1
|
Batram-Zantvoort S, Wandschneider L, Razum O, Miani C. A critical review: developing a birth integrity framework for epidemiological studies through meta-ethnography. BMC Womens Health 2023; 23:530. [PMID: 37817176 PMCID: PMC10565979 DOI: 10.1186/s12905-023-02670-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023] Open
Abstract
Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.
Collapse
Affiliation(s)
- Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (Ined), Aubervilliers, France
| |
Collapse
|
2
|
Miani C, Leiße A, Wandschneider L, Batram-Zantvoort S. Experiences of giving birth during the COVID-19 pandemic: a qualitative analysis of social media comments through the lens of birth integrity. BMC Pregnancy Childbirth 2023; 23:32. [PMID: 36647019 PMCID: PMC9841489 DOI: 10.1186/s12884-022-05326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Social media offer women a space to discuss birth-related fears and experiences. This is particularly the case during the COVID-19 pandemic when measures to contain the spread of the virus and high rates of infection have had an impact on the delivery of care, potentially restricting women's rights and increasing the risk of experiencing different forms of mistreatment or violence. Through the lens of birth integrity, we focused on the experiences of women giving birth in Germany as shared on social media, and on what may have sheltered or violated their integrity during birth. METHODS Using thematic analysis, we identified key themes in 127 comments and associated reactions (i.e. "likes", emojis) posted on a Facebook public page in response to the dissemination of a research survey on maternity care in the first year of the COVID-19 pandemic. RESULTS Women contributing to the dataset gave birth during March and December 2020. They were most negatively affected by own mask-wearing -especially during the active phase of labour, not being allowed a birth companion of choice, lack of supportive care, and exclusion of their partner from the hospital. Those topics generated the most reactions, revealing compassion from other women and mixed feelings about health measures, from acceptation to anger. Many women explicitly formulated how inhumane or disrespectful the care was. While some women felt restricted by the tight visiting rules, those were seen as positive by others, who benefited from the relative quiet of maternity wards and opportunities for postpartum healing and bonding. CONCLUSION Exceptional pandemic circumstances have introduced new parameters in maternity care, some of which appear acceptable, necessary, or beneficial to women, and some of which can be considered violations of birth integrity. Our research calls for the investigation of the long-term impact of those violations and the reassessment of the optimal conditions of the delivery of respectful maternity during the pandemic and beyond.
Collapse
Affiliation(s)
- Céline Miani
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany ,grid.77048.3c0000 0001 2286 7412Sexual and Reproductive Health and Rights Research Unit, Ined, France
| | - Antonia Leiße
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| | - Lisa Wandschneider
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| |
Collapse
|
3
|
Nedberg IH, Vik ES, Kongslien S, Mariani I, Valente EP, Covi B, Lazzerini M, Roda DD, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time. Int J Gynaecol Obstet 2022; 159 Suppl 1:85-96. [PMID: 36530008 PMCID: PMC9877678 DOI: 10.1002/ijgo.14460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. METHODS Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. RESULTS Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83-4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. CONCLUSION Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.
Collapse
Affiliation(s)
- Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Sigrun Kongslien
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Costa R, Rodrigues C, Dias H, Covi B, Mariani I, Valente EP, Zaigham M, Vik ES, Grylka‐Baeschlin S, Arendt M, Santos T, Wandschneider L, Drglin Z, Drandić D, Radetic J, Rozée V, Elden H, Mueller AN, Barata C, Miani C, Bohinec A, Ruzicic J, de La Rochebrochard E, Linden K, Geremia S, de Labrusse C, Batram‐Zantvoort S, Ponikvar BM, Sacks E, Lazzerini M. Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:39-53. [PMID: 36530012 PMCID: PMC9877819 DOI: 10.1002/ijgo.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.
Collapse
Affiliation(s)
- Raquel Costa
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal,Lusófona University/HEI‐Lab: Digital Human‐environment Interaction LabsLisbonPortugal
| | - Carina Rodrigues
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal
| | - Heloísa Dias
- Regional Health Administration of the AlgarveLisbonPortugal
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Mehreen Zaigham
- Department of Obstetrics and GynecologyInstitution of Clinical Sciences Lund, Lund University, Lund and Skåne University HospitalMalmöSweden
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Susanne Grylka‐Baeschlin
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional Association of Lactation Consultants in Luxembourg)LuxembourgLuxembourg
| | - Teresa Santos
- Universidade EuropeiaLisbonPortugal,Plataforma CatólicaMed/Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica PortuguesaLisbonPortugal
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | - Zalka Drglin
- National Institute of Public HealthLjubljanaSlovenia
| | | | | | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and Gynecology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Antonia N. Mueller
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de LisboaLisbonPortugal
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany,Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Anja Bohinec
- National Institute of Public HealthLjubljanaSlovenia
| | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sara Geremia
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Stephanie Batram‐Zantvoort
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | | | - Emma Sacks
- Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | |
Collapse
|
5
|
Drandić D, Drglin Z, Mihevc Ponikvar B, Bohinec A, Ćerimagić A, Radetić J, Ružičić J, Kurbanović M, Covi B, Valente EP, Mariani I, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's perspectives on the quality of hospital maternal and newborn care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina. Int J Gynaecol Obstet 2022; 159 Suppl 1:54-69. [PMID: 36530003 PMCID: PMC9877897 DOI: 10.1002/ijgo.14457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia. METHOD Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020 and July 1, 2021 answered an online questionnaire including 40 WHO standards-based quality measures. RESULTS A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%-62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%-69.7% experienced difficulties in accessing routine antenatal care, 60.3%-98.1% were not allowed a companion of choice, 17.4%-39.2% reported that health workers were not always using personal protective equipment, and 21.2%-53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%-62.8% of spontaneous vaginal births. Additionally, 22.6%-55.9% of women received inadequate breastfeeding support, 21.5%-62.8% reported not being treated with dignity, 11.0%-30.5% suffered abuse, and 0.7%-26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia. CONCLUSION Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence-based, respectful care for all mothers and newborns are urgently needed. CLINICALTRIALS gov Identifier: NCT04847336.
Collapse
Affiliation(s)
| | - Zalka Drglin
- National Institute of Public HealthLjubljanaSlovenia
| | | | - Anja Bohinec
- National Institute of Public HealthLjubljanaSlovenia
| | | | | | | | | | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Pumpure E, Jakovicka D, Mariani I, Vaska A, Covi B, Valente EP, Jansone‐Šantare G, Knoka AR, Vilcāne KP, Rezeberga D, Lazzerini M, Roda DD, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Morano S, Chertok I, Artzi‐Medvedik R, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures. Int J Gynaecol Obstet 2022; 159 Suppl 1:97-112. [PMID: 36530013 PMCID: PMC9878132 DOI: 10.1002/ijgo.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. METHODS Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. RESULTS 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). CONCLUSION This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required. CLINICALTRIALS gov Identifier:NCT04847336.
Collapse
Affiliation(s)
- Elizabete Pumpure
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | | | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Gita Jansone‐Šantare
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | | | | | - Dace Rezeberga
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
de Labrusse C, Abderhalden‐Zellweger A, Mariani I, Pfund A, Gemperle M, Grylka‐Baeschlin S, Mueller AN, Valente E, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards. Int J Gynaecol Obstet 2022; 159 Suppl 1:70-84. [PMID: 36530005 PMCID: PMC9877813 DOI: 10.1002/ijgo.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.
Collapse
Affiliation(s)
- Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Alessia Abderhalden‐Zellweger
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Anouck Pfund
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Michael Gemperle
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | | | - Antonia N. Mueller
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Otelea MR, Simionescu AA, Mariani I, Valente EP, Nanu MI, Nanu I, Handra CM, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's assessment of the quality of hospital-based perinatal care by mode of birth in Romania during the COVID-19 pandemic: Results from the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:126-136. [PMID: 36530009 PMCID: PMC9877960 DOI: 10.1002/ijgo.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess women's perceptions of the quality of maternal and newborn care (QMNC) received in hospitals in Romania during the COVID-19 pandemic by mode of birth. METHODS A validated anonymous online questionnaire based on WHO quality measures. Subgroup analysis of spontaneous vaginal birth (SVB), emergency cesarean, and elective cesarean and multivariate analyses were performed, and QMNC indexes were calculated. Maternal age, educational level, year of birth, mother born in Romania, parity, type of hospital, and type of professionals assisting the birth were used for multivariate analysis. RESULTS A total of 620 women completed the survey. Overall, several quality measures suggested gaps in QMNC in Romania, with the lowest QMNC indexes reported for provision of care and availability of resources. Women who had either elective or emergency cesarean compared with those who had SVB more frequently lacked early breastfeeding (OR 2.04 and 2.13, respectively), skin-to-skin contact (OR 1.73 and 1.75, respectively), rooming-in (OR 2.07 and 1.96, respectively), and exclusive breastfeeding at discharge (OR 2.27 and 1.64, respectively). Compared with elective cesarean, emergency cesarean had higher odds of ineffective communication by healthcare providers (OR 1.65), lack of involvement in choices (OR 1.58), insufficient emotional support (OR 2.07), and no privacy (OR 2.06). Compared with other modes of birth, a trend for lower QMNC indexes for emergency cesarean was observed for all domains, while for elective cesarean the QMNC index for provision of care was significantly lower. CONCLUSION Quality indicators of perinatal care remain behind targets in Romania, with births by cesarean the most affected. CLINICALTRIALS GOV IDENTIFIER NCT04847336.
Collapse
Affiliation(s)
| | - Anca Angela Simionescu
- Department of Obstetrics and GynecologyUniversity of Medicine and Pharmacy Carol DavilaBucharestRomania,Department of Gynecology and ObstetricsFilantropia Clinical HospitalBucharestRomania
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Michaela Iuliana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | - Ioana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | | | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Costa R, Barata C, Dias H, Rodrigues C, Santos T, Mariani I, Covi B, Valente EP, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:137-153. [PMID: 36530002 PMCID: PMC9878220 DOI: 10.1002/ijgo.14507] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. METHODS Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. RESULTS Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). CONCLUSION Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.
Collapse
Affiliation(s)
- Raquel Costa
- EPIUnitInstituto de Saúde Pública, Universidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal,Lusófona University/HEI‐Lab: Digital Human‐Environment Interaction LabsPortoPortugal
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de LisboaLisbonPortugal,Associação Portuguesa Pelos Direitos da Mulher na Gravidez e PartoLisbonPortugal
| | - Heloísa Dias
- Administração Regional de Saúde do AlgarveAlgarvePortugal
| | - Carina Rodrigues
- EPIUnitInstituto de Saúde Pública, Universidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal
| | - Teresa Santos
- Universidade EuropeiaLisbonPortugal,Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica PortuguesaLisbonPortugal
| | - Ilaria Mariani
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Miani C, Wandschneider L, Batram-Zantvoort S, Covi B, Elden H, Nedberg IH, Drglin Z, Pumpure E, Costa R, Rozée V, Otelea MR, Drandić D, Radetic J, Abderhalden-Zellweger A, Ćerimagić A, Arendt M, Mariani I, Linden K, Ponikvar BM, Jakovicka D, Dias H, Ruzicic J, de Labrusse C, Valente EP, Zaigham M, Bohinec A, Rezeberga D, Barata C, Pfund A, Sacks E, Lazzerini M, Drandić Roda D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:9-21. [PMID: 36530006 DOI: 10.1002/ijgo.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. METHODS Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. RESULTS Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. CONCLUSION We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.
Collapse
Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Helen Elden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elizabete Pumpure
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Raquel Costa
- Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Lusófona University/HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,SAMAS Association, Bucharest, Romania
| | | | | | - Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Karolina Linden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Heloisa Dias
- Administração Regional de Saúde do Algarve, Algarve, Portugal
| | | | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Anja Bohinec
- National Institute of Public Health, Ljubljana, Slovenia
| | - Dace Rezeberga
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal
| | - Anouk Pfund
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Namer Y, Wandschneider L, Stieglitz S, Starke D, Razum O. Racism in public health services: A research agenda. Front Public Health 2022; 10:1039963. [PMID: 36504940 PMCID: PMC9729794 DOI: 10.3389/fpubh.2022.1039963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.
Collapse
Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany,Research Institute Social Cohesion, Bielefeld, Germany,*Correspondence: Yudit Namer
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sigsten Stieglitz
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Dagmar Starke
- Akademie für Öffentliches Gesundheitswesen, Düsseldorf, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany,Research Institute Social Cohesion, Bielefeld, Germany
| |
Collapse
|
12
|
Miani C, Wandschneider L, Batram-Zantvoort S, Covi B, Elden H, Hersoug Nedberg I, Drglin Z, Pumpere E, Costa R, Lazzerini M. Individual and country-level variables associated with the medicalization of birth. Eur J Public Health 2022. [PMCID: PMC9594081 DOI: 10.1093/eurpub/ckac129.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction According to the World Health Organization, the medicalisation of birth tends “to undermine the woman's own capability to give birth and negatively impacts her childbirth experience”. The COVID-19 pandemic has disrupted maternity care, with potential increase in the medicalisation of birth and in occurrences of disrespectful maternity care. We aim to investigate potential associations between individual and country-level factors and medicalisation of birth in 15 European countries during the COVID-19 pandemic. Methods We collected data through an online, anonymous survey for women who gave birth in 2020-2021. We ran multivariable, multi-level logistic regression models estimating associations between indicators of medicalisation (caesarean section (CS), instrumental vaginal birth (IVB), episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country-level. Results Among 27173 women, 24.4% had a CS, and 8.8% an IVB. Among women with IVB, 41.9% reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalisation. For example, women who reported having CS, IVB and episiotomy reported not feeling treated with dignity more frequently than women who didn't have those interventions (respectively: OR: 1.37; OR: 1.61; OR: 1.51; all: p < 0.001). Country-level variables contributed to explaining some of the variance between countries. Conclusions We recommend a greater emphasis in health policies on the promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor the medicalisation of reproductive care. Speakers/Panellists Emanuelle Pessa Valente WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS, Trieste, Italy
Collapse
Affiliation(s)
- C Miani
- School of Public Health, Bielefeld University , Bielefeld, Germany
- Ined , Aubervilliers, France
| | - L Wandschneider
- School of Public Health, Bielefeld University , Bielefeld, Germany
| | | | - B Covi
- WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS , Trieste, Italy
| | - H Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg , Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital , Gothenburg, Sweden
| | - I Hersoug Nedberg
- Department of Community Medicine, UiT The Arctic University of Norway , Tromso, Norway
| | - Z Drglin
- National Institute of Public Health , Ljubljana, Slovenia
| | - E Pumpere
- Riga Maternity Hospital , Riga, Latvia
- Department of Obstetrics and Gynecology, Riga Stradins University , Riga, Latvia
| | - R Costa
- EPIUnit, University of Porto , Porto, Portugal
| | - M Lazzerini
- WHO Collaborating Centre, Institute for Maternal and Child Health IRCCS , Trieste, Italy
| |
Collapse
|
13
|
Wandschneider L, Podar D, Wetzel L, Luetke Lanfer H, Skrypnikova O, Razum O, Selig S, Namer Y. Syllabi collection on diversity and intersectionality in public health: reflecting on the development. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Highlighting the intersectionalities between different markers of diversity and health inequities encourages the reconsideration of normativities in public health (PH). We developed an open access collection of syllabi on the relevance of intersectionality and diversity in PH together with the Association of Schools of Public Health in the European Region (ASPHER).
Objectives
We developed the syllabi in a participatory, iterative process guided by transformative teaching pedagogy. We reflect on this process and how this can inform the enhancement of the syllabi themselves, as well as future curriculum development.
Results
We recruited a core group of 9 PH researchers, teachers and professionals from all career levels from participants of introductory session presentations in different settings (e.g., 14th EPHC, ASPHER Retreat). The core group met once a month for one year online, and each meeting took the form of co-working sessions in breakout rooms to develop the syllabi based on interest and expertise. We designed a qualitative online survey to evaluate and ensure the scientific rigor and pedagogical value of the syllabi. We invited critical and constructive input from ASPHER member school professionals with expertise in intersectionality, diversity or curriculum development in PH in terms of content and pedagogy.
Conclusions
Drawing from the expertise of the PH community we combined diverse professional and cultural backgrounds, experiences from different career levels and PH education systems, as well as specialisation in the PH field. The transformative pedagogical approach was considered particularly valuable in strengthening competences such as reflexive strategies and self-, social- and global awareness which are key to teaching on diversity and intersectionality issues. The peer-review structure supports the uptake in PH education and a sustainable implementation. The collection will also allow PH faculty to diversify their pedagogical approaches.
Key messages
• Inclusion of health inequities, diversity and social injustice issues is crucial in public health curricula, since an intersectional perspective is increasingly acknowledged in public health research.
• The syllabi collection will equip public health teachers of all career levels to develop their own course material on social identities and their significance for public health.
Collapse
Affiliation(s)
- L Wandschneider
- School of Public Health, Bielefeld University , Bielefeld, Germany
| | - D Podar
- School of Public Health, Bielefeld University , Bielefeld, Germany
| | - L Wetzel
- Health Sciences, University of Applied Sciences Fulda , Fulda, Germany
| | - H Luetke Lanfer
- School of Public Health, Bielefeld University , Bielefeld, Germany
| | - O Skrypnikova
- School of Public Health, National University of Kyiv-Mohyla Academy , Kyiv, Ukraine
| | - O Razum
- School of Public Health, Bielefeld University , Bielefeld, Germany
| | - S Selig
- Department of Public Health and Health Sciences, University of Michigan-Flint , Michigan-Flint, USA
| | - Y Namer
- School of Public Health, Bielefeld University , Bielefeld, Germany
| |
Collapse
|
14
|
Namer Y, Wandschneider L, Middleton J, Davidovitch N, Razum O. Corrigendum: How Can Schools of Public Health Actively Promote Peace? Public Health Rev 2022; 43:1605297. [PMID: 36245830 PMCID: PMC9559562 DOI: 10.3389/phrs.2022.1605297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/20/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- *Correspondence: Lisa Wandschneider,
| | - John Middleton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Nadav Davidovitch
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
- School of Public Health, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| |
Collapse
|
15
|
Batram-Zantvoort S, Wandschneider L, Niehues V, Razum O, Miani C. Maternal self-conception and mental wellbeing during the first wave of the COVID-19 pandemic. A qualitative interview study through the lens of "intensive mothering" and "ideal worker" ideology. Front Glob Womens Health 2022; 3:878723. [PMID: 36132187 PMCID: PMC9484320 DOI: 10.3389/fgwh.2022.878723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Mothers tended to be responsible for most of the (additional) caregiving and domestic tasks during the COVID-19 pandemic while simultaneously having to pursue their work duties. Increased role conflicts, parenting stress, and exhaustion predict adverse mental health. We aimed to examine how women referred to and made sense of dominant gender norms in their arrangements of pandemic daily life and how these beliefs impacted their maternal self-conception. Qualitative interviews with 17 women were analyzed through the lens of "intensive mothering" ideology and "ideal workers" norms, emphasizing notions of maternal guilt rising from a perceived mismatch between the ideal and actual maternal self-conception. We found that mothers' notions of guilt and their decreases in health link to dominant discourses on motherhood and intersect with "ideal worker" norms. As such, these norms amplify the burden of gendered health inequalities.
Collapse
Affiliation(s)
- Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | | | | | | |
Collapse
|
16
|
Wandschneider L, Sauzet O, Razum O, Miani C. Development of a gender score in a representative German population sample and its association with diverse social positions. Front Epidemiol 2022; 2:914819. [PMID: 38455329 PMCID: PMC10910995 DOI: 10.3389/fepid.2022.914819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/02/2022] [Indexed: 03/09/2024]
Abstract
Background Gender as a relational concept is rarely considered in epidemiology. However, an in-depth reflection on gender conceptualisation and operationalisation can advance gender analysis in quantitative health research, allowing for more valid evidence to support public health interventions. We constructed a context-specific gender score to assess how its discriminatory power differed in sub-groups defined by social positions relevant to intersectional analyses, i.e., sex/gender, race, class, age and sexual attraction. Methods We created a gender score with the help of multivariable logistic regression models and conditional probabilities based on gendered social practices and expressed on a masculinity-femininity continuum, using data of the German Socioeconomic Panel. With density plots, we exploratively compared distributions of gendered social practices and their variation across social groups. Results We included 13 gender-related variables to define a gender score in our sample (n = 20,767). Variables on family and household structures presented with the highest weight for the gender score. When comparing social groups, we saw that young individuals, those without children, not living with a partner or currently living in a same-sex/gender partnership, showed more overlap between feminine/masculine social practices among females and males. Conclusions The distribution of gendered social practices differs among social groups, which empirically backs up the theoretical notion of gender being a context-specific construct. Economic participation and household structures remain essential drivers of heterogeneity in practices among women and men in most social positions. The gender score can be used in epidemiology to support concerted efforts to overcome these gender (in)equalities-which are important determinants of health inequalities.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
17
|
Lazzerini M, Covi B, Mariani I, Drglin Z, Arendt M, Nedberg IH, Elden H, Costa R, Drandić D, Radetić J, Otelea MR, Miani C, Brigidi S, Rozée V, Ponikvar BM, Tasch B, Kongslien S, Linden K, Barata C, Kurbanović M, Ružičić J, Batram-Zantvoort S, Castañeda LM, Rochebrochard EDL, Bohinec A, Vik ES, Zaigham M, Santos T, Wandschneider L, Viver AC, Ćerimagić A, Sacks E, Valente EP. Corrections to “Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: Online survey investigating maternal perspectives in 12 countries of the WHO European Region”. Lancet Reg Health Eur 2022; 19:100461. [PMID: 35891895 PMCID: PMC9306332 DOI: 10.1016/j.lanepe.2022.100461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
18
|
Wandschneider L, Miani C, Razum O. Decomposing intersectional inequalities in subjective physical and mental health by sex, gendered practices and immigration status in a representative panel study from Germany. BMC Public Health 2022; 22:683. [PMID: 35392864 PMCID: PMC8991479 DOI: 10.1186/s12889-022-13022-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background The mapping of immigration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited. Methods To map inequalities in self-reported physical and mental health in Germany at the intersections of sex, gendered practices and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (on a femininity-masculinity continuum). Results We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant males with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant females with feminine gendered practices for physical health (-1,36; 95% CI [-2,09; -0,64]) and among non-immigrant females with feminine practices for mental health (-2,51; 95% CI [-3,01; -2,01]). Conclusions Patterns of physical and mental health vary along the intersectional axes of sex, gendered practices and immigration status. These findings highlight the relevance of intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13022-1.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitaetsstr. 25, 33615, Bielefeld, Germany.,Research Institute Social Cohesion (RISC), Bielefeld University, Bielefeld, Germany
| |
Collapse
|
19
|
Wandschneider L, Namer Y, Davidovitch N, Nitzan D, Otok R, Leighton L, Signorelli C, Middleton J, Martin-Moreno JM, Chambaud L, Lopes H, Razum O. The Role of Europe’s Schools of Public Health in Times of War: ASPHER Statement on the War Against Ukraine. Public Health Rev 2022; 43:1604880. [PMID: 35371592 PMCID: PMC8966375 DOI: 10.3389/phrs.2022.1604880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Dorit Nitzan
- School of Public Health, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Lore Leighton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Carlo Signorelli
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - John Middleton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Jose M. Martin-Moreno
- ASPHER Honours’ Committee, Brussels, Belgium
- Department of Preventive Medicine and Public Health, Medical School and INCLIVA, University of Valencia, Valencia, Spain
| | | | - Henrique Lopes
- Public Health Unit, Institute of Health Sciences, Catholic University of Portugal, Lisbon, Portugal
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- *Correspondence: Oliver Razum,
| |
Collapse
|
20
|
Lazzerini M, Covi B, Mariani I, Drglin Z, Arendt M, Nedberg IH, Elden H, Costa R, Drandić D, Radetić J, Otelea MR, Miani C, Brigidi S, Rozée V, Ponikvar BM, Tasch B, Kongslien S, Linden K, Barata C, Kurbanović M, Ružičić J, Batram-Zantvoort S, Castañeda LM, Rochebrochard EDL, Bohinec A, Vik ES, Zaigham M, Santos T, Wandschneider L, Viver AC, Ćerimagić A, Sacks E, Valente EP. Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region. Lancet Reg Health Eur 2022; 13:100268. [PMID: 34977838 PMCID: PMC8703114 DOI: 10.1016/j.lanepe.2021.100268] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. FINDINGS 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. INTERPRETATION Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. FUNDING The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT04847336.
Collapse
Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | | | - Helen Elden
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska university hospital, Dept of Obstetrics & Gynecology, Gothenburg, Sweden
| | - Raquel Costa
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
| | | | | | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Serena Brigidi
- Department of Anthropology, Philosophy and Social Work. Medical Anthropology Research Center (MARC). Rovira i Virgili University (URV), Tarragona, Spain
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
| | | | - Barbara Tasch
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
- Neonatal intensive care unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sigrun Kongslien
- Department of health and care sciences, UiT The Arctic University of Norway
| | - Karolina Linden
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
| | - Anja Bohinec
- National Institute of Public Health, Ljubljana, Slovenia
| | - Eline Skirnisdottir Vik
- Department of health and caring sciences, Western Norway University of Applied Sciences, Norway
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Teresa Santos
- Universidade Europeia, Lisboa, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | | | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - IMAgiNE EURO study group
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- National Institute of Public Health, Ljubljana, Slovenia
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
- Department of community medicine, UiT The Arctic University of Norway
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska university hospital, Dept of Obstetrics & Gynecology, Gothenburg, Sweden
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
- Roda – Parents in Action, Zagreb, Croatia
- Centar za mame, Belgrade, Serbia
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Anthropology, Philosophy and Social Work. Medical Anthropology Research Center (MARC). Rovira i Virgili University (URV), Tarragona, Spain
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
- Neonatal intensive care unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Department of health and care sciences, UiT The Arctic University of Norway
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal
- Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
- Institut Català de la Salut, Generalitat de Catalunya, Spain
- Department of health and caring sciences, Western Norway University of Applied Sciences, Norway
- Obstetrics & Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Universidade Europeia, Lisboa, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal
- Institut Català d'Antropologia (ICA), Barcelona, Spain
- NGO Baby Steps, Sarajevo, Bosnia-Herzegovina
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| |
Collapse
|
21
|
Lazzerini M, Covi B, Mariani I, Giusti A, Valente EP, Ćerimagić A, Drandić D, Kurbanović M, Virginie R, Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Verardi G, Zanin B, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Vaska A, Jakovicka D, Rudzīte P, Ērmane E, Vilcāne KP, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Yarotskaya E, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Viver AC, Elden H, Linden K, Zaigham M, Sengpiel V, De Labrusse C, Abderhalden A, Pfund A, Thorn H. Quality of care at childbirth: findings of IMAgiNE EURO in Italy during the first year of the COVID‐19 pandemic. Int J Gynaecol Obstet 2022; 157:405-417. [PMID: 35092692 PMCID: PMC9087757 DOI: 10.1002/ijgo.14119] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
Objective Investigate the quality of maternal and newborn care (QMNC) during childbirth in the first year of COVID‐19 pandemic in Italy, from the mothers' perspective, as key service users. Methods Women who gave birth in an Italian facility from March 1, 2020 to February 29, 2021 answered an online questionnaire including 40 WHO Standard‐based Quality Measures. Descriptive and multivariate quantile regression analyses were performed. Results In total, 4824 women were included, reporting heterogeneity of practices across regions: among 3981 women who underwent labour 78.4% (63.0%–92.0%) were not allowed a companion of choice, 44.6% (28.9%–53.3%) had difficulties in attending routine antenatal visits, 36.3% (24.9%–61.1%) reported inadequate breastfeeding support, 39.2% (23.3%–62.2%) felt not involved in medical choices, 33.0% (23.9%–49.3%) experienced unclear communication from staff, 24.8% (15.9%–39.4%) were not always treated with dignity and 12.7% (10.1%–29.3%) reported abuses. Findings in the group of women who did not experience labour were substantially similar. Multivariate analyses confirmed a significant lower QMNC index for regions in southern Italy compared to North and Central regions. Conclusion Mothers reported substantial inequities in the QMNC across Italian regions. Future studies should monitor QMNC over time. Meanwhile, actions to ensure high QMNC for all mothers and newborns across Italy are urgently required. Mothers giving birth in the first year of the COVID‐19 pandemic reported substantial inequities across Italian regions in the QMNC around the time of childbirth.
Collapse
Affiliation(s)
- Marzia Lazzerini
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Benedetta Covi
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | - Angela Giusti
- National Centre for Diseases Prevention and Health Promotion National Institute of Health Rome Italy
| | - Emanuelle Pessa Valente
- Institute for Maternal and Child Health ‐ IRCCS “Burlo Garofolo” ‐ WHO Collaborating Centre for Maternal and Child Health Trieste Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Wandschneider L, Batram-Zantvoort S, Alaze A, Niehues V, Spallek J, Razum O, Miani C. Self-reported mental well-being of mothers with young children during the first wave of the COVID-19 pandemic in Germany: A mixed-methods study. Womens Health (Lond) 2022; 18:17455057221114274. [PMID: 35997231 PMCID: PMC9424892 DOI: 10.1177/17455057221114274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Mothers of young children have been identified as a particularly vulnerable group during the COVID-19 pandemic. We aimed to explore how occupational, psychosocial and partnership-related factors were associated with their self-reported mental well-being during the first COVID-19 wave. METHODS Five hundred fifty participants of the BaBi cohort study (est. 2013, Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online survey and to take part in email interviews (April-May 2020). With survey data, we assessed self-reported mental well-being through validated instruments (eight-item Patient Health Questionnaire; short version of the Symptom Checklist) and ran linear regression models for occupational, psychosocial and partnership-related factors. We performed content analysis on the interviews' data to further understand the determinants of the women's mental well-being. RESULTS One hundred twenty-four women participated in the survey; of which 17 also participated in the interviews. A perceived lack of support in childcare was associated with higher levels of depressive symptoms, while having a higher internal locus of control was associated with lower levels. Psychological distress was higher in those reporting lack of emotional or childcare support. Interviews confirmed the interplay of potential stressors and highlighted the difficulties to reconcile different expectations of motherhood. DISCUSSION Occupational, psychosocial and partner-related factors can act (to varying degree) both as resources and stressors to the self-reported mental well-being of mothers of young children. These impacts took different forms and created opportunities or challenges, depending on specific life circumstances, such as work or family situations, relationships and own psychosocial resources. Although not representative, our study contributes to building the COVID-19 evidence base, delineating the mental health toll of the pandemic on mothers of young children and the factors that contribute to it.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
| | - Anita Alaze
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
| | - Vera Niehues
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Institute
for Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg,
Germany
| | - Oliver Razum
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and
International Public Health, School of Public Health, Bielefeld University,
Bielefeld, Germany
- Céline Miani, Department of Epidemiology
and International Public Health, School of Public Health, Bielefeld University,
Universitaetsstr. 25, 33615 Bielefeld, Germany.
| |
Collapse
|
23
|
Namer Y, Wandschneider L, Middleton J, Davidovitch N, Razum O. How can Schools of Public Health Actively Promote Peace? Public Health Rev 2021; 42:1604459. [PMID: 34909237 PMCID: PMC8544177 DOI: 10.3389/phrs.2021.1604459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/17/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - John Middleton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Nadav Davidovitch
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium.,School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| |
Collapse
|
24
|
Miani C, Batram-Zantvoort S, Wandschneider L, Spallek J, Razum O. Potential of Standard Perinatal Data for Measuring Violation of Birth Integrity. Front Glob Womens Health 2021; 1:581244. [PMID: 34816160 PMCID: PMC8594012 DOI: 10.3389/fgwh.2020.581244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 12/10/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Measuring the phenomenon of violation of birth integrity (vBI) (e.g., obstetric violence) relies in part on the availability and content of maternity care providers' data. The population coverage and linkage possibilities that these data provide make for a yet untapped potential. Although vBI is a complex phenomenon best measured with dedicated instruments, we argue that maternity care providers' data could contribute to enhance our knowledge of the manifestations and frequency of vBI, and allow for analyses across different sub-groups of the population. Looking into the German standardized perinatal data, we investigate which variables are relevant to vBI-related research, and how complete their reporting is. Methods: First, we analyse state-of-the-art frameworks and recommendations, and, for each vBI-related domain, we search for and list corresponding variables in the perinatal data which could contribute to a better understanding of vBI issues. Second, we use an example and analyse the content of perinatal data obtained between 2013 and 2016 in the context of the BaBi birth cohort study set in Bielefeld, Germany. We use descriptive statistics to assess the completeness of the data. Results: The vBI-related variables can be classified in three main categories: discrimination based on specific patient socio-demographic attributes (e.g., height and weight to calculate BMI before pregnancy, foreign origin), indication for medical interventions (i.e., medicalization-related variables: indication for cesarean sections and induction), and supportive care, in particular the mobilization dimension (e.g., continuous fetal heartbeat monitoring). The data analyses included 876 births, of which 601 were vaginal birth. We found poor reporting on demographic variables in terms of completeness. Medicalization and mobilization variables are better documented, although limited in scope. Conclusions: Putting more emphasis on the completeness of standardized data could increase their potential for vBI-related research. Perinatal data alone are insufficient to assess vBI, but a broader, theory-informed discussion of indicators to be included in standardized datasets would contribute to capturing the different aspects of integrity violation in a more systematic way and expand the evidence-base on different types of vBI.
Collapse
Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
25
|
Miani C, Wandschneider L, Niemann J, Batram-Zantvoort S, Razum O. Measurement of gender as a social determinant of health in epidemiology-A scoping review. PLoS One 2021; 16:e0259223. [PMID: 34731177 PMCID: PMC8565751 DOI: 10.1371/journal.pone.0259223] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/18/2021] [Indexed: 11/18/2022] Open
Abstract
Background The relevance of gender as a social determinant of health and its role in the production of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which often stem from disciplines outside of epidemiology, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a scoping review to 1) map the evidence of how gender can be operationalised in quantitative epidemiology and 2) design a tool to critically evaluate the measures identified. Methods We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO). Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed checklist, we assessed their relevance from an analytical perspective (e.g. intersectionality) and their potential for implementation in epidemiology. Results Gender measures principally assessed gender roles and norms, gender-based discrimination and violence, and structural gender (in)equality. Of the 344 measures included in this review, the majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender through stereotypes of femininity and masculinity. Only few measures allowed for an intersectional approach and a multilevel understanding of gender mechanisms. From a practical point of view, gender measures demonstrated potential for use in varied populations and contexts. Conclusions A range of gender measures are readily available for epidemiological research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven scoping review, we highlighted strengths and limitations of such measures and provided analytical tools for researchers interested in conducting intersectional, gender-sensitive analyses.
Collapse
Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- * E-mail:
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jana Niemann
- Institute of Medical Sociology, Martin-Luther University Halle-Wittenberg, Halle, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
26
|
Wandschneider L, Sauzet O, Razum O, Miani C. Exploring gendered practices by social position in epidemiology: the gender score applied to Germany. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Gender as a relational concept is rarely taken into account in epidemiology, yet an in-depth reflection on gender conceptualisation and operationalisation can advance gender analysis in quantitative health research, allowing for more valid evidence to support public health interventions. We constructed a context-specific gender score to assess how its discriminatory power differed in sub-groups defined by social positions investigated in intersectional analyses, i.e. sex/gender, race, class, age and sexual orientation.
Methods
We created a gender score based on gendered social practices on a masculinity-femininity continuum (ranging from 0-1) using data of the German Socioeconomic Panel. With density plots, we exploratively compared distributions of gendered social practices and their variation across social groups.
Results
We included 13 gender-related variables to define a gender score in our sample (n = 20,767). Variables on family and household structures presented with the highest weight for the gender score. Calculating tertiles, the score ranged between 0.01 and 0.68, 0.69 and 0.93 and 0.94 to 1 in women and 0 and 0.18, 0.19 and 0.40 and 0.41 to 1 in men, showing that the distribution for women is more skewed than for men. Comparing social groups, we saw that young individuals, those without children, not living with a partner or currently living in a same-sex/gender partnership, showed more overlap between feminine/masculine social practices among men and women.
Conclusions
Our explorative findings showed that the distribution of gendered social practices differed among social groups, which empirically backed up the theoretical notion of gender being a context-specific construct. Economic participation and household structures remain essential drivers of heterogeneity in practices among women and men in most social positions. Concerted efforts must continue to overcome these gender (in)equalities - which are important determinants of health inequalities.
Key messages
Family and household structures are crucial to constructing the gender score, indicating that interpersonal relationships are key determinants of gendered social practices. Including gendered practices in representative health monitoring data could allow for differentiation of biological sex and socially constructed gendered practices that drive health inequalities.
Collapse
Affiliation(s)
- L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - O Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
27
|
Miani C, Leisse A, Wandschneider L, Batram-Zantvoort S. Social media and experiences of maternity care during the Covid-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574722 DOI: 10.1093/eurpub/ckab165.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Social media offer expecting and new mothers a space to discuss birth-related fears, hopes and experiences. This is particularly the case during the Covid-19 pandemic, which has altered delivery of maternity care. Measures to reduce transmission risk in birth facilities and changes in birth plans are likely to have had an impact on new mothers' experiences of birth and birth care. From a feminist epidemiology perspective, seeking to incorporate more the views of the “researched”, we explored themes discussed by (expecting) mothers on social media, hoping that those real-life concerns would find echo in the design of future research instruments for data collection. Methods Using content analysis, we identified key themes in 200+ comments posted on a social media public page as a reaction to the dissemination of a research survey on maternity care during the Covid-19 pandemic in Germany. Results In the comments, the most mentioned topics were own mask wearing, having a companion of choice during birth, visiting hours, and the possibility to welcome visitors (e.g. siblings of the newborn, other relatives and friends). Those topics also generated the most reactions, revealing compassion from other women and mixed feeling about health measures (from acceptance to anger). Concerns about quality or appropriateness of care were almost absent from the data. Conclusions Social media content analysis shows clearly that women giving birth during the pandemic are most concerned with a specific set of disrupting and potentially upsetting measures. These spontaneous testimonies differ content-wise from what research surveys tend to ask women about (e.g. care standards). Those discrepancies are to some extent inevitable, but integrating more bottom-up generated topics from social media into research instruments could help move forward toward better care. Key messages On social media, women were most concerned with own mask wearing, presence of a birth companion and visits from the newborn’s siblings. Social media analysis brings valuable insights into what matters the most to women who give birth during the pandemic and could inform future research developments.
Collapse
Affiliation(s)
- C Miani
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - A Leisse
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - L Wandschneider
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | | |
Collapse
|
28
|
Abstract
Abstract
Background
The mapping of migration-related health inequalities remains challenging, since immigrant populations constitute a heterogenous socially constructed group whose health experiences differ by social determinants of health. In spite of the increasing awareness that population mobility and its effects on health are highly gendered, an explicit gender perspective in epidemiology is often lacking or limited.
Methods
To map health inequalities in Germany at the intersection of sex, gender and immigration status, we used data from the German Socioeconomic Panel (SOEP) and applied an intercategorical intersectional approach conducting multilevel linear regression models. We differentiated between sex (male/female) as reported in the survey and gendered social practices, quantified through a gender score (femininity-masculinity continuum).
Results
We included 20,897 participants in our analyses. We saw an intersectional gradient for physical and mental health. Compared to the reference group, i.e. non-immigrant men with masculine gendered practices, physical and mental health steadily decreased in the intersectional groups that did not embody one or more of these social positions. The highest decreases in health were observed in the intersectional group of immigrant women with feminine gendered practices for physical health (-1.54 CI -2.41;-0.79) and among non-immigrant women with feminine practices for mental health (-2.71 CI -3.19;-2.14).
Conclusions
We saw differentiated patterns of physical and mental health along the intersectional axes of sex, gender and immigration status, both for physical and mental health. These findings highlight the relevance of these intersections in describing population health statuses and emphasise the need to take them into account when designing public health policies aiming at effectively reducing health inequalities.
Key messages
Being a man and having masculine gendered practices were associated with higher mental and physical health scores, for both immigrants and non-immigrants. Adopting an intersectional perspective, which takes into account social positions (e.g. gender, immigration status) and their impact on health inequalities, can help to target public health policies.
Collapse
Affiliation(s)
- L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
29
|
Wandschneider L, Namer Y, Siepmann I, Khutan R, Otok R, Middleton J, Razum O, Selig S. An introductory course on social identities and their importance in public health. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Social identities - e.g., sex/gender, ethnicity, ability, sexual orientation - and their intersections shape health inequalities in societies. Yet, a systematic, critical integration into public health curricula is lacking, especially in the European region. To address this gap, we developed a curriculum on social identities and their importance in public health in collaboration with ASPHER.
Objectives
The curriculum enables students to identify mechanisms of privilege and oppression related to social identities, and to learn how to determine biases within public health structures (and oneself). Moreover, it equips them with tools and skills to address and change biases in their practices to ultimately reduce health inequities.
Results
We conceptualized the curriculum in an iterative and participatory process in a group of students, young professionals and senior researchers from different countries in Western Europe and North America. The curriculum covers three core elements: 1) the introduction of concepts and terminology on diversity, equity and social identities in relation to health inequalities, 2) the reflection on the role of public health professionals and their responsibility within this system; and 3) spotlights on specific social identities, e.g., sex/gender or social class. In addition, it provides guidance on teaching methods to empower a broad range of public health professionals to engage with the course materials more easily.
Conclusions
The curriculum has the potential to strengthen the capacities of future public health professionals to acknowledge the relevance of social identities and how to respond effectively to contribute to health equity. After piloting and revisions, the course will be made available on an open access platform.
Collapse
Affiliation(s)
- L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Y Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - I Siepmann
- Faculty of Health, Medicine, and Life Sciences, Maastricht University, Maastricht, Netherlands
- ASPHER, Brussels, Belgium
| | - R Khutan
- Department of Public Health Outreach & Engagement, Faculty of Education Health & Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - R Otok
- ASPHER, Brussels, Belgium
| | | | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - S Selig
- Department of Public Health and Health Sciences, University of Michigan-Flint, Michigan-Flint, USA
| |
Collapse
|
30
|
Batram-Zantvoort S, Wandschneider L, Razum O, Miani C. Myths of ‘good motherhood’ and the wellbeing of mothers during the Covid-19 pandemic. Eur J Public Health 2021. [PMCID: PMC8574689 DOI: 10.1093/eurpub/ckab165.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Measures to contain the Covid-19 pandemic had major impacts on families, e.g., due to the unpredictable closing of childcare facilities and schools. Parents had to re-arrange their work, childcare and household obligations. Methods We conducted 17 email interviews with mothers having at least one child aged < =6 years. Topics included adjustments to the pandemic situation, views on motherhood and wellbeing. We analysed data through content analysis. Results We found differing consequences on the wellbeing of the interviewees. One group articulated a deceleration of daily life and increased satisfaction due to doing more justice to their role as mother. Another group felt highly stressed and overloaded. Some expressed having shaky hands and heart palpitations, others felt mentally exhausted. The idea of not being a ‘good mother' was expressed by many, provoking guilt and self-doubt. Most interviewees referred to ideological myths of motherhood, picturing mothers as caring and sacrificial, yet well-organized managers of the family. Norms imposed on ‘working mothers' require their full effort and an ability to manage employers' demands. These conflicting norms reveal tensions between the roles mothers find themselves in, potentially leading to adverse (mental) health outcomes. Conclusions Our analysis shows that myths of ‘good motherhood' act as a perpetuation mechanism of traditional gender roles and increase the social burden many mothers are expected to carry, adding to the challenges the global pandemic brought on families. Negative consequences on (mental) health require mitigation strategies, putting mothers at the centre of Covid-19 response policies. Key messages The Covid-19 pandemic exacerbates traditional gender roles and the multiple social burdens that mothers are expected to carry. Conflicting norms imposed on mothers reveal tensions between the different roles they find themselves in, potentially leading to adverse (mental) health outcomes.
Collapse
Affiliation(s)
- S Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
31
|
Wandschneider L, Namer Y, Otok R, Middleton J, Razum O. Teaching Diversity in Public Health Through a Transformative Approach-An ASPHER Initiative. Front Public Health 2020; 8:588111. [PMID: 33313039 PMCID: PMC7709470 DOI: 10.3389/fpubh.2020.588111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Robert Otok
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - John Middleton
- The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,The Association of Schools of Public Health in the European Region (ASPHER), Brussels, Belgium
| |
Collapse
|
32
|
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany.
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
| | - Nurcan Akbulut
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany
| |
Collapse
|
33
|
Wandschneider L, Batram-Zantvoort S, Razum O, Miani C. Representation of gender in migrant health studies - a systematic review of the social epidemiological literature. Int J Equity Health 2020; 19:181. [PMID: 33054755 PMCID: PMC7556985 DOI: 10.1186/s12939-020-01289-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective in migration-related epidemiological research can contribute to adequately analyse and interpret the health of migrants. This systematic review gives a comprehensive overview on how gender has been conceptualised, operationalised and measured in social epidemiologic studies aiming to assess the influence of gender on health among migrants. Methods We searched PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO and conducted backward reference searching. Reviewers independently selected studies, extracted data and conducted the quality assessment. Eligible studies actively aimed to understand, identify or explain the influence of gender on migrants’ health, whereby the role of gender can encompass a variety of mechanisms, processes or states of differentiation, discrimination and/or inequality. Results Almost all of the 43 studies were cross-sectional and focussed on health outcomes in the post-migration phase. The most common theme of research was the health of male migrants in the US, and in particular of men who have sex with men (MSM). All studies treated gender as a binary variable (men vs. women), without discussing additional types of gender identities. A minority of studies differentiated clearly between sex and gender. Gender was mostly operationalised through attitudes toward gender roles and gender-based discrimination, experienced at the individual level. Community and societal level gender measures capturing structural gender determinants were underrepresented. Conclusions The intersections of migration and gender suggested synergistic effects on health that only become visible when considering those two social determinants together. Future research needs to embrace a multilevel and non-binary understanding of gender and reflect on the influence of gender in the different phases of the migration journey. Systematic review registration PROSPERO CRD42019124698.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany.
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, POB 10 01 31, 33501, Bielefeld, Germany
| |
Collapse
|
34
|
Wandschneider L, Batram-Zantvoort S, Razum O, Miani C. Measurement of gender as a social construct in quantitative health research – a critical review. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The relevance of gender as a social determinant of health inequalities is now broadly acknowledged. However, the plethora of existing approaches to capture gender, which are often stemming from disciplines outside of public health, makes it difficult to assess their practicality and relevance for a given research purpose. We conducted a critical review to 1) map the evidence of how gender can be operationalised in quantitative health research and 2) critically evaluate the identified measures.
Methods
We identified peer-reviewed articles in electronic databases (PubMed, Embase and PsycINFO), as well as grey literature in OpenGrey and on the website of governmental and not-for-profit organisations that actively encourage gender-sensitive public health research. Eligible sources described the quantitative operationalisation of the social dimension of gender. With the help of a newly developed scorecard, we assessed their relevance from a theory perspective (e.g. intersectionality) and the potential for implementation from a practical, epidemiological point of view.
Results
Gender measures principally assessed gender roles, gender-based discrimination and gender (in)equality. The majority lacked theoretical foundation, and tended to reinforce the binary understanding of gender identity through stereotypes of femininity and masculinity. An intersectional approach was found mostly in data-driven composite measures. Those also had the advantage of being easy to construct with standard health monitoring data.
Conclusions
A range of gender measures are readily available for public health research, addressing different levels and dimensions of gender as a social construct. With our theory-informed, practice-driven critical review, we highlighted their strengths and limitations and provided analytical tools for researchers interested in conducting intersectional gender-sensitive analyses.
Key messages
Gender and its impact on health can be captured through a range of measures (e.g. scales, indices). Among those, non-binary, theory-informed understandings of gender remain underrepresented. With the help of a newly developed scorecard, our critical review highlights the various gender measures’ strengths and limitations from a theory perspective and a practical point of view.
Collapse
Affiliation(s)
- L Wandschneider
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - S Batram-Zantvoort
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
35
|
Batram-Zantvoort S, Miani C, Wandschneider L, Razum O. Measurement of violation of maternal integrity in childbirth: review from a multilevel perspective. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Violation of maternal integrity (VMI) during childbirth is reported by women and observed by researchers globally. It has serious health consequences for the mother and the infant in the short and long-term. The terminology to capture VMI ranges from disrespect and abuse to mistreatment and obstetric violence. This variety of terms and concepts is reflected in a multitude of operationalisation and measurement strategies.
Methods
In a scoping review, we examined how VMI has been measured in quantitative studies. Using a theoretically informed framework differentiating between the macro, meso, and microlevel, we reflected on the dimensions of VMI included as items in measurement instruments and categorised them in the framework, aiming to highlight the dominantly chosen approaches to VMI as well as the still under-researched fields and perspectives on drivers, expressions and consequences of VMI.
Results
The majority of scales and surveys described in the studies concentrated on the interactional aspects of VMI, located on the microlevel (e.g. verbal abuse, neglect by care providers). Only a few studies dealt with meso-level factors potentially associated with VMI (e.g. staff shortage). Macro-level perspectives on health policies and legislation, gender equity or societal norms remained rare. Instruments used to measure VMI were very heterogeneous and therefore non-comparable with regard to the outcomes and prevalence of VMI.
Conclusions
There is a need to adopt a multilevel perspective to identify further expressions and effects of VMI. Furthermore, the role of macro-level, structural determinants should be investigated. Last, the use of compatible instruments is required to obtain comparable data on VMI nature and prevalence.
Key messages
Measurement instruments of VMI mainly cover interactional aspects of the phenomenon. The meso-, and macrolevel dimensions of VMI are under-researched. The heterogeneity of the instruments measuring VMI hinders comparison of the outcomes and their prevalence.
Collapse
Affiliation(s)
- S Batram-Zantvoort
- School of Public Health, Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - C Miani
- School of Public Health, Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - L Wandschneider
- School of Public Health, Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| | - O Razum
- School of Public Health, Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
36
|
Akbulut N, Limaro N, Wandschneider L, Dhonkal R, Davidovitch N, Middleton J, Razum O. ASPHER statement on racism and health: racism and discrimination obstruct public health's pursuit of health equity. Int J Public Health 2020; 65:727-729. [PMID: 32683584 PMCID: PMC7368593 DOI: 10.1007/s00038-020-01442-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 10/26/2022] Open
Affiliation(s)
- Nurcan Akbulut
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Lisa Wandschneider
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | | | - Oliver Razum
- Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.
| |
Collapse
|
37
|
Wandschneider L, Sauzet O, Breckenkamp J, Spallek J, Razum O. Small-Area Factors and Their Impact on Low Birth Weight-Results of a Birth Cohort Study in Bielefeld, Germany. Front Public Health 2020; 8:136. [PMID: 32411644 PMCID: PMC7199350 DOI: 10.3389/fpubh.2020.00136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/03/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study "Health of infants and children in Bielefeld/Germany." The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research.
Collapse
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Odile Sauzet
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Center for Statistics, Bielefeld University, Bielefeld, Germany
| | - Jürgen Breckenkamp
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Jacob Spallek
- Department of Public Health, Faculty of Social Work, Health, and Music, Brandenburg University of Technology Cottbus–Senftenberg, Senftenberg, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
38
|
Wandschneider L, Namer Y, Razum O. Public health scientists in the crosshairs. Science 2020; 367:861-862. [DOI: 10.1126/science.abb1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, D-33501 Bielefeld, North Rhine Westphalia, Germany
| | - Yudit Namer
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, D-33501 Bielefeld, North Rhine Westphalia, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, D-33501 Bielefeld, North Rhine Westphalia, Germany
| |
Collapse
|
39
|
Batram-Zantvoort S, Wandschneider L, Razum O, Miani C. Violation of maternal integrity during childbirth: a micro-, meso- and macrostructural perspective. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Violation of maternal integrity (VMI) during childbirth is reported by women world-wide and reflects one aspect of gender-related violence against women. Terminology and concepts to describe VMI range from disrespect and abuse over mistreatment in childbirth to obstetric violence. The choice of terms might determine the scope of reference: while mistreatment encompasses rather interactional forms of VMI embedded on a microstructural level of society, obstetric violence includes a critical view on gendered power imbalances and is therefore considering cultural, political and economic exposures situated on macro- and meso-level. To identify different ways of explicitly integrating or implicitly reflecting micro-, meso- and macrostructural dimensions of VMI, we examine terminology, methodology and results in published research.
Methods
For our review, we chose a meta-ethnographic approach, viewing studies on VMI as primary data in terms of defining, collecting, describing and analysing the phenomena of VMI. Our goal lies in first determining the explanatory model of each study and second synthesising these findings to outline a multilevel framework on maternal integrity.
Findings
Studies predominantly concentrate on interaction-related determinants of VMI. To integrate macro- and mesostructural factors of VMI within a comprehensive framework, further epidemiological research on structural and social determinants of maternal health as well as interdisciplinary collaboration on the intertwining of gender imbalances in health care is needed.
Conclusions
By differentiating between macro-to-micro-level factors of VMI, potential causes that go beyond the interaction level (e.g. policy, financial allocation, legal laws, maternal care conditions) can be identified to improve both research and implementation in obstetric care.
Collapse
Affiliation(s)
- S Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| |
Collapse
|
40
|
Wandschneider L, Batram-Zantvoort S, Razum O, Miani C. Operationalisation of gender and migration in epidemiological research – a systematic review. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Gender as a social construct contributes to determine who migrates and which migration-related risks and opportunities emerge in all phases of the migration trajectory. Simultaneously, migration influences the individual as well as societal definition and perception of gender roles. An explicit gender perspective beyond biological sex in migration-related epidemiological research would contribute to adequately analyse, assess and interpret the health situation of migrants.
Methods
The systematic review synthesises how gender is conceptualised, operationalised and used for interpretation in migration-related epidemiological research. We search PubMed, Embase, CINAHL, the Cochrane Library, EconLit and PsycINFO as well as the reference lists of the included studies. Eligible studies actively aim to understand, identify or explain the influence of gender on health.
Results
20 cross-sectional studies met the eligibility criteria. The majority of studies analysed gender effects on mental health (e.g. depression) and sexual health (e.g. risk behaviour). The majority of the study population is made up of male sexual minorities with Latin American background living in the USA. Gender is mainly operationalised through gender roles, attitudes and gender-based discrimination. These dimensions are mostly conceptualised at the individual level, only a minority of studies applies meso- or macro-level indicators to measure structural gender effects.
Discussion
We identified research gaps with regard to macro-level mechanisms of gender, immigrant populations in Europe and interactions of migration and gender in epidemiological research. The majority is restricted to sex- or sexual orientation related issues, but this systematic review helps to identify good practice examples that may contribute to the development of a guideline on how to integrate a gender perspective in migration-related epidemiological research.
Systematic Review Registration: PROSPERO CRD42019124698
Collapse
Affiliation(s)
- L Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - S Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - O Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| | - C Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld, Germany
| |
Collapse
|
41
|
Dyck M, Wenner J, Wengler A, Bartig S, Fischer F, Wandschneider L, Santos-Hövener C, Razum O. [Migration and health in Germany-available data sources]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:935-942. [PMID: 31187181 DOI: 10.1007/s00103-019-02973-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Migration background plays an important role in analyses of health inequalities in Germany. The heterogeneity of people with and without migration background requires a differentiated recording of migration-related characteristics. The latest overview of representative data sources from the Health Reporting (GBE) that included information on migration background was compiled in 2008. AIM The aim of this article is to describe existing data sources reporting the health situation of people with and without a migration background. MATERIALS AND METHODS Starting from the websites and publications of owners of GBE data, representative studies and routine data sources were identified. All sources that consider at least one migration-related characteristic were included. For all included studies, migration-related characteristics, information on the social situation, and health-related indicators were collected. RESULTS A total of 46 data sources (including 19 routine data sources and 27 studies) were included. The most common indicators of the migration background are nationality (n = 36) and the country of birth (n = 29). Health-related indicators cover a wide range of issues. DISCUSSION Routine data sources continue to collect little information on the migration background (usually only nationality) and thus constrain migration-differentiated analyses of the health situation. Survey data allow for more nuanced analysis. However, the actual analysis possibilities and content knowledge of the respective data sources were not the subject of this article.
Collapse
Affiliation(s)
- Maria Dyck
- AG3 Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland. .,Lehrstuhl für Versorgungsforschung, Fakultät für Gesundheit (Department für Humanmedizin), Universität Witten/Herdecke, Witten, Deutschland.
| | - Judith Wenner
- AG3 Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Annelene Wengler
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Susanne Bartig
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Florian Fischer
- AG2 Bevölkerungsmedizin und Versorgungsforschung, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Lisa Wandschneider
- AG3 Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| | - Claudia Santos-Hövener
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin, Deutschland
| | - Oliver Razum
- AG3 Epidemiologie & International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, Bielefeld, Deutschland
| |
Collapse
|
42
|
Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany.
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| | - Oliver Razum
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, 33615 Bielefeld, Germany
| |
Collapse
|
43
|
Wandschneider L, Bruns-Philipps E. Gesundheitsfördernde Elemente in den Kerncurricula für niedersächsische Grundschulen, wo sind sie integriert, wie lassen sie sich stärken – Erstellung einer Handreichung für das Lehrpersonal. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1602027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
44
|
Wandschneider L, Rueff J, Branco J. Ten years' experience with trophoblastic tumors in Portugal. Adv Exp Med Biol 1984; 176:429-34. [PMID: 6093473 DOI: 10.1007/978-1-4684-4811-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Between 1971 and 1980, 220 patients were observed and treated. The patients were classified according to various parameters: age, previous pregnancies, pathology reports of specimens obtained from the uterus, and site of metastasis. The study stressed the possibility of 100% cure in patients with hydatidiform mole, while in choriocarcinoma, late diagnosis was responsible for the failure in effective treatment.
Collapse
|