We need to stop female genital mutilation!

Over the next decade around 30 million girls under age 15 are at risk of FGM/C. Given that there is no physical benefit for the girls and acknowledging that FGM/C involves physical, psychological, social and reproductive harm, we, along with major international and national governmental and non-governmental organizations find FGM/C a severe violation of human rights. We must encourage vigorous action among health providers, civil society, womens organizations, funders, international agencies, international and national courts of justice, global and religious leaders, and governments to change this unacceptable practice.Fil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Miller, Suellen. University of California; Estados UnidosFil: Salaria, Natasha. Biomed Central; Reino Unid

The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO’s mother−baby friendly birthing facilities initiative

AbstractRecent evidence indicates that disrespectful/abusive/coercive service delivery by skilled providers in facilities, which results in actual or perceived poor quality of care, is directly and indirectly associated with adverse maternal and newborn outcomes. The present article reviews the evidence for disrespectful/abusive care during childbirth in facilities (DACF), describes examples of DACF, discusses organizations active in a rights-based respectful maternity care movement, and enumerates some strategies and interventions that have been identified to decrease DACF. It concludes with a discussion of one strategy, which has been recently implemented by FIGO with global partners—the International Pediatrics Association, International Confederation of Midwives, the White Ribbon Alliance, and WHO. This strategy, the Mother and Baby Friendly Birth Facility (MBFBF) Initiative, is a criterion-based audit process based on human rights’ doctrines, and modeled on WHO/UNICEF’s Baby Friendly Facility Initiative

The true cost of maternal death: Individual tragedy impacts family, community and nations

The death of a woman in pregnancy and childbirth is globally considered an individual tragedy and a human rights violation. Given the inequities in death that occur to marginalized, poor, and vulnerable women in low and middle income countries, there is no doubt that maternal death is a horrific injustice. However, the long term global burden of disease goes far beyond this tragedy. Recent research is demonstrating that there are disastrous consequences in infant and child mortality, loss of economic opportunities, spiraling cycles of poverty in the families and communities where women die giving birth. The journal Reproductive Health has published a supplement “The True Cost of Maternal Death,” which includes original research from two major study groups. Harvard’s Francois-Xavier Bagnoud (FXB) Center for Health and Human Rights conducted a multi-country, mixed methods study of the impact of maternal mortality on newborn health and survival, family functioning, interrupted education and economic degradation in four high maternal mortality countries, Tanzania, South Africa, Malawi, and Ethiopia. A collaborative group from Family Care International (FCI), the International Center of Research on Women (ICRW), and the Kenya Medical Research Institute (KEMRI)-Center for Disease Control (CDC)-Research Collaboration conducted research into true costs of maternal death in Kenya. These articles demonstrate the enormous costs that ripple out from the maternal death, and the intergenerational and multi-sectorial disruptions related to maternal mortality. It is important in this period of post-MDG strategy planning period that donors, governments, and NGOs be aware not only of the individual level tragedy of the loss of a mother’s life, but also the financial and health costs associated with maternal mortality, and to keep the focus on maternal health as a key issue in all aspects of development, not just health.Fil: Miller, Suellen. University of California; Estados UnidosFil: Belizan, Jose. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Nonatonic obstetric haemorrhage: effectiveness of the nonpneumatic antishock garment in egypt.

The study aims to determine if the nonpneumatic antishock garment (NASG), a first aid compression device, decreases severe adverse outcomes from nonatonic obstetric haemorrhage. Women with nonatonic aetiologies (434), blood loss > 1000 mL, and signs of shock were eligible. Women received standard care during the preintervention phase (226) and standard care plus application of the garment in the NASG phase (208). Blood loss and extreme adverse outcomes (EAO-mortality and severe morbidity) were measured. Women who used the NASG had more estimated blood loss on admission. Mean measured blood loss was 370 mL in the preintervention phase and 258 mL in the NASG phase (P < 0.0001). EAO decreased with use of the garment (2.9% versus 4.4%, (OR 0.65, 95% CI 0.24-1.76)). In conclusion, using the NASG improved maternal outcomes despite the worse condition on study entry. These findings should be tested in larger studies

Strategic assessment of reproductive health in the Dominican Republic

This report documents the findings of a strategic assessment of reproductive health in the Dominican Republic (DR), carried out by the Ministry of Health and Social Welfare (SESPAS) and the Dominican Social Security Institute with support from the Population Council’s Expanding Contraceptive Choice (ECC) program and its Latin American and Caribbean regional offices, and the United States Agency for International Development (USAID). The USAID/DR has been working closely with SESPAS to understand the major reproductive health problems in the DR. To better assist SESPAS and to plan the country’s Reproductive Health Strategy for 2002–2007, USAID asked the Population Council’s ECC program to conduct a strategic assessment of reproductive health in the DR. This participatory study was designed to identify strengths, prioritize problems, and work with community, governmental, and nongovernmental stakeholders to develop recommendations for strategic interventions to improve reproductive health in the DR

Hypertension

Defining hypertension in pregnancy is challenging because blood pressure levels in pregnancy are dynamic, having a circadian rhythm and also changing with advancing gestational age. The accepted definition is a sustained systolic (sBP) of ≥140 mmHg or a sustained diastolic blood pressure (dBP) ≥90 mmHg, by office (or in-hospital) measurement. Measurement of blood pressure in pregnancy should follow standardised methods, as outside pregnancy. Blood pressure measurement may occur in three types of settings, which will dictate in part, which measurement device(s) will be used. The settings are (1) health care facility; and two types of settings outside the facility: (2) ‘ambulatory’ blood pressure measurement (ABPM); and (3) home blood pressure measurement (HBPM). Furthermore, blood pressure can be measured using auscultatory (mercury or aneroid devices) or automated methods. Factors to consider when selecting a blood pressure measurement device include validation, disease specificity, observer error and the need for regular recalibration. The accuracy of a device is repeatedly compared to two calibrated mercury sphygmomanometers (the gold standard), by trained observers, over a range of blood pressures and for women with different hypertensive disorders of pregnancy; only a few devices have been validated among women with pre-eclampsia. This chapter discusses the advantages and/or disadvantages of the various settings and devices. Low- and middle-income countries (LMICs) bear a disproportionate burden of maternal morbidity and mortality from the hypertensive disorders of pregnancy. While regular blood pressure monitoring can cost-effectively reduce this disparity, LMIC-health systems face unique challenges that reduce this capacity. Assessment of service gaps and programmatic responses to ensure access to blood pressure measurement are a priority, supported where appropriate by implementation research.Publisher PD

Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study.

ObjectivesTo explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery.MethodsWe recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results.ResultsAcross post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4).ConclusionsOur longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported

A case of recurrent giant cell tumor of bone with malignant transformation and benign pulmonary metastases

Giant cell tumor (GCT) of bone is a locally destructive tumor that occurs predominantly in long bones of post-pubertal adolescents and young adults, where it occurs in the epiphysis. The majority are treated by aggressive curettage or resection. Vascular invasion outside the boundary of the tumor can be seen. Metastasis, with identical morphology to the primary tumor, occurs in a few percent of cases, usually to the lung. On occasion GCTs of bone undergo frank malignant transformation to undifferentiated sarcomas. Here we report a case of GCT of bone that at the time of recurrence was found to have undergone malignant transformation. Concurrent metastases were found in the lung, but these were non-transformed GCT