Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Kenya

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Kenya, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Kenya

Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Nigeria

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Nigeria, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Nigeria

Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Ethiopia

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Ethiopia, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Ethiopia

The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya.

INTRODUCTION: For many women living with HIV (WLWH), the disclosure of positive status can lead to either an extension of former violence or new conflict specifically associated with HIV status disclosure. This study aims to explore the following about WLWH: 1. the women's experiences of intimate partner violence (IPV) risks following disclosure to their partners; 2. an analysis of the women's views on the role of health providers in preventing and addressing IPV, especially following HIV disclosure. METHODS: Thirty qualitative interviews were conducted with purposively selected WLWH attending clinics in Kenya. Data were coded using NVivo 9 and analyzed thematically. RESULTS: Nearly one third of the respondents reported experiencing physical and/or emotional violence inflicted by their partners following the sero-disclosure, suggesting that HIV status disclosure can be a period of heightened risk for partner stigma and abuse, and financial withdrawal, and thus should be handled with caution. Sero-concordance was protective for emotional and verbal abuse once the partner knew his positive status, or knew the woman knew his status. Our results show acceptance of the role of the health services in helping prevent and reduce anticipated fear of partner stigma and violence as barriers to HIV disclosure. Some of the approaches suggested by our respondents included couple counselling, separate counselling sessions for men, and facilitated disclosure. The women's narratives illustrate the importance of integrating discussions on risks for partner violence and fear of disclosure into HIV counselling and testing, helping women develop communication skills in how to disclose their status, and reducing fear about marital separation and break-up. Women in our study also confirmed the key role of preventive health services in reducing blame for HIV transmission and raising awareness on HIV as a chronic disease. However, several women reported receiving no counselling on safe disclosure of HIV status. CONCLUSION: Integration of partner violence identification and care into sexual, reproductive and HIV services for WLWH could be a way forward. The health sector can play a preventive role by sensitizing providers to the potential risks for partner violence following disclosure and ensuring that the women's decision to disclose is fully informed and voluntary

Exploring the association between FGM/C and fistula: A review of the evidence

Female genital mutilation/cutting (FGM/C) and fistula are both conditions that have a range of health, socioeconomic, and lifestyle causes and consequences for women globally. There have been sparse empirical and conceptual efforts to look at how these two conditions manifest and relate to one another. This rigorous review of the literature aims to fill this research gap by assessing the state of evidence on the association of FGM/C and fistula and conceptually mapping this association within broader social, political, and health-systems contexts. Based on the findings, the authors of this report have developed a conceptual mapping framework to situate the evidence of an association between FGM/C and fistula, including high-income countries and low- and middle-income countries where migrants or underserved populations lack access to proper pregnancy and delivery care. The authors recommend that researchers, as well as policy and program implementers, think through and utilize the framework in their work in order to consider the intersectional influences on both conditions

Addressing barriers to quality of underutilized commodities and services for prevention and management of pre-eclampsia and eclampsia in Kenya

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and treatment, including potential supply-chain bottlenecks, 2) investigate similarities and differences in PE/E knowledge, attitudes, and care-seeking behaviors among providers, women, and community members, and 3) generate lessons for scaling up proven underutilized PE/E interventions more effectively. A desk review of relevant Kenyan policies was conducted in addition to eight focus group discussions and 114 in-depth interviews with policymakers and program implementers

Retrospective cohort study: Clinical presentation and outcomes of pre-eclampsia and eclampsia at Kenyatta National Hospital, Nairobi, Kenya

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for early and late onset pre-eclampsia. This report details the study’s findings, showing that out of the 620 records reviewed, 44 percent of pre-eclamptic and eclamptic women exhibited early onset of pre-eclampsia, while 56 percent had late onset. Early onset of pre-eclampsia was associated with greater disease severity as well as adverse maternal and perinatal outcomes. Early detection, continuous monitoring, identification of risk factors, and prompt referral are critical in mitigating the serious consequences of pre-eclampsia and eclampsia

Integrating tuberculosis case finding and treatment into postnatal care

Under the USAID funded FRONTIERS program, the Population Council conducted a study in six health facilities in Western Kenya that demonstrated that screening for TB within an antenatal care (ANC) setting is feasible and acceptable among the service providers. However, a major challenge remains: although TB detection is encouraged among ANC clients within the maternal and child health clinics in the country, providers in these settings fail to appreciate the need for a continuum of care from pregnancy through to the postnatal period. In order to address this gap, the APHIA II Operations Research Project developed and tested an intervention to improve TB screening, case detection, treatment, and care among postnatal women. The findings demonstrate that while it is feasible to use postnatal care services as a platform for TB screening and case detection, the actual number of cases detected was extremely low, even though the facilities were located in areas expected to have high prevalence. It might be important for program managers and policymakers to decide whether routine TB screening in RH services is justifiable, given the very low cases of TB detected

Reducing barriers to accessing fistula repair: Implementation research in Uganda

The Population Council, in collaboration with Fistula Care Plus and EngenderHealth, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing fistula screening, diagnosis, and treatment in Uganda. Following a baseline assessment, researchers implemented a multi-pronged intervention utilizing a mobile hotline, transport voucher, and mass media tools to increase community awareness. This brief provides key messages and recommendations for overcoming barriers hindering access to fistula care services. Health systems and external stakeholder support are essential for sustaining trends