Paula Tavrow

Rape Myth Attitudes in Rural Kenya Toward the Development of a Culturally Relevant Attitude Scale and “Blame Index”

Rape myth attitudes (RMAs) can excuse men for rape, placing blame on female victims. This study identified and classified RMAs in rural western Kenya through 31 focus group discussions with youths and adults. We found that about half of the participants were likely to blame victims unconditionally. Stereotypes about rape victims and perpetrators were rife. Five of seven standardly used RMA categories emerged spontaneously in focus groups, along with a new category: “she owed him.” Based on the data, we developed a “blame index” to assess the likelihood of community victim blaming in Kenya. To reduce victim blaming and bring about more prosecutions for rape, community education, teacher training, and reforms of rape laws are highly recommended.

Incentives and barriers to implementing national hospital standards in Uganda

OBJECTIVE The objective of this study was to elicit hospital staffs knowledge, attitudes, and current practices regarding hospital standards and to assess the level of motivation for staff and hospitals to meet new standards. DESIGN This was a qualitative study using in-depth interviews and focus group discussions with staff in four hospitals. There was no intervention. SETTING Four rural public and private not-for-profit hospitals in central Uganda. PARTICIPANTS Medical superintendents and other staff of four hospitals in Uganda who were familiar with the use of standards and had participated in a previous Uganda national accreditation program (Yellow Star). RESULTS All staff expressed strong support for the development and implementation of hospital standards, but also said they would need more recognition and ongoing motivation. They cited the need for technical assistance, funding, and training as the main obstacles. Key areas requiring standards were: infection control, cleanliness and hygiene, infrastructure and medical records. CONCLUSIONS There was strong support for the development and implementation of hospital standards. The main perceived obstacles to the implementation of hospital standards are resource limitations and technical capability. There is a need to develop and implement preliminary standards for hospitals in Uganda.

Do ambivalent women have an unmet need for family planning? A longitudinal study from Bali, Indonesia.

INTRODUCTION Fertility intentions often can predict contraceptive demand and fertility outcomes. Little is known about women reporting ambivalent fertility intentions, who are usually classified as having an unmet need for contraception. This studys objectives were to determine 1) which fertility intention group ambivalent women more closely resemble and 2) whether ambivalent women seem to have an unmet contraceptive need. METHODS We analyzed longitudinal data from 1,018 married Balinese women aged 15 to 45, of whom 33% desired more children, 52% wanted no more, and 14% were ambivalent. Ambivalent women were compared with those with definitive intentions using bivariate analyses. Regression analysis was used to determine the predictors of birth avoidance. RESULTS Although ambivalent women were significantly older, and had less education and more children than women who wanted more children, ambivalent women were more similar in their contraceptive use to those who wanted more children than those who wanted no more. However, in terms of birth outcomes, ambivalent women resembled more the women who intended to avoid childbearing: After 4 years, 33% of ambivalent women had another birth compared with 29% of women who wanted no more and 57% of women who desired more children. Contraceptive use at baseline did not predict ambivalent womens fertility outcomes, unlike the other groups. CONCLUSION Despite their relatively low rates of contraceptive use at baseline, ambivalent women generally avoided giving birth during the study period. This suggests that ambivalent women may not have a high unmet need for family planning.

Who Meets Their Intentions to Stop Childbearing? Results of a Longitudinal Study in Rural Eastern Bali, Indonesia

In this longitudinal study from rural Bali, Indonesia, we sought to identify the predictors of birth avoidance among 665 married women of reproductive age who reported the intention to stop childbearing. We found that almost 30% of women who wanted no more children had a subsequent birth during the 4-year study period. Women at highest risk for an unwanted birth were younger, had fewer children, and did not use a long-term contraceptive method. The ability to meet intentions to stop childbearing depended on womens motivation (family size), fecundity (proxied by age), and their use of long-term contraceptive methods. Our results suggest that to reduce unwanted births among rural women, family planning providers should recommend long-term methods to younger women with smaller family sizes who express clear intentions to stop childbearing.

Developing hospital accreditation standards in Uganda

BACKGROUND Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self-assessment hospital accreditation tool developed for a resource-limited context. METHODS We invited 60 stakeholders to review a set of standards (from which a self-assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self-assessment. The study was completed in 8 weeks. RESULTS Hospital self-assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24-h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment. CONCLUSION We have demonstrated the feasibility of a self-assessment approach to hospital standards in low-income country setting. This low-cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministrys efforts to take the next steps. Copyright

Intimate Partner Violence Screening Practices in California After Passage of the Affordable Care Act

Under the Affordable Care Act (ACA), insurance coverage should include screening for intimate partner violence (IPV). In this article, we present self-reported IPV screening practices and provider confidence from a post-ACA cross-sectional survey of 137 primary care clinicians in California. Only 14% of the providers reported always screening female patients for IPV and about one third seemed never to screen. Female providers were more likely to screen and use recommended direct questioning. Most providers lacked confidence in screening, referral, and record-keeping. Serving a low-income population predicted more frequent screening and better record-keeping. Overall, IPV screening in primary care was inadequate and needs attention.

Women’s empowerment related to pregnancy and childbirth: introduction to special issue

Empowerment is widely acknowledged as a process by which those who have been disempowered are able to increase their self-efficacy, make life-enhancing decisions and obtain control over resources [1-3]. In addition, empowerment is multi-dimensional: a woman may be empowered in one dimension or sphere (such as financial) but not in another (such as in in sexual and reproductive decision-making). Most countries now recognize the importance for girls and women to become more empowered--both as an endpoint in itself, as well as to achieve a more gender equitable society [4]. More recently, researchers have been assessing the contexts and mechanisms by which empowerment directly or indirectly affects various aspects of women’s health [5-7]. Understanding better the situations where greater empowerment is associated with improved health outcomes can assist policy-makers in planning and prioritizing their investments.

Advocacy Coalition for Safer Sex in the Adult Film Industry: The Case of Los Angeles County’s Measure B

Background. Performers in the adult film industry are routinely exposed to bloodborne pathogens. In 2012, public health advocates in Los Angeles County convinced voters to pass a ballot initiative—Measure B—to mandate condom use on adult film sets. This article presents a case study of the advocacy coalition’s strategies used to achieve greater workplace safety using the advocacy coalition framework. Method. The authors were given access to all memoranda, market research, and campaign tools used to promote Measure B. To reconstruct adult film industry counterefforts, the authors reviewed trade publications, social media, and blog posts. Results. When legislative efforts failed, advocates engaged in a step-by-step strategy built around voters to achieve passage of a ballot initiative mandating condom use for all adult films produced in Los Angeles County. Although the industry immediately filed a lawsuit after passage of Measure B, its constitutionality has been upheld. Conclusions. Measure B passed because public health advocates were able to assemble scientific evidence, build public support, counter false claims, and maintain consistent messages throughout the campaign. The adult film industry lacked social capital, cohesion, and nimbleness. To bolster regulatory efforts, appealing to voters to favor safe workplaces may be an effective advocacy strategy for other industries.

Composite measures of women’s empowerment and their association with maternal mortality in low-income countries

BackgroundMaternal mortality has declined significantly since 1990. While better access to emergency obstetrical care is partially responsible, women’s empowerment might also be a contributing factor. Gender equality composite measures generally include various dimensions of women’s advancement, including educational parity, formal employment, and political participation. In this paper, we compare several composite measures to assess which, if any, are associated with maternal mortality ratios (MMRs) in low-income countries, after controlling for other macro-level and direct determinants.MethodsUsing data from 44 low-income countries (half in Africa), we assessed the correlation of three composite measures – the Gender Gap Index, the Gender Equity Index (GEI), and the Social Institutions and Gender Index (SIGI) – with MMRs. We also examined two recognized contributors to reduce maternal mortality (skilled birth attendance (SBA) and total fertility rate (TFR)) as well as several economic and political variables (such as the Corruption Index) to see which tracked most closely with MMRs. We examined the countries altogether, and disaggregated by region. We then performed multivariate analysis to determine which measures were predictive.ResultsTwo gender measures (GEI and SIGI) and GDP per capita were significantly correlated with MMRs for all countries. For African countries, the SIGI, TFR, and Corruption Index were significant, whereas the GEI, SBA, and TFR were significant in non-African countries. After controlling for all measures, SBA emerged as a predictor of log MMR for non-African countries (β = –0.04, P = 0.01). However, for African countries, only the Corruption Index was a predictor (β = –0.04, P = 0.04). No gender measure was significant.ConclusionsIn African countries, corruption is undermining the quality of maternal care, the availability of critical drugs and equipment, and pregnant women’s motivation to deliver in a hospital setting. Improving gender equality and SBA rates is unlikely to reduce MMR in Africa unless corruption is addressed. In other regions, increasing SBA rates can be expected to lower MMRs.