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Sexual and reproductive health rights knowledge and reproductive health services utilization among rural reproductive age women in Aleta Wondo District, Sidama zone, Ethiopia: community based cross-sectional study

• Tariku Tadesse 1 ,
• Mesay Hailu Dangisso 2 &
• Teshome Abuka Abebo 2  

BMC International Health and Human Rights volume  20 , Article number:  4 ( 2020 ) Cite this article

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Various countries in the world have achieved promising progress in promoting, protecting and guaranteeing sexual and reproductive health rights (SRHRs) since the 1994 International Conference on Population and Development (ICPD) in Cairo. However, SRHRs have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their successful implementation. This study was intended to determine the magnitude of SRHRs knowledge, reproductive health services utilization and their independent predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia.

A community-based cross-sectional study was conducted among 833 rural reproductive-age women from April to May 2019. A systematic random sampling technique was employed to select households, and a structured questionnaire was used to gather the data. EPI INFO version 7 was used to enter the data, and SPSS version 23 was used for data analysis. Logistic regression analysis was employed to assess the association between outcomes and explanatory variables. Odds ratios at 95% CI were also computed and reported.

Of 833 respondents, 43.9% had good knowledge of SRHR, and 37% had used at least one sexual and reproductive health (SRH) service. Variables that had a statistically significant association with SRHR knowledge in multivariable analysis were: had formal education, household with the highest income, having information sources for SRH services, and knowing about SRH services and providing institutions. SRH services utilization was associated with: having information sources for SRH services, had formal education, household with the highest income, and knowing about SRH services and providing institutions.

In this study demographic and economic factors, such as education and household monthly income were positively identified as independent predictors for knowledge of SRHR and SRH services utilization. Therefore, responsible government sectors and NGOs should design and implement programs to promote women’s educational status and household economic status to enhance women’s SRHR knowledge and SRH services utilization.

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Sexual and reproductive health rights (SRHR) are fundamental to people’s health and survival, to economic development, and the wellbeing of humanity. The global health and human rights communities have proactively worked for decades to define and advance SRHR, encountering both advances and considerable setbacks [ 1 , 2 ]. Reproductive rights were succinctly described at ICPD as resting on, “the basic right of all couples and individuals to decide freely and responsibly the number, spacing, and timing of their children and to have the information and means to do so.” Reproductive health rights and sexual rights are invariably human rights recognized by various human rights instruments. Sexual rights offer individuals the opportunity to freely choose partners without any form of discrimination and freedom to assert on and exercise safer sex [ 2 , 3 ].

The Millennium Development Goals (MDGs) in 2000, health and development initiatives including the 2030 Agenda for Sustainable Development, and the movement toward universal health coverage further support the realization of the reproductive health rights that were already recognized in the ICPD in 1994 [ 4 ]. The Ethiopian government has responded to international conventions and human rights treaties like ICPD, MDGs, and SDGs by reviewing its laws and policies. One of the responses was the development of the National Reproductive Health Strategy to promote utilization of SRH services and information, reduce gender-based violence and harmful traditional practices [ 5 ]. Article 35 of the country’s constitution refers to women’s equality with men and their rights to information and the right to be protected from the dangers of pregnancy and childbirth [ 6 ]. The Ministry of Health designed a five-year Health Sector Transformation Plan (HSTP) that devotes special attention to maternal health service utilization to reduce maternal mortality through implementation of high impact interventions like antenatal care (ANC), skilled birth services and postnatal care (PNC), women’s empowerment, gender mainstreaming, abortion care, fistula care, adolescent and reproductive health care [ 5 , 7 ].

In Ethiopia, reproductive health service quality and access are among the major public health challenges. A recent nationwide survey revealed that 41% of currently married women are utilizing modern contraceptive methods. Also the survey results show that 74% of women who gave birth in the 5 years preceding the survey received antenatal care from a skilled provider at least once for their last pregnancy, and urban women were more likely than rural women to have received ANC from a skilled provider. Among the total live births in the 5 years preceding the survey, 50% were delivered by a skilled provider and 48% were delivered in a health facility. In the last 2 years preceding survey, 34% of women reported receiving a PNC check-up in the first 2 days after birth [ 8 ]. Moreover, female genital mutilation (FGM) is still practiced despite Ethiopia bans medicalization of FGM.

The existence of customary practices and deeply-rooted beliefs that discriminate on the grounds of gender and sexual orientation all testify to a failure to effectively realize sexual and reproductive health rights in Africa [ 9 ]. A study conducted in Ethiopia reported various instances of harmful traditional practices during perinatal period such as food prohibition, home delivery, and discarding colostrum. Such harmful traditional practices, beliefs, and taboos are often implicated in determining the care received by mothers during pregnancy and childbirth [ 10 ].

SRHR knowledge among rural reproductive-age women is barely studied in Ethiopia. Almost all available studies on knowledge of SRHR in Ethiopia were conducted among female adolescent students in the university, high school or reproductive-age women in urban settings. Those studies revealed that there was low-level SRHR knowledge among participants [ 11 , 12 , 13 , 14 ].

Sexual and reproductive health rights are inherent entitlements for women. These rights have not been recognized to their maximum potential in Ethiopia, despite the domestication of the international instruments related to their implementation. Because SRHR information is scarce in the study area, this study aimed to determine the magnitude of SRHRs knowledge and use of SRH services and their predictors among rural reproductive-age women in the Aleta Wondo District, Ethiopia.

Study setting, design and period

A community-based cross-sectional study was conducted from April 03 to May 15, 2019. The study was conducted in the Aleta Wondo district, which is found in Sidama Zone, Southern Nations Nationalities and Peoples Region (SNNPR). The district is located 65 km south of Hawassa City and 333 km south of Addis Ababa, the capital city of Ethiopia. At the end of 2018, the aggregate population of the district was 200,593, and the reproductive age women account for 23.3% (46,738) of the district’s total population. The district constitutes 27 rural kebeles (smallest administrative unit in Ethiopia). There were seven public health centers and 27 health posts in the district in 2019.

Population and sample size determination

All reproductive age group women who were inhabitants of rural kebeles of Aleta Wondo district were a source population. A single population proportion formula was used to determine the sample size for determining the level of sexual and reproductive health rights knowledge and practice. In sample size calculation, 50 % of sexual and reproductive health rights knowledge or practice was taken because of lack of similar study conducted among reproductive age women [ 15 ]. Also, we used 5% margin of error, 95% confidence interval, 10% non-response rate and design effect of 2. The sample size calculation yielded a final sample size of 845.

Sampling procedure

Out of the 27 kebeles found in the district administration, seven kebeles (25%) were selected by a lottery method. The sample was proportionally allocated to the selected kebeles. A systematic random sampling was implemented to select households where reproductive-age women were residing. A list of total households with reproductive-age women present in the family folder of the kebele administration was used as a sampling frame. The family folder contains the list of total households (locally called “Aba-Wora”) in the kebele administration. It is regularly updated and given a number by the administrative bodies through health extension workers of the kebele. For each kebele a sampling interval K was determined. The initial household was selected by a lottery method employing a number between one and K. In case more than one woman in a given household was identified, priority was given to a mother.

Study variables

Dependent variables: sexual and reproductive rights knowledge and sexual and reproductive health services utilization.

Sexual and reproductive health services utilization: ever used at least one of the sexual and reproductive health services in healthcare facilities. To assess the SRH services utilization a series of six questions were used. Participants who ever used at least one of SRH services was coded 1 (yes) and never used any of services was coded 0 (No). A woman who had at least one of the sexual and reproductive health services during her life time considered as she had sexual and reproductive health services.

Sexual and reproductive health rights knowledge: a series of thirteen knowledge related questions about sexual and reproductive health rights were employed to assess SRHR knowledge [ 1 , 11 , 12 , 13 , 14 , 16 , 17 ]. Women’s response to each question was coded one for ‘correct’ response and zero for ‘incorrect’ response. Good knowledge of SRHR was defined as equal to or greater than median value of the sum of correct responses Women had poor knowledge of SRHR when the sum correct responses less than the median. Cronbach alpha (α) was calculated to check reliability of knowledge measuring tools. The Cronbach alpha (α) for knowledge was 0.804.

Independent variables: age, educational status, religion, occupation, monthly income, educational status of husband, educational status of husband’s mother, occupation of a husband, family income, previous exposure to reproductive health services, having favorable attitude towards SRH services, exposure to SRHR information, access to health facility and health care utilization, social and cultural factors, women’s autonomy and decision making.

Data collection procedures

An interviewer-administered structured questionnaire was used to gather the data. The questionnaire was first prepared in English and then translated into Sidamigna by language experts and then translated back into English to check completeness and consistency. It consisted of socio-demographic characteristics, sexual and reproductive health services, and information utilization, questions related to sexual and reproductive health rights knowledge and practice and source of information. Seven nurses collected the data, and two nurses supervised the data collection process.

Data quality assurance

The data collectors and local supervisors were trained for 2 days regarding the objective of the study and how to ask and probe questions during the data collection, and maintaining the confidentiality of the respondents’ information. Before conducting the primary study, a pretest was carried out in two kebeles which were not included in the main study to ensure the validity and reliability of tools. The results of the pretest were discussed, and corrections and changes were made on the questionnaire. The principal investigator and local supervisors supervised the data collection process on a daily basis. At the end of each day, questionnaires were carefully reviewed and checked for completeness, accuracy, and consistency, and corrective measures were undertaken whenever necessary.

Data analysis

The collected data were entered into EPI INFO version 7.2.2.6 computer software and analyzed using SPSS version 20 statistical program. Descriptive data were presented in frequencies and percentage using Tables. A bivariate analysis was conducted to determine the association between outcome variables and each independent variable. In bivariate analysis, variables whose P -value < 0.25 were considered as candidate variables for the multivariable logistic regression model to identify independent predictors by controlling confounding variables.

Ethical considerations

Ethical clearance was obtained from the Institutional Review Board of College of Medicine and Health Sciences, Hawassa University. Written consent was also obtained from local authorities and concerned government bodies from the Aleta Wondo District Administration. After a brief introduction of the study objective, benefit and possible risk of participation, informed verbal consent was obtained from each study subject and from parents/guardians for participants who were 16–18 years age group. To ensure confidentiality of selected respondents, their official names were not indicated on the structured questionnaire.

Socio-demographic and economic characteristics of the participants

Out of intended 845 study participants, a total of 833 (98.6%) reproductive age women were interviewed. The youngest was 16 years old. The mean age of participants was 29.29 + 6.4 years. More than half, 453(54.4%) of the respondents were from the age group of 25–34 years. The majority (741 or 89.0%) of the participants were married. Regarding ethnicity, 785 (94.3%) of them belong to the Sidama ethnic group. About 81% or 673 respondents were protestant Christians. The majority (536 or 64.3%) of the participants attended formal education (at least a primary level) (Table  1 ). Participants who had at least one source for RSH services information (either radio, TV, school teacher etc. …) were 89, and 84% of participants had awareness about SRH services (Fig.  1 ).

Have source of information and awareness for SRH services among reproductive age women Aleta Wondo woreda, Sidama, 2019(n = 833)

Knowledge about reproductive and sexual health rights

The median score was 6.0 out of 13. More than half (56.1%) of participants were found to have poor knowledge. Participants who knew the minimum age of marriage, right to safe abortion and right to have information and services of family planning were 405 (48.6%), 204 (24.5%) and 479 (57.5%), respectively. Participants who knew the right to access to all SRH services without husbands’ permission were 306 (36.7%). Less than half, 326 (39.1%), of the participants knew a presence of legal support for victims of GBV. Half of participants, 419 (50.3%), knew of the right to decide to be free against FGM. Fifty-nine percent of participants didn’t agree with the statement of right to choose the partner, and only 279 (33.5%) of the participants knew about the right to decide whether or not and when to have children (Table  2 ).

Utilization of sexual and reproductive health services

Less than half of the participants, 384 (46.1%), had been counseled on harmful traditional practices (HTP) including FGM. Among participants who had a history of pregnancy and childbirth, 554 (66.5%) delivered in health facility. Also 605 (72.6%), and 436 (52.3%) had ANC and PNC services in health facility respectively. Participants who ever used family planning services and HIV counselling were 657 (78.9%) and 453 (54.4%), respectively. Moreover, 145(17.4%) of the participants had counseled and treatment for STI and 64 (7.7%) participants had safe abortion care at health facilities (Table  3 ).

Predictors of sexual and reproductive health rights knowledge

Independent variables which were associated with SRHR knowledge at binary logistic regression analysis were women’s educational status, household monthly income, husband’s occupation, husband’s educational status, mother-in-law’s educational status, having at least one of the SRHR information sources and knowing SRH services and providing institutions. In multivariate logistic regression analysis, women’s educational status, household monthly income, having at least one SRHS information source and knowing SRH services and providing institutions were found to be independent predictors of sexual and reproductive health rights knowledge. Participants who had formal education were about 27 times more likely to be knowledgeable than the participants who didn’t attend formal education [AOR: 27.812, 95%CI: 13.650, 56.669]. Participants who had the highest percentile of monthly income were four times more likely to be knowledgeable than participants who had the lowest percentile of monthly income [4.048, 95%CI: 2.432, 6.736]. Participants who had at least one source of information on SRHR were four times more likely to be knowledgeable than participants who didn’t have information sources [4.339, 95%CI: 1.236, 15.232]. Participants who knew about SRH services and providing institutions were nine times more likely to be knowledgeable than participants who didn’t know about SRH services [AOR: 9.158,95% CI: 3.390,24.738] (Table  4 ).

Predictors of sexual and reproductive health services utilization

In binary logistic regression analysis, maternal age, marital status, women’s educational status, household’s monthly income, husband’s occupation, husband’s educational status, mother-in- law’s educational status, having sexual and reproductive health information sources and knowing about SRH services and providing institutions were significantly associated with utilization of SRH services. In multivariate logistic regression analysis, women’s educational status, household’s monthly income, and knowing about SRH services and providing institutions were independent predictors of SRH services utilization. Participants who had formal education were about 5 times more likely to utilize SRH services than participants who didn’t have formal education [AOR: 4.807, 95%CI: 2.899, 7.968]. Participants who had highest monthly income were two times more likely to utilize SRH services than participants who had the lowest monthly income, [AOR: 2.223, 95%CI: 1.475, 3.349], and participants who knew about SRH services and providing institutions were four times more likely to utilize SRH services than participants who did not know SRH services and providing institutions [AOR: 4.012, 95%CI: 1.881, 8.560] (Table  5 ).

In this study 43.9% of respondents had good knowledge of sexual and reproductive health rights. The finding of our study was lower than reports from various studies conducted in Ethiopia; Wolayta Sodo University, Shire Town Tigray, Northern, Asella Town, and Adet Tana Haik College [ 11 , 12 , 13 , 14 ] and a study conducted among married women in Nepal [ 18 ]. The potential difference could be due to differences in study population and study site. In our study, rural women were respondents, unlike other studies conducted in Ethiopia among university or college students.

Less than half (48.6%) of participants knew the minimum age of lawful marriage. This figure was lower than studies conducted in Nepal [ 16 , 17 ]. This could be due to difference in the study setting, socio-economic, and education status of participants and access to SRHR information sources. Participants who knew about the right to access to all SRH services without husbands’ permission were 36.7%. This is may be due to male dominance in decision making about utilization of health services.

In this study women from household with the highest monthly income and those with formal education and with sources of information were more knowledgeable than others. This finding is consistent with the studies conducted at Shire Town [ 12 ], in Oromiya, Asella town [ 13 ] and the study from Nepal [ 18 ]. Also a study conducted in Bangladesh revealed that the respondents, who were literate, were more aware of their reproductive health rights [ 19 ]. This could be due to the fact that higher socioeconomic status is typically associated with better health, including better sexual and reproductive health awareness and practices, which could be attributed to better access to information. Participants who had formal education and attaining higher educational status enhances women’s ability to access information and services to exercise more control over their reproductive lives [ 20 , 21 ]. In some settings women’s higher educational attainment is associated with improved access to health care, fewer births, healthier and better educated children than women with lower educational status [ 22 ]. Education can empower women with a new vision and normative orientation, better health care, better employment opportunities outside home, and better knowledge of access to SRH services [ 20 ].

Regarding SRH services utilization, it was found that 37.0% of the respondents had ever had SRH services, a lower figure than in Nepal [ 18 ], in Mizan Tepi (65%) and Nekemte town in Ethiopia [ 23 , 24 ]. This was due to differences in the study settings and study population. Other studies were conducted among female university or college students, who had more exposure to SRH services.

In this study, respondents who had formal education, those from households with the highest income, and those who knew about reproductive health services were more likely to utilize SRH services as compared to their counterparts. This figure was similar to the finding of 2016 demographic and health survey, and other studies conducted in Ethiopia [ 8 , 24 , 25 ]. This could be due to the fact that a more educated segment of population may have better information about the services and those with the highest monthly income may have improved access to different sources of information such as radio, newspaper or other print and mass media and which, in turn, could contribute to increasing demand for health services.

The cross-sectional design of the study did not permit a determination of the temporal relationship between dependent and independent variables. Various scientific procedures were undertaken during tool preparation, study participants selection, data collection and analysis to reduce bias and control confounders.

Both knowledge and practice of reproductive and sexual health rights are enormously important to achieve HSTP of Ethiopia and the targets of health related SDGs. In this study context specific factors, such as education and household monthly income were identified as predictors for knowledge of SRHR and SRH services utilization. Stakeholders and government should conduct programs to promote women’s educational status and household economic status to enhance women’s SRHR Knowledge and SRH services utilization.

Availability of data and materials

The data will be available from the corresponding author upon justifiable requests.

Abbreviations

Antenatal Care

Ethiopian Demographic and Health Survey

Female Genital Mutilation

Human immunodeficiency virus

Health Sector Transformational Plan

Harmful Traditional Practices

International Conference on Population and Development

Postnatal Care

Sustainable Development Goals

Sexual and Reproductive Health

Sexual and Reproductive Health and Rights

World Health Organization

UN Population Fund. Programme of action adopted at the international conference on population and development, Cairo, Sept 5–13, 1994. New York: United Nations Population Fund; 2004.

Google Scholar  

UN Population Fund, Center for Reproductive Rights. ICPD and human rights: 20 years of advancing reproductive rights through UN treaty bodies and legal reform. 2013.

Serra S. ICPD beyond 2014: moving beyond missed opportunities and compromises in fulfillment of sexual and reproductive health and rights. Glob Public Health. 2014;1:3.

UNFPA, Sexual and reproductive health for all- reducing poverty, advancing development and protecting human rights, 2010.

Federal Democratic Republic of Ethiopia Ministry of Health, National reproductive health strategy 2006–2015, 2006.

The Federal Democratic Republic of Ethiopia-Constitution of the Federal democratic Republic of Ethiopia, 1995.

The Federal Democratic Republic of Ethiopia Ministry of Health- Health Sector transformational plan-HSTP 2015/16–2019/20 (2008–2012 EFY) October 2015.

Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF. Ethiopia mini demographic and health survey 2019: key indicators. Rockville: EPHI and ICF; 2019.

Pretoria University Law Press, Reproductive and sexual rights in sub-Saharan African courts, volume III 2017.

Gedamu H, Tsegaw A, Debebe E. The prevalence of traditional malpractice during pregnancy, child birth, and postnatal period among women of childbearing age in meshenti town, 2016. Int J Reprod Med. 2018;2018:5945060, 7 pages. https://doi.org/10.1155/2018/5945060 .

Article   PubMed   PubMed Central   Google Scholar  

Yohannes MA, Abebaw GW, Zelalem BM. Knowledge of reproductive and sexual rights among university students in Ethiopia. BMC Int Health Hum Rights. 2013;13:12.

Article   Google Scholar  

Gebretsadik GG, Weldearegay GG. Knowledge on reproductive and sexual rights and associated factors among youths, Shire town, Tigray, Northern Ethiopia. Int J Res Pharm Sci. 2016;6(2):30–7.

TigistTafa Assessment of reproductive health right knowledge and practice among preparatory school female students of Asellatown,Oromiya region in Ethiopia:Addis Ababa university school of public health, 2015.

Mulatu A, Dabere N, Getachew S, Ayal D. Knowledge and attitude towards sexual and reproductive health rights and associated factors among Adet Tana Haik college students, Northwest Ethiopia. BMC Res Notes. 2019;12:80.

Sullivan L. Power and sample size determination. http://sphweb.bumc.bu.edu/otlt/MPH-Modules/BS/BS704_Power/BS704_Power_print.html . Accessed on 7 Feb 2020.

Yadav RK, et al. Knowledge and practice on reproductive heath rights among married women in Nepal. JHAS. 2016;5(1):53–7.

Kaphle M. Awareness and utilization of reproductive rights among the women of reproductive age in Kapan VDC, Nepal. JHAS. 2013;3(1):5–9.

Yadav RK et.al. Knowledge and practice on reproductive heath. JHAS, 2016, Vol. 5, No. 1 P 53–57.

Hossain MK, Mondal MNI, Akter MN. Reproductive health rights of women in the rural areas of Meherpur District in Bangladesh. J Reprod Infertil. 2011;12(1):23–32.

PubMed   PubMed Central   Google Scholar  

Jejeebhoy S. Women’s education, autonomy and reproductive behavior: experience from developing countries. New York: Oxford University Press; 1995.

WHO, Maternal mortality, to improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed, 2014.

Güneş PM. The role of maternal education in child health: evidence from a compulsory schooling law. Econ Educ Rev. 2015;47:1–16.

Yayehyirdah Y, Rediet G, Matewal Y, Melkamsew A, Kifle A, Alemayehu A, Fuad N. Assessment of knowledge, attitude and practice to ward reproductive health services among MizanTepi University TepiCampass students, Sheka Zone Ethiopia. IMedpub J. 2017;3(1):11.

Wakgari B, Taklu M, Mulusew G, Melese S. Sexual and reproductive health services utilization and associated factors among secondary school students in Nekemte town. Reprod Health J. 2018;15:64.

Atitegeb A, Teketo K, Getachew H. Level of young people sexual and reproductive health service utilization and its associated factors among young people in Awabel District, Northwest Ethiopia. PLoS One. 2016;11(3):0151613.

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Acknowledgements

We are very grateful to the Hawassa University for the financial support to this study and all study participants for their commitment in responding to our questionnaire.

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TTD wrote the proposal, participated in data collection, analyzed the data and drafted the paper. MHD and TAA revised and approved proposal, participated in data analysis and subsequent drafts preparation of the manuscript. All authors read and approved the final manuscript.

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Ethical approval was obtained from Hawassa University, Institutional Review Board of College of Medicine and Health Sciences. A written consent was also obtained from local authorities and concerned government bodies from Aleta Wondo District Administration. After a brief introduction of study’s objective, benefits and risk of participation, informed verbal consent was obtained from each study subject. Verbal consent was also obtained from parents/guardians for 16–18 years old participants. To ensure confidentiality of respondents, their names were not indicated on the questionnaire.

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English language questionnaire.

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Tadesse, T., Dangisso, M.H. & Abebo, T.A. Sexual and reproductive health rights knowledge and reproductive health services utilization among rural reproductive age women in Aleta Wondo District, Sidama zone, Ethiopia: community based cross-sectional study. BMC Int Health Hum Rights 20 , 4 (2020). https://doi.org/10.1186/s12914-020-00223-1

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DOI : https://doi.org/10.1186/s12914-020-00223-1

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The suggested tasks for Master’s graduates in reproductive health by experts in Iran

Mahsa shakour.

1 PhD Student, Student Research Committee, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Nikoo Yamani

2 Assistant Professor, Department of Medical Education, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Soheila Ehsanpour

3 Department of Midwifery, Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Background:

Reproductive health is an important health topic. There are many challenges in reproductive health and it is necessary to train experts to manage them. The aim of this study was to define the tasks of Master of Science (MSc) graduates in reproductive health through comprehensive needs assessment to establish the course.

Materials and Methods:

The study comprised of three steps. In the first step, through literature review, the draft and basic fields of main tasks were defined. In the second step, by establishing a focus group of 10 experts, the tasks were extracted on the basis of the country’s needs. In the third step, a Delphi study was carried out among 51 experts who were selected to finalize the list of tasks and their priorities using three criteria of “importance”, “feasibility” and “availability”.

57 tasks were extracted with regard to the four main functions of management and planning, education, consultation, and screening in reproduction age of men and women. According to Delphi’s results and their priorities, 45 tasks were important and feasible but not available, and they were higher-priority tasks.

Conclusions:

The tasks extracted are consistent with the framework of reproductive health provided by the World Health Organization (WHO) and the American Guideline of Educational Planning. However, considering the differences of problems in Iran comparing with other countries, the list is not exactly similar to any list prepared for other countries. Therefore, it is necessary to consider the results of this research in university curriculums.

I NTRODUCTION

Reproductive health is an important health topic, adolescence, and puberty of men and women. It also influences the health of future generations.[ 1 ] By expansion of science, particularly medical sciences, and considering the importance of health, reproductive health is one of the appropriate indices in evaluation of countries’ development, especially for developing countries.[ 2 ]

According to the definition provided by WHO, reproductive health is a state of complete physical, mental, and social wellbeing in reproduction process and function throughout one’s life. Therefore, all people should have a healthy and satisfactory sexual life, and be able to freely make decision about the time and method of bearing their child. In this regard, all people should have the right to access information, facilities and the highest standards of reproductive and sexual health without any discrimination, obligation or violence.[ 3 ]

Contrary to the definition of reproductive health and the policies of the United Nations Population Fund, most countries, including the USA, Canada, and Japan, mostly rely on the traditional approach of mother and child health, based on the susceptibility of women in reproduction and fertility roles and paying special attention to the physiologic characteristics of women and their needs. In this regard, ministry of health is responsible for policy-making and general planning for men and women in various aspects. It should be noted that in recent years, application of the gender equality policies and the working plan of the Women’s World Conference in Beijing have caused considerable development in health sector and the policies and plans of ministry of health on topics, such as sexual health and AIDS, screening of cancers, mental health, and prevention of domestic violence.[ 4 ]

Our society also faces some challenges in reproductive health, which should be fundamentally addressed. Moreover, by following the health and education regulations, these problems can be prevented or treated, or their rehabilitation be facilitated. Some of these problems to consider are infertility, breast cancer, prostate cancer, puberty health, sexual dysfunction, illegal abortions, menopause, health care in these stages of life and new fatal sexually transmitted diseases, such as AIDS. For instance, breast cancer is among the most common cancers in Iranian women.[ 5 ] By increasing the general knowledge, timely diagnosis and effective treatment, more than 50% of the cancer patients would experience a long life.[ 6 ] Therefore, organized educational, health, and therapeutic plans on prevention of breast cancer are required to increase the knowledge level and attitude of women toward breast cancer, and consequently promoting their participation in the screenings.[ 7 ] With regard to abortion, the statistics published in 2008 indicated that the global rate of unsafe abortion increased from 19.7 million cases in 2003 to 21.8 million cases in 2008, which mostly occur in third world countries.[ 8 ] This is while the rate was expected to reduce, owing to the improvement in health facilities and conditions. Furthermore, according to the results obtained by Vahidi et al.,[ 9 ] almost one fourth of Iranian women experience primary infertility in their married life, with the incidence rate of 3.4%. The couples’ age, health, treatment modalities, the age of marriage, and fertility potential are important factors in interpretation of the prevalence of primary infertility.[ 9 ] By providing training and access to appropriate consultation, this problem could certainly be overcome to a great extent.

Considering the problems exist in sexual and reproductive health, it is necessary to establish an applied major, which directly deals with the problems of reproduction in the society. In this regard, defining the tasks of graduates in this major in Iran as the first step of educational planning is necessary. Occupational analysis is usually the first step in educational planning to determine what students should learn. Occupational analysis of educational planning is fragmentation of the learning items that the students are expected to learn about how to do the job.[ 10 ] Occupational analysis helps us to define the skills required for students in learning the prerequisites. Therefore, it is necessary to consult the specialist in the field and those who may involve in the process in this respect.[ 11 ]

The aim of this study was to define the tasks of the MSc graduates of reproductive health by experts. The viewpoints of the experts were obtained online. Web services have been used in some vast needs assessment programs in the world.[ 12 ] Considering the extension and distribution of the study population, this method was more appropriate for the study.

M ATERIALS A ND M ETHODS

The study comprised of three steps. In the first step, through literature review, the draft and basic fields of main tasks related to the job of MSc graduates of reproductive health were defined. Then, in the second step and by establishing a focus group of 10 experts of various specialties, the fields and tasks were extracted on the basis of the country’s needs. The jobs of these experts were related to reproductive health. The group consisted of two faculty members of midwifery, four PhD students of reproductive health with the career in being faculty members, two obstetricians, one geneticist and one urologist. The group members had a history of working in this field and some of them were involved in curriculum planning. Then, small groups of three experts were formed to discuss the list of the major’s establishment objectives and its tasks, and finally they achieved consensus on the items. To make sure about the tasks that were extracted by the focus group of experts, the tasks were sent for the representative of each group, and some required modifications were done and returned back to them; ultimately the approved tasks were determined to be used for opinion poll of other experts. In the third step, Delphi study was carried out using the Web to finalize the list of tasks and their priorities. At this step, it was necessary to perform priority setting of the tasks[ 13 ] and the opinions of experts were obtained. The sampling was goal oriented, and the experts were selected among the Iranian obstetrics and gynecology specialists, PhD students of reproductive health, the professionals in the field, faculty members of reproductive health, mother and child health, and midwifery. Fifty-one experts attended the opinion poll. The faculty members were selected from the medical universities with MSc Courses, such as Isfahan, Ahwaz, Tabriz, Tehran, Shiraz, and Mashhad, and the medical universities which served as the referral centers of some provinces, including Yazd, Kermanshah, Mazandaran, Golestan, Guilan, and Sistan-va Baluchestan. First they were contacted or verbally agreed to participate in the study. The aims of the study and the method of opinion poll were described on a website. The questionnaire was also presented on the website. The questionnaire included the items on tasks extracted in previous steps, which were presented along with the opinion poll guideline and priority-setting criteria. Furthermore, the website guideline with illustrations and examples was prepared and mailed to the participants. To avoid problems related to it, the participants’ cell phone numbers were defined as their ID and password.

Priority setting was performed according to a method of Altschuld’s book, with the three criteria of “importance”, “feasibility” and “availability”. The importance was evaluated from experts’ viewpoints. Feasibility was defined as the level the task could be fulfilled by a reproductive health MSc graduate and availability was the fact that this service is now provided or not. Availability was scored in a 1-3 range; if the service is now completely provided, it scored 3, if it is not provided at all, it scored 1, and if it is provided to some extent, it scored 2. Accordingly, the “importance” factor was scored in a 1-5 range, and the “feasibility” was scored between 1 and 3, and the participants scored the items according to the lowest and highest scores. The items that obtained scores less than the median value (3 for 5-point scale and 2 for 3-point scale) were considered to be less important or unavailable or infeasible. The eight conditions produced are provided in Table 1 .

All priority conditions of the tasks

In the opinion poll webpage, the participants could write down their comments on each task in specific boxes. The comments were reachable for the researcher as they were sent. After performing the opinion poll, the scores of each priority-setting criterion and the mean score for each task were calculated. Priority setting was then carried out according to Table 1 .

In the first step, the draft of tasks in 19 main areas was obtained using literature review. Then, in the second step, the tasks were completed and modified by evaluation of the focus group. Then they were categorized on the basis of the four main stages of reproduction and its four subsidiary classifications. 57 tasks were extracted with regard to the four main functions of management and planning, education, consultation, and screening in reproduction age of men and women; that is, before and during puberty, before marriage, reproduction (pre- pregnancy, pregnancy, post-pregnancy and infertility), and menopause and older age.

In the third step, to achieve the best possible results from the opinion poll, we tried to make use of the comments of experts and health managers from ministry of health and different universities, who were scientifically competent and had enough experience in this field. Of those who attended the study, 33% were specialists in the field of mother and child health, and 29% in the field of reproductive health. The remaining were gynecologists, health specialists, and specialists in other related fields.

The 57 tasks and their mean scores assigned to priority- setting criteria are provided in Table 2 .

Results of priority setting of the tasks

With regard to table 2, tasks No. 18, 22, 26, 35, 36, 37, 38, 41, 42, 43, and 44 obtained the mean importance score above the median score 3, the feasibility score above the median score 2, and the availability scores above the median score 2. This shows that the item is important, feasible, and available, and further action is not required for it; thus, the item can be eliminated, or has a low priority. As can be observed, the tasks deal with topics, such as high-risk pregnancy, breast feeding, and family planning. In contrast, task No. 9 obtained a low feasibility score, and can be evaluated.

The remaining tasks (45 tasks) are the needs; we should focus on meeting them.

With regard to the results obtained and considering the viewpoints of the needs assessment team, tasks No. 42, 41, 37, 36, and 35 were eliminated. However, considering the relevance of items No. 22, 18, 26, 38, 43, and 44 to the major, and as the needs assessment team agreed, these items were not eliminated, but received lower priority in educational planning.

D ISCUSSION

We took advantage from expert’s opinions in evaluating the tasks of MSc graduates of reproductive health. In this respect, the scientific and working experiences of the experts were considered. All the extracted tasks were set in a health, rather than clinical framework. The tasks extracted were consistent with the framework of reproductive health provided by the WHO and the American Guideline of Educational Planning. However, according to the differences in problems of our country with those of the others, the list of tasks was not exactly similar to any list prepared for other countries.[ 14 , 15 ]

Altschuld method was used to perform the priority- setting in needs assessment, because the major did not exist before. Thus, it was not possible to determine the gap between the present and desirable states. Moreover, there are currently other specialties that provide services in the same field in the health system. So, in needs assessment, the importance of tasks defined for meeting the needs of people’s reproductive health were considered, as well as the unavailability and feasibility of the services.

The results showed that in experts’ opinion, all the tasks extracted were important for the graduates, and most of the tasks, 46 out of 57, were not currently provided. These tasks were related to management and planning, education and consultation about the puberty and pre-

puberty health and the issues related to them, sexual health, elderly health, menopause, empowerment of women, and participation of men. The experts believed that the items were important (all scored above 4), and were not available for the people.

According to the experts, of the tasks proposed 10 items were currently provided in the health system. These items were feasible; however, since they were available and were provided by graduates of other specialties, the items were not given high priorities. The 10 tasks mentioned were specified as “the needs that do not require further action” according to the priority-setting scale. Thus, it is not necessary to train new specialists to provide these services. With regard to the remaining tasks, the experts believed that the services were not provided at all or provided to degrees less than “somehow”. Moreover, except for “management and planning for changing of gender beliefs and superstitions of families and the society”, on which the experts did not agree, all other items were feasible. Therefore, these services should necessarily be provided by some individuals or systems. In this regard, these extracted items were considered as the tasks of graduates of the major.

General evaluation of the tasks extracted indicated that the process of defining tasks of reproductive health was performed multi dimensionally and accurately. The tasks defined cover all stages of reproductive age and all feasible duties in the field of health. Reproductive health for the two ends of reproduction age, that is, adolescence and higher ages, are important issues in Iranian reproductive health. This is because although almost 34% of the current Iranian population is young, the elderly population in urban areas has been grown fourfold in the past 30 years.[ 16 ] Furthermore, in near future, a high percentage of the population would be old, and consequently the reproductive health needs associated with these ages would become important. Thus, accurate educational planning to train providers of these services is a must.

Management and planning, consultation, education and other items related to reproductive health in older age groups of men and menopause of women were of the main tasks defined for the major. These tasks can be of the current and future tasks, which should receive appropriate attention. This is due to the increasing growth in elderly population in Iran, as it is estimated that in 2031, elderly population boom will occur in Iran, and 25%-30% of the population will then be above 50 years of age.[ 17 ]

The tasks related to sexual health were among the tasks that were considered in all stages of life. In spite of obtaining high scores, these services are not provided by other jobs and thus are not available. The tasks of education and consultation about the gender and sexual roles were defined in this regard. Many studies have been carried out on adolescents, and showed that the adolescents were unfamiliar with sexual issues, and there is a need for education and consultation of adolescents in this respect.[ 18 – 21 ] Some researchers have evaluated gender roles of men and women and found the problems of this field. They recommend that by pre and post marriage consultation, the couples should become familiar with mental schema and cultural cliché, and the influence of these factors on mental assessment of sexual arousal and satisfaction with sexual relationship. Moreover, the importance of these factors should be taught to decrease the problems of married life.[ 22 ] Considering the tasks defined for the major, the graduates can more specifically meet the needs of the society in this respect.

Another task was related to empowerment of women. A branch of this item is “violence against women”, which is a topic proposed by the WHO as an item for assessment and follow up in reproductive health.[ 15 ] Some researchers believe that violence against women and children within the families has decreased; however, the problems require education with the aim of changing the behavior.[ 23 ]

Department of Reproductive Health in the WHO with the aid of the United Nations Population Fund (UNFPA) and Human Reproduction Program (HRP) has defined the main topics of reproductive health. These topics would be helpful in research on reproductive health and making the policy makers, scientists, health care providers, physicians, consumers, and representatives of the society aware of the research priorities in development of reproductive and gender health. The topics were namely, older age and reproductive and gender health, family planning, women’s circumcision, and other harmful practices, infertility, mothers’ health and abortion, urinary tract infections, sexually transmitted

diseases, AIDS, relationship between reproductive health and AIDS, unsafe abortions, and violence against women.[ 15 ] Considering the health state of our society and frequency of the problems, most of these topics are among the main topics in our country. However, some less frequent topics in our country, such as women’s circumcision, were not placed among the main topics, and considering the young population of Iran, some topics such as those related to adolescents were mentioned as the main topics in reproductive health needs.

Some limitations of the study were obligation in selection of the participants from the specialists of the field, because they were mostly busy and did not have enough time to answer the questions. To overcome this problem, the study was better to be performed in a larger time interval and during academic off day. Considering the results obtained, the authorities should develop the reproductive health major in subgroups, such as sexual health, research in reproductive health, and reproduction rights, and also modify the curriculum of courses related to the field for students of medical sciences. Furthermore, researchers should carry out more studies on the neglected tasks of physicians in reproductive health.

A CKNOWLEDGMENT

I would appreciate my dear teachers, specialists, experts in health ministry and clinics and all of my friends, especially Dr. Ashraf Kazemi, Dr. Shahnaz Kohan, and Dr. Tayebe Ziaee for their kind cooperation and encouragement.

This article was derived from an MSc thesis in Isfahan University of Medical Sciences, No: 389284.

Source of Support: Isfahan University of Medical Sciences

Conflict of Interest: None declared.

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Alumni Spotlight: Aries Nuño, MSPH '23

• Degree Program: MSPH
• Area of Interest: Women's, Sexual and Reproductive Health
• Graduation Year: 2023 
• Hometown: Balch Springs, TX
• Previous Degree(s) Earned: BS in Public Health, University of North Texas

What sparked your interest in public health?

For as long as I can remember,  I have always been driven to support my community through volunteer opportunities, which allowed me to witness firsthand the need for accessible and equitable health services. From AmeriCorps to the Peace Corps, my passion for public health grew, especially while serving in the Peace Corps in Lesotho, where I worked as an HIV/AIDS Prevention Specialist. This experience opened my eyes to the profound impact that public health initiatives can have on an individual's life, particularly in underserved and marginalized communities. I desired to pursue a career focused on creating sustainable, culturally sensitive health solutions that empower individuals and improve sexual health outcomes worldwide.  

What led you to choose Bloomberg School of Public Health and join the Department of Population, Family and Reproductive Health?

The Bloomberg School's renowned reputation and strong focus on Women's Sexual and Reproductive Health were major factors in my decision. The Department of Population, Family, and Reproductive Health (PFRH) offered a curriculum that aligned perfectly with my interests regarding socio-cultural implications on sexual and reproductive health.

How did your degree prepare you for current and future roles? What aspects of the PFRH degree program did you find most useful? 

The degree program provided me with essential skills in qualitative and quantitative research, data analysis, and program development. My focus on female genital mutilation/cutting (FGM/C) and assisting with local and international projects on this topic significantly built my foundational and applicable skills. These projects required in-depth research and practical application of my studies, culminating in my master’s thesis on FGM/C ( Exploring the Experiences of FGM/C Affected Migrant Women in Western Nations: A Scoping Review of Accessing Sexual and Reproductive Health Services ). 

Balancing academics with practical experiences is valuable, but finding your unique path and staying true to your passions is what will ultimately lead to a fulfilling career and personal growth.

Describe your current position and responsibilities in a way that will inform current and prospective students about career opportunities in your field.

As the Training and Technical Assistance Coordinator at  Sahiyo , my role revolves around designing and implementing educational and advocacy programs to address FGM/C, primarily in the US. My primary responsibilities include developing training modules tailored to diverse audiences, establishing partnerships with NGOs, governmental bodies, and community organizations, project management and capacity building of local and international partners by providing training and technical assistance, and producing comprehensive reports that showcase program outcomes, organizational impact, and areas for improvement.

How did you build your sense of community during your time as a PFRH student?

While it's easy to get caught up in schoolwork, meeting deadlines, and writing papers, It was important for me to set aside time for social and outdoor activities. Whether it was grabbing ice cream with a friend, attending a board game night, or a day hike, these moments helped me connect with my peers and have a much-needed break with fresh air! 

What was your favorite thing about living in Baltimore while you were a student?

While I lived in Baltimore briefly, I enjoyed engaging with community locals who shared stories about the city's history and what they personally loved about it. Their tales of Baltimore's past gave me a deeper appreciation for the city's rich cultural heritage. One of my favorite places to study on weekends was the Peabody Library , with its stunning architecture and calming atmosphere. 

Do you have any advice for prospective students?  

I would encourage prospective students to actively engage with the community, both on and off-campus. It's important to take advantage of networking opportunities, seek mentorship, and participate in research or volunteer activities. However, it's equally important not to get caught up in the prestige or the allure of what others are doing. While some opportunities may seem competitive, remember that the goal is not to compete or outdo your peers; instead, you should focus on discovering what opportunities truly with your interests and goals. Balancing academics with practical experiences is valuable, but finding your unique path and staying true to your passions is what will ultimately lead to a fulfilling career and personal growth. 

Dalla Lana School of Public Health

• What’s New

Ten DLSPH doctoral students named 2024 Vanier Scholars

August 13/2024

Six Institute of Health Policy, Management and Evaluation (IHPME) students and four Public Health Sciences (PHS) students were named 2024 Vanier Scholars, earning funding to support their doctoral studies.

By Bonnie O’Sullivan, with content from Marielle Boutin’s IHPME article  

DLSPH is delighted to congratulate ten doctoral students who have been recognized as 2024 Vanier Scholars. This group of inspiring doctoral students were selected for this prestigious award based on three equally weighted criteria: academic excellence, research potential and leadership. Each scholar has earned $50,000 per year for three years to support their doctoral studies as part of the Vanier Canada Graduate Scholarships .  

Named after Canada’s first francophone Governor General, Major-General George P. Vanier , this scholarship is awarded to those studying health research, natural sciences and/or engineering, or social sciences and humanities. The research focuses of our DLSPH representatives range from improving health equity through machine learning to examining how socioeconomic position influences cardiovascular disease among youth.  

Dean Adalsteinn (Steini) Brown  says that the breadth of research topics these scholars represent is bound to make positive impact on the Canadian healthcare system.    

“Our school’s community is known for our curiosity, integrity, leadership and rigour. These ten doctoral students are excellent representatives of what it means to be a DLSPH public health and health systems researcher. Congratulations to our 2024 Vanier Scholars!”  

Our DLSPH 2024 Vanier Scholars  

Research Title: An intersectional political economy perspective to understand how social and economic policies influence the employment experiences and health inequalities among marginalized workers in Canada.  

Momtaz Begum, a Social and Behavioural Health Sciences student, is studying issues relating to labour market experience and health among minority workers in Toronto’s discount nail salon industry. Begum’s research will analyze policies and legislations to identify gaps that may be contributing to these workers’ inequitable employment and health experiences.   

Begum says receiving a Vanier Scholarship “is both a recognition and a pathway that is amplifying and ushering my enthusiasm, passion and perseverance to work towards creating a more equitable and just society.”  

Research Title: From menarche to menopause: examining the impact of reproductive health history on obesity and diabetes among postmenopausal women in the United States.  

Claire Cook’s research focuses broadly on women’s health and chronic disease. Cook’s thesis will examine reproductive health, focusing on menarche, obesity and diabetes, to understand contributing factors to chronic disease burden and healthy aging in postmenopausal women.  

Cook, who is studying Epidemiology , says, “I believe this work has important implications for research, clinical practice, and public health intervention as reproductive health history presents a currently untapped opportunity for chronic disease screening, identification, and prevention among women across the life course.”  

Research Title: Improving the early detection and diagnosis of childhood cancers in Cameroon: An evaluation of the clinical and cost-effectiveness of an adapted early warning signs and symptoms (EWSS) intervention.  

Gilbert Bryan Gascon’s research uses implementation science approaches to integrate evidence-based early diagnosis programs for children with cancer in low- and middle-income countries.    

“I hope this recognition helps bring life to my vision, which was always to help bring health solutions for communities who are underrepresented in research and medicine, particularly in a world where children seem to be undervalued,” says the Health Systems Research student.  

Research Title: An evaluation of socioeconomic inequalities in cardiovascular health among Canadian children and adolescents.  

Nicholas Grubic’s research examines how socioeconomic position influences the risk of cardiovascular disease among Canadian youth. Using nationally representative survey data, the Epidemiology student will explore the distributional inequalities in cardiovascular health indicators. Grubic will evaluate how the association between adolescent lifestyle behaviours and cardiovascular risk in adulthood differs according to socioeconomic position, using data from a Canadian cohort study.    

“I am honoured to join a distinguished group of scholars who are collectively driving evidence-based innovations in healthcare, public health, and policy,” says Grubic. “This award also reflects the unparalleled support and guidance I have received from numerous mentors at the University of Toronto and other institutions across Canada and internationally.”  

Research Title: Adult impact of complex childhood-onset diseases.  

Sarah Malecki’s research focuses on adults who have had childhood-onset complex diseases, aiming to measure the disease impact on their adult lives and track the long-term effects.   

“Having the support of a Vanier Scholarship during my graduate studies will ensure that I am able to dedicate the time needed for my research,” says the Clinical Epidemiology and Health Care Research student. “Being named a future leader of research excellence in Canada gives me further confidence and inspiration to pursue a research career in medicine.”  

Research Title: Enhancing equity and mitigating overdiagnosis of prostate cancer through the development and evaluation of machine learning-driven organized prostate cancer screening policies.  

Nguyen’s research focus is on enhancing health equity and reducing prostate cancer overdiagnosis by developing a machine-learning model for more effective and equitable prostate-specific antigen test screening.  

  “Receiving the Vanier Canada Graduate Scholarship is incredibly motivating as I embark on this new chapter in my training,” says the Clinical Epidemiology and Health Care Research student. “It brings me significantly closer to my ambition of becoming a surgeon-scientist, working at the intersection of health policy, artificial intelligence, and cancer care delivery to tackle health disparities.”  

Research Title: Evaluating Long-term Outcomes Among Older Adults with Severe Injury in Ontario to Improve Post-Trauma Care.  

Gemma Postill’s aim is to improve the recovery time of older adults after traumatic injury and help them remain at home longer by creating machine learning models that improve client care. The IHPME student’s research focuses on the use of machine learning and health data to study long-term outcomes of these patients.  

“I was thrilled and deeply honoured to be named a Vanier Scholar,” says the Clinical Epidemiology and Health Care Research student. “The Vanier Canada Graduate Scholarship recognizes and awards academic excellence, research potential, and leadership. As I continue my journey to become a clinician scientist, I could not be more excited by this recognition!”  

Research Title: Examining the Effect of Continuing Prenatal Antidepressant Exposure on Maternal and Offspring Cardiometabolic Health.  

Lauren Tailor’s thesis focuses on perinatal and pediatric pharmacoepidemiology. Tailor’s goal is to generate evidence on the effect of continued prenatal antidepressant use on maternal and long-term offspring cardiometabolic health outcomes.  

“My research aims to enhance the understanding of the cardiometabolic safety of antidepressants during pregnancy,” explains Tailor, an Epidemiology student. “By offering evidence-based information on mental health medications for mothers and their children, I strive to empower healthcare providers, pregnant individuals, and their families to make informed choices. This work aspires to improve prenatal mental health and maternal and offspring cardiometabolic outcomes, reduce stigma, and influence healthcare policies.”  

Research Title: Inclusive excellence in MD admissions: access to capital and the inequities in academic assessment.  

Conrad Tsang’s research focuses on how socioeconomic and other factors influence selection in medical school admissions.  

“The financial support gives me more freedom and flexibility to pursue the higher-risk but potentially higher-reward research avenue that could make important contributions and impact,” says Tsang, who is enrolled in the Health Professions Education Research program.  

Research Title: Exploring the accessibility and quality of virtual mental health care among youth and young adults with mental health needs.  

Erica Wennberg’s research explores access, safety, effectiveness and fairness of virtual mental health care for youth and young adults compared to in-person care.  

“My career goal is to become a clinician-scientist with a research focus in health equity,” says the Clinical Epidemiology and Health Care Research  student. “Being named a Vanier Scholar alongside an amazing group of doctoral students across Canada has only deepened this conviction. I look forward to continuing to grow in the remaining years of my PhD with the support of the scholarship.”   

Amanda Seitz, Associated Press Amanda Seitz, Associated Press

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• Copy URL https://www.pbs.org/newshour/nation/pregnant-women-in-distress-report-being-turned-away-from-ers-despite-federal-law

Pregnant women in distress report being turned away from ERs despite federal law

WASHINGTON (AP) — Bleeding and in pain, Kyleigh Thurman didn’t know her doomed pregnancy could kill her.

Emergency room doctors at Ascension Seton Williamson in Texas handed her a pamphlet on miscarriage and told her to “let nature take its course” before discharging her without treatment for her ectopic pregnancy.

When the 25-year-old returned three days later, still bleeding, doctors finally agreed to give her an injection intended to end the pregnancy. But it was too late. The fertilized egg growing on Thurman’s fallopian tube would rupture it, destroying part of her reproductive system.

That’s according to a complaint Thurman and the Center for Reproductive Rights filed last week asking the government to investigate whether the hospital violated a federal law when staff failed to treat her initially in February 2023.

READ MORE: More than 6 in 10 Americans support protecting access to in vitro fertilization, AP-NORC poll finds

“I was left to flail,” Thurman said. “It was nothing short of being misled.”

Even as the Biden administration publicly warned hospitals to treat pregnant patients in emergencies, facilities continue to violate the federal law. The issue became a focus for the administration following reports of women being improperly treated in emergency rooms after the Supreme Court’s decision to overturn the constitutional right to an abortion more than two years ago.

More than 100 pregnant women in medical distress who sought help from emergency rooms were turned away or negligently treated since 2022, an Associated Press analysis of federal hospital investigations has found.

Two women – one in Florida and one in Texas – were left to miscarry in public restrooms. In Arkansas, a woman went into septic shock and her fetus died after an emergency room sent her home. At least four other women with ectopic pregnancies had trouble getting any treatment, including one California woman who needed a blood transfusion after she sat for nine hours in an emergency waiting room.

The White House says hospitals must offer abortions when needed to save a woman’s health, despite state bans. Texas is challenging that guidance and, earlier this summer, the Supreme Court declined to resolve the issue.

Abortion bans complicate risky pregnancy care

In Texas, where doctors face up to 99 years of prison if convicted of performing an illegal abortion, medical and legal experts say the law is complicating decision-making around emergency pregnancy care.

Although the state law says termination of ectopic pregnancies is not considered abortion, the draconian penalties scare Texas doctors from treating those patients, the Center for Reproductive Rights argues.

“As fearful as hospitals and doctors are of running afoul of these state abortion bans, they also need to be concerned about running afoul of federal law,” said Marc Hearron, a center attorney. Hospitals face a federal investigation, hefty penalties and threats to their Medicare funding if they break the federal law.

The organization filed two complaints last week with the Centers for Medicare and Medicaid Service alleging that different Texas emergency rooms failed to treat two patients, including Thurman, with ectopic pregnancies.

Another complaint says Kelsie Norris-De La Cruz, 25, lost a fallopian tube and most of an ovary after an Arlington, Texas, hospital sent her home without treating her ectopic pregnancy, even after a doctor said discharge was “not in her best interest.”

“The doctors knew I needed an abortion, but these bans are making it nearly impossible to get basic emergency healthcare,” she said in a statement. “I’m filing this complaint because women like me deserve justice and accountability from those that hurt us.”

Conclusively diagnosing an ectopic pregnancy can be difficult. Doctors cannot always find the pregnancy’s location on an ultrasound, three separate doctors consulted for this article explained. Hormone levels, bleeding, a positive pregnancy test and ultrasound of an empty uterus all indicate an ectopic pregnancy.

“You can’t be 100% — that’s the tricky part,” said Kate Arnold, an OB-GYN in Washington. “They’re literally time bombs. It’s a pregnancy growing in this thing that can only grow so much.”

Texas Right to Life Director John Seago said the state law clearly protects doctors from prosecution if they terminate ectopic pregnancies, even if a doctor “makes a mistake” in diagnosing it.

“Sending a woman back home is completely unnecessary, completely dangerous,” Seago said.

But the state law has “absolutely” made doctors afraid of treating pregnant patients, said Hannah Gordon, an emergency medicine physician who worked in a Dallas hospital until last year.

“It’s going to force doctors to start creating questionable scenarios for patients, even if it’s very dangerous,” said Gordon. She left Texas hoping to become pregnant and worried about the care she’d get there.

Gordon recalled a pregnant patient at her Dallas emergency room who had signs of an ectopic pregnancy. Because OB-GYNs said they couldn’t definitively diagnose the problem, they waited to end the pregnancy until she came back the next day.

“It left a bad taste in my mouth,” Gordon said.

“Oh my God, I’m dying.”

In Thurman’s case, when she returned to Ascension Seton Williamson a third time, her OB-GYN told her she’d need surgery to remove the fallopian tube, which had ruptured. Thurman, still heavily bleeding, balked. Losing the tube would jeopardize her fertility.

But her doctor told her she risked death if she waited any longer.

“She came in and she’s like, you’re either going to have to have a blood transfusion, or you’re going to have to have surgery or you’re going to bleed out,” Thurman said, through tears. “That’s when I just kind of was like, “oh my God, I’m, I’m dying.”

WATCH:  Why little is known about what causes many pregnancies to end in miscarriage

Ascension Seton Williamson declined to comment on Thurman’s case, but said in a statement the hospital “is committed to providing high-quality care to all who seek our services.”

In Florida, a 15-week pregnant woman leaked amniotic fluid for an hour in Broward Health Coral Springs’ emergency wait room, according to federal documents. An ultrasound revealed the patient had no amniotic fluid surrounding the fetus, a dangerous situation that can cause serious infection.

The woman miscarried in a public bathroom that day, after the emergency room doctor listed her condition as “improved” and discharged her, without consulting the hospital’s OB-GYN.

Emergency crews rushed her to another hospital, where she was placed on a ventilator and discharged after six days.

Abortions after 15 weeks were banned in Florida at the time. Broward Health Coral Springs’ obstetrics medical director told an investigator that inducing labor for anyone who presents with pre-viable premature rupture of membranes is “the standard of care, has been a while, regardless of heartbeat, due to the risk to the mother.”

The hospital declined to comment or share its policies with the AP.

In another Florida case, a doctor admitted state law had complicated emergency pregnancy care.

“Because of the new laws … staff cannot intervene unless there is a danger to the patient’s health,” a doctor at Memorial Regional Hospital in Hollywood, Florida, told an investigator who was probing the hospital’s failure to offer an abortion to a pregnant woman whose water broke at 15 weeks, well before the fetus could survive.

Troubles extend beyond abortion ban states

Serious violations that jeopardized a mother or her fetus’ health occurred in states with and without abortion bans, the AP’s review found.

In interviews with investigators, two short-staffed hospitals – in Idaho and Washington – admitted to routinely directing pregnant patients to drive to other hospitals.

A pregnant patient at a Bakersfield, California, emergency room was quickly triaged, but staff failed to realize the urgency of her condition, a uterine rupture. The delay, an investigator concluded, may have contributed to the baby’s death.

Doctors at emergency rooms in California, Nebraska, Arkansas and South Carolina failed to check for fetal heartbeats or discharged patients who were in active labor, leaving them to deliver at home or in ambulances, according to the documents.

Nursing and doctor shortages that have plagued hospitals since the onset of COVID-19, trouble staffing ultrasounds around-the-clock, and new abortion laws are making the emergency room a dangerous place for pregnant women, warned Dara Kass, an emergency medicine doctor and former U.S. Health and Human Services official.

“It is increasingly less safe to be pregnant and seeking emergency care in an emergency department,” she said.

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Guest Essay

Kamala Harris Needs to Seize the Narrative on Abortion

By Mary Ziegler

Ms. Ziegler is a law professor at the University of California, Davis, and the author of “Roe: The History of a National Obsession.”

Protecting reproductive rights is one of Democrats’ strongest issues, and their ability to capitalize on it may decide a tight election. Chances are even better now with Kamala Harris, a candidate known for her unapologetic positions on the issue, at the top of the ticket.

And yet Democrats have not fully capitalized on this apparent advantage. Though Donald Trump was responsible for appointing the Supreme Court justices who were crucial in striking down Roe v. Wade — a campaign promise that thrilled parts of the electorate and dismayed others — in this election cycle he seems to have avoided the ire of many voters because he insists a second term won’t matter much to reproductive rights one way or another, especially in states that protect abortion access.

The reality is that a second Trump term — or a first Harris term — could fundamentally change Americans’ reproductive lives and health. With Ms. Harris formally introducing herself to voters as the Democratic presidential nominee next week at the party’s convention, now is the time to make the case for what she could do — and what Mr. Trump might — over the next four years.

It will not be enough to blame Mr. Trump for abortion bans already on the books or to warn that he wants to pass a nationwide ban . Ms. Harris, like President Biden, has vowed to sign into law a bill “restoring and protecting reproductive freedom in every state .”

These messages are powerful, but they look to the past or point to possible futures that voters may dismiss as unrealistic — and thus inapplicable to their lives. Ms. Harris needs to drive home that in a post-Roe world, Mr. Trump would probably have unusual power to criminalize abortion. She must also convey that under a Republican administration, there would be no state in the country where reproductive rights would be absolutely secure. Furthermore, she has a chance to overcome a problem that plagued Mr. Biden’s campaign: explaining what could be done to expand reproductive rights.

Ms. Harris, who has worked to connect Mr. Trump to Project 2025 , the plan created by conservative groups and former Trump officials as a blueprint for the next Republican president, must remind voters that many key conservative proposals for reproductive rights in a second Trump administration would not require congressional approval. Mr. Trump, she must emphasize, could do a great deal of damage through the use of executive power alone.

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