Women’s Autonomy and Unintended Pregnancy Among Currently Pregnant Women in Bangladesh

This paper examines the net effect of women's autonomy on their pregnancy intention status among currently pregnant Bangladeshi women. This study is based on data from the Bangladesh Demographic Health Survey, 2007 (BDHS). A subset of interviews from currently pregnant women (718) were extracted from 10,146 married women of reproductive age. The BDHS 2007 used a pre-tested, structured questionnaire to collect sociodemographic, women's empowerment, and pregnancy information. Associations between unintended pregnancy and explanatory variables were assessed using bivariate analysis. Logistic regression was used to assess the net effect of women's autonomy on current pregnancy intention status after controlling for other variables. Results indicate that women's autonomy is a significant predictor of unintended pregnancy after adjusting for other factors. A unit increase in the autonomy scale decreases the odds of unintended pregnancy by 16%. Besides autonomy, our results also indicate that current age, number of children ever born, age at marriage, religion, media access, and contraceptive use exert strong influences over unintended pregnancy. Women who have ever used contraceptives are 82% more likely to classify their current pregnancies as unintended compared with women who are non-users of contraceptives. Improvement in women's autonomy and effective and efficient use of contraceptives may reduce unintended pregnancies as well as improve reproductive health outcomes.     

Women’s Autonomy and Skilled Attendance During Pregnancy and Delivery in Nepal

Objectives This study aims to explore the association between women’s autonomy and skilled attendance during pregnancy and delivery in Nepal. Methods We adopt data from the Nepal Demographic and Health Survey (NDHS, 2011). We include only married women who gave birth in the 5 years preceding the survey (N = 4148). Women’s autonomy was assessed on the basis of four indicators of decision making: healthcare, visiting friends or relatives, household purchases and spending earned money. Each indicator was dichotomized (yes/no) and then summarized into a single variable to measure overall autonomy. Next, we measured health attendance (skilled vs. unskilled) during antenatal and delivery care. The association between women’s autonomy and skilled attendance was analysed using a logistic regression model. Results Most women had a medium (40 %) and high (35 %) level of overall autonomy. The proportion of women accessing skilled providers during antenatal and delivery care was 51 and 36 %. Women with autonomy in healthcare, visiting friends or relatives, making household purchases and spending money earned were associated with a higher likelihood of receiving care from skilled providers during antenatal care and delivery. An elevated probability of access to skilled attendance during antenatal (aOR 1.33; 95 % CI 1.10–1.59) and delivery care (aOR 1.38; 95 % CI 1.12–1.70) was reported among women with higher levels of overall autonomy. Conclusion Women’s autonomy was significantly associated with the maternal health care utilization by skilled attendants. This study will provide insights for policy makers to develop strategies in improving maternal health.     

Women’s Autonomy and Maternal Health-Seeking Behavior in Ethiopia

This paper examines the net effect of women’s autonomy on their health seeking behavior in Ethiopia. We hypothesize that women with higher autonomy are more likely to seek health care during pregnancy and delivery than those with lower autonomy. The paper also examines whether the autonomy-health utilization relationship is influenced by individual (education, work status, religion) and, household (wealth and rural–urban residence) level factors, all of which are important for both autonomy and health-care utilization. Results indicate that women’s autonomy remains significant even after adjusting for other individual and household variables. Besides autonomy, our results highlight other individual and household level influences on the health seeking behaviors of women in Ethiopia. Results also demonstrate the need to look beyond individual level factors when examining the health seeking behaviors of women in Ethiopia. The statistical significance of some individual-level measures, such as education means it cannot be used as proxy for women’s autonomy. This calls for policy makers not only to empower women, but also provide them with better formal education.     

On the Stability of Reported Pregnancy Intentions from Pregnancy to 1 Year Postnatally: Impact of Choice of Measure,Timing of Assessment,Women’s Characteristics and Outcome of Pregnancy

Objectives

Retrospective, cross-sectional estimates of pregnancy intention, as used in the Demographic Health Survey (DHS), are the global norm. The London Measure of Unplanned Pregnancy (LMUP) is a newer, psychometrically validated measure which may be more reliable. This paper assesses the reliability of the LMUP and the DHS question over the first postnatal year and explores the effects of maternal characteristics or pregnancy outcome on reported pregnancy intention.

Methods

We compared the test–retest reliability of the LMUP (using the AC coefficient) and DHS question (using the weighted Kappa) over the first postnatal year using data from Malawian women. We investigated the effect of maternal characteristics and pregnancy outcome using t-tests, Chi squared or Fisher’s exact tests, and calculated odds ratios to estimate effect size.

Results

The DHS question was associated with a statistically significant decrease in the prevalence of unplanned pregnancies from 1-to-12 months postnatally; the LMUP was not. The LMUP had moderate to substantial reliability (0.51–0.66); the DHS had moderate reliability (0.56–0.58). The LMUP’s stability was not related to any of the factors examined; the stability of the DHS varied by marital status (p?=?0.033), number of children (p?=?0.048) and postnatal depression (p?<?0.001). Both underestimated unintended pregnancy postnatally vis-à-vis the LMUP in pregnancy.

Conclusions for Practice

The LMUP is a more reliable measure of pregnancy intention than the DHS in the first postnatal year and does not vary by maternal characteristics or pregnancy outcome. The LMUP should become the gold-standard for measuring pregnancy intention and should be collected in pregnancy or at the first postnatal opportunity.

     

Women’s Intimate Partner Violence Perpetration During Pregnancy and Postpartum

The purpose of this longitudinal study was to examine the prevalence of women’s psychological, minor physical, and severe physical intimate partner violence (IPV) perpetration during the first 18 weeks of pregnancy and at 6 weeks postpartum and to compare women who used each type of IPV to those who did not. Women who increased their IPV perpetration over time were also compared to women who decreased or did not change their IPV perpetration over time. A sample of 180 women participated in a larger study of the well-being of pregnant women. Data were collected via self-report survey and 122 participants were retained at follow-up. At both time points, more women in the sample reported IPV perpetration (baseline n = 132; follow-up n = 73) than IPV victimization (baseline n = 114; follow-up n = 66). Women who perpetrated IPV reported higher levels of IPV victimization, reported partner alcohol misuse, stress, depression, and lower dyadic adjustment compared to women who did not. Women’s IPV perpetration was associated with several negative outcomes. Findings suggest that IPV screening during pregnancy and postpartum should include women’s IPV perpetration and should be conducted at multiple time points, since women’s IPV experiences may change over time.     

SafeMotherMedicine: Aiming to Increase Women’s Empowerment in Use of Medications During Pregnancy and Breastfeeding

Maternal and Child Health Journal - Approximately 80% of pregnant women use medications. There is a need for evidence based medicines information that provide realistic risk estimates as pregnant...     

Gestational Women’s Perceptions About the Harms of Cigarette and E-Cigarette Use During Pregnancy

Objectives

The purpose of this study was to examine differences between perceived harm of cigarette and electronic cigarette (e-cigarette) use while pregnant and differences between healthcare providers’ communication about these products during pregnancy.

Methods

A convenience sample of gestational women (n?=?218; ages 18–45) living in the US completed an online survey between May and December 2017. Participants reported perceived likelihood of adverse health outcomes (e.g., low birth weight, sudden infant death syndrome) among infants/children born to mothers who used cigarettes/e-cigarettes. T-tests and two-way ANOVAs examined differences between risk perceptions of using cigarettes/e-cigarettes while pregnant based on pregnancy status (previously pregnant, currently pregnant, future pregnant). Chi-square analyses examined differences between healthcare provider communication about cigarette/e-cigarette use during pregnancy.

Results

Overall, participants believed adverse health outcomes were significantly more likely to be caused by maternal use of cigarettes than e-cigarettes. Participants who planned to be pregnant reported higher endorsement that smoking combustible cigarettes would cause a miscarriage (p?<?.05) or increased blood pressure (p?<?.05) for a child than currently pregnant participants. Participants reported healthcare providers asked about (p?<?.05), advised them not to use (p?<?.001), and talked to them about health effects of smoking combustible cigarettes while pregnant (p?<?.001) significantly more than e-cigarettes.

Conclusions for Practice

Healthcare providers working with pregnant women should perform the 5As behavioral intervention method to provide pregnant women with tobacco cessation care. They should also discuss the absolute harm nicotine exposure (via cigarettes or e-cigarettes) can have on fetal health and development.

     

Men’s Controlling Behaviors and Women’s Experiences of Physical Violence in Malawi

In the feminist paradigm, intimate partner violence (IPV) among heterosexual couples is gender asymmetric and largely a tactic of male control. However, research on the relationship between men’s controlling behavior and physical violence against women is limited. This study examines whether having a controlling partner is associated with women’s reports of experiencing physical violence in Malawi. Bivariate and multivariate analyses were conducted using data from 8,385 women who completed the domestic violence module of the Malawi 2004 Demographic and Health Survey. About 18 % of women reported they had experienced moderately severe physical violence and 1 % experienced very severe violence in the past 12 months. A third of women reported their partners had ever been controlling. Results from multivariable ordinal logistic regression showed that women who had controlling partners were significantly more likely to report experiencing physical violence. Other factors significantly associated with women’s experience of physical violence included women who reported initiating physical violence against their partners, women’s work status, partners’ lower education level, and partners’ alcohol consumption. Women with controlling partners were at increased risk of experiencing physical violence in the past year. However, women who reported initiating physical violence in the past year were nearly four times more likely to experience partner violence in the same time period. Future research should attempt to elucidate these two important risk factors for IPV.     

Assessment of Toxic Metals and Phthalates in Children’s Toys and Clays

Toxic metals and phthalates are introduced in the manufacturing of plastic toys and modeling clays. In Lebanon, inexpensive plastic toys and modeling clays (sold in dollar stores) are affordable and popular, and there is no legislation to monitor or regulate such toys. This study aimed to assess the quality of inexpensive plastic toys and modeling clays imported in Lebanon. Metal concentrations in toys, namely, zinc [not detectable (ND) to 3,708 μg/g], copper (ND to 140), chromium (ND to 75 μg/g), tin (ND to 39 μg/g), and cadmium (Cd) (ND to 20 μg/g), were lower than the European Union (EU) Directive limits, whereas lead (ND to 258 μg/g) in 10 % of samples and antimony (Sb) (ND to 195 μg/g) in 5 % of samples were greater than the EU limits. In modeling clays, most of the metals were lower than the EU Directive limits except for Cd and arsenic (As). Cd was detected in 83 % of samples, with a mean level of 9.1 μg/g, which is far greater than the EU Directive limit (1.9 μg/g). The As mean level of 4.5 μg/g was greater than the EU limit (4.0 μg/g) and was detected in 9 % of samples. Phthalic acid esters (PAEs) were found in 60 % of children’s toys and 77 % of modeling clays. Phthalic acid butyl ester had the highest-level PAE encountered and was ≤59.1 % in one type of clay. However, among children’s toys, di(4-octyl) ester terephthalic acid was the highest encountered phthalate at a concentration of 25.7 %. The community survey indicated that 82 % of households purchase their toys from inexpensive shops and that only 17 % of parents were aware of the health hazard of such toys. Consequently, an intervention plan was proposed for the provision of safe toys to children.     

Lactation Patterns in Women with Hypertensive Disorders of Pregnancy: An Analysis of Illinois 2012–2015 Pregnancy Risk Assessment Monitoring System (PRAMS) Data

Maternal and Child Health Journal - Hypertensive disorders of pregnancy have lifelong implications on maternal cardiovascular health. Breastfeeding has a variety of maternal benefits, including...     

Women’s Quality of Life in the Premenopausal and Postmenopausal Periods

Purpose The purpose of this research was to determine the relationship between menopausal symptoms and quality of life in women in the pre and postmenopausal periods.Methods and instruments All 171 women in the climacteric period who registered at the Pamukkale University Education and Research Hospital Obstetrics and Gynecology Clinic between January and July 2001 were included in the study. A questionnaire asking for sociodemographic information, complaints related to the climacteric period, and HRT use, as well as the WHOQOL brief, were used in order to obtain data.Findings One hundred of the women who participated in the study were premenopausal and 71 were postmenopausal and the mean age was 47.39 (SD=6.65). No significant difference was found in pre and postmenopausal women in the comparison of their quality of physical life, psychological, social relationships and environment scores (p>0.05). The physical quality of life scores for those without vasomotor complaints in the pre and postmenopausal periods were significantly higher in those with a high educational level and women who had been menopausal between 1–5 years and more than 10 years (p<0.05). Age and HRT use in postmenopausal women were not found to affect quality of life scores (p>0.05).Result We did not find any significant difference in the quality of life of pre and postmenopausal women.     

Correlates of Pregnant Women’s Participation in a Substance Use Assessment and Counseling Intervention Integrated into Prenatal Care

Maternal and Child Health Journal - Screening and referral for substance use are essential components of prenatal care. However, little is known about barriers to participation in substance use...     

Women’s Autonomy in Infant Feeding Decision-Making: A Qualitative Study in Nairobi,Kenya

Maternal and Child Health Journal - Exclusive breastfeeding (EBF) is the optimal way to feed young infants. Guidelines recommend that women living with HIV on antiretroviral therapy should EBF for...     

Evaluating Provider Advice and Women’s Beliefs on Total Weight Gain During Pregnancy

Excessive gestational weight gain (GWG) is associated with complications for both mother and child. Minority women are at increased risk for excessive GWG, yet are underrepresented in published weight control interventions. To inform future interventions, we examined the prevalence and accuracy of provider advice and its association with personal beliefs about necessary maternal weight gain among predominantly Latina pregnant women. Secondary analysis examining baseline data (N = 123) from a healthy lifestyle randomized controlled trial conducted in and urban area of the South East. Only 23.6 % of women reported being told how much weight to gain during pregnancy; although 58.6 % received advice that met Institute of Medicine recommendations. Concordance of mothers’ personal weight gain target with clinical recommendations varied by mothers’ pre-pregnancy weight status [χ ₍₄₎ ²  = 9.781, p = 0.044]. Findings suggest the need for prenatal providers of low-income, minority women to engage patients in shaping healthy weight gain targets as a precursor to preventing excessive GWG and its complications.     

Hunger and Food Insecurity in Nairobi’s Slums: An Assessment Using IRT Models

Although linked to poverty as conditions reflecting inadequate access to resources to obtain food, issues such as hunger and food insecurity have seldom been recognized as important in urban settings. Overall, little is known about the prevalence and magnitude of hunger and food insecurity in most cities. Yet, in sub-Saharan Africa where the majority of urban dwellers live on less than one dollar a day, it is obvious that a large proportion of the urban population must be satisfied with just one meal a day. This paper suggests using the one- and two-parameter item response theory models to infer a reliable and valid measure of hunger and food insecurity relevant to low-income urban settings, drawing evidence from the Nairobi Urban Health and Demographic Surveillance System. The reliability and accuracy of the items are tested using both the Mokken scale analysis and the Cronbach test. The validity of the inferred household food insecurity measure is assessed by examining how it is associated with households’ economic status. Results show that food insecurity is pervasive amongst slum dwellers in Nairobi. Only one household in five is food-secure, and nearly half of all households are categorized as “food-insecure with both adult and child hunger.” Moreover, in line with what is known about household allocation of resources, evidence indicates that parents often forego food in order to prioritize their children.     

Women’s Experience and Understanding of Food Cravings in Pregnancy: A Qualitative Study in Women Receiving Prenatal Care at the University of North Carolina–Chapel Hill

BackgroundAlthough the occurrence of food cravings during pregnancy is well established, there is a paucity of qualitative data on pregnant women’s perceptions of and responses to food cravings. This study sought to assess and describe pregnant women’s experiences and behaviors pertaining to food cravings.MethodsEight focus groups were conducted with 68 pregnant women in their second trimester from March 2015 to October 2016. Using a semistructured approach, the facilitator asked women open-ended questions regarding their experience of eating behaviors and food cravings. The content from the focus groups was analyzed using a bottom-up approach based on grounded theory and constant comparison analysis.ResultsParticipants described cravings as urgent, food-specific, and cognitively demanding occurrences that were differentiated from hunger. They described beliefs surrounding the physiological causes of cravings and rationales for satisfying their cravings. Strategies used to manage cravings included environmental modifications to limit proximity and availability of craved foods, cognitive and behavioral strategies like distraction, and acceptance through satisfying the craving. Participants described food cravings as a psychologically salient aspect of their pregnancy, reporting a variety of emotional precursors and reactions surrounding their cravings.ConclusionsA better understanding of food cravings may assist with the development of interventions to improve eating behaviors and reduce eating-related distress during pregnancy. Acceptance regarding food cravings was indicated as a way to diffuse pregnancy-related stress. These findings contribute to our understanding of psychological influences on eating behaviors in pregnant women.     

Migrant Women’s Perceptions of Healthcare During Pregnancy and Early Motherhood: Addressing the Social Determinants of Health

Recent guidelines from the World Health Organization emphasize the need to monitor the social determinants of health, with particular focus on the most vulnerable groups. With this in mind, we evaluated the access, use and perceived quality of care received by migrant women during pregnancy and early motherhood, in a large urban area in northern Portugal. We performed semi-structured interviews in 25 recent mothers, contacted through welfare institutions, who had immigrated from Eastern European countries, Brazil, or Portuguese-speaking African countries. Six native-Portuguese women of equal economic status were also interviewed for comparison. Misinformation about legal rights and inadequate clarification during medical appointments frequently interacted with social determinants, such as low social-economic status, unemployment, and poor living conditions, to result in lower perceived quality of healthcare. Special attention needs to be given to the most vulnerable populations in order to improve healthcare. Challenges reside not only in assuring access, but also in promoting equity in the quality of care.