<b>Pregnant women in war zones</b>

Akol, Achier Deng; Caluwaerts, Séverine; Weeks, Andrew

doi:10.1136/bmj.i2037

Cited by 15 publications

(12 citation statements)

References 4 publications

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“…Our study found that the destruction of health care infrastructure in the occupied areas deprived pregnant women of quality health care for several months. This corresponds to previous research by Akol et al [ 11 ], which suggests that the lack of antenatal and perinatal care in war increases the risk of anemia, malnutrition, and concomitant disease. Our study has not identified malnutrition, but has rather found unbalanced nutrition practices, the negative health effects of which tend to appear later and could thus not be felt or measured at this point of research.…”

Section: Discussionsupporting

confidence: 91%

“…WHO and UNICEF [ 10 ] have reported severe disruptions of vaccination practices in Ukraine since 2014. Moreover, conflict and displacement also have significant harmful psychological impact on both mothers and children [ 11 ]. However, these issues are often overlooked by traditional humanitarian response measures, which tend to focus on the provision of basic services, such as food and water, shelter, sanitation, and medical emergency services [ 9 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

Nidzvetska

Rodriguez-Llanes

Aujoulat

et al. 2017

IJERPH

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Due to the conflict that started in spring 2014 in Eastern Ukraine, a total of 1.75 million internally displaced persons (IDPs) fled the area and have been registered in government-controlled areas of the country. This paper explores perceived health, barriers to access to healthcare, caring practices, food security, and overall financial situation of mothers and young children displaced by the conflict in Ukraine. This is a qualitative study, which collected data through semi-structured in-depth interviews with nine IDP mothers via Skype and Viber with a convenience sample of participants selected through snowball technique. Contrary to the expectations, the perceived physical health of mothers and their children was found not to be affected by conflict and displacement, while psychological distress was often reported. A weak healthcare system, Ukraine’s proneness to informal payments, and heavy bureaucracy to register as an IDP were reported in our study. A precarious social safety net to IDP mothers in Ukraine, poor dietary diversity, and a generalized rupture of vaccine stocks, with halted or delayed vaccinations in children were identified. Increasing social allowances and their timely delivery to IDP mothers might be the most efficient policy measure to improve health and nutrition security. Reestablishment and sustainability of vaccine stocks in Ukraine is urgent to avoid the risks of a public health crisis. Offering psychological support for IDP mothers is recommended.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

Nidzvetska

Rodriguez-Llanes

Aujoulat

et al. 2017

IJERPH

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“…But these nuances might get lost when tabloids and/or persons with different agendas become involved, which has happened before in relation to this method [ 143 ], see also Wikipedia. Women with a completed family who have been offered and have accepted an opportunistic TO might consider themselves exceptionally lucky in future if DMPA is unobtainable because of physicians’ and nurses’ strikes, because USAID lost funding or because of civil war with perhaps many cases of rape [ 163 , 164 ].…”

Section: Hiv/aidsmentioning

confidence: 99%

Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it

Verkuyl

2016

Contracept Reprod Med

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BackgroundDespite the increased prevalence of reversible contraception, global unintended pregnancy rates are stable. Mistakes, method failures, side effects, alcohol, stock-outs, fears, costs, delays, myths, religious interference, doctors with other priorities, traditions and lack of health professionals may all factor in. Yet these unintended pregnancies ― nearly a hundred million annually ― cause much individual suffering, and in the long run, can aggravate conflicts, poverty, forced emigration and climate change. Presently, non-poor women postpone childbearing because of longer educational trajectories and careers. Sterilisations are therefore less often regretted or coerced. For poor-resourced women with a completed family, an unwanted pregnancy often has serious consequences, including crossing the (extreme) poverty line in the wrong direction, choosing an unsafe abortion, or even death. Caesarean sections (CSs), which currently stand at around 23 million annually, are increasing. On an “intention-never-to-become-pregnant-again” analysis, choosing a partial, and even more so a total bilateral tubectomy to be implemented during an ― anyway performed ― CS is by far the most reliable and safe contraceptive choice compared to meaning to start female or male sterilisation or any other contraceptive method later, and it reduces the chance of a future ovarian carcinoma substantially. CSs make subsequent pregnancies more dangerous. Simultaneously, they provide convenient, potentially cost-free opportunities for voluntary permanent contraception (PC): particularly important if there is no guaranteed future access to reliable contraception, safe abortion and well-supervised labour.Partial solutionMillions of women are within reach of attaining freedom from the “tyranny of excessive fertility” when they have a CS. Therefore, any woman who might conceivably be of the firm opinion that her family will be (over) completed after delivery should antenatally have “what if you have a CS” counselling to assess whether she would like a tubectomy/ligation. Yet many are not provided with this option: leading to frequent regret, more often than having been giving that choice would.ConclusionWithholding antenatal counselling about the option of PC for in case the delivery might become a CS is very prevalent, yet often more medically risky, and morally questionable than when, even in labour, a doctor sometimes decides in the absence of earlier counselling, considering numerous factors, to provide the choice to undergo a concurrent sterilisation if s/he is convinced that would be in the patient’s best interest.

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“…These vulnerabilities increase in conflict situations, and as a result, structural inequalities rooted in gender norms impact women’s health [ 13 ]. For instance, studies have identified that during conflicts, girls and women experience poor access to essential sexual and reproductive health services [ 17 ], high rates of unsafe abortions [ 13 , 14 ], and increases in maternal mortality [ 12 ]. In summary, the evidence strongly suggests girls and women in conflict settings are more likely to face social inequalities accessing sexual, reproductive and maternal health care, and these inequalities may worsen or broaden over time.…”

Section: Introductionmentioning

confidence: 99%

How do we reach the girls and women who are the hardest to reach? Inequitable opportunities in reproductive and maternal health care services in armed conflict and forced displacement settings in Colombia

et al. 2018

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ObjectivesThis paper assesses inequalities in access to reproductive and maternal health services among females affected by forced displacement and sexual and gender-based violence in conflict settings in Colombia. This was accomplished through the following approaches: first, we assessed the gaps and gradients in three selected reproductive and maternal health care services. Second, we analyzed the patterns of inequalities in reproductive and maternal health care services and changes over time. And finally, we identified challenges and strategies for reaching girls and women who are the hardest to reach in conflict settings, in order to accelerate progress towards universal health coverage and to contribute to meeting the Sustainable Development Goals of good health and well-being and gender equality by 2030.MethodsThree types of data were required: data about health outcomes (relating to rates of females affected by conflict), information about reproductive and maternal health care services to provide a social dimension to unmask inequalities (unmet needs in family planning, antenatal care and skilled births attendance); and data on the female population. Data sources used include the National Information System for Social Protection, the National Registry of Victims, the National Administrative Department of Statistics, and Demographic Health Survey at three specific time points: 2005, 2010 and 2015. We estimated the slope index of inequality to express absolute inequality (gaps) and the concentration index to expresses relative inequality (gradients), and to understand whether inequality was eliminated over time.ResultsOur findings show that even though absolute health care service-related inequalities dropped over time, relative inequalities worsened or remain unchanged. All summary measures still indicated the existence of inequalities as well as common patterns. Our findings suggest that there is a pattern of marginal exclusion and incremental patterns of inequality in the reproductive and maternal health care service provided to female affected by armed conflict.ConclusionsOverall, the effects of conflict continue to threaten reproductive and maternal health in Colombia, impeding progress towards the realization of universal health care (UHC) and reinforcing already-existing inequities. Key messages and steps forward include the need to understand the two distinct patterns of inequalities identified in this study in order to prompt improved general policy responses. Addressing unmet needs in reproductive and maternal health requires supporting gender equality and prioritizing the girls and women in regions with the highest rates of victims of armed conflict, with the objective of leaving no girl or woman behind. This analysis represents the first attempt to analyze coverage-related inequality in reproductive and maternal health care services for female affected by armed conflict in Colombia. As the World Health Organization and global health systems leaders call for more inclusive engagement, this approac...

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Pregnant women in war zones

Abstract: Forgotten victims, killed by violence and by a lack of available care

Cited by 15 publications

References 4 publications

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

Maternal and Child Health of Internally Displaced Persons in Ukraine: A Qualitative Study

Recent developments have made female permanent contraception an increasingly attractive option, and pregnant women in particular ought to be counselled about it

How do we reach the girls and women who are the hardest to reach? Inequitable opportunities in reproductive and maternal health care services in armed conflict and forced displacement settings in Colombia

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