Obstetric fistula: Can community midwives make a difference? Findings from four districts in Kenya

As part of the UNFPA Global Campaign to End Obstetric Fistula, the Population Council and UNFPA built on Kenya’s Community Midwifery Approach to develop a comprehensive community midwifery intervention strategy that aimed at increasing skilled attendants at birth and prevention of obstetric fistula. This report seeks to understand the experiences of women affected by fistula and whether community midwives can contribute to preventing obstetric fistula in rural settings in Kenya. The key recommendations emerging from this report are to: update health facility midwives in maternal and neonatal health (MNH) skills including prevention, treatment, and care of obstetric fistula; train more community midwives; increase community awareness; and listen to men and women and involve them in community health committees and district health plans for improving MNH, taking into account cultural sensitivities. Detailed activities regarding the recommendations are outlined at four different levels: the community, the linkages between community and health services, the health facility, and the policy level. The report recommends that these be reviewed and incorporated into annual operational plans

Formative research on factors influencing access to fistula care and treatment in Uganda

This formative research builds upon the results of a systematic review by the Population Council for better understanding of the barriers and enabling factors for fistula repair care and access in Uganda. The study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results reveal the nuances of women’s experiences, along with the additional perspectives of their spouses, family members, community stakeholders, and fistula camp care providers including nurses/counselors, surgeons, and facility and district managers. Barriers and enablers to fistula repair care are clustered around the following factors: psychosocial, cultural, social, financial, transportation, facility shortages, quality of care, awareness, policy and political environments, and healing and reintegration. The report includes recommendations for policy and practice that reinforce the need for targeted programming strategies to increase access for obstetric fistula repair

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 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

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

High Impact Practices—Detecting and managing hypertension in the extended postnatal period: Preventing postnatal pre-eclampsia and eclampsia

The Population Council developed High Impact Practice (HIP) briefs for three strategies that show promise for improving prevention, detection, and management of Hypertensive Disorders in Pregnancy (HDPs). This brief focuses on one of those strategies: detecting and managing hypertension in the extended postnatal period. Key points presented are: the extended postnatal period provides an opportunity to monitor a woman’s blood pressure (BP) and check for persistent hypertension; if BP is measured routinely at any contact with the health system during the extended postnatal period, hypertension is more likely to be detected and managed appropriately; women with pre-eclampsia have a 3.7-fold increased risk of future hypertension, a 2.2-fold risk of ischemic heart disease, and a 1.8-fold risk of stroke; measure every woman’s BP after birth, daily until discharge; if women continue to have high BP postnatally, they must receive hypertensive medicines with close follow-up; women who were previously normotensive during pregnancy may develop hypertension or pre-eclampsia for the first time after delivery. Detecting, and/or managing unresolved BP during the postnatal period is one of several promising HIPs in maternal health

Ending Eclampsia: PHC PH/E_plus Model

Pre-eclampsia and eclampsia (PE/E)—life-threatening high blood pressure and excess protein in the urine after 20 weeks gestation—is a leading cause of pregnancy-related deaths. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. The Population Council implemented a two-phase intervention involving training, mentoring, and supervising providers at secondary facilities on detection and management of PE/E patients (Phase 1), and training primary health care (PHC) providers to administer a modified loading dose of magnesium sulphate and refer women to secondary health facilities for monitoring (Phase 2). This brief describes the Population Council’s implementation research study to evaluate this task-shifting process around the prevention, detection, and management of PE/E at the PHC level. The study showed that not only were PHC providers effectively able to carry out this task, but maternal mortality in the intervention group decreased

Strengthening postnatal care services including postpartum family planning in Kenya

The objectives of this study were to develop and introduce a strengthened postnatal care package into one hospital and four health centers in one district in Kenya, to document the feasibility, acceptability, and quality of care of the strengthened postnatal care, and to evaluate the effectiveness of the postnatal package on women’s reproductive health behaviors. The study was implemented jointly by the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project and by Jhpiego’s ACCESS-FP project, both funded by USAID. A postnatal care–family planning orientation package for providers was developed that incorporated relevant maternal and newborn healthcare services in the postnatal period with a specific focus on postpartum family planning. The package developed and tested through this project proved to be acceptable to clients and providers and can be introduced fairly easily through a three-day orientation training and enhanced through supportive supervision. To raise the standard of care further, future use of this training and supervision package as a standard protocol for the Ministry of Health in Kenya or elsewhere should include a clinical skills component for maternal and neonatal complications

Barriers to obstetric fistula treatment in low-income countries: A systematic review

Obstetric fistula is a maternal morbidity condition that occurs in some low-income countries and is caused by prolonged obstructed labor that results in a hole between the vagina and the bladder or rectum through which urine or feces leak. Unrepaired fistula can lead to lifelong ostracism, stigma, and shame. Obstetric fistula is preventable and treatable, but women in these countries experience delays in seeking repair due to a number of factors including awareness of their condition as well as the potential for treatment, resources necessary for seeking care, lack of skilled fistula surgeons, and long hospital waiting times. UNFPA estimates that 2 to 3.5 million women are currently living with fistula worldwide. The true number may actually be higher. This review aims to identify and understand the barriers affecting women’s access to fistula repair, to inform the design of possible interventions that may be effective in addressing these barriers. This work may also identify research gaps surrounding fistula in low-income countries that require targeted formative research before interventions can be designed