Investigating and Improving Access to Reproductive Healthcare for Vulnerable Migrant Women in France

Background: Homelessness and housing instability in the host countries are central features of the experience of migration to the EU. Although migrant women across the EU encounter obstacles in accessing healthcare services, little is known on the health and access to healthcare services for unstably housed migrant women. The DSAFHIR project aims to better describe the risks faced by migrant women in situations of administrative and social vulnerability, to analyze the barriers to access healthcare and to test specific health interventions. Methods: The DSAFHIR project consists of a two-wave mixed-method survey and the implementation of two tailored sexual health interventions. 474 migrant women aged 18 to 77 years housed in social hotels were surveyed at inclusion. After the implementation of sexual health interventions, respondents were contacted for the follow-up survey (n=284). Discussion: The project provides needed data on migrant women’s health and healthcare access, including non-French speakers. It allows to draw lessons on feasibility and acceptability of quantitative and qualitative surveys on this hard-to-reach population. A high response rate in both waves of the survey (84% and 85%) suggests good acceptability. The attrition is comparable to other migrant longitudinal surveys (60% of the original sample completed the follow-up survey, or 40% of attrition), suggesting that relying on cell phones is possible for follow-up even in contexts of housing instability

IUD use in France: women's and physician's perspectives

Objective While the intra-uterine device (IUD) is the second most popular contraceptive method in France, its use remains low among women most at risk of unintended pregnancies. Acknowledging the conjoint role of women and physicians in contraceptive decision making, we investigate the determinants of IUD use and IUD recommendations from the user and prescriber perspectives. Study design Data are drawn from 2 national probability surveys (population-based and physician surveys) on sexual and reproductive health in France. The population based survey comprised 3,563 women ages 15–49 at risk of an unintended pregnancy in 2010 and the physician survey included 364 general practitioners (GPs) and 401 gynecologists practicing in private offices in 2010–2011. Analyses were performed using logistic regression models. Results Altogether, 21.4% of women were IUD users, with substantial differences by age and parity. Less than 1% of young women (<25 years) and 3% of nulliparous were current IUD users in 2010. The odds of IUD use were four times higher in women followed by a gynecologist as compared to a GP. Mirroring these results, gynecologists were more likely to recommend IUDs than GPs. Misconception about IUD risks was widespread among women and providers. Medical training and information, professional practice settings, and ever use of IUDs also informed physician’s likelihood of recommending IUDs, regardless of specialty. Conclusions The study reveals the intersection of individual and professional influences on contraceptive use patterns. The considerable age discrepancy in IUD use in France, with very few young women most at risk of an unintended pregnancy using the method, reflects a knowledge gap shared by users and providers. These findings suggest there are significant opportunities to improve contraceptive care in France. Implications This study stresses the need to inform women and doctors about the benefits and risks of IUDs for all women. Substantial efforts are required to improve the medical curriculum, in order to promote evidenced based family planning counseling and provide GPs with the technical skills to insert IUDs

Les inégalités sociales d'accès à la contraception en France

Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle and the COCON group.- Social inequalities in access to contraception in France Since contraception was legalized in France in 1967, there has been a sustained increase in use of medical contraception, notably third generation contraceptive pills that are not reimbursed by the social security. This change in contraceptive behaviour may well have generated new forms of inequality. This article shows that social inequalities in contraceptive use in France have changed in recent decades. At the beginning of the 1 980s, access to the pill and the intrauterine device (IUD) was characterized by large inequalities. These inequalities subsequently declined sharply, for the pill in the 1990s and for the IUD at the end of the 1990s. COCON data show for the first time that such inequalities now affect access to third generation oral contraceptives. In addition to the financial obstacle of high price, the inequalities in access to these non-refundable products seem to result from women's expectations, which are related to their social class, and from the behaviour of the prescribing doctors, which also varies with the woman's social class. However, women seem not to prefer these new productsBajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle et l'équipe Cocon,- Les inégalités sociales d'accès à la contraception en France Depuis la légalisation de la contraception en 1967, le recours à la contraception médicalisée, et notamment aux pilules de troisième génération non remboursées, ne cesse d'augmenter. Cette modification du paysage contraceptif a pu générer de nouvelles formes d'inégalités. L'article montre que les inégalités sociales en matière de contraception en France se sont déplacées de décennie en décennie. Au début des années 1980, l'accès à la pilule et au stérilet était marqué par de fortes disparités. Ces disparités se sont par la suite fortement réduites, pour la pilule dans les années 1990, puis pour le stérilet à la fin des années 1990. Pour la première fois, les données de l'enquête Cocon montrent qu'elles concernent désormais l'accès aux pilules de troisième génération. Ces inégalités d'accès à des produits non remboursés par la Sécurité sociale semblent résulter, outre du frein financier que représente leur prix élevé, d'attentes différentes des femmes, liées à leur appartenance sociale, ainsi que des comportements des prescripteurs qui varient aussi selon l'appartenance sociale des femmes. Ces nouveaux produits ne semblent toutefois pas être plus appréciés des femmes.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle y el equipo Cocon.- Las desigualdades sociales en el acceso a la anticoncepción en Francia Desde que se legisló el uso de anticonceptivos, en 1967, el acceso médico a éstos, y en particular a las pildoras no reembolsables de tercera generación, sigue aumentando. Es posible que taies cambios en el paisaje anticonceptivo hayan generado nuevas formas de desigualdad. Este articulo muestra que las desigualdades sociales en el uso de anticonceptivos en Francia se han ido desplazando década tras década. A principios de los aňos ochenta había fuertes dis- paridades de acceso a la pildora y al DIU. Estas disparidades se fueron reduciendo durante los aňos noventa, en el caso de la pildora, y hacia finales de los noventa, en el caso del DIU. Por primera vez, los datos de la encuesta Cocon muestran que taies desigualdades se manifiestan actualmente en el uso de las pildoras de tercera generación. Además del obstáculo financiero que supone el precio elevado de estas pildoras, tales desigualdades de acceso a productos no reembolsables por la Seguridad Social parecen derivarse de diferentes expectativas por parte de las mujeres segun su nivel social y a comportamientos también variables según nivel social de la mujer por parte de quienes las prescriben. Sin embargo, estos nuevos productos no parecen gozar de mayor apreciación entre las mujeres.Bajos N., Oustry P., Leridon Henri, Bouyer J., Job-Spira N., Hassoun D. Les inégalités sociales d'accès à la contraception en France. In: Population, 59ᵉ année, n°3-4, 2004. pp. 479-502

Social Inequalities in Access to Contraception in France

Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle and the COCON group.- Social Inequalities in Access to Contraception in France Since contraception was legalized in France in 1967, there has been a sustained increase in use of medical contraception, notably third generation contraceptive pills that are not reimbursed by the social security. This change in contraceptive behaviour may well have generated new forms of inequality. This article shows that social inequalities in contraceptive use in France have changed in recent decades. At the beginning of the 1980s, access to the pill and the intrauterine device (IUD) was characterized by large inequalities. These inequalities subsequently declined sharply, for the pill in the 1990s and for the IUD at the end of the 1990s. COCON data show for the first time that such inequalities now affect access to third generation oral contraceptives. In addition to the financial obstacle of high price, the inequalities in access to these non-refundable products seem to result from women's expectations, which are related to their social class, and from the behaviour of the prescribing doctors, which also varies with the woman's social class. However, women seem not to prefer these new products.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle et l'équipe Cocon.- Les inégalités sociales d'accès à la contraception en France Depuis la légalisation de la contraception en 1967, le recours à la contraception médicalisée, et notamment aux pilules de troisième génération non remboursées, ne cesse d'augmenter. Cette modification du paysage contraceptif a pu générer de nouvelles formes d'inégalités. L'article montre que les inégalités sociales en matière de contraception en France se sont déplacées de décennie en décennie. Au début des années 1980, l'accès à la pilule et au stérilet était marqué par de fortes disparités. Ces disparités se sont par la suite fortement réduites, pour la pilule dans les années 1990, puis pour le stérilet à la fin des années 1990. Pour la première fois, les données de l'enquête Cocon montrent qu'elles concernent désormais l'accès aux pilules de troisième génération. Ces inégalités d'accès à des produits non remboursés par la Sécurité sociale semblent résulter, outre du frein financier que représente leur prix élevé, d'attentes différentes des femmes, liées à leur appartenance sociale, ainsi que des comportements des prescripteurs qui varient aussi selon l'appartenance sociale des femmes. Ces nouveaux produits ne semblent toutefois pas être plus appréciés des femmes.Bajos Nathalie, Oustry Pascale, Leridon Henri, Bouyer Jean, Job-Spira Nadine, Hassoun Danielle y el equipo Cocon.- Las desigualdades sociales en el acceso a la anticoncepción en Francia Desde que se legisló el uso de anticonceptivos, en 1967, el acceso médico a éstos, y en particular a las pildoras no reembolsables de tercera generación, sigue aumentando. Es posible que taies cambios en el paisaje anticonceptivo hayan generado nuevas formas de desigualdad. Este articulo muestra que las desigualdades sociales en el uso de anticonceptivos en Francia se han ido desplazando década tras década. A principios de los aňos ochenta había fuertes dis- paridades de acceso a la píldora y al DIU. Estas disparidades se fueron reduciendo durante los aňos noventa, en el caso de la píldora, y hacia finales de los noventa, en el caso del DIU. Por primera vez, los datos de la encuesta Cocon muestran que taies desigualdades se manifiestan actualmente en el uso de las pildoras de tercera generación. Además del obstáculo financiero que supone el precio elevado de estas pildoras, tales desigualdades de acceso a productos no reembolsables por la Seguridad Social parecen derivarse de diferentes expectativas por parte de las mujeres según su nivel social y a comportamientos también variables según nivel social de la mujer por parte de quienes las prescriben. Sin embargo, estos nuevos productos no parecen gozar de mayor apreciación entre las mujeres.Bajos N., Oustry P., Leridon Henri, Bouyer J., Job-Spira N., Hassoun D. Social Inequalities in Access to Contraception in France. In: Population (English edition), 59ᵉ année, n°3-4, 2004. pp. 415-437

Ustekinumab to target granulomatous dermatitis in recalcitrant ulcerative necrobiosis lipoidica: case report and proposed mechanism

We present a 42-year-old woman with no history of diabetes or glucose intolerance who had a 5-year history of ulcerative necrobiosis lipoidica (NL). Despite failure of multiple medications, she experienced clearing of her ulcers after her treatment was changed to ustekinumab. We discuss our patient’s disease course and elaborate upon mechanistic reasons for her improvement related to ustekinumab therapy

Comparison between microparticles and nanostructured particles of FeSn2 as anode materials for Li-ion batteries

The performances and mechanisms of two types of anodes formed by FeSn2 microparticles and nanostructured FeSn2, respectively, were studied by Mossbauer spectroscopy and electrochemical testing. The specific capacity, which is within the range 400-600 mAh g(-1) even at high C-rate, did not vary with cycle number over 50-60 cycles for the microparticles but progressively decreased for the nanostructured material. In the two cases, the first discharge consists in the irreversible transformation of FeSn2 into Fe/Li7Sn2 nanocomposite. The capacity fade is attributed to the growth and/or coalescence of the particles during cycling. (C) 2010 Elsevier B.V. All rights reserved

Comparison between microparticles and nanostructured particles of FeSn(2) as anode materials for Li-ion batteries

International audienc

Investigating and Improving Access to Reproductive Healthcare for Vulnerable Migrant Women in France

International audienceBackground: Homelessness and housing instability in the host countries are central features of the experience of migration to the EU. Although migrant women across the EU encounter obstacles in accessing healthcare services, little is known on the health and access to healthcare services for unstably housed migrant women. The DSAFHIR project aims to better describe the risks faced by migrant women in situations of administrative and social vulnerability, to analyze the barriers to access healthcare and to test specific health interventions. Methods: The DSAFHIR project consists of a two-wave mixed-method survey and the implementation of two tailored sexual health interventions. 474 migrant women aged 18 to 77 years housed in social hotels were surveyed at inclusion. After the implementation of sexual health interventions, respondents were contacted for the follow-up survey (n=284). Discussion: The project provides needed data on migrant women’s health and healthcare access, including non-French speakers. It allows to draw lessons on feasibility and acceptability of quantitative and qualitative surveys on this hard-to-reach population. A high response rate in both waves of the survey (84% and 85%) suggests good acceptability. The attrition is comparable to other migrant longitudinal surveys (60% of the original sample completed the follow-up survey, or 40% of attrition), suggesting that relying on cell phones is possible for follow-up even in contexts of housing instability

Parcours migratoire, violences déclarées, et santé perçue des femmes migrantes hébergées en hôtel en Île-de-France. Enquête Dsafhir.

International audienceAccommodation in emergency hotels is a particularly precarious form of emergency sheltering. Confronted with violence, migrant women accommodated in emergency hotels are characterised by several types of vulnerabilities. This has a negative impact on their health status and exacerbates their difficulties of access to healthcare.The Dsafhir survey, conducted in 2017 among 469 migrant women accommodated in emergency hotels, mainly describes the perceived health status of these women and the variety of forms of violence they have experienced (physical, psychological, sexual, economic, administrative), the relationships they have (or used to have) with perpetrators (spouse, relatives, representatives of the state authority), as well as the temporality of the acts incriminated (violence ocurring before migration, during their migratory journey, or in France).By processing the quantitative (n=469) and the qualitative (n=30) Dsafhir data, this article describes the health status and violence that accommodated migrant women were exposed to, by characterising the types of violence, the links with the perpetrators, and by placing them in the temporality of migration routes. Sexual violence, moreover is dealt with specific attention.Our results show that these women are particularly vulnerable to experiencing violence in their lifetime.By questioning respondents in « ordinary households », the largest statistical surveys on violence usually and considerably under-represent these marginalised women. In addition, these women often do not have access to healthcare, even though this situation has a proven negative impact on their health.La « mise à l’abri » à l’hôtel est une forme particulièrement précaire d’hébergement d’urgence. Les femmes migrantes hébergées à l’hôtel cumulent des facteurs de vulnérabilité face aux violences. Ce contexte a un effet délétère sur leur état de santé et renforce leurs difficultés d’accès aux soins de santé.L’enquête Droits, santé et accès aux soins des femmes hébergées immigrées et réfugiées en Île-de-France (Dsafhir), menée auprès de 469 femmes migrantes vivant à l’hôtel en 2017, permet notamment de décrire l’état de santé perçu de ces femmes et la diversité des formes de violence qu’elles ont subies (physiques, psychologiques, sexuelles, économiques et administratives), les liens qui les unissent (ou les unissaient) aux auteurs des violences (conjoint, membre de la famille, représentant de l’autorité, etc.), ainsi que la temporalité des actes incriminés (violences survenant avant la migration, pendant le trajet migratoire, en France).En mobilisant les données quantitatives (n=469) et qualitatives (n=30) de cette enquête, cet article décrit les états de santé et les violences auxquelles ont été exposées les femmes migrantes mises à l’abri en les caractérisant (types de violence, lien avec l’auteur) et en les plaçant dans la temporalité des parcours migratoires. Les violences sexuelles font l’objet d’une attention spécifique.Les résultats montrent que ces femmes sont particulièrement exposées au fait de subir des violences au cours de leur vie.Les grandes enquêtes statistiques sur les violences, parce qu’elles interrogent des répondants dans des « ménages ordinaires », sous-représentent largement cette population de femmes marginalisées. En outre, elles sont rarement prises en charge, sur le plan médico-psycho-social, alors que ces expériences ont un impact négatif avéré sur leur état de santé