The Bangladesh Women\u27s Health Coalition

The Bangladesh Women\u27s Health Coalition (BWHC) represents an important initiative in the movement toward more responsive modes of family planning delivery. In the context of a society where there are strict limits on the social role and physical mobility of most girls and women, BWHC has set itself the ambitious goal of enabling women—no matter what their income or education—to learn how to manage their own reproductive health and the health of their children in a way that enhances their sense of strength and competence. One of the real strengths of BWHC has been its willingness to learn from experience and to continually modify its range of services and mode of service delivery to better address the needs of its clients. The report offers specific lesssons drawn from the BWHC experience. BWHC clinics are not intended to be models for replication, but are examples of what can be done to develop high-quality services with limited resources

Advancing sexual and reproductive health and rights in low- and middle-income countries : implications for the post-2015 global development agenda

The post-2015 global agenda must prioritize equality, quality and accountability in sexual and reproductive health and rights (SRHR). While the last two decades have seen a patchwork of health sector reforms that have had mixed effects on equality of access and on the quality of Sexual and Reproductive Health (SRH) services, significant national efforts demonstrate the possibility of alternative approaches that promote both equality and quality. Early investments in the poorest girls from the poorest communities can have important pay-offs. The next priority actions to close the quality gap in SRH services are delineated

The status of women: Conceptual and methodological issues in demographic studies

This paper explores several conceptual problems in social demographic studies of the status of women, including failure to recognize the multidimensionality of women's status and its variation across social “locations,” the confounding of gender and class stratification systems, and the confounding of access to resources with their control. Also discussed are some generic problems in the measurement of female status, such as the sensitivity of particular indicators to social context, and the need to select consistent comparisons when judging the extent of gender inequality.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45651/1/11206_2005_Article_BF01115740.pd

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The impact of women's social position on fertility in developing countries

This paper examines ideas about possible ways in which the extent of women's autonomy, women's economic dependency, and other aspects of their position vis-à-vis men influence fertility in Third World populations. Women's position or “status” seems likely to be related to the supply of children because of its links with age at marriage. Women's position may also affect the demand for children and the costs of fertility regulation, though some connections suggested in the literature are implausible. The paper ends with suggestions for future research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45660/1/11206_2005_Article_BF01124382.pd

Commentary : promoting healthy adolescent development through comprehensive sexuality education

Sexual and reproductive health (SRH) programmes recognize that fundamental improvements in the lives of girls and young women require changes in the attitudes of boys and men that perpetuate gender and inequality and power imbalances. Studies suggest that interventions delivered according to the UNESCO standards increase awareness, and are able to change attitudes on gender equality and power structures, at least in the short run. Examples of promising programmes are given

Reproductive Health: The continuing challenge

Adrienne Germain, a core negotiator for the US government during the Cairo and Beijing Conferences, reflects on how challenging it is to put into action hard-won promises. She argues that on balance things are going well but that the good is hampered by the bad . . . and the ugly. Development (1999) 42, 38–40. doi:10.1057/palgrave.development.1110008