Exploring barriers and enablers of service provision for survivors of human trafficking in the Bay Area: An action research study

Despite increasing recognition of public health and rights issues associated with human trafficking globally and in the United States following the Trafficking Victims Protection Act of 2000, there has been limited research on how to systematically strengthen service access for survivors of sex and labor trafficking. The experience of service providers may provide insight into how trafficking survivor responses and service networks function in California’s Bay Area. This study explores provider perspectives on existing service networks and collaboration dynamics, including the barriers to and enablers of long-term service provision and survivor follow-up. A participatory research design included qualitative interviews with key informants working at nongovernmental organizations, organizational website reviews, and consultation with network service providers in the Greater San Francisco Bay Area. This study approach allowed for eliciting in-depth reflections of service provision, collective generation of stakeholder mapping, and consensus-driven recommendations arising from barriers and enablers to anti-trafficking service provision. This report enhances stakeholder awareness of existing organizational and policy resources and offers insights into research and programming on how anti-trafficking service response networks can be strengthened to provide survivor-centric support in the long-term

Trust in Maternity Care: A Contextual Exploration of Meaning and Determinants in Peri-Urban Kenya

Background: Trust in providers and health facilities is important to care-seeking and to health system quality and accountability. In Kenya, trust has been little-explored. ‘Trust’ is a multidimensional concept offering a distinctive lens on facility responsiveness during labor and delivery. This study explores the meaning and determinants of trust, and potential trust-building avenues, in the maternity setting. Methods: A theoretically-driven qualitative approach was used to study trust from a range of local perspectives. Focus groups (n=8, N=70) with recently delivered women (RDW), pregnant women, and male partners and in-depth-interviews (n=33) with RDW, providers, management, and community health workers (CHWs), were conducted in and around a public sub-county-level hospital in peri-urban Central Kenya. Interviews were audio-recorded, transcribed, and translated. Textual analysis consisted of inductive and deductive coding of themes and memo writing. Results: Chapter IV describes the meaning and types of trust in maternity care reported across all participants. Trust in the maternity setting is nested within understandings of institutional and societal trust and can be analyzed into relational types. Content areas of trust include confidence, communication, integrity, mutual respect, competence, fairness, confidentiality, and systems trust. Overlap of trust content areas across relationship types suggests a shared understanding of trust across hierarchical perspectives: women and communities (use care/least power), CHWs (facilitate accessing care/low-medium power), providers (deliver care/medium-high power), and management (affect care/high power). Chapters V and VI describe a multi-faceted determinants framework for trust in the maternity setting clustered around patient/individual, provider, health facility, community, accountability, and structural factors. Chapter VII shows that building trust in maternity care requires a multi-faceted effort by various actors. This chapter presents cross-perspective evidence that critical trust-building mechanisms center on users, provider-patient interactions, provider-management interactions, facility environments, community-facility relationships, and supportive socio-political commitments. Conclusions: Trust is contextually relevant to maternity care in Kenya. This study’s findings about the multidimensionality of trust contribute to a growing body of global and regional trust research. In particular, the study highlights the multi-faceted clustering of trust determinants and recognizes the importance of perspective and socio-political context in understanding and building trust

Formative research on factors influencing access to fistula care and treatment in Uganda

This formative research builds upon the results of a systematic review by the Population Council for better understanding of the barriers and enabling factors for fistula repair care and access in Uganda. The study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results reveal the nuances of women’s experiences, along with the additional perspectives of their spouses, family members, community stakeholders, and fistula camp care providers including nurses/counselors, surgeons, and facility and district managers. Barriers and enablers to fistula repair care are clustered around the following factors: psychosocial, cultural, social, financial, transportation, facility shortages, quality of care, awareness, policy and political environments, and healing and reintegration. The report includes recommendations for policy and practice that reinforce the need for targeted programming strategies to increase access for obstetric fistula repair

Reducing barriers to accessing fistula repair: Implementation research in Katsina

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina state

Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Kenya

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Kenya, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Kenya

Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Ethiopia

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care (ANC) use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Ethiopia, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Ethiopia

Autonomy, intimate partner violence, and maternal health-seeking behavior: Findings from mixed-methods analysis in Nigeria

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In Nigeria, maternal health-seeking behaviors are influenced by numerous interrelated factors. Little research exists on how gender dynamics and norms, including acceptability of various forms of IPVAW, may influence women’s decision-making autonomy, health-seeking behavior, and overall well-being. This country brief highlights quantitative and qualitative findings on the relationship between women’s autonomy and IPVAW acceptability and maternal health-seeking behaviors in Nigeria

"There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans

<p>Abstract</p> <p>Introduction</p> <p>Roma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism--personal, internalized, and institutional--affect access to maternal health care among Romani women.</p> <p>Methods</p> <p>Eight focus groups of Romani women aged 14-44 (n = 71), as well as in-depth semi-structured interviews with gynecologists (n = 8) and key informants from NGOs and state institutions (n = 11) were conducted on maternal health care seeking, experiences during care, and perceived health care discrimination. Transcripts were coded, and analyzed using a grounded theory approach. Themes were categorized into domains.</p> <p>Results</p> <p>Twenty-two emergent themes identified barriers that reflected how racism affects access to maternal health care. The domains into which the themes were classified were perceptions and interactions with health system, psychological factors, social environment and resources, lack of health system accountability, financial needs, and exclusion from education.</p> <p>Conclusions</p> <p>The experiences of Romani women demonstrate psychosocial and structural pathways by which racism and discrimination affect access to prenatal and maternity care. Interventions to address maternal health inequalities should target barriers within all three levels of racism.</p

High blood pressure: Pregnant and postpartum women face hidden danger

This article is part of the Maternal Health Initiative’s CODE BLUE series, developed in partnership with EMD Serono, a business of Merck KGaA, Darmstadt, Germany. Every year, 18 million women of reproductive age die from non-communicable diseases (NCDs) which poses a growing and often overlooked challenge to global maternal health. The CODE BLUE series aims to bring to light and explore these issues

Implementing components of the PHC for PE/E Model in Pakistan: A cost analysis

Pre-eclampsia/Eclampsia (PE/E) is the third leading cause of maternal mortality in Pakistan. Women with PE are at increased risk for organ damage or failure, pre-term birth, loss of pregnancy, and stroke. PE can progress to eclampsia, which is characterized by seizures, and may be associated with kidney and liver damage, as well as maternal death. The risks of PE/E can be mitigated with regular screening during antenatal care and the postnatal period. Regular monitoring of PE can lessen progression to severe PE/E, and severe PE/E can be managed through administration of magnesium sulfate and antihypertensive drugs. Between 2016 and 2018, the Population Council, in collaboration with the Provincial Health Department, Government of Sindh Pakistan, implemented an intervention to confront PE/E that was part of the Ending Eclampsia project that implemented aspects of the (5-component) Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Pakistan was comprised of task sharing to detect and manage PE/E with PHC providers (component 1), and increased ANC uptake at the community level (component 3). This Country Brief describes the economic cost for implementing the two components in Pakistan