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Disrespect and abuse (D&A) during facility-based childbirth

Source: Maternal Health Task Force

Researchers Share Lessons Learned From Measuring the Prevalence of Disrespect and Abuse

Posted on 

By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public Health

Disrespect and abuse (D&A) during facility-based childbirth has been identified as a widespread problem, but just how commonly it happens is not well understood. Several studies have attempted to measure the prevalence of D&A during childbirth in health facilities across the globe, resulting in a wide range of estimates. Given that variations in reported prevalence may be at least in part the result of differences in definitions, measurement tools and data collection methods, comparing the extent of D&A across diverse settings remains challenging.

In order to better understand the trade-offs related to various methods for measuring the prevalence of D&A, the Maternal Health Task Force (MHTF)’s Rima Jolivet and Harvard Chan doctoral student David Sando conducted a systematic literature review to find all of the studies that have attempted to measure D&A during childbirth in health facilities. They then collaborated with the authors of these studies to compare methods and offer lessons learned.

The following five studies were included in the review:

The prevalence estimates in these five studies ranged from 15% to 98%. Given that all of these studies were conducted in low-resource settings in sub-Saharan Africa with similar maternal health delivery systems, the wide variation was likely due at least in part to differences in the way that researchers chose study sites and participants, defined D&A and collected data from participants.

Recommendations for future studies

The authors offered recommendations for researchers conducting studies that involve measuring the prevalence of D&A in order to maximize reliability, validity and comparability of results:

  1. Study site and population: Ensuring that there are no systematic differences in the study sample compared to the target population is important.
  2. Inclusion criteria: All women receiving maternity care in the study facility should have equal chance of being included regardless of their pregnancy outcomes. Stratified analyses can be used to examine different sub-groups of interest.
  3. Standardization vs. localization: Standardization of measurement across different study populations would ensure comparability of findings between studies, but ensuring valid measures that capture the constructs of D&A as perceived and experienced in the local context is also key. It is therefore important to acknowledge the tension between standardization and localization in developing instruments to measure the prevalence of D&A. Use of standard categories could help maximize comparability, while some leeway may be needed for context-specific operationalization of those categories.
  4. Environment: When possible, conducting interviews with women in a safe, neutral setting outside of the health facility where they may have experienced D&A can help participants feel more comfortable and open.
  5. Timing: In contrast to the typical understanding of recall deteriorating over time, in this context, women’s self-reports of D&A may be more accurate when solicited after they have had some time to process their experiences. More research is needed in this area.
  6. Data collection methods: Direct observation is generally regarded as the gold standard for measuring observable phenomena in prevalence studies. However, if the outcome of interest is women’s experiences of care, using women’s self-reports–ideally collected using patient-developed or patient-validated measures and participatory research techniques—is a better method.

Are you working on measuring the prevalence of disrespect and abuse during facility-based childbirth? We want to hear from you!

Read the full open access paper, “Methods used in prevalence studies of disrespect and abuse during facility based childbirth: Lessons learned.”

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Poverty and mental illness

Poverty and mental health

A review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy

“Poverty increases the risk of mental health problems and can be both a causal factor and a consequence of mental ill health. Mental health is shaped by the wide-ranging characteristics (including inequalities) of the social, economic and physical environments in which people live. Successfully supporting the mental health and wellbeing of people living in poverty, and reducing the number of people with mental health problems experiencing poverty, require engagement with this complexity. […]

Although mental health problems can affect anyone at any time, they are not equally distributed and prevalence varies across social groups.”

Although this policy review is based on UK data it is relevant for everybody working in the mental health sector

 

 

Suicidal thoughts during pregnancy

Perinatal depression and anxiety are serious mental health problems and are among the leading causes of maternal morbidity and mortality worldwide!

Pregnant women are at higher risk for suicidal ideation and behaviours compared to the general population.

Suicide has been identified as one of the major contributors to the global mortality burden and there is a growing concern over the increase in suicidal ideation and behaviour among pregnant women.

Studies in low- and middle-income countries put the rate of maternal death due to suicide at somewhere between 0.65% and 3.55%. In such cases, risk factors include poverty, lack of support, lack of trust in health systems and coexisting mental illnesses.

Suicidal thoughts experienced during pregnancy can continue beyond the initial postpartum period, affecting the well-being of both mother and child.

More about pregnancy and suicidal ideation in our infographic

International Day of Action For Women’s Health: Ensuring Respectful Maternity Care

Crosspost from Maternal Health Task Force blog by Kayla McGowan, Project Coordinator, Women and Health Initiative, Harvard T.H. Chan School of Public Health

“As we celebrate International Day of Action for Women’s Health on May 28, we reflect on the physical, emotional and psychosocial dimensions of women’s health as well as the reasons to support girls’ and women’s health throughout the lifecycle.

With Sustainable Development Goal (SDG) 5 calling for an end to all forms of discrimination against all women and girls everywhere, the elimination of all violence against women and girls and universal access to sexual and reproductive health and rights by 2030, now is the time to draw attention to the many elements of and impediments to women’s health and rights […]

Read the full blog entry: International Day of Action For Women’s Health: Ensuring Respectful Maternity Care | Maternal Health Task Force

PMHP – in the international arena

Members of the Perinatal Mental Health Project (PMHP) presented to delegates at the International Marcé Society Biennial Scientific Meeting in Swansea and the World Congress of Psychiatry in Madrid last month. Here are some highlights and insights from our two presenters:

Presentation by Director, Simone Honikman

Simone was invited to speak about the PMHP as part of a symposium entitled “Born this Way: finding solutions to global challenges in Perinatal Mental Health”. The symposium convenor, Professor Carlos Zubaran, of the University of Western Sydney, had also arranged for speakers from Norway, Spain, Israel and Portugal to present. The PMHP presentation was unique in that our project was able to present solutions to high levels of depression and anxiety in contexts where resources are limited. The symposium was well attended, generated vibrant discussion as well as potential connections for future collaborations.

Sim_Symposium

Simone Honikman with fellow symposium speakers

Read the abstract of the presentation ‘Maternal mental health and health service design‘ by Simone Honikman here: MMH_abstract

Presentation by Research Associate, Thandi van Heyningen
Research Associate

Thandi’s presentation was about screening for maternal depression and anxiety in a low-resource primary care antenatal setting in South Africa. She spoke about the use of various screening instruments as well as potential psychosocial risk factors. The results of this research from Hanover Park, have shown that a short, binary-scoring screening instrument that is easy to administer and score, performs as well as longer, more complex screening tools in detecting maternal anxiety and depression. The Whooley depression screen, which consists of two questions about mood symptoms and a third “help” question shows promise as a screening tool for the early detection of maternal depression and anxiety in these settings.

Read the abstract of the presentation: ‘Development of a mental health screening instrument for low-resource, primary-care antenatal settings in South Africa’ here: MentalHealthScreening_Abstract

#Marceconf

“Creating Change in Perinatal Mental Health” Apart from Thandi, many speakers inspired at the Marcé Conference (Photo: John Cox after his speech)

Placing mental health on the UN’s post-2015 development agenda

Mental health leaders and advocates gathered in Geneva, Switzerland this past week as the “Preventing Suicide, A Global Imperative“ report was publicly released by the World Health Organization (WHO) after the WHO launched implementation discussions of the Global Mental Health Action Plan adopted by the United Nations 66th assembly last year. Today, leaders join together under a new group #FundaMentalSDG to advocate adding clear, measurable mental health targets to the United Nations Post Millennium 2015 development goals currently in development and about to be negotiated by UN member states, following the UN High-level Stocktaking Event on the Post-2015 Development Agenda in New York on 11 – 12 September 2014.

According to the report by WHO, suicide is preventable, mental health disorders are treatable, and yet because we don’t significantly address it we lose over 800,000 lives annually, it is the second leading cause of death globally for youth ages 15-29, and is estimated to cost the United States alone over 100 billion dollars every year. #FundaMentalSDG invites other organizations, institutions, and world leaders to unite by collectively asking the United Nations to include a specific mental health target and two indicators in this critical post-millennium agenda. 

The #FundaMentalSDG group was developed as world leaders agree we must take a collaborative, multi-sectoral approach in elevating the work done in mental health.  Dr. Shekhar Saxena, Director of the Department of Mental Health and Substance abuse, states in the Global Suicide Report:  “This report, the first WHO publication of its kind, presents a comprehensive overview of suicide, suicide attempts and successful suicide prevention efforts worldwide. We know what works. Now is the time to act”.

The July 19th 2014 United Nations draft of the Post-Millennium Goals includes an overall Health Goal: ‘Proposed goal 3. Ensure healthy lives and promote well-being for all at all ages’.  A recent Editorial in the British Medical Journal (BMJ) by Professors Graham Thornicroft and Vikram Patel, of King’s College London and London School of Hygiene and Tropical Medicine respectively, calls upon colleagues worldwide to include within this Health Goal the following specific mental illness target:

‘The provision of mental and physical health and social care services for people with mental disorders, in parity with resources for services addressing physical health.’

They also propose that this is directly supported by 2 indicators related to the WHO Mental Health Action Plan 2013-2020, adding that it is very difficult to achieve results without specific measurements:

  1. ‘To ensure that service coverage for people with severe mental disorders in each country will have increased to at least 20% by 2020 (including a community orientated package of interventions for people with psychosis; bipolar affective disorder; or moderate-severe depression).’
  2. ‘To increase the amount invested in mental health (as a % of total health budget) by 100% by 2020 in each low and middle income country’

According to Thornicroft and Patel’s article in the BMJ, there is compelling evidence to show that improved global mental health is a necessity for overall human and societal development. For example, “poorer mental health is a precursor to reduced resilience to conflict,” and not only that, “it is also a barrier to achieving the suggested goal for promoting peaceful and inclusive societies for sustainable development, providing access to justice for all, building effective, accountable and inclusive institutions at all levels.”

In a Policy Brief produced by #FundaMentalSDG entitled “Call to Action: The Need to Include Mental Health Target and Indicators in the Post-2015 Sustainable Development Goals”, it reviews the high prevalence of mental illness (1 in four people experience mental illness in their lifetime), the global emergency mental illness is causing insofar as human rights violations, stigma and discrimination, and the fact that mental illness can reduce lifespan by 20 years. Further, the brief points out that in low and middle income countries, up to 98 percent of people with mental health problems do not receive any treatment, as evidenced research proofs. Mental health has impact across the whole range of SDGs, and thus can be seen as a cross cutting issue.

#FundaMentalSDG is an initiative which aims to include a specific mental health target in the post-2015 SDG agenda. The initiative is  committed to the principle that there can be no health without mental health, and no sustainable development without including mental health into the post-2015 SDG agenda. The #FundaMentalSDG initiative is led by the #FundaMentalSDG Steering Group, composed of leaders in the field of global mental health, drawn from a wide range of service user, caregiver, advocacy, policy, service delivery and research organizations.

To support the initiative, visit www.fundamentalsdg.org/show-your-support and take action today.

For more information, see

www.fundamentalsdg.org

www.facebook.com/fundamentalsdg 

twitter.com/FundaMentalSDG 

hashtag #FundaMentalSDG 

 

World Health Assembly

Sixty-seventh World Health Assembly
19–24 May 2014

The World Health Assembly is the decision-making body of WHO. It is attended by delegations from all WHO Member States and focuses on a specific health agenda prepared by the Executive Board. The main functions of the World Health Assembly are to determine the policies of the Organization, appoint the Director-General, supervise financial policies, and review and approve the proposed programme budget. The Health Assembly is held annually in Geneva, Switzerland.

Follow the discussion on Twitter: #WHA67

To view and download the main documents check WHO website

Pregnancy and childbirth outcomes among adolescent mothers

a multi-country study by the World Health Organization (WHO)

published in ‘BJOG: An International Journal of Obstetrics & Gynaecology’

Special Issue: Maternal and Perinatal Morbidity and Mortality: Findings from the WHO Multicountry Survey

Volume 121Issue Supplement s1pages 40–48,March 2014

BJOG_SupplementWebBanner200x200_2

Results

A total of 124 446 mothers aged ≤24 years and their infants were analysed. Compared with mothers aged 2024 years, adolescent mothers aged 10–19 years had higher risks of eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery and severe neonatal conditions. The increased risk of intra-hospital early neonatal death among infants born to adolescent mothers was reduced and statistically insignificant after adjustment for gestational age and birthweight, in addition to maternal characteristics, mode of delivery and congenital malformation. The coverage of prophylactic uterotonics, prophylactic antibiotics for caesarean section and antenatal corticosteroids for preterm delivery at 2634 weeks was significantly lower among adolescent mothers.

Conclusions

Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Pregnancy prevention strategies and the improvement of healthcare interventions are crucial to reduce adverse pregnancy outcomes among adolescent women in low- and middle-income countries.

To access the full article go to the Wiley Online Library  

Maternal deaths due to HIV not declining

.. despite Prevention of Mother-To-Child Transmission (PMTCT) success in South Africa

article by Keith Alcorn @ ‘aidsmap’

Read the final paragraph of this sobering article. The PMHP asks why are mothers defaulting their antiretrovirals or not engaging with care?

Could the fact that more than one third have depression or anxiety have anything to do with it? Providing the testing and treatment protocols is not be enough. The health system needs to address the distress experienced by HIV positive pregnant women.

For the full article go to aidsmap

Health-Care Summit

IMPUMELELO Social Innovations Centre

 in partnership with the University of Stellenbosch Business School (USB) is hosting a

Health-Care Summit

“Innovative Strategies and Systematic Interventions to Improve Health-Care in South Africa”

on 14 March 2014

The Impumelelo Social Innovations Centre has been awarding innovation and best practice in various sectors aimed at improving the quality of life of the poor for 13 years.The PMHP will have the opportunity to present at the closing panel.

Watch Simone Honikman, the PMHP director’s, presentation 

on You Tube (at 1h 38 min)

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