14 research outputs found

    Women's Sexual Empowerment and Contraceptive Use in Ghana

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    Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93761/1/j.1728-4465.2012.00318.x.pd

    U.S. Women's Intended Sources for Reproductive Health Care

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    Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd

    Children with disorders of sex development: A qualitative study of early parental experience

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    <p>Abstract</p> <p>Background</p> <p>Clinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation.</p> <p>Objectives</p> <p>To characterize parental experiences in the early clinical care of children born with DSD.</p> <p>Study Design</p> <p>Content analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD.</p> <p>Results</p> <p>Four major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support.</p> <p>Conclusions</p> <p>Parents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.</p

    Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis

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    Abstract Background Amniotic fluid embolism (AFE) is a rare, life threatening obstetric complication, often associated with severe coagulopathy. Induced abortions are extremely safe procedures however complications including AFE can occur. Case presentation A 29-year-old previously healthy woman, gravida 1 para 0, presented for a scheduled second trimester induced abortion via dilation and evacuation at 22-weeks gestation. The case was complicated by a suspected AFE with associated profound coagulopathy. Viscoelastic point-of-care coagulation analysis was used to successfully and swiftly guide management of her coagulopathy. Conclusion AFE can occur in the setting of induced abortion. This case report suggests viscoelastic point-of-care coagulation analyzers may aid in the management of pregnancy-related coagulopathy by providing faster coagulation assessment than laboratory testing, and facilitating timely, targeted management of coagulopathy.http://deepblue.lib.umich.edu/bitstream/2027.42/173649/1/12884_2019_Article_2680.pd

    Shifting norms: pregnant women’s perspectives on skilled birth attendance and facility–based delivery in rural Ghana

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    Skilled birth attendance (SBA) and healthcare facility (HCF) delivery are effective means of reducing maternal mortality. However, their uptake remains low in many low-income countries. The present study utilized semi-structured interviews with 85 pregnant women attending an antenatal clinic in Akwatia, Ghana (May-July 2010) to better understand the barriers to SBA and HCF delivery through the underrepresented perspective of pregnant women. Interview transcripts were analyzed using grounded theory methodology. Participants described community support for and uptake of HCF delivery as increasing and becoming normalized, but barriers remain: (1) maltreatment by midwives; (2) cost associated with HCF delivery despite waived facility fees; (3) the need for a support person for HCF delivery; (4) difficulties in transportation; and (5) precipitous labor. Given the importance of community in Ghanaian health care decision-making, increasing community support for HCF delivery suggests progress toward increasing uptake of SBA and HCF delivery, however important actionable barriers remain.Les services des accoucheuses qualifiĂ©s (SAQ) et des Ă©tablissements de santĂ© (SES) sont des moyens efficaces de rĂ©duire la mortalitĂ© maternelle. Cependant, leur acceptation reste faible dans de nombreux pays Ă  faible revenu. La prĂ©sente Ă©tude s’est servie des entretiens semi-structurĂ©s recueillis auprĂšs des 85 femmes enceintes qui frĂ©quentaient un dispensaire prĂ©natal Ă  Akwatia, Ghana (entre les mois de mai et juillet 2010) afin de mieux comprendre les obstacles Ă  la prestation des SAQ et SES Ă  travers les perspectives sous-reprĂ©sentĂ©es chez les femmes enceintes. Les transcriptions des entrevues ont Ă©tĂ© analysĂ©es en utilisant une mĂ©thodologie basĂ©e sur le « grounded theory ». Les participants ont signalĂ© que le soutien communautaire pour l’accouchement dans les SES et de l’adoption des SES augmentent et se normalisent, mais que des obstacles demeurent: (1) les mauvais traitements infligĂ©s par des sages-femmes, (2) le coĂ»t associĂ© Ă  la prestation des SES en dĂ©pit des frais d&apos;Ă©tablissement supprimĂ©s; (3) la nĂ©cessitĂ© d&apos;une personne de soutien pour l’accouchement dans les SES, (4) des difficultĂ©s de transport, et (5) du travail prĂ©cipitĂ©. Compte tenu de l&apos;importance de la communautĂ© concernant la prise de dĂ©cision en matiĂšre de soins de santĂ© au Ghana la hausse du soutien communautaire pour l’accouchement dans les SES est une indication du progrĂšs vers l’utilisation croissante de la prestation des SAQ et des SES mais il reste toujours d’importants obstacles rĂ©alisable

    Interpersonal Relationships and Social Support in Transitioning Narratives of Black Transgender Women in Detroit

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    Social support has been shown to play a key role in overcoming adversities associated with marginalized identities, yet there is a dearth of information regarding the role of social networks in the gender transition process, particularly in ethnic minority transgender communities. This study uses life history narratives, and a modified grounded theory analysis, to explore the impact of interpersonal relationships on the gender transition process of Black transgender women in Detroit, Michigan. The following interpersonal interactions were significant: family reactions to self-recognition of femininity, coming out as gay prior to transgender identity disclosure, contact with an out transwoman, emotional and physical distancing from existing social networks, building relationships in transgender communities and reinitiating contact with biological family. Findings highlight familial and peer relationship dynamics that featured prominently during gender transition
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