Sandra D. Lane

Structural Violence and Racial Disparity in HIV Transmission

Abstract Among women of color in the United States, infection with the human immunodeficiency virus (HIV) is rising. Most of the research on this topic, however, has focused on individual-level risk factors, which do not fully explain racial or ethnic differences in infection rates. This article uses structural violence as a conceptual framework to examine ecological-level risk factors leading to disparate rates of heterosexually transmitted HIV among women of color in Syracuse, New York. Three ecological pathways to disproportionate infection are discussed: community rates of infection, concurrent partnerships, and increased vulnerability. The discussion of the pathways considers the following macro-level risk factors: disproportionate incarceration rates of African American men, residential segregation, gang turf, constraints on access to sexually transmitted disease services, an African American sex ratio in which women outnumber men, social norms stigmatizing homosexuality, and commercial sales of douching products. The authors argue that health care providers and policy analysts must address ecological-level risk factors for HIV transmission in underserved communities.

Latrine ownership as a protective factor in inflammatory trachoma in Egypt.

We investigated the association between inflammatory trachoma in children aged 1-5 and environmental and sociodemographic risk factors in a rural Nile Delta hamlet. Inflammatory trachoma clustered in households, emphasising the child-to-child nature of transmission in the hamlet. Multiple logistic regression analysis revealed three factors predicting inflammatory trachoma in children: the absence of a latrine in the household, school-age siblings with inflammatory trachoma, and additional same-age siblings (with or without disease) in the household. In the Egyptian setting the presence of pit latrines in all houses, even when full and unscreened, might result in a reduction in trachoma prevalence in this population from the current 49% to 35%. The construction of pit latrines may offer the simplest and most acceptable environmental method for reducing trachoma in this trachoma endemic area.

Judging the Other: Responding to Traditional Female Genital Surgeries

Traditional female genital circumcision, or female genital mutilation, performed upon women in some non-Western cultures has provoked considerable international controversy since the late 1970s. Western feminists, physicians, and ethicists condemn such practice. Having made moral judgement against female genital mutilation, however, what is the next step? There is clearly an impasse between cultural relativism on the one hand and universalism on the other. Those at the forefront of the debate on female genital mutilation must learn to work respectfully with, instead of independently of, local resources for cultural self-examination and change. The authors discuss cultural relativism and moral universalism; female circumcision in sections on epidemiology, health effects, and culture, religion, and social change; the debate historically; the response of Arab and African women; and moving beyond the impasse.

From population control to reproductive health: An emerging policy agenda

This article reviews the background to the current debates between advocates of population control and reproductive health as frameworks for national and international health policies. Population control has been a dominant metaphor in international family planning programs since the 1960s. Population control has frequently meant pursuing a single-minded goal of fertility limitation, often without sufficient attention to the rights of family planning clients. This narrow focus has led to some coercive policies, numerous ethical violations, and ineffective family planning programs. In the last decade there has been the beginning of a policy shift, advocated by a growing number of activists and researchers in womens health, from population control to reproductive health. A reproductive health framework would provide a broader programmatic focus that could bring needed attention to such issues as sexually transmitted diseases, infertility, abortion, reproductive cancers and womens empowerment generally.

Investigation of Metronidazole Use during Pregnancy and Adverse Birth Outcomes

ABSTRACT To assess whether treatment with metronidazole during pregnancy is associated with preterm birth, low birth weight, or major congenital anomalies, we conducted chart reviews and an analysis of electronic data from a cohort of women delivering at an urban New York State hospital. Of 2,829 singleton/mother pairs, 922 (32.6%) mothers were treated with metronidazole for clinical indications, 348 (12.3%) during the first trimester of pregnancy and 553 (19.5%) in the second or third trimester. There were 333 (11.8%) preterm births, 262 (9.3%) infants of low birth weight, and 52 infants (1.8%) with congenital anomalies. In multivariable analysis, no association was found between metronidazole treatment and preterm birth (odds ratio [OR], 1.02 [95% confidence interval [CI], 0.80 to 1.32]), low birth weight (OR, 1.05 [95% CI, 0.77 to 1.43]), or treatment in the first trimester and congenital anomalies (OR, 0.86 [0.30 to 2.45]). We found no association between metronidazole treatment during the first or later trimesters of pregnancy and preterm birth, low birth weight, or congenital anomalies.

Roles, work, health perceptions and health resources of women: A study in an Egyptian delta hamlet☆

Womens health needs can only be described and programs to address them implemented with an understanding of womens multiple roles and responsibilities. A life-cycle approach to examining womens roles and responsibilities provides a useful framework to achieve such understanding. This paper describes the results of a study conducted in a rural village in Egypt that examines the daily life experiences of women, their work, their family responsibilities, their health perceptions and their health resources. We argue that programs designed to address womens health needs must consider these critical aspects of their lives. This argument is based on the premise that womens health needs have been neglected and efforts to ameliorate this situation should be a top priority in the international health care agenda of the 1990s.

Effects of intimate partner violence on pregnancy trauma and placental abruption.

AIMS Intimate partner violence (IPV) during pregnancy increases womens risk of pregnancy complications and adverse birth outcomes. The goal of this study was to examine the association between IPV and prenatal trauma and placental abruption during pregnancy. METHODS Prenatal and hospital obstetrical charts were reviewed for 2873 women who gave birth between January 2000 and March 2002 in a Northeastern city. We examined associations among sociodemographic characteristics, health-related variables, IPV, and pregnancy trauma and placental abruption using univariate and multivariate logistic regression. RESULTS Of the 2873 women in the analyses, 105 (3.7%) reported IPV during prenatal care. After controlling for sociodemographic variables; tobacco, alcohol, and drug use; preeclampsia; and gestational diabetes during pregnancy, women who reported IPV also had higher odds of pregnancy trauma and placental abruption (adjusted odds ratio [OR] 32.08, 95% confidence interval [CI] 14.33-71.80, p < 0.01, and OR 5.17, 95% CI 1.37-19.51, p < 0.05, respectively). CONCLUSIONS This study found that IPV is a significant and independent risk factor for pregnancy trauma and placental abruption after controlling for factors typically associated with these outcomes. This study has implications for partner violence screening and intervention policies among pregnant women and highlights the importance of making distinctions about the type of IPV that women experience.

Parental Literacy and Infant Health: An Evidence-Based Healthy Start Intervention

Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire’s lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.

Racial and ethnic disparity in low birth weight in Syracuse, New York

This case-racial and ethnic disparity in low birth weight-is one of a series of teaching cases in the Case-Based Series in Population-Oriented Prevention (C-POP). It has been developed for use in medical school and residency prevention curricula. The complete set of cases is presented in this supplement to the American Journal of Preventive Medicine. Low birth weight is a leading cause of infant mortality. Unfortunately, despite declining rates of infant mortality, racial and ethnic disparities in both low birth weight and infant mortality rates persist. In this teaching case, a clinical vignette is used to draw attention to this public health priority in Syracuse, New York. Students learn essential epidemiology skills such as identifying limitations of sources of data and calculating relative risks, using the example of low birth weight. In performing these skills, students also identify etiologies for such disparity. Finally, students discuss interventions that, when implemented, may decrease infant mortality rates.

Buying safety: The economics of reproductive risk and abortion in Egypt

This article examines the economics of abortion safety in Egypt. Under Egyptian law induced abortion is restricted to cases in which two physicians certify that the pregnancy presents a danger to the health or life of the mother. Despite this legal restriction, the available data indicate that abortion is quite widely practiced. Multifaceted strands of legal, religious, economic, and health care policy influence both discourse about and access to abortion in Egypt. Interviews with 18 Egyptian women who sought to terminate their pregnancies revealed a wide range of abortion methods that varied in both safety and cost. Three levels of safety were identified: (1) indigenous (wasfa baladi) methods were potentially the least safe; (2) biomedical abortions at clandestine clinics appeared safer than indigenous methods, but were not without risk: and (3) biomedical abortions administered by private gynecologists, were the most safe. Safety is expensive. Wealthy women can literally buy safety, while poor womens lack of financial resources put their lives at great risk.