International Perspectives on Sexual and Reproductive Health最新文献

Context: Ethnic and linguistic concordance are important dimensions of the patient-physician relationship, and are linked to health care disparities. However, evidence on the associations between health behavior and outcomes and patient-provider concordance is limited, especially in low- and middle-income settings.

Methods: To examine how concordance between women and their primary health midwife is associated with women's receipt of postpartum IUD counseling, observational data from a cluster-randomized trial assessing an intervention to increase postpartum IUD counseling were used. Data on 4,497 women who delivered at six hospitals in Sri Lanka between September 2015 and March 2017 were merged with data on 245 primary health midwives, and indicators of linguistic concordance, ethnic concordance and their interaction were generated. Multivariate logistic regression analyses were used to assess the associations between concordance and women's receipt of counseling.

Results: Women from non-Sinhalese groups in Sri Lanka face disparities in the receipt of postpartum IUD counseling. Compared with the ethnolinguistic majority (Sinhalese women who speak only Sinhala), non-Sinhalese women have lower odds of having received postpartum IUD counseling, whether they speak both Sinhala and Tamil (odds ratio, 0.6) or only Tamil (0.5). Ethnic discordance- rather than linguistic discordance-is the primary driver of this disparity.

Conclusions: The findings highlight the need for interventions that aim to bridge the sociocultural gaps between providers and patients. Matching women and their providers on ethnolinguistic background may help to reduce disparities in care.

Context: Researchers have long assumed that familiarity between an interviewer and a survey participant reduces the validity of responses, especially for such sensitive behaviors as abortion. However, little empirical evidence exists on this issue.

Methods: Data on 6,041 women aged 15-49 and 133 interviewers who took part in the second (2017) round of the Performance Monitoring and Accountability 2020 survey in Rajasthan, India, were used to examine the effect of interviewer-respondent acquaintance and participation in the prior survey round on women's reporting of induced abortion. Associations were identified using multivariate, multilevel models that adjusted for respondent, interviewer and community characteristics, and that included interviewer random effects.

Results: On average, interviewers completed interviews with 41 respondents from their assigned cluster; they reported that they were acquainted with 61% of respondents and that 13% of respondents had participated in the prior survey round. Four percent of women reported having had an abortion. Neither interviewer-respondent acquaintance nor participation in the previous survey round was associated with abortion reporting in any of the multivariate models or in additional sensitivity analyses.

Conclusions: The findings do not support the hypothesis that respondent familiarity with the interviewer or the survey process is associated with lower reporting of sensitive behaviors, like abortion. Future studies should further explore these and other design features to identify those that provide statistically significant improvements in the reporting of abortion and other sensitive behaviors.

Context: Medicalization of female genital cutting (i.e., having the procedure done by a medical professional) has increased in Egypt in recent years. The relationship between a woman's social position and the decision to use a trained health professional to perform genital cutting is not well understood.

Methods: Data from the 2005, 2008 and 2014 Egypt Demographic Health Surveys on 11,455 women whose daughter had undergone female genital cutting were used to examine relationships between mothers' social position and medicalization. Logistic regression models were used to identify associations between measures of social position and the decision to have genital cutting done by a trained provider.

Results: Seventy-nine percent of women had had their daughter cut by a trained health professional. The odds of medicalization were greater among women who had a primary education (odds ratio, 1.2) or a secondary or higher education (1.8) rather than no education; who lived in wealthier households rather than in the poorest ones (1.4-2.6); and who shared decision making on large household purchases rather than had no say in such decisions (1.2). In addition, working for pay and the magnitude of the age difference between women and their husband were negatively associated with medicalization (0.99 and 0.9, respectively).

Conclusions: A woman's social position in Egypt is associated with medicalization of her daughter's genital cutting. Research is needed to explore the social meaning attributed to medicalized genital cutting, which may inform campaigns that could decrease the prevalence of the procedure.

Context: Medication abortion has the potential to transform the provision of safe abortion care in low- and middle-income countries, and can be provided with minimal clinical skills and equipment. In Nepal, first-trimester abortion using mifepristone and misoprostol is legally available at government-certified health facilities, but little is known about pharmacy workers' perspectives regarding pharmacy-based provision.

Methods: In-depth interviews were conducted in 2015 with 19 pharmacy owners and auxiliary nurse-midwives in two districts of Nepal to examine respondents' views on medication abortion and on potential legal provision of medication abortion from pharmacies. Two coders independently reviewed interview transcripts, and coded and analyzed them using a thematic approach.

Results: Participants were confident that they could provide safe medication abortion and felt that they filled an important niche by providing affordable, convenient and confidential services to women in their communities. They saw benefits of integrating pharmacies into legal abortion networks in Nepal, such as improved access to medication abortion and greater privacy. Participants also felt that the quality of the care they provided could be improved through ongoing training of pharmacy-based providers and formal incorporation of such providers into existing networks of abortion provision to streamline referrals.

Conclusions: Integration of pharmacies into the legal abortion provision system could aid in regulation and training. Consideration of pharmacy workers' perspectives can help to ensure the sustainability and success of safe abortion programs.