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INTERNATIONAL CONFERENCE ON WOMEN'S HEALTH AND AMOGS ZONAL CONFERENCE, LONI, INDIA

A Global Perspective on Women’s Health throughout the Lifespan

Judy Lewis,USA 

A woman’s life opportunities are affected by social, cultural, political, and economic factors beginning with conception and continuing until the end of life. Female gender is a risk factor for selective abortion, female at birth is greeted with less joy, female during childhood may result in malnutrition, neglect of health, loss of education, female at adolescence can mean early marriage and motherhood, female young to middle age is a risk for maternal mortality, poor economic opportunities and limited voice in family and community decision-making, older age brings a host of chronic conditions, poor access to care and loss of social status, especially with widowhood. All of these life stages are affected by violence against women, civil conflict and migration.

There have been many calls for addressing women’s health and eliminating disparities. The United Nations has organized four world conferences on women: Mexico City (1975), Copenhagen (1980), Nairobi (1985) and Beijing (1995). Beijing focused on gender equality as the underlying cause to be addressed and the resolutions were adopted unanimously by 189 countries. Beijing was followed by a series of five-year reviews of progress. Women Deliver has been another major advocacy and policy organization. Women’s empowerment, equity and health outcomes are essential components of the SDGs and the MDGs. Recent white papers have emphasized this importance, one example is “The Health of Women and Girls Determines the Health and Well-Being of Our Modern World.” The UN Secretary General’s Global Strategy for Women and Children’s Health and the WHO Partnership for Maternal Newborn and Child Health’s Global Strategy for Women's and Children's Health have provided additional attention to the issues.

Women’s health throughout the lifespan has been recognized as essential for global progress. The World Health Organization now has an Assistant Director General for Family, Women’s and Children’s Health through the Life-course, Dr. Flavia Bustreo. On the 20th Anniversary of the Beijing Declaration and Platform of Action, she identified ten main issues as priorities. These are cancer (breast and cervical), reproductive health, maternal health, HIV, sexually transmitted infections, violence against women, mental health, non-communicable diseases, adolescence and aging. The expansion of women’s health beyond reproduction and child care is a foundational step to achieving gender equity and eliminating health and social disparities.

As health professionals committed to improving care for women, we must address women’s health from a broad and comprehensive perspective. This also means engaging women in establishing the priorities and decision-making, and working with men, family, communities and government.

Health-Related Sustainable Development Goal (SDG3) Targets Attainment Among Women Exposed to Intimate Partner Violence 

Amany H. Refaat, Egypt

Health related Sustainable Development Goal (SDG 3) aims to ensuring healthy lives. This study investigates the consequences of Intimate Partner Violence (IPV) on achieving SDG3 targets among women and their children. Methodology: Data from latest DHS of 28 countries using the domestic violence module was analyzed. IPV was defined by women ever exposure to emotional, physical, severe or sexual violence from spouse. Achieving SDG3 among women was measured by Proportion of births attended by skilled health personnel; need for family planning satisfied with modern methods and receiving antenatal care four or more times. They were measured among children by Proportion of Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds; No stunting or Wasting. The influence of IPV was estimated through adjusted OR after controlling for women’s age, educational level, residence and wealth. Results: Exposure to IPV was among one third of the women (36%) mainly physical (27%) and emotional (25%). Adjusted OR with 95%CI for influence of IPV on women utilization of skilled birth attendants was 0.649 (0.576-0.730); needs for family planning with modern methods satisfied was 0.859 (0.842-0.876) and receiving four visits of antenatal care was 0.880 (0.856-0.904). Maternal exposure to IPV had adjusted OR with 95%CI among their children for DTP3 immunization as 0.960 (0.943-0.986); no stunting as 0.910 (0.877-0.943) and no wasting as 0.845 (0.796-0.897). Conclusion & Recommendation: Exposure to IPV had a negative influence on all SDG3 targets among women and their children. Programs aiming to achieve SDG3 targets should endorse policies for prevention of IPV

Using culturally appropriate strategies to communicate women’s health 

Prof. Godwin N. Aja, Nigeria

Middle and low-income countries carry some of the highest rates of maternal morbidity and mortality. It is, therefore, critical that evidence based health interventions are communicated effectively to reach a wide range of adolescent girls and women. This presentation highlights some culturally innovative strategies for communicating women’s health information in resource-constrained communities. 

Reproductive Health of Adolescent Girls - Global Challenges

Dr.S. Chhabra, India

Around 1.2 milion population,one among five persons is an adolescent, around 1.3 billion worldwide, with 260 million women and 280 million men aged 15–19 in developing countries as most(88 %) adolescents are in developing countries. As nature and science help adolescents become survivors of risky infancy/ childhood and they march towards adulthood,they face many challenges of right development and right functions. Not only there are possibilities of variations/deviations,trivial to dangerous in the development of reproductivehealth system, and susceptibility to various dangers which affect their reproductive andfuture health even normal physiological functions affect adolescents life, simple example is dysmenohreawhich 90% of girls get, affecting their learning, work and social life. The concept of health of adolescents,as a special group,characterized by many rapid, interrelated changes of body, mind, and social relationshipsis relatively new.Problems related to adolescence are being put in the agenda of policy makers, health planners and health professionals since recent past. The way adolescents experience the transition from childhood to adulthood and the advocacies of do and do notsvarywidely depending upon socioeconomic and environmental milieu around their lives and the society they are part.Therefore the social and cultural recognition of the concept and values during adolescence vary substantially between populations around the globe. For many girls in developing countries, the onset of puberty marks a time of heightened vulnerability to leaving school, marriage, sexual exploitation by relatives, employers,pregnancy, HIV infection,violence and soon.They face,many such problems related to sexuality,with too little factual information, too little guidance and too little access to health care. Due to stigma, of pregnancy, honor killings and suicides go on.There are variations in numbers but teenage pregnancy, safe/unsafe abortions, safe / unsafe births are global public health problems. Somecountries have restricted laws others do not permit induced abortion. Girls are nonimmune to other disorders.Gynecological disordersincluding cancers are not uncommonwith possibilities of major impact on reproduction and their future life.

Adolescence is a crossroad to the promotion of future health and should be gateway. The benefits, which occur in meeting the challengs of promoting health and development of adolescents, far outweigh the costs saved by neglect of adolescents needs. Their health is not only important for their sake, but for the health of communities and generations to come. However despite urgent needs, program efforts have been slow surrounded by controversies. In some countries of the world there are still controversies in relation to information to unwed girls about sex related matters. Sex education in many societies is often a challenging and difficult issue for both youth and adults.Little is known about overall reproductive morbidity, during and outside the child bearing,but is estimated to be of large magnitude. What is visible is only the tip of the iceberg. Adolescentcancer survivors need to have safe future. The need is of modalities of the rigorous implementation of health programs for the adolescents with concept of prevention, early case detection, cure, rehabilitation, and health promotion.Helping adolescents’protect their own health should be an public health priority. Beyond benefiting young people themselves, increased investment in adolescents sexual and reproductive health contributes to broader development goals,especially improvement in the overall status of women, eventually, reduction in poverty and further national development.

Violence against women and the Indian Health System

Adv.Kamayani Bali Mahabal, India

Violence against women is a violation of human rights and a pressing public health issue Preventing violence and responding to survivors requires action from all sectors, and health services play a crucial role. In India, Despite the legislative and policy mandates with explicit direction for the health sector, there is no definitive roadmap for improving the health systems response to violence against women in India. The talk highlights challenges and shortcomings in India’s health systems response to violence against women and recommends cross cutting sector approach.

Maternal Near Miss Review- A Quality of Care Indicator

Prof. Surekha Tayade, India

Maternal mortality ratio is a critical indicator to assess the quality of services provided by a health care system. India has made significant progress in reducing MMR from 167 in 2011-13 to 130 in 2015-16per 100 000 live births. India’s present MMR is below the Millennium Development Goal (MDG) target and puts the country on track to achieve the Sustainable Development Goal (SDG) target of an MMR below 70 by 2030. Among the several strategies, the Maternal Death Review launched in 2010 was an important initiative.There is a need to further accelerate this decline. Amajor limitation of the MDR process is that the stakeholders involved in the service delivery of the pregnant woman look at it with great suspicion in view of fear of public scrutiny and outrage and even litigation. Moreover, the mother who interacted with the system is not available to share her experience.

What is Maternal NearMiss?

A woman who survives life threatening conditions during pregnancy, abortion, and childbirth or within 42 days of Pregnancy termination, irrespective of receiving emergency medical/surgical interventions, is called Maternal Near Miss. Near-miss audit has been considered a less threatening approach than maternal death audit, and can be used to identify the processes and policies to improve the quality of maternal health care. Compared with Maternal Death Review, the fear of blame and punishment is less in near-miss reviewsas the woman who has been saved, will be complimenting the heath care delivery institute. It can in practice; more easily lead to implementation of changes that will improve the quality of services.Moreover, Near-miss events, generally occur more frequently than maternal deaths providing a more reliable data, regarding health system functioningand gaps therein, the resolution of which, can ultimately lead to an improved health system.

MNM-R provides a lot of learning opportunities, which is available more easily due to the availability of the mother as well as the willingness of health professionals who are eager to share their ‘success’ stories. All near misses should be interpreted as free lessons and opportunities to improve the quality of service provisionprograms.

Incidence of Maternal NearMiss

The incidence of MNM varies depending on the criteria used for its definition. The prevalence rates of maternal near miss varied between 0.6% and 14.98% for disease-specific criteria, between 0.04% and 4.54% for management-based criteria and between 0.14% and 0.92% for organ-based dysfunction based on Mantel criteria. The rates are higher in low-income and middle-income countries of Asia and Africa. Based on one meta-analysis, the estimate was 0.42% (95% confidence intervals CI 0.40-0.44%) for the organ dysfunction criteria. Studies from developing countries especially in the African region have reported a high incidence of near miss when compared to the developed world

Causes of Maternal NearMiss

Causes of near miss are similar to that of maternal deaths prevailing in the area. Hemorrhage, hypertensive disorders, sepsis and obstructed labor are the most important causes in the developing countries. WHO conducted a systematic review and recorded wide regional variation. Hemorrhage was the leading cause of maternal deaths in Africa (33.9%) and in Asia (30.8%) while in Latin America and the Caribbean, hypertensive disorders were responsible for 25% deaths. Anemia was reported as an important cause in 12.8% deaths in Asia, 3.7% in Africa and none in the developed countries. Medical disorders complicating pregnancy are proving to be more important causes than hemorrhage, which was previously the primary killer. Similar causes have been reported for maternal near miss. While a biological complication is assigned as a cause of MNM, in fact most MNM cases result from a chain of events that includes many social, cultural and medical factors. The MNM review toolidentifies gaps and reasons for severe maternal morbidities which could also lead to maternal deaths so that corrective actions to fill such gaps can be taken for improving service delivery. Private sector providers may also find this useful in instituting maternal near miss reviews

Maternal NearMiss and Quality of Care

Globally, there has been a paradigm shift in the maternal care strategy since the 1990's. According to the World Health Statistics 2011, the proportion of deliveries attended by skilled health personnel rose from 58% in 1990 to 68% in 2008 at the global level. In India also there has been a policy change with promotion of institutional births, births by skilled birth attendants and provision of Emergency Obstetric Care. Severe morbidity data are vital for policy planners to know the requirements of essential and emergency obstetric care (EmOC) to manage these. It is also assumed to be a better indicator than maternal mortality alone for designing, monitoring, followup and evaluation of safe motherhood programs. The near miss approach has been suggested to evaluate and improve the quality of care provided by the health system. By reviewing near miss cases we can learn about the processes and their deficiencies that are in place for the care of pregnant women. This would result in identifying the pattern of severe maternal morbidity and mortality, strengths and weakness in the referral system and the clinical interventions available and the ways in which improvements can be made.

The three delays defined to understand the gaps in access to health care can be very well identified by MNM review. The first delay is in seeking care by the woman and/or her family as they are unaware of the need for care. The second delay is in reaching an appropriate health-care facility with reasons such as distance, lack of transport, cost or socio-economic barriers. The third delay occurs in receiving adequate care at the facility resulting from errors in diagnosis and clinical decision-making, or lack of medical supplies and poor staff proficiency in the management of obstetric emergencies. In developing countries, about 75% of women with severe obstetric morbidity are in a critical condition upon arrival, underscoring the significance of the first two delays. Availability, accessibility, cost of health-care and behavioral factors play an important role in the utilization of maternal health services. about 75% of women with severe obstetric morbidity are in a critical condition upon arrival, underscoring the significance of the first two delays. Availability, accessibility, cost of health-care and behavioral factors play an important role in the utilization of maternal health services.

Maternal NearMiss Indicators

Maternal near miss ratio is the ratio of the number of maternal near miss cases and live births. It is an estimation of the amount of care and resources that would be needed in an area or facility. Another important indicator is maternal near miss mortality ratio which is the ratio of the number of maternal near miss and deaths, higher ratio, indicates better care. In conclusion, maternal near miss has emerged as an adjunct to investigation of maternal deaths as the two represent similar pathological and circumstantial factors leading to severe maternal outcome. They provide useful information on quality of health-care at all levels. 

Evidence-Based Roles Played by Parents and School Teachers in Prevention of Unplanned Pregnancies Among Youth in Tshwane, South Africa

Prof. Todd M. Maja, South Afria

Unplanned pregnancies among youth are major reproductive health problems impacting negatively on individuals, families and communities.For many young mothers, pregnancy and parenthood mean an early conclusion to their education with consequently reduced career opportunities, increased likelihood that they will find themselves socially excluded and living in poverty. The increased rate of pregnant girls still at school in Tshwane, raised concern among parents, teachers and all involved in promoting adolescent health. The aim of the study was to establish the roles played by parentsand school teachers in prevention unplanned pregnancy among youth in Tshwane in efforts to shape youth for tomorrow. The target population comprised parents of young girls and boys and school teachers at research sites. Purposive sampling was used to select participants for each group.

Individual in-depth interviewswere held separatelywith parents and school teachersto determine their respective roles in prevention of unplanned pregnancies among youth in Tshwane. Field notes were taken during the interviews and these were transcribed verbatim. Tech’s (Cresswell, 2009) model of content analysis was used to analyse data. Ethical considerations were adhered to throughout the study. Measures of trustworthiness were applied to ensure credibility of the study.

Major findings revealed the following themes, Parents: Problems in communication about sexuality issues with their young girls and boys; peer pressure and preventative measures against unplanned pregnancies.School teachers: Sexuality education in curriculum, sexual behaviour of youth and preventative measures against unplanned pregnancies. Participants suggested that both male and female youth must be responsible for prevention of teenage pregnancies and open communication by parents about sexuality issues with young girls and boys must be encouraged.

Role of ‘Women and Health Together for the Future’, a Non-Profit Organisation in Women’s Health Issues

 Hester Julie, South Africa

Objectives - Women's experience of health and disease differ from those of men, due to unique biological, social and behavioral conditions. Particular concern is widespread discrimination against women,leaving them disadvantaged.Women and Health Together for the Future (WHTF) is a registered NPO of committed women and men from diverse professions, academic, community organizers and activists from 22 countries who educate, advocate and implement programs for women’s health around the globe This paper evaluates the role of WHTF in addressing women’s health issues.

Methods- Descriptive analytical method was used and organizational framework, vision mission statement, objectives, activities, projects and collaborative work of WHTF was evaluated.

Results- WHTF began in 1991 as a taskforce of The Network: TUFH and continues thiscollaboration with financial support from GHETS since 2003. In 2018 it was incorporated as an NGO in the Republic of South Africa. WHTF works with communities to learn women’sperspectives andneeds; mentors women to becomeleaders in health, teaches health professions’ students the knowledge and skills needed to meetwomen’s needs and respect their rights and funds skills development of communitywomen to assess their problems andimprove health care and development. 45 seed grants ($3000 each) in 11 developing countries addressing violence against women, safe motherhood, family planning, nutrition, cervical and breast cancer, HIV, refugee/IDP health, men’s participation and adolescent health have been granted.The Women’s Health Learning Package (WHLP) a comprehensive educational tool incorporating case studies and discussion in global, regional and country settings has been developed with9 modules on important women’s health topics. WHTF has an active listserv of over 200 professionals with numerous publications and presentations at international meets

Conclusion- Twenty eight years of dedicated work of WHTF strongly supports the organizations projection and commitment as a non-profit organisation addressing women’s health issues 

Gender-based violence in Indian Rural Communities- Determinants, Challenges, Concerns 

Prof. Surekha Tayade, India

Introduction- Gender-based violence (GBV) is violence directed against a person because of their gender. Both women and men experience gender-based violence but the majority of victims are women and girls. Gender-based violence is a phenomenon deeply rooted in gender inequality, and continues to be one of the most notable human rights violations within all societies. GBV and violence against women are terms that are often used interchangeably as it has been widely acknowledged that most gender-based violence is inflicted on women and girls, by men. However, using the ‘gender-based’aspect is important as it highlights the fact that many forms of violence against women are rooted in power inequalities between women and men.Under the Istanbul Convention acts of GBV are emphasized as resulting in ‘physical, sexual, psychological or economic harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.’Violence against women in India refer to physical or sexual violence committed against Indian women, typically by a man. Common forms of violence against women in India include acts such as domestic abuse, sexual assault, and murder. In order to be considered violence against women, the act must be committed solely because the victim is female Extent-According to the National Crime Records Bureau of India, reported incidents of crime against women increasedby 6.4% during 2012, and a crime against a woman is committed every three minutes. According to the National Crime Records Bureau, in 2011, there were greater than 228,650 reported incidents of crime against women, while in 2015, there were over 300,000 reported incidents, a 44% increase.65% of Indian men believe women should tolerate violence in order to keep the family together, and women sometimes deserve to be beaten. In January 2011, the International Men and Gender Equality Survey (IMAGES) Questionnaire reported that 24% of Indian men had committed sexual violence at some point during their lives.An interview based survey carried out in rural area of central India, reported that all women experienced some form of violence outside their homes and 13 % experienced sexual assault. All but 3 % experienced violence by husbands. This included 48 % threatening to hit, 51 %throwing a hard object, 51 % pushing /shoving, and 51 % other violence and 57 % repeated violence. 6 % experience violence during pregnancy. However, if we compare with a men’s survey carried out in the same area, men reported only 17.40 % of VAW and did not consider many of the happenings as VAW Forms- Violence against women could take various forms like Dowry deaths, honor killings, Female infanticide, sex selective abortions, sexual crimes like rape, marital rape , human trafficking and forced prostitution, domestic violence, Coercion,abduction, perpetuation, child marriage, intimate partner violence etc. Physical injury is the most visible form of domestic violence. The scope of physical domestic/intimate partner violence includes slapping, pushing, kicking, biting, hitting, throwing objects, strangling, beating, threatening with any form of weapon, or using a weapon.[22] Worldwide, the percentage of women who suffer serious injuries as a result of physical domestic violence tends to range from 19% - 55%. Psychological abuse can erode a woman’s sense of self-worth and can be incredibly harmful to overall mental and physical wellbeing. Emotional/psychological abuse can include harassment; threats; verbal abuse such as name-calling, degradation and blaming; stalking; and isolation. Domestic sexual assault is a form of domestic violence involving sexual/reproductive coercion and marital rape. Under Indian law, marital rape is not a crime,[24][25] except during the period of marital separation of the partnersFactors- Many factors affect GBV. Influences include wife’s job; family income; and urbanization and rigid gender roles. Aman is more likely to use GBV; if (as a child) he saw violence between his parents Alcohol consumption by husbands increases GBVrisk. GBVrisk may be lower for educated women as education may improve gender equality. We might expect GBV prevalence to rise, if women reject traditional ideas: “conflict is likely to increase as their freedom increases”. “According to the theory of patriarchal control, husbands develop standards of gratification for completely dominating their wives and children. When this domination is threatened they feel deprived, suffer psychic distress and in their uncontrollable rage they beat their wives for domestic domination. Violence as a punishment for women’s actions is closely linked to men’s sense of entitlement to certain masculine privileges. For example, domestic violence related to women not cooking food properly is linked to men’s sense of entitlement to food cooked by his wife in the time and manner that he wants. When women do not perform their tasks properly men feel that it is appropriate and right to punish them. Women’s employment may challenge patriarchy, provoking violence, but employment may be an effect rather than a cause, a means of survival rather than a manifestation of empowerment. A woman may be more likely to seek work if her family is poor, her home environment unstable, and her husband drinks or is having extramarital sex. High domestic violence prevalence is seen in slums and rural areas as compared to urban.

Challenges- Underreporting is one of the major challenge. Surveys underestimate GBV risks. Crime data also understates GBV prevalence: only a small fraction of domestic violence is reported to police India’s GBV crimerate may be around 44 times the number of crimes reported by the . Some women may not report violence because there are barriers to prosecuting GBV in India. Caste, class, religious bias and race also determine whether action is taken or not. For example, poor or lower-caste females do not have the same access to legal enforcement or education and often have trouble getting help from law enforcement. Other factors outside culture that demonstrate differences in domestic violence prevalence and gender disparities in India include socioeconomic class, educational level, and family structure beyond the patriarchal framework. “Stress factors” are critical to understanding varying rates of domestic violence in other scopes outside of region-specific factors. These stress-related factors within the household include low educational attainment, poverty, young initial age of marriage, having multiple children, and other limiting engendered development factors. Fear of abandonment by family and very poor rates of legal convictions are leading women towards a state of despair especially in rural area.Rural Men report a lower incidence of VAW as compared to women and are in a stateof denial. Advocacy and change in attitude in the community is necessary to first accept that there is a high prevalence of VAW so that interventions can be planned and implemented

Maternal Near Miss: An Indicator for Maternal Health and Maternal Care

Dr.Vidyadhar Bangal, India

Maternal mortality is one of the important indicators used for the measurement of maternal health. Improvement of maternal health is one of the millennium development goals, MDG 5 with Target 5 A that calls for the reduction of maternal mortality ratio by three quarters between 1990 and 2015.(1) Since 1990, though maternal deaths world-wide have dropped by 47%, the number of maternal deaths in developing countries remains high. The global maternal mortality ratio is 210/100,000 births while it is about 240 in developing countries as compared to 14/100,000 in developed countries.(2,3) India has also reported a decline with the figure for 2007-2009 being 212/100 000 births from 398 in 1997-1998 and 301 in 2001- 2003.(4,5)

Although maternal mortality remains a significant public health problem, maternal deaths are rare in absolute numbers especially within a community, so that assessment of effects of care is difficult.(6) To overcome this challenge, notion of severe acute maternal morbidity (SAMM) and near miss event was introduced in maternal health care to complement information obtained with review of maternal deaths.(7)

Near miss is defined as very ill pregnant or recently delivered woman who nearly died but survived a complication during pregnancy, childbirth or within 42 days of termination of pregnancy. SAMM refers to a life-threatening disorder that can endup in near miss with or without residual morbidity or mortality. Women who develop SAMM during pregnancy share many pathological and circumstantial factors related to their condition. Although some of these women die, a proportion of them narrowly escape death. Near miss cases and maternal deaths together are referred to as severe maternal outcome (SMO).Severe morbidity data are vital for policy planners to know the requirements of essential and emergency obstetric care (EmOC) to manage these. It is also assumed to be a better indicator than maternal mortality alone for designing, monitoring, followup and evaluation of safe motherhood programs.(8,9,10)

Maternal mortality is one of the important indicators used for the measurement of maternal health. Although maternal mortality ratio remains high, maternal deaths in absolute numbers are rare in a community. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. It is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy. So far various nomenclature and criteria have been used to identify maternal near-miss cases and there is lack of uniform criteria for identification of near miss. The World Health Organization recently published criteria based on markers of management and organ dysfunction, which would enable systematic data collection on near miss and development of summary estimates. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely hemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the three delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health. 

References

1. Fifty-fifth Session of the United Nations General Assembly. New York: United Nations; 2000. Sep 18, United Nations Millennium Declaration. General Assembly document, No. A/RES/55/2. [Google Scholar]

2. World Health Organization. Maternal Mortality in 2005: estimates Developed by WHO, UNICEF, UNFPA, and the World Bank. Geneva, Switzerland: World Health Organization; 2010. pp. 15–6. [Google Scholar]

3. World Health Organization. WHO, UNICEF, UNFPA, and the World Bank Estimates. Geneva, Switzerland: World Health Organization; 2012. Trends in Maternal Mortality: 1990-2010. [Google Scholar]

4. Vital Statistics Division, Ministry of Home Affairs. New Delhi: Government of India; 2006. Registrar General of India. Maternal Mortality in India: 1997-2003, Trends, Causes and Risk Factors. [Google Scholar]

5. Vital Statistics Division, Ministry of Home Affairs. New Delhi: Government of India; 2011. Registrar General of India. Special Bulletin on Maternal Mortality in India, 2007-09. [Google Scholar]

6. Koblinsky MA. Beyond maternal mortality - Magnitude, interrelationship, and consequences of women's health, pregnancy-related complications and nutritional status on pregnancy outcomes. Int J Gynaecol Obstet. 1995;48(Suppl):S21–32. [PubMed] [Google Scholar]

7. Souza JP, Cecatti JG, Parpinelli MA, Serruya SJ, Amaral E. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study. BMC Pregnancy Childbirth. 2007;7:20. [PMC free article] [PubMed] [Google Scholar]

8. Ronsmans C, Fillipi V. Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer. Geneva, Switzerland: World Health Organization; 2004. Reviewing severe maternal morbidity: Learning from survivors from life threatening complications; pp. 103–24. [Google Scholar]

9. Pattinson RC, Buchmann E, Mantel G, Schoon M, Rees H. Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries? BJOG. 2003;110:889–93. [PubMed] [Google Scholar]

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Prevalence and Economic Costs of Violence Against Women in South Sudan

Khalifa Elmusharaf1, Stacey Scriver2, Carol Ballantine2, Srinivas Raghavendra2, Mrinal Chadha2 and Nata Duvvury2 , Sudan

Introduction: Violence against women and girls (VAWG) is widely recognised as a violation of human rights and a challenge to public health. Further, VAWG is an under-examined, but crucial component of the overall crisis in South Sudan. VAWG has economic and social costs that have not been adequately recognised either in South Sudan or internationally. The impacts of VAWG on economic development has not been adequately investigated, analysed or quantified in South Sudan. This DFID funded research estimates the prevalence and costs of violence against women and girls (VAWG) in South Sudan.

Methods: We conducted household survey of 1996 houses in six states in South Sudan using a random stratified sampling with probability of selection proportional to size. Prevalence and costs were estimated in the last 12 months of the interview. Findings: The prevalence of intimate partner violence (IPV) is 72%, the family violence is 42%, the workplace violence is 32%, the violence in the public space is 55%, and the violence in educational institutions is 82%. In each form of violence, women experienced different types of violence including economic, psychological, physical or sexual. As a result of IPV, 41% reported injuries and 57% of women who have children reported psychological impacts on their children. 7% of survivors sought help from police, courts or health officials. The out of pocket expenditure was US$21.3 on average per survivor. Among women who reported violence-related productivity loss, the average missed work days per year is 8 days. The average missed care work days is 5 days. Partners on average missed 4 days. The average schools’ days missed is 5 days.

Conclusions: VAWG imposes an unrecognised burden on women's health and on care work in the home. It has a significant impact on the welfare of households. These costs not only impact individual women and their families but also ripple through society and the economy at large. Addressing VAWG must be a central pillar of the peace process to ensure economic stability in post-conflict context.

Innovative Resources for Health Professions Education: A Module on Cervical Cancer

Deyanira González de León1(Mexico), Shakuntala Chhabra2, Arpita Jaiswal3, Addis Abeba Salinas1, Clara I.

Hernández4, Surekha Tayade2, Faith Nawagi5, Sarah Kiguli.5

Cervical cancer is a critical public health problemin which poverty and gender inequalities hinder women’s right to quality health care.Even though cervical cancer is one of the most preventable and treatable cancers, its incidence and mortality ratesin all developing regions of the world are unacceptable.In general, health professions education does not provide future doctors and nurses with a wide perspective about the social determinants of women’s health. The Women and Health Learning Package (WHLP), produced by Women and Health: Together for the Future, is an online resource that includes a series of learning modules developed by academics from universities around the world. The modules are designed to help students acquire a wider perspective on women’s health issues that are often considered difficult to address due to cultural, ethical, legal or political considerations.We present the Module on Cervical Cancer as an example of the efforts needed to change the way in which knowledge on women’s health is understood and transmitted to health professions students. The module contains global and regional statistical data on cervical cancer, basic information about the evolution of the disease, a description of the current methods and strategies for its early detection and treatment, and information about HPV vaccines.It also containscountry overviews and case studies from India,Mexico and Uganda,three developing countries where cervical cancer is a major challenge for public health systems. 

About the association

Committed women and men from diverse

professions: academics, community

organizers and activists from over 22

countries who educate, advocate and

implement programs to improve women’s

health around the globe.


Address of association

Women and Health Together for the Future (WHTF)

Global Health Education, Training and Service (GHETS)

8 North Main Street, Suite 404

A leboro MA 02703 United States

http://www.ghets.org/wh 

Contacts

Dr. Hester Julie

Executive Director, WHTF

hjulie@uwc.ac.za


Dr. Judy Lewis

Chair, WHTF 

lewisj@uchc.edu


Micarla Abrahams

Administrative Staff, WHTF

micarlaabrahams@gmail.com



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