health, Reproductive Health, Religion Regions: Africa, West Africa Countries: Sierra Leone

Year: 1996

Women's Health Care in Operation Iraqi Freedom: A Survey of Camps with Echelon I or II Facilities

Citation:

Thomson, Brook Allen, and Peter Edward Nielsen. 2006. “Women’s Health Care in Operation Iraqi Freedom: A Survey of Camps with Echelon I or II Facilities.” Military Medicine 171 (3): 216-9.

Authors: Brook Allen Thomson , Peter Edward Nielsen

Abstract:

OBJECTIVE: To assess women's perceptions of health care delivery in Operation Iraqi Freedom.

METHODS: An anonymous questionnaire was distributed through command channels to female soldiers stationed in camps receiving echelon I or II care. Questions covered predeployment screening, contraceptive method availability and side effects, accessibility of gynecologic care, field hygiene counseling, and smoking status.

RESULTS: Two hundred fifty-one (91%) of 275 surveys were returned. Twenty-two percent of respondents had received no annual gynecologic examination including the Papanicolaou test/cervical cytologic study in the past year. Irregular bleeding was the most common gynecologic side effect. Ortho Evra patches fell off in 58% of cases; 23% of soldiers changed contraceptive methods because of unavailability, 21% experienced gynecologic problems, and 44% could not access gynecologic care. Twenty-six percent received predeployment menstrual hygiene counseling, and 77% attempting cycle control succeeded.

CONCLUSIONS: Gynecologic screening, contraceptive options, and cycle control counseling must occur before deployments. Specialty gynecologic care and medications for cycle control should be readily accessible to all female soldiers during deployments.

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, Reproductive Health Countries: United States of America

Year: 2006

Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom

Citation:

Albright, Todd S., Alan P. Gehrich, Johnnie Wright Jr., Christine F. Lettieri, Susan G. Dunlow, and Jerome L. Buller. 2007. “Pregnancy during Operation Iraqi Freedom/Operation Enduring Freedom.” Military Medicine 172 (5): 511–14.

Authors: Todd Albright , Alan P. Gehrich, Johnnie Wright Jr., Christine F. Lettieri, Susan G. Dunlow, Jerome L. Buller

Abstract:

The purpose of this study was to evaluate pregnancy during war-time deployment. A retrospective review of gynecology visits was evaluated at Camp Doha, Kuwait, from August 2003 through April 2004. Of the 1,737 visits, 77 demonstrated a positive pregnancy test. These charts were evaluated for factors that may lead to important information for future deployments. The average age of the female soldier with a positive pregnancy test in theater was 27 +/- 7 years. The primary presenting complaint was amenorrhea. Ninety-two percent had an ultrasound. Fifty-four percent of visits were active duty, followed by Reserve, National Guard, and civilian government employees. Ninety-two percent were administratively redeployed. Seventy-seven percent of the soldiers became pregnant in country. Twenty-three percent arrived in country pregnant. Given the number of pregnancies before and during deployment, current screening procedures as well as new concepts in prevention need to be addressed.

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, Reproductive Health, Military Forces & Armed Groups Regions: Americas, North America Countries: United States of America

Year: 2007

Women in War: Operational Issues of Menstruation and Unintended Pregnancy

Citation:

Christopher, Leslie A., and Leslie Miller. 2007. “Women in War: Operational Issues of Menstruation and Unintended Pregnancy.” Military Medicine 172 (1): 9–16.

Authors: Leslie Christopher, Leslie Miller

Abstract:

With rapid and frequent deployments around the world, the current high level of military operations demands combat readiness of every military member. In the U.S. Armed Forces, women represent 15% of active duty troops and 17% of reserve and Guard troops and are a critical component for mission accomplishment. The operational issues of menstruation and unintended pregnancy, unique to this population, can decrease a female member's military readiness and affect her ability to deploy. Strategies to mitigate and even eliminate these concerns include the optional use of hormonal medications to induce reversible menstrual cycle suppression. These medications, traditionally indicated for contraception, should be considered essential for female troops during training and deployment. This article, tailored specifically for military women, provides valuable information regarding the risks and benefits, as well as the various options available for menstrual cycle suppression.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health, Military Forces & Armed Groups, Militaries Regions: Americas, North America Countries: United States of America

Year: 2007

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