Association between intimate partner violence and male alcohol use and the receipt of perinatal care : evidence from Nepal demographic and health survey 2011-2016

The utilization of perinatal care services among women experiencing intimate partner violence (IPV) and male alcohol use is a major problem. Adequate and regular perinatal care is essential through the continuum of pregnancy to mitigate pregnancy and birth complications. The aim of this study is to determine the association between IPV and male alcohol use and the receipt of perinatal care in Nepal. This study used pooled data from 2011 and 2016 Nepal Demographic and Health Surveys (NDHS). A total of 3067 women who interviewed for domestic violence module and had most recent live birth 5 years prior surveys were included in the analysis. Multivariable logistic regression analysis was performed to determine the association between IPV and male alcohol use and the receipt of perinatal care. Of the total women interviewed, 22% reported physical violence, 14% emotional violence, and 11% sexual violence. Women who were exposed to physical violence were significantly more likely to report non-usage of institutional delivery [adjusted Odds Ratio (aOR) = 1.30 (95% Cl: 1.01, 1.68)] and skilled delivery assistants [aOR = 1.43 (95% Cl: 1.10, 1.88)]. Non-attendance of 4 or more skilled antenatal care visits was associated with a combination of alcohol use by male partner and exposure to emotional [aOR = 1.42 (95% Cl: 1.01, 2.00)] and physical violence [aOR = 1.39 (95% Cl: 1.03, 1.88)]. The negative association between IPV and perinatal care suggests it is essential to develop comprehensive community- based interventions which integrates IPV support services with other health services to increase the uptake of perinatal care through the continuum of pregnancy

Exploring the factors impacting on access and acceptance of sexual and reproductive health services provided by adolescent-friendly health services in Nepal.

Adolescent-friendly health programs have been in place in Nepal since 2008, yet uptake of the services for sexual and reproductive health remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their acceptance and utilization from the perspectives of adolescents, health care staff, and key community informants. This study applied a qualitative research design involving six focus groups with 52 adolescents and in-depth interviews with 16 adolescents, 13 key informants, and 9 health care providers from six adolescent-friendly health facilities in Nepal. Thematic analysis was conducted for data analysis. The key themes identified as barriers include access issues due to travel, institutional health care barriers, perceived lack of privacy and confidentiality, and the unprofessional attitudes of staff towards the sexual health needs of adolescents. These themes are underpinned by gendered ideology and a moral framework around the sexual behavior of adolescents. Interview responses suggested that health care providers take a policing role in prescribing adolescents' conformity to this moral framework in their delivery of reproductive health care and services. While physical access to health services may be problematic for some adolescents, this is not the priority issue. Attention needs to be given to increasing the capacity of health care providers to deliver services without imposing their own and socially sanctioned moral frameworks around adolescent sexual behavior. Such capacity building should include training that is experiential and emphasizes the importance of confidentiality and non-judgmental attitudes

‘I’m telling you … the language barrier is the most, the biggest challenge’ : barriers to education among Karen refugee women in Australia

This article examines factors influencing English language education, participation and achievement among Karen refugee women in Australia. Data were drawn from ethnographic observations and interviews with 67 participants between 2009 and 2011, collected as part of a larger qualitative study exploring the well-being of Karen refugee women in Sydney. Participants unanimously described difficulty with English language proficiency and communication as the ‘number one’ problem affecting their well-being. Gendered, cultural and socio-political factors act as barriers to education. We argue that greater sensitivity to refugees’ backgrounds, culture and gender is necessary in education. Research is needed into the combined relationships between culture and gender across pre-displacement, displacement and resettlement and the impact of these factors on post-immigration educational opportunities. Training is needed to sensitise educators to the complex issues of refugee resettlement. The paper concludes with recommendations for service provision and policy

Examining the knowledge, attitudes and practices of domestic and international university students towards seasonal and pandemic influenza

Abstract Background Prior to the availability of the specific pandemic vaccine, strategies to mitigate the impact of the disease typically involved antiviral treatment and “non-pharmaceutical” community interventions. However, compliance with these strategies is linked to risk perceptions, perceived severity and perceived effectiveness of the strategies. In 2010, we undertook a study to examine the knowledge, attitudes, risk perceptions, practices and barriers towards influenza and infection control strategies amongst domestic and international university students. Methods A study using qualitative methods that incorporated 20 semi-structured interviews was undertaken with domestic and international undergraduate and postgraduate university students based at one university in Sydney, Australia. Participants were invited to discuss their perceptions of influenza (seasonal vs. pandemic) in terms of perceived severity and impact, and attitudes towards infection control measures including hand-washing and the use of social distancing, isolation or cough etiquette. Results While participants were generally knowledgeable about influenza transmission, they were unable to accurately define what ‘pandemic influenza’ meant. While avian flu or SARS were mistaken as examples of past pandemics, almost all participants were able to associate the recent “swine flu” situation as an example of a pandemic event. Not surprisingly, it was uncommon for participants to identify university students as being at risk of catching pandemic influenza. Amongst those interviewed, it was felt that ‘students’ were capable of fighting off any illness. The participant’s nominated hand washing as the most feasible and acceptable compared with social distancing and mask use. Conclusions Given the high levels of interaction that occurs in a university setting, it is really important that students are informed about disease transmission and about risk of infection. It may be necessary to emphasize that pandemic influenza could pose a real threat to them, that it is important to protect oneself from infection and that infection control measures can be effective.</p

&#145;Being a Good Woman&#146;: suffering and distress through the voices of women in the Maldives

This ethnographic study explored the social and cultural context of Maldivian women's emotional,social and psychological well-being and the subjective meanings they assign to their distress. Thecentral question for the study was: How is suffering and distress in Maldivian women explained,experienced, expressed and dealt with? In this study participant observation was enhanced bylengthy encounters with women and with both biomedical and traditional healers. The findingsshowed that the suffering and distress of women is embedded in the social and economiccircumstances in which they live, the nature of gender relations and how culture shapes theserelations, the cultural notions related to being a good woman; and how culture defines andstructures women's place within the family and society. Explanations for distress includedmystical, magical and animistic causes as well as social, psychological and biological causes.Women&#146;s experiences of distress were mainly expressed through body metaphors andsomatization. The pathway to dealing with their distress was explained by women's tendency tonormalize their distress and what they perceived to be the causes of their distress.This study provides an empirical understanding of Maldivian women's mental well-being. Basedon the findings of this study, a multi dimensional model entitled the Mandala for Suffering andDistress is proposed. The data contributes a proposed foundation upon which mental healthpolicy and mental health interventions, and curricula for training of health care providers in theMaldives may be built. The data also adds to the existing global body of evidence on socialdeterminants of mental health and enhances current knowledge and developments in the area ofcultural competency for health care. The model and the lessons learnt from this study have majorimplications for informing clinicians on culturally congruent ways of diagnosing and managingmental health problems and developing patient-centred mental health services

Indian migrant women's experiences of motherhood and postnatal support in Australia : a qualitative study

Background: The postpartum period can be challenging for many women. For migrant women, the arrival of a new baby brings unique issues. This study aimed to explore the experiences of motherhood and postpartum support of Indian migrant mothers. Methods: A qualitative descriptive naturalist inquiry was adopted, with data collected through face-to-face, semi-structured, in-depth interviews with a purposive sample of 11 English speaking Indian migrant women over 18 years old, (6 weeks to 6 months postpartum) in 2016. The data were thematically analysed. Findings: Four themes were found in this study: the role of social support in postpartum care, support from health services, a psycho-emotional journey with socio-cultural expectations and struggling to bridge two cultures. Many of the women felt alone and were distressed with undertaking household duties and caring for older children, as this would not have happened in India. The women expressed needing practical support until they settled back into their normal lives. Women never sought professional advice for their ongoing mental health concerns. Conflicting advice from health professionals left some women confused about their expectations of traditional and modern postnatal care. Conclusion: This study gives a unique insight into the experiences of Indian migrant women following birth. There is a need for culturally sensitive and appropriate postnatal services that encourage Indian men to support their partners and help women to find alternative sources of culturally appropriate support. It is vital that mental health support is a key component of any such program of care

"Nothing special, everything is maamuli": socio-cultural and family practices influencing the perinatal period in urban India.

Globally, India contributes the largest share in sheer numbers to the burden of maternal and infant under-nutrition, morbidity and mortality. A major gap in our knowledge is how socio-cultural practices and beliefs influence the perinatal period and thus perinatal outcomes, particularly in the rapidly growing urban setting.Using data from a qualitative study in urban south India, including in-depth interviews with 36 women who had recently been through childbirth as well as observations of family life and clinic encounters, we explored the territory of familial, cultural and traditional practices and beliefs influencing women and their families through pregnancy, childbirth and infancy. We found that while there were some similarities in cultural practices to those described before in studies from low resource village settings, there are changing practices and ideas. Fertility concerns dominate women's experience of married life; notions of gender preference and ideal family size are changing rapidly in response to the urban context; however inter-generational family pressures are still considerable. While a rich repertoire of cultural practices persists throughout the perinatal continuum, their existence is normalised and even underplayed. In terms of diet and nutrition, traditional messages including notions of 'hot' and 'cold' foods, are stronger than health messages; however breastfeeding is the cultural norm and the practice of delayed breastfeeding appears to be disappearing in this urban setting. Marriage, pregnancy and childbirth are so much part of the norm for women, that there is little expectation of individual choice in any of these major life events.A greater understanding is needed of the dynamic factors shaping the perinatal period in urban India, including an acknowledgment of the health promoting as well as potentially harmful cultural practices and the critical role of the family. This will help plan culturally appropriate integrated perinatal health care