Bio-mechanical risk factors for uterine prolapse among women living in the hills of west Nepal: A case-control study.

OBJECTIVE:To investigate whether heavy load carrying, wearing a patuka, and body position at work are risk factors for uterine prolapse among Nepali women. METHODS:Community-based case-control study of 448 women (170 cases of uterine prolapse; 278 controls) aged 18-60 years in Kaski district, Nepal was conducted. Women diagnosed with uterine prolapse were cases. Two controls were recruited for each case, frequency-matched by residential area and age. Multivariate logistic regression was used to investigate associations between outcome and exposures. RESULTS:No association of heavy load carrying with uterine prolapse was observed; women who never used a patuka had lower odds of uterine prolapse (odds ratio = 0.18, 95% confidence interval = 0.05-0.71). Women working in a sitting position had higher odds than those working in a standing position (odds ratio = 2.94, 95% confidence interval = 1.74-4.96), as did women who mainly worked in a bending position (odds ratio = 2.45, 95% confidence interval = 1.12-5.34). Housewives were more prone to uterine prolapse than women engaged in farming (odds ratio = 2.13, 95% confidence interval = 1.31-3.47). CONCLUSION:Using a patuka, occupation, and body position during work were all associated with uterine prolapse. No association was found with heavy load carrying, although that might be attributable to the cross-sectional nature of study recruitment

Societal attitude and behaviours towards women with disabilities in rural Nepal: pregnancy, childbirth and motherhood

Abstract Background This study reviews the attitudes and behaviours in rural Nepalese society towards women with disabilities, their pregnancy, childbirth and motherhood. Society often perceives people with disabilities as different from the norm, and women with disabilities are frequently considered to be doubly discriminated against. Studies show that negative perceptions held in many societies undervalue women with disabilities and that there is discomfort with questions of their control over pregnancy, childbirth and motherhood, thus limiting their sexual and reproductive rights. Public attitudes towards women with disabilities have a significant impact on their life experiences, opportunities and help-seeking behaviours. Numerous studies in the global literature concentrate on attitudes towards persons with disabilities, however there have been few studies in Nepal and fewer still specifically on women. Methods A qualitative approach, with six focus group discussions among Dalit and non-Dalit women without disabilities and female community health volunteers on their views and understandings about sexual and reproductive health among women with disabilities, and 17 face-to-face semi-structured interviews with women with physical and sensory disabilities who have had the experience of pregnancy and childbirth was conducted in Rupandehi district in 2015. Interviews were audio-recorded, transcribed, and translated into English before being analysed thematically. Results The study found negative societal attitudes with misconceptions about disability based on negative stereotyping and a prejudiced social environment. Issues around the marriage of women with disabilities, their ability to conceive, give birth and safely raise a child were prime concerns identified by the non-disabled study participants. Moreover, many participants with and without disabilities reported anxieties and fears that a disabled woman’s impairment, no matter what type of impairment, would be transmitted to her baby, Participants – both disabled and non-disabled, reported that pregnancy and childbirth of women with disabilities were often viewed as an additional burden for the family and society. Insufficient public knowledge about disability leading to inaccurate blanket assumptions resulted in discrimination, rejection, exclusion and violence against women with disabilities inside and outside their homes. Stigma, stereotyping and prejudice among non-disabled people resulted to exclusion, discrimination and rejection of women with disabilities. Myths, folklore and misconceptions in culture, tradition and religion about disability were found to be deeply rooted and often cited as the basis for individual beliefs and attitudes. Conclusion Women with disabilities face significant challenges from family and society in every sphere of their reproductive lives including pregnancy, childbirth and motherhood. There is a need for social policy to raise public awareness and for improved advocacy to mitigate misconception about disability and promote disabled women’s sexual and reproductive rights

Data from: Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

Background: Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. Methods: A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. Results: All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05). Conclusions: Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities

Devkota_Perception Survey_Data Set

Primary data, collected in the field. Data analysed using SPSS and transferred to X

Data from: Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

Background: Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. Methods: A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. Results: All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the ‘Health Facility’ dimension and associated items, was found to differ (p<0.05), this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to ‘Cleanliness and Facilities’, ‘Open and Friendliness’ and ‘Compassion and Kindness’ were highly significant (p<0.001), with women with disabilities rating these as better than women without disabilities. On the other hand, women without disabilities rated the ‘Availability of cash Incentives’ more highly (p<0.01). No significant differences were found between Dalit and non-Dalit women in perceived quality of care, except in relation to ‘Cleanliness and facilities’, which Dalit women rated lower than non-Dalits (p<0.05). Conclusions: Perceptions about the quality of care differed significantly by disability status but not by caste. All groups rated the quality of healthcare delivery, interpersonal and personal factors as well as access to services ‘low.’ Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes. Greater attention is required by policy makers, health planners and providers to the improvement of quality of care in health facilities

Healthcare provider’s attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal

Abstract Background Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider’s attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider’s attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth. Method The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes. Results Mean ATDP score among healthcare providers (78.52; SD = 14.75), was low compared to the normative score of 100 or higher. Nurses/auxiliary nurse midwives obtained the highest mean score (85.59, SD = 13.45), followed by general clinical health workers (Mean score = 82.64, SD 15.10). The lowest score was obtained by Female Community Health Volunteers (FCHV) (Score = 73.75, SD = 13.40) (P  0.05). This may reflect the small number of individuals, who have had training on disability thus far, or the nature or quality of the training currently available. The majority of qualitative interview participants perceived providers to have the negative attitude with poor knowledge, skills and preparation for providing care to persons with disabilities. Few participants perceived the providers as kind, respectful, caring or helpful. Conclusion Overall, provider’s attitude towards disability was found to be negative with poor knowledge and skills about providing services. This may have adversely impact maternal healthcare service utilization by women with disabilities. More organized, effective training for healthcare providers is required through on-going mainstream efforts to develop favorable attitudes towards disability. Further research on this subject is also needed

Does women’s caste make a significant contribution to adolescent pregnancy in Nepal? A study of Dalit and non-Dalit adolescents and young adults in Rupandehi district

Abstract Background Adolescent pregnancy is a public health concern worldwide. There are disparities in the occurrence of adolescence pregnancy in different social groups and settings; however, few studies have focused on the contribution of a woman’s caste in early pregnancy in Nepal. This study aimed to examine the association between caste and adolescent pregnancy; and investigate factors that influence this among women of Dalit and non-Dalit caste groups. Methods A cross sectional survey among 457 women, age between 14 and 24 years was carried out in Rupandehi district of Nepal. Bivariate and multivariate logistic regression analysis using a stepwise entry method was performed to assess the association of women’s caste, ethnicity and other socio-demographic and individual factors with early pregnancy. Results Over two thirds of the participants (69%) were pregnant during adolescence. The highest percentage of adolescent pregnancies were reported among women from Janajati groups (77%) and the lowest in Brahmin/Chhetri caste groups (45%); while 72.5% of women from Dalit caste groups reported adolescent pregnancy. When adjusted for demographic and individual variables, early pregnancy was less likely among women who were from Brahman/Chhetri (OR: 0.60; 95% CI: 0.30, 1.22) and Madhesi/Muslim (OR 0.56; 95% CI: 0.23, 1.36) compared to women from the Dalit caste, but multivariate regression analysis found none of these were statistically significant. Women who had secondary level education (OR: 0.34; 95% CI: 0.17, 0.65), had married after 17 years of age (OR: 0.02; 95% CI: 0.01, 0.14) and had attended fairs/clubs (OR: 0.40; CI: 0.21, 0.79) were significantly less likely to experience early age pregnancy. Women who drank alcohol (OR: 5.18; 95% CI: 1.02, 26.32) were significantly more likely to become pregnant during adolescence compared to women who did not drink alcohol. Conclusions Women’s caste had no direct contributory role in the early pregnancy of the sample. Education, age at marriage and individual behaviours were the key contributing factors. Reducing the number of adolescent pregnancies requires addressing the factors that lead to and perpetuate child marriage; keeping girls within education systems for longer; increase the knowledge and control of girls over their own reproductive health and planning; and actions that promote gender respect within relationships, decision-making and negotiation among both girls and boys

Disability, Caste, and Intersectionality: Does Co-Existence of Disability and Caste Compound Marginalization for Women Seeking Maternal Healthcare in Southern Nepal?

Background: Disability and caste are two different forms of oppression; however, people of the Dalit caste in Nepal and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15–49 years. Maternal healthcare service utilization was assessed by antenatal care (ANC), health facility (HF) delivery, and postnatal care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by inclusion of a disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery, and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30–0.84) and PNC (OR 0.47, CI 0.25–0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste, and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05–0.74). Conclusions: Disabled women—whether Dalit or non-Dalit—had lower rates of utilizing all maternal healthcare services than non-disabled women. Interestingly, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention be re-examined and more nuanced interventions considered to ensure improved access and outcomes among all vulnerable groups