Women's Sexual Empowerment and Contraceptive Use in Ghana

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93761/1/j.1728-4465.2012.00318.x.pd

U.S. Women's Intended Sources for Reproductive Health Care

Introduction: The current sociopolitical climate and context of the Affordable Care Act have led some to question the future role of family planning clinics in reproductive health care. We explored where women plan to get their future contraception, pelvic exam/pap smears, and sexually transmitted infection testing, with a focus on the role of family planning clinics. Methods: Data were drawn from a study of United States adults conducted in January 2013 from a national online panel. We focused on English-literate women aged 18?45 years who answered items on intended sources of care (private office/health maintenance organization [HMO], family planning clinic, other, would not get care) for reproductive health services. We used Rao-Scott F tests to compare intended sources across sociodemographic groups, and logistic regression to model odds of intending to use family planning clinics. Probability weights were used to adjust for the complex sampling design. Results: The response rate was 61% (n?=?2,182). Of the 723 respondents who met the inclusion criteria, approximately half intended to use private offices/HMOs. Among some subgroups, including less educated (less than high school), lower annual incomes (<$25,000) and uninsured women, the proportion intending to use family planning clinics was higher than the proportion intending to use private office/HMO in unadjusted analyses. Across all service types, unmarried and uninsured status were associated with intention to use family planning clinics in multivariable models. Conclusions: While many women intend to use private offices/HMOs for their reproductive health care, family planning clinics continue to play an important role, particularly for socially disadvantaged women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140133/1/jwh.2014.5116.pd

Intention to deliver in a healthcare facility and healthcare facility‐based delivery rates among women in Akwatia, Ghana

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135204/1/ijgo161.pd

Children with disorders of sex development: A qualitative study of early parental experience

<p>Abstract</p> <p>Background</p> <p>Clinical research on psychological aspects of disorders of sex development (DSD) has focused on psychosexual differentiation with relatively little attention directed toward parents' experiences of early clinical management and their influence on patient and family psychosocial adaptation.</p> <p>Objectives</p> <p>To characterize parental experiences in the early clinical care of children born with DSD.</p> <p>Study Design</p> <p>Content analysis of interviews with parents (n = 41) of 28 children, newborn to 6 years, with DSD.</p> <p>Results</p> <p>Four major domains emerged as salient to parents: (1) the gender assignment process, (2) decisions regarding genital surgery, (3) disclosing information about their child's DSD, and (4) interacting with healthcare providers. Findings suggested discordance between scientific and parental understandings of the determinants of "sex" and "gender." Parents' expectations regarding the benefits of genital surgery appear largely met; however, parents still had concerns about their child's future physical, social and sexual development. Two areas experienced by many parents as particularly stressful were: (1) uncertainties regarding diagnosis and optimal management, and (2) conflicts between maintaining privacy versus disclosing the condition to access social support.</p> <p>Conclusions</p> <p>Parents' experiences and gaps in understanding can be used to inform the clinical care of patients with DSD and their families. Improving communication between parents and providers (and between parents and their support providers) throughout the early clinical management process may be important in decreasing stress and improving outcomes for families of children with DSD.</p

Case report of amniotic fluid embolism coagulopathy following abortion; use of viscoelastic point-of-care analysis

Abstract Background Amniotic fluid embolism (AFE) is a rare, life threatening obstetric complication, often associated with severe coagulopathy. Induced abortions are extremely safe procedures however complications including AFE can occur. Case presentation A 29-year-old previously healthy woman, gravida 1 para 0, presented for a scheduled second trimester induced abortion via dilation and evacuation at 22-weeks gestation. The case was complicated by a suspected AFE with associated profound coagulopathy. Viscoelastic point-of-care coagulation analysis was used to successfully and swiftly guide management of her coagulopathy. Conclusion AFE can occur in the setting of induced abortion. This case report suggests viscoelastic point-of-care coagulation analyzers may aid in the management of pregnancy-related coagulopathy by providing faster coagulation assessment than laboratory testing, and facilitating timely, targeted management of coagulopathy.http://deepblue.lib.umich.edu/bitstream/2027.42/173649/1/12884_2019_Article_2680.pd

Shifting norms: pregnant women’s perspectives on skilled birth attendance and facility–based delivery in rural Ghana

Skilled birth attendance (SBA) and healthcare facility (HCF) delivery are effective means of reducing maternal mortality. However, their uptake remains low in many low-income countries. The present study utilized semi-structured interviews with 85 pregnant women attending an antenatal clinic in Akwatia, Ghana (May-July 2010) to better understand the barriers to SBA and HCF delivery through the underrepresented perspective of pregnant women. Interview transcripts were analyzed using grounded theory methodology. Participants described community support for and uptake of HCF delivery as increasing and becoming normalized, but barriers remain: (1) maltreatment by midwives; (2) cost associated with HCF delivery despite waived facility fees; (3) the need for a support person for HCF delivery; (4) difficulties in transportation; and (5) precipitous labor. Given the importance of community in Ghanaian health care decision-making, increasing community support for HCF delivery suggests progress toward increasing uptake of SBA and HCF delivery, however important actionable barriers remain.Les services des accoucheuses qualifiés (SAQ) et des établissements de santé (SES) sont des moyens efficaces de réduire la mortalité maternelle. Cependant, leur acceptation reste faible dans de nombreux pays à faible revenu. La présente étude s’est servie des entretiens semi-structurés recueillis auprès des 85 femmes enceintes qui fréquentaient un dispensaire prénatal à Akwatia, Ghana (entre les mois de mai et juillet 2010) afin de mieux comprendre les obstacles à la prestation des SAQ et SES à travers les perspectives sous-représentées chez les femmes enceintes. Les transcriptions des entrevues ont été analysées en utilisant une méthodologie basée sur le « grounded theory ». Les participants ont signalé que le soutien communautaire pour l’accouchement dans les SES et de l’adoption des SES augmentent et se normalisent, mais que des obstacles demeurent: (1) les mauvais traitements infligés par des sages-femmes, (2) le coût associé à la prestation des SES en dépit des frais d&apos;établissement supprimés; (3) la nécessité d&apos;une personne de soutien pour l’accouchement dans les SES, (4) des difficultés de transport, et (5) du travail précipité. Compte tenu de l&apos;importance de la communauté concernant la prise de décision en matière de soins de santé au Ghana la hausse du soutien communautaire pour l’accouchement dans les SES est une indication du progrès vers l’utilisation croissante de la prestation des SAQ et des SES mais il reste toujours d’importants obstacles réalisable

Interpersonal Relationships and Social Support in Transitioning Narratives of Black Transgender Women in Detroit

Social support has been shown to play a key role in overcoming adversities associated with marginalized identities, yet there is a dearth of information regarding the role of social networks in the gender transition process, particularly in ethnic minority transgender communities. This study uses life history narratives, and a modified grounded theory analysis, to explore the impact of interpersonal relationships on the gender transition process of Black transgender women in Detroit, Michigan. The following interpersonal interactions were significant: family reactions to self-recognition of femininity, coming out as gay prior to transgender identity disclosure, contact with an out transwoman, emotional and physical distancing from existing social networks, building relationships in transgender communities and reinitiating contact with biological family. Findings highlight familial and peer relationship dynamics that featured prominently during gender transition

Navigating Community Institutions: Black Transgender Women\u27s Experiences in Schools, the Criminal Justice System, and Churches

Young transgender women, especially those of color, are negatively impacted by suicidality, HIV, residential instability, survival sex work, and other challenges. This study used an oral narrative approach to collect life histories of 10 young black transwomen between 18 and 24 years of age residing in Detroit, Michigan. This study used grounded theory analysis to explore institutional violence, discrimination, and harassment (VDH). Participants described their experiences navigating three community institutions (schools, the criminal justice system, and churches) and broader society. Results highlight VDH through gender policing at school, sexual victimization in the criminal justice system, and negative judgment of gender variation in faith-based institutions. Participants reference the essential role of support systems, including other transgender individuals, in both their gender identity development and the navigation of institutions. Significant policy intervention is needed to protect and support transwomen, and prevent VDH perpetuated against them. Across all institutions, policy and practice interventions can focus on use of transgender appropriate and sensitive language, prevention of physical and sexual assaults, and antidiscrimination measures. Specific policy recommendations and future research directions are outlined