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Simbar M, Kiani Z, Nasiri Z, KhodaKarami N, Nazarpour S, Fakari FR, Keyvanfar S, Majd HA. The self-care situation analysis of reproductive-aged women in Tehran: a survey study. BMC Womens Health 2023; 23:624. [PMID: 38007431 PMCID: PMC10675894 DOI: 10.1186/s12905-023-02763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 11/04/2023] [Indexed: 11/27/2023] Open
Abstract
BACKGROUND Along with a global increase in the prevalence of infectious and non-communicable diseases, self-care with an emphasis on reproductive health Self-care has received special attention. Given the importance of women's health, assessment of their self-care status using a valid and reliable tool seems to be necessary to determine the needs for future women's reproductive health promotion interventions. The present study aimed to assess the women's self-care at reproductive age in Tehran, to determine women's health needs based on global guidelines for women's health. METHODS This was a descriptive cross-sectional study on 1051 women of reproductive age, living in Tehran. The Subjects were recruited using a multi-stage sampling method. The women completed a socio-demographic and valid and reliable questionnaire to assess their self-care status. The data were analyzed using SPSS 24 and by Pearson, Spearman, ANOVA, and regression tests. RESULTS The mean score of self-care was 49.57 ± 23.50% in the reproductive-aged women. The lowest scores were related to psychosocial health (32.12 ± 29.93%) and reproductive-sexual health (49.74 ± 27.99%) respectively. There were significant positive correlations between the self-care and women's education level (r = 0.180; p < 0.01), and husband's education level (r = 0.272; p < 0.01), while there was a negative significant correlation between the self-care and the family size (r = - 0.135; p < 0.01). CONCLUSION The findings showed inadequate self-care among reproductive-aged women in Tehran. The most important challenge in their self-care behaviors was related to psychosocial and reproductive-sexual health. It seems to provide a package for promoting women's self-care in four areas of physical, psychosocial, reproductive-sexual health, and screening tests, with an emphasis on the first two priorities, namely psychosocial and reproductive health necessary in Tehran.
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Affiliation(s)
- Masoumeh Simbar
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Nasiri
- General Directorate of Health, The Deputy of Social and Cultural Affairs of Tehran Municipality, Tehran, Iran
| | - Nahid KhodaKarami
- Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch, Islamic Azad University, Chalous, Iran
| | - Farzaneh Rashidi Fakari
- Department of Midwifery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Sepideh Keyvanfar
- Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Alavi Majd
- Department of Biostatistics, School of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ekrem EC, Kurt A. Developing the sexual and reproductive health knowledge scale in emergencies. Eur J Obstet Gynecol Reprod Biol 2023; 289:177-182. [PMID: 37690280 DOI: 10.1016/j.ejogrb.2023.08.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE This study aims to develop the The Sexual and Reproductive Health Knowledge Scale in Emergencies (SRHKE) to evaluate the sexual and reproductive health knowledge of nurses in exceptional circumstances and cases. METHOD This methodological study was conducted with a total of 311 nurses from two hospitals in the Western Black Sea Region of Turkey between December 2021 and May 2022. The data were collected using a descriptive information form and SRHKE. The content validity, construct validity, and internal consistency of the scale were tested. RESULTS The scale had a four-factor structure, and these factors explained 65% of the total variance in the measured variable. It had high internal consistency (Cronbach's alpha coefficient values were 0.826 for the 1st factor, 0.814 for the 2nd factor, 0.788 for the 3rd factor, 0.723 for the 4th factor, and 0.896 for the total scale). The item-total score correlation values of the scale ranged from 0.479 to 0.659. Pearson's correlation coefficients calculated for the evaluation of construct validity ranged from 0.519 to 0.749 (p < 0.005). CONCLUSION SRHKE has high validity and reliability. The scale can be used by nurses in Turkish society to determine their levels of sexual and reproductive health knowledge in emergencies.
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Affiliation(s)
- Ebru Cirban Ekrem
- Lecturer of Nursing Department, Faculty of Health Sciences, Bartin University, Ağdacı Campus, 74110 Bartin, Turkey.
| | - Aylin Kurt
- Nursing Department, Faculty of Health Sciences, Bartin University, Ağdacı Campus, 74110 Bartin, Turkey.
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. The impact of the COVID-19 pandemic on contraceptive methods, abortion, and unintended pregnancy: a cross-sectional study. BMC Womens Health 2023; 23:357. [PMID: 37403093 DOI: 10.1186/s12905-023-02512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/27/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND AND AIM By creating an international emergency, the COVID-19 pandemic may have led to compromised reproductive health care, including family planning services, and thus increased unintended pregnancies and unsafe abortions. This study was conducted to compare methods of contraception, abortion, and unintended pregnancies in those served by the health centers of Babol city in Iran, both before and during the COVID-19 pandemic. METHODS A cross-sectional study was conducted including 425 participants registered to the health centers of Babol city, Mazandaran province, Iran. Using a multi-stage method, 6 urban health centers and 10 rural centers were selected for inclusion. Proportional allocation method was used for sampling those who met the inclusion criteria. A questionnaire was used to collect data in relation to individual characteristics and reproductive behaviors via 6 questions focused upon methods and preparation of contraception, number and type of abortions, and number and causes of unintended pregnancy from July to November 2021. The data were analyzed using SPSS software version 26. Significance level was considered to be p < 0.05 in all tests. RESULTS Most participants aged between 20 and 29 years old had a diploma level of education, were housewives and lived in the city. Prior to the pandemic, 32.0% used modern contraceptive methods and 31.6% used these during the pandemic. No change in the combination of contraceptive methods used was observed between these two periods. Approximately two-thirds used the withdrawal method in both periods. The majority of participants in both periods purchased their contraceptives from a pharmacy. Unintended pregnancy increased from 20.4% prior to the pandemic to 25.4% during the pandemic. Abortions increased from 19.1% prior to the pandemic to 20.9% during the pandemic, although these findings were not found to be statistically significant. Contraceptive methods had a statistically significant relationship with age, education, spouse's education, spouse's occupation, and place of residence. The number of unintended pregnancies had a significant relationship with age, the educational level of both participants and their spouses and socio-economic status, and the number of abortions had a statistically significant relationship with the age and education level of the spouse (p > 0.05). CONCLUSION Despite there being no change in contraceptive methods compared to the pre-pandemic period, an increase in the number of unintended pregnancies, abortions and illegal abortions was observed. This may be indicative of an unmet need for family planning services during the COVID-19 pandemic.
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Affiliation(s)
- Fatemeh Rezaei
- MSc in Midwifery, Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- PhD in Midwifery, The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Fremantle, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Rezaei F, Amiri-Farahani L, Haghani S, Pezaro S, Behmanesh F. Comparing reproductive intentions before and during the COVID-19 pandemic: a cross-sectional study. BMC Health Serv Res 2023; 23:545. [PMID: 37231470 DOI: 10.1186/s12913-023-09551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND AND AIM Reproductive behaviors and intentions are affected by several factors, including the COVID-19 pandemic crisis. This study was conducted with the aim of comparing the intention to reproduce and its causes in Iran during the period prior to and during the COVID-19 pandemic. METHODS This descriptive-comparative study included 425 cisgender women from 6 urban health centers and 10 rural centers in Babol city, Mazandaran province, Iran. Urban and rural health centers were selected using a multi-stage approach with proportional allocation. A questionnaire was used to collect data in relation to individual characteristics and reproductive intentions. RESULTS Most participants aged between 20 and 29 years had a diploma level of education, were housewives and lived in the city. The intention to reproduce decreased from 11.4% before the pandemic to 5.4% during the pandemic (p = 0.006). The most common reason for wanting to have children prior to the pandemic was not having children (54.2%). During the pandemic, a desire to reach the ideal number of children was the most common reason to want to have children (59.1%), though no statistically significant difference was observed between the two periods (p = 0.303). The most common reason for not wanting to have children in both periods was having enough children already (45.2% before and 40.9% during the pandemic). The reasons for not wanting to have children had a statistically significant difference between the two periods (p < 0.001). Reproductive intentions had a statistically significant relationship with the variables of age (p < 0.001), the education level of both participants (p < 0.001) and spouses (p = 0.006), occupation (p = 0.004), and socio-economic status (p < 0.001). CONCLUSION Despite restrictions and lockdowns, the COVID-19 pandemic had a negative impact on people's desire to reproduce in this context. Economic problems caused by the sanctions which increased during the COVID-19 crisis may be one of the reasons for a reduction in people's intentions to become parents. Future research could usefully investigate whether this decrease in the desire to reproduce will lead to significant changes in population level and future birth rates.
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Affiliation(s)
- Fatemeh Rezaei
- Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amiri-Farahani
- Department of Reproductive Health and Midwifery, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, University of Medical Sciences, Tehran, Iran.
| | - Shima Haghani
- Department of Biostatistics, Nursing and Midwifery Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sally Pezaro
- The Research Centre for Healthcare and Communities, Coventry University, Coventry, UK
- The University of Notre Dame, Notre Dame, Australia
| | - Fereshteh Behmanesh
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. of Iran
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Kobeissi L, Pyone T, Moran AC, Strong KL, Say L. Scaling up a monitoring and evaluation framework for sexual, reproductive, maternal, newborn, child, and adolescent health services and outcomes in humanitarian settings: A global initiative. DIALOGUES IN HEALTH 2022; 1:None. [PMID: 36569812 PMCID: PMC9767412 DOI: 10.1016/j.dialog.2022.100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/02/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Background Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent (SRMNCAH) data from humanitarian settings are often sparse and variable in quality across different settings due to the lack of a standardised set of indicators across the different agencies working in humanitarian settings. This paper aims to summarise a WHO-led global initiative to develop and scale up an SRMNCAH monitoring and evaluation framework for humanitarian settings. Methods This research revolved around three phases. The first and the last phase involved global consultations with lead international agencies active in SRMNCAH in humanitarian settings. The second phase tested the feasibility of the proposed indicators in Afghanistan, Bangladesh, the Democratic Republic of the Congo, and Jordan, using different qualitative research methods (interviews with 92 key informants, 26 focus group discussions with 142 key stakeholders, facility assessments and observations at 25 health facilities or sites). Results Among the 73 proposed indicators, 47 were selected as core indicators and 26 as additional indicators. Generally, there were no major issues in collecting the proposed indicators, except for those indicators that relied on death reviews or population-level data. Service availability and morbidity indicators were encouraged. Abortion and SGBV indicators were challenging to collect due to political and sociocultural reasons. The HIV and PMTCT indicators were considered as core indicators, despite potential sensitivity in some settings. Existing data collection and reporting systems across the four assessed humanitarian settings were generally fragmented and inconsistent, mainly attributed to the lack of coordination among different agencies. Interpretation Implementing agencies need to collaborate effectively to scale up this agreed-upon set of SRMNCAH framework to enhance accountability and transparency in humanitarian settings.
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Affiliation(s)
- Loulou Kobeissi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Thidar Pyone
- Science Division, World Health Organization, Geneva, Switzerland
- Corresponding author at: Office of Chief Scientist, Science Division, World Health Organization, 20 Avenue Appia, World Health Organisation, 1211 Geneva 27, Switzerland.
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Kathleen L. Strong
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Bahamondes L, Makuch MY, Margatho D, Charles CM, Brasil C, de Amorin HSF. Assessment of the availability of sexual and reproductive healthcare for Venezuelan migrant women during the SARS-CoV-2 pandemic at the north-western border of Brazil-Venezuela. J Migr Health 2022; 5:100092. [PMID: 35313677 PMCID: PMC8928724 DOI: 10.1016/j.jmh.2022.100092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/03/2022] [Accepted: 03/16/2022] [Indexed: 01/03/2023] Open
Abstract
Access to essential SRH services. Less SRH services offered. Lack of availability and access to contraceptives. Impact on health infrastructure. Reallocation of beds to attend COVID-19 cases. Shortage of healthcare providers. Challenges and opportunities for strengthening SRH services. Doubts about the management of the pandemic due to conflicting messages.
Background The public healthcare system of Roraima state, at the north-western border Brazil-Venezuela, experienced an impact due to the incoming of Venezuelan migrants and to the SARS-CoV-2 (COVID-19) pandemic. After the beginning of the pandemic, the Brazilian government closed the border; however, migration continued through informal paths. There is scarce information regarding the availability of sexual and reproductive health (SRH) services at settings impacted both by migration and the COVID-19 pandemic. Consequently, we aimed to assess the availability and access to SRH services for Venezuelan migrant at Roraima state during the COVID-19 pandemic. Methods We conducted a cross-sectional study with data collected during the pandemic using an electronic questionnaire. We interviewed three policy makers responsible for the directorate of primary care both at the municipal and state level; the directors of the two public hospitals and the two referral centres for women's health in Boa Vista, and in Pacaraima the director of the hospital and of the basic health post. We also interviewed 20 out of the 34 (58.8%) managers of the basic health posts in Boa Vista and 10 healthcare providers (physicians and nurses). Data collected covered issues pertaining to access to SRH services, and explored the impacts of the COVID-19 on continuation, access, and use of SRH services. Results It was reported that 60% of the beds in the public sector were reallocated for COVID-19 cases and 26 out of the 34 (76%) health posts assessed interrupted the provision of SRH services, including contraceptive provision and gynaecological consultation, since these were considered not essential services. Most of the participants, (25/36; 69.4%) reported that both the state and the municipal health authorities implemented community outreach using telephone, social media, radio, and television, with guidance for the population on how to seek care using the healthcare network. Conclusions The healthcare system in Roraima was impacted firstly by the need to provide SRH to a large number of Venezuelan migrant women, and after an effort to adapt to the reality that this migrant crisis posed; this system was affected by the needs to adapt to the COVID-19 pandemic.
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Affiliation(s)
- Luis Bahamondes
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP 13084-971, Brazil
- Corresponding author at: Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, 13084-971, Campinas, SP, Brazil. Telephone: +55-19-3289-2856; Fax: +55-19-3289-2440.
| | - Maria Y Makuch
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP 13084-971, Brazil
| | - Deborah Margatho
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP 13084-971, Brazil
| | - Charles M. Charles
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP 13084-971, Brazil
| | - Cinthia Brasil
- Direction of Basic Attention Care, Health Secretary, Municipality of Boa Vista, Boa Vista, RR, Brazil
| | - Helder SF de Amorin
- Direction of Primary Healthcare, Health Secretary, State of Roraima, Boa Vista, RR, Brazil
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Kobeissi LH, Ashna M, Messier K, Moran AC, Say L, Strong KL, Foster A. Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child and adolescent health indicators in humanitarian settings: a multimethods, multicountry qualitative study protocol. BMJ Open 2021; 11:e041270. [PMID: 34907036 PMCID: PMC8671919 DOI: 10.1136/bmjopen-2020-041270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION In 2019, over 70 million people were forcibly displaced worldwide. Women and girls comprise nearly half of this population and are at heightened risk of negative sexual and reproductive health outcomes. With the collapse of health systems, reduced resources and increased vulnerabilities from displacement, there is a need to strengthen current practices and ensure the delivery of comprehensive sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) services. Recognising the need for consistency in data collection, analysis and use, the WHO developed a list of core SRMNCAH monitoring and evaluation indicators for services and outcomes in humanitarian settings. This research will explore the feasibility of collecting this core set of SRMNCAH indicators in displacement contexts. METHODS AND ANALYSIS We will undertake a multimethods qualitative study in seven humanitarian settings: Afghanistan, Albania, Bangladesh, Cameroon, the Democratic Republic of the Congo, Iraq and Jordan. We selected sites that reflect diversity in geographic region, sociocultural characteristics, primary location(s) of displaced persons and nature and phase of the crisis. Our study consists of four components: key informant interviews, facility assessments, observational sessions at select facilities and focus group discussions with front-line healthcare personnel. We will analyse our data using descriptive statistics and for content and themes. We will begin by analysing data from each setting separately and will then combine these data to explore concordant and discordant results, triangulate findings and develop global recommendations. ETHICS AND DISSEMINATION The University of Ottawa's Research Ethics Board and the Research Project Review Panel (RP 2) of the World Health Organization-Department of Sexual and Reproductive Health as well as local IRBs of PIs' research institutions reviewed and approved this protocol. We intend to disseminate findings through workshops at the WHO country, regional and headquarter levels, as well as through local, national and international conferences, workshops, peer-reviewed publications, and reports.
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Affiliation(s)
- Loulou Hassan Kobeissi
- Sexual and Reproductive Health and Research, Organisation mondiale de la Sante, Geneve, Switzerland
| | - Manizha Ashna
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Kassandre Messier
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Cambridge Reproductive Health Consultants, Cambridge, Massachusetts, USA
| | - Allisyn C Moran
- Department of Maternal, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Lale Say
- Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Kathleen Louise Strong
- Department of Maternal, Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland
| | - Angel Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Makuch MY, Osis MJD, Brasil C, de Amorim HS, Bahamondes L. Reproductive health among Venezuelan migrant women at the north western border of Brazil: A qualitative study. J Migr Health 2021; 4:100060. [PMID: 34405200 PMCID: PMC8352082 DOI: 10.1016/j.jmh.2021.100060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/05/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Venezuela has been immersed in an economic and social crisis with a high number of migrant people. An important proportion of Venezuelan migrants have crossed the north western border Brazil-Venezuela were the United Nations High Commissioner for Refugees (UNHCR) has established 13 shelters. Our objectives were to know perspectives and views of Venezuelan migrant women hosted at UNHCR shelters on some SRH issues. METHODS We conducted a qualitative study between November 2019 and February 2020 with 12 focus group discussions (FGDs), with 111 Venezuelan migrant women of reproductive age (18-49 years old). FGDs were performed in a closed space that guaranteed confidentiality, were recorded, verbatim transcribed and data were analised for thematic manifest content. FINDINGS The themes identified were perspectives on: i) health care for pregnant and postnatal women, ii) access to modern contraceptive methods, and iii) HIV and sexually transmitted diseases (STDs). Despite the general satisfaction with obstetric care, women noted few challenges pertaining to their experiences during first entry to antenatal care, labour, delivery and postnatal care. They were in agreement that access to long-acting reversible contraceptives was difficult, mainly to the copper-intrauterine device (IUD); which when available it was erratic. Hormonal-IUD and implants were almost inexistent. This was of major concern to the women, as it prevented them from the ability to plan their reproductive lives. Although knowledge on STDs/HIV prevention and transmission was adequate; the predominance of traditional gender imbalance in the relations was observed and these attitudes have been discussed as a barrier for migrant women to protect themselves against HIV/STD infection. CONCLUSION These migrant women needed help to understand the language and functioning of the healthcare system, to overcome barriers and challenges while seeking access to SRH care. They faced significant gender vulnerability that needs to be addressed within their new life. Our findings could be useful for health authorities and international organisations to start actions to improve SRH and mitigate suffering.
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Affiliation(s)
- Maria Y. Makuch
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas 13084-971, SP, Brazil
- Centre for Reproductive Health in Campinas (Cemicamp), Campinas, SP, Brazil
| | - Maria Jose D. Osis
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas 13084-971, SP, Brazil
- Centre for Reproductive Health in Campinas (Cemicamp), Campinas, SP, Brazil
- Department of Collective Health, Faculty of Medicine of Jundiaí, Jundiai, SP, Brazil
| | - Cinthia Brasil
- Direction of Basic Attention Care, Health Secretary, Municipality of Boa Vista, Boa Vista, RR, Brazil
| | - Helder S.F. de Amorim
- Direction of Basic Attention Care, Health Secretary, State of Roraima, Boa Vista, RR, Brazil
| | - Luis Bahamondes
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas 13084-971, SP, Brazil
- Centre for Reproductive Health in Campinas (Cemicamp), Campinas, SP, Brazil
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Kobeissi L, Nair M, Evers ES, Han MD, Aboubaker S, Say L, Rollins N, Darmstadt GL, Blanchet K, Garcia DM, Hagon O, Ashorn P. Setting research priorities for sexual, reproductive, maternal, newborn, child and adolescent health in humanitarian settings. Confl Health 2021; 15:16. [PMID: 33771212 PMCID: PMC7995567 DOI: 10.1186/s13031-021-00353-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background An estimated 70.8 million people are forcibly displaced worldwide, 75% of whom are women and children. Prioritizing a global research agenda to inform guidance, service delivery, access to and quality of services is essential to improve the survival and health of women, children and adolescents in humanitarian settings. Method A mixed-methods design was adapted from the Child Health and Nutrition Research Initiative (CHNRI) methodology to solicit priority research questions across the sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) domains in humanitarian settings. The first step (CHNRI) involved data collection and scoring of perceived priority questions, using a web-based survey over two rounds (first, to generate the questions and secondly, to score them). Over 1000 stakeholders from across the globe were approached; 177 took part in the first survey and 69 took part in the second. These research questions were prioritized by generating a research prioritization score (RPP) across four dimensions: answerability, program feasibility, public health relevance and equity. A Delphi process of 29 experts followed, where the 50 scored and prioritized CHRNI research questions were shortlisted. The top five questions from the CHNRI scored list for each SRMNCAH domain were voted on, rendering a final list per domain. Results A total of 280 questions were generated. Generated questions covered sexual and reproductive health (SRH) (n = 90, 32.1%), maternal health (n = 75, 26.8%), newborn health (n = 42, 15.0%), child health (n = 43, 15.4%), and non-SRH aspects of adolescent health (n = 31, 11.1%). A shortlist of the top ten prioritized questions for each domain were generated on the basis of the computed RPPs. During the Delphi process, the prioritized questions, based on the CHNRI process, were further refined. Five questions from the shortlist of each of the SRMNCAH domain were formulated, resulting in 25 priority questions across SRMNCAH. For example, one of the prioritized SRH shortlisted and prioritized research question included: “What are effective strategies to implement good quality comprehensive contraceptive services (long-acting, short-acting and EC) for women and girls in humanitarian settings?” Conclusion Data needs, effective intervention strategies and approaches, as well as greater efficiency and quality during delivery of care in humanitarian settings were prioritized. The findings from this research provide guidance for researchers, program implementers, as well as donor agencies on SRMNCAH research priorities in humanitarian settings. A global research agenda could save the lives of those who are at greatest risk and vulnerability as well as increase opportunities for translation and innovation for SRMNCAH in humanitarian settings. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00353-w.
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Affiliation(s)
- Loulou Kobeissi
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland.
| | - Mahalakshmi Nair
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Egmond Samir Evers
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Mansuk Daniel Han
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | | | - Lale Say
- SRH Integration in Health Systems (SHS), Department of Sexual and Reproductive Health and Research (SRH), World Health Organization (WHO), Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing (MCA),World Health Organization, Universal Health Coverage - Life Course Division (UHC/LC), Geneva, Switzerland
| | - Gary L Darmstadt
- Maternal and Child Health, Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, USA
| | - Karl Blanchet
- Geneva Centre of Humanitarian Studies, University of Geneva, the Graduate Institute, Geneva, Switzerland
| | - Daniel Martinez Garcia
- Women and Child Health Unit, Medical Department of Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Olivier Hagon
- Center for Humanitarian Medicine and Disaster Management (CHMDM), WHO Collaborative center, Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Per Ashorn
- Center for Child Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Taylor MM, Kobeissi L, Kim C, Amin A, Thorson AE, Bellare NB, Brizuela V, Bonet M, Kara E, Thwin SS, Kuganantham H, Ali M, Oladapo OT, Broutet N. Inclusion of pregnant women in COVID-19 treatment trials: a review and global call to action. LANCET GLOBAL HEALTH 2020; 9:e366-e371. [PMID: 33340453 PMCID: PMC7832459 DOI: 10.1016/s2214-109x(20)30484-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 11/04/2020] [Indexed: 12/31/2022]
Abstract
Inclusion of pregnant women in COVID-19 clinical trials would allow evaluation of effective therapies that might improve maternal health, pregnancy, and birth outcomes, and avoid the delay of developing treatment recommendations for pregnant women. We explored the inclusion of pregnant women in treatment trials of COVID-19 by reviewing ten international clinical trial registries at two timepoints in 2020. We identified 155 COVID-19 treatment studies of non-biological drugs for the April 7–10, 2020 timepoint, of which 124 (80%) specifically excluded pregnant women. The same registry search for the July 10–15, 2020 timepoint, yielded 722 treatment studies, of which 538 (75%) specifically excluded pregnant women. We then focused on studies that included at least one of six drugs (remdesivir, lopinavir–ritonavir, interferon beta, corticosteroids, chloroquine and hydroxychloroquine, and ivermectin) under evaluation for COVID-19. Of 176 such studies, 130 (74%) listed pregnancy as an exclusion criterion. Of 35 studies that evaluated high-dose vitamin treatment for COVID-19, 27 (77%) excluded pregnant women. Despite the surge in treatment studies for COVID-19, the proportion excluding pregnant women remains consistent. Exclusion was not well justified as many of the treatments being evaluated have no or low safety concerns during pregnancy. Inclusion of pregnant women in clinical treatment trials is urgently needed to identify effective COVID-19 treatment for this population.
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Affiliation(s)
- Melanie M Taylor
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland; Department of Global Programmes of HIV, Hepatitis, and STI, WHO, Geneva, Switzerland; Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
| | - Caron Kim
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Avni Amin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Anna E Thorson
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Nita B Bellare
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Vanessa Brizuela
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Mercedes Bonet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Edna Kara
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | | | - Moazzam Ali
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Olufemi T Oladapo
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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11
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Tran NT, Greer A, Kini B, Abdi H, Rajeh K, Cortier H, Boboeva M. Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen. Confl Health 2020; 14:81. [PMID: 33250933 PMCID: PMC7686834 DOI: 10.1186/s13031-020-00326-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product. Methods Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates. Results Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations. Conclusion Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.
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Affiliation(s)
- Nguyen Toan Tran
- Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, PO Box 123, Sydney, NSW 2007 Australia.,Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1206 Genève, Switzerland.,Training Partnership Initiative of the Inter-Agency Working Group on Reproductive Health in Crises, Women's Refugee Commission, 15 West 37th Street, New York, NY 10018 USA
| | - Alison Greer
- Training Partnership Initiative of the Inter-Agency Working Group on Reproductive Health in Crises, Women's Refugee Commission, 15 West 37th Street, New York, NY 10018 USA
| | - Brigitte Kini
- World Health Organization Country Office in the Democratic Republic of Congo, Avenue des Cliniques 42, BP 1899 Kinshasa I, Democratic Republic of Congo
| | - Hassan Abdi
- Consultant, PO Box 617, Garissa, 70100 Kenya
| | - Kariman Rajeh
- World Health Organization, PO Box 543, Sana'a, Yemen
| | | | - Mohira Boboeva
- World Health Organization, Global Health Cluster, Avenue Appia 20, 1211, 27 Geneva, Switzerland
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12
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Bahamondes L, Laporte M, Margatho D, de Amorim HSF, Brasil C, Charles CM, Becerra A, Hidalgo MM. Maternal health among Venezuelan women migrants at the border of Brazil. BMC Public Health 2020; 20:1771. [PMID: 33228642 PMCID: PMC7682772 DOI: 10.1186/s12889-020-09912-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Guaranteeing the sexual and reproductive health and rights (SRHR) of populations living in fragile and humanitarian settings is essential and constitutes a basic human right. Compounded by the inherent vulnerabilities of women in crises, substantial complications are directly associated with increased risks of poor SRHR outcomes for displaced populations. The migration of Venezuelans, displaced due to current economic circumstances, is one of the largest in Latin America's history. This study aims to provide an overview of the sexual and reproductive health (SRH) issues affecting migrant Venezuelan women in the state of Roraima, Brazil. METHODS Face-to-face interviews were conducted from 24 to 30 November 2019. Data collection covered various issues involving access to and use of SRH services by 405 migrant Venezuelan women aged 18-49 years. The Minimum Initial Service Package readiness assessment tools, available from the Inter-Agency Working Group on Reproductive Health in Crises, were used in the data collection. RESULTS Most commonly, the women reported unmet family planning needs. Of these, a significant proportion reported being unable to obtain contraceptive methods, particularly long-acting reversible contraceptives, either due to the woman's inability to access them or their unavailability at healthcare centres. Although a significant proportion of women were largely satisfied with the attention received at the maternity hospital, both before and during childbirth, 24.0% of pregnant or postpartum women failed to receive any prenatal or postnatal care. CONCLUSION Meeting the essential SRHR needs of migrant Venezuelan women in Roraima, Brazil is a challenge that has yet to be fully addressed. Given the size of this migrant population, the Brazilian healthcare system has failed to adapt sufficiently to meet their needs; however, problems with healthcare provision are similar for migrants and Brazilian citizens. Efforts need to be encouraged not only in governmental health sectors, but also with academic, non-governmental and international organisations, including a coordinated approach to ensure a comprehensive SRHR response. Given the current high risks associated with the SARS-CoV-2 pandemic, meeting the SRHR needs of migrant populations has become more critical than ever.
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Affiliation(s)
- L Bahamondes
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil.
| | - M Laporte
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - D Margatho
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - H S F de Amorim
- Direction of Basic Attention Care, Health Secretary, State of Roraima, Boa Vista, RR, Brazil
| | - C Brasil
- Direction of Basic Attention Care, Health Secretary, Municipality of Boa Vista, Boa Vista, RR, Brazil
| | - C M Charles
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - A Becerra
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
| | - M M Hidalgo
- Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Caixa Postal 6181, Campinas, SP, 13084-971, Brazil
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13
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Desrosiers A, Betancourt T, Kergoat Y, Servilli C, Say L, Kobeissi L. A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings. BMC Public Health 2020; 20:666. [PMID: 32398129 PMCID: PMC7216726 DOI: 10.1186/s12889-020-08818-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/30/2020] [Indexed: 11/21/2022] Open
Abstract
Background Accessibility of sexual and reproductive health (SRH) services in many lower-and-middle-income countries (LMICs) and humanitarian settings remains limited, particularly for young people. Young people facing humanitarian crises are also at higher risk for mental health problems, which can further exacerbate poor SRH outcomes. This review aimed to explore, describe and evaluate SRH interventions for young people in LMIC and humanitarian settings to better understand both SRH and psychosocial components of interventions that demonstrate effectiveness for improving SRH outcomes. Methods We conducted a systematic review of studies examining interventions to improve SRH in young people in LMIC and humanitarian settings following Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) standards for systematic reviews. Peer-reviewed journals and grey literature from January 1, 2000 to December 31, 2018 were included. Two authors performed title, abstract and full-text screening independently. Data was extracted and analyzed using a narrative synthesis approach and the practice-wise clinical coding system. Results The search yielded 813 results, of which 55 met inclusion criteria for full-text screening and thematic analysis. Primary SRH outcomes of effective interventions included: contraception and condom use skills, HIV/STI prevention/education, SRH knowledge/education, gender-based violence education and sexual self-efficacy. Common psychosocial intervention components included: assertiveness training, communication skills, and problem-solving. Conclusions Findings suggest that several evidence-based SRH interventions may be effective for young people in humanitarian and LMIC settings. Studies that use double blind designs, include fidelity monitoring, and focus on implementation and sustainability are needed to further contribute to this evidence-base.
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Affiliation(s)
- Alethea Desrosiers
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Theresa Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Yasmine Kergoat
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Chiara Servilli
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Lale Say
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland.
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14
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Belizán JM, Miller S, Chandra-Mouli V, Pingray V. Identifying the needs and problems of those left behind, and working with them to address inequities in sexual and reproductive health: a key focus of Reproductive Health for 2020. Reprod Health 2020; 17:6. [PMID: 31959231 PMCID: PMC6971915 DOI: 10.1186/s12978-020-0856-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina.
| | - Suellen Miller
- Safe Motherhood Program, University of California, San Francisco, USA
| | | | - Verónica Pingray
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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15
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Khosla R, Lavelanet A, Ganatra B, Johnson BR. Improving access to safe abortion services in humanitarian crises. Confl Health 2018. [DOI: 10.1186/s13031-018-0160-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Bustreo F, Gorna R, Nabarro D. Knowledge for effective action to improve the health of women, children and adolescents in the sustainable development era. Bull World Health Organ 2016; 94:310-310A. [PMID: 27147754 PMCID: PMC4850545 DOI: 10.2471/blt.16.174243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Flavia Bustreo
- Family, Women's and Children's Health, World Health Organization avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Robin Gorna
- Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
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