Frontiers in global women's health最新文献

{"title":"Midwives' experiences working with women and girls surviving violence in Yemen: a qualitative study.","authors":"Marwah Al-Zumair, Luz Marina Leegstra, Hussein Zaid, Raisa Ferrer Pizarro, Monia Al-Zumair, Lamya Bawahda, Albrecht Jahn, Lauren Maxwell","doi":"10.3389/fgwh.2025.1450053","DOIUrl":"10.3389/fgwh.2025.1450053","url":null,"abstract":"<p><strong>Background: </strong>Yemeni women and girls have long endured pervasive violence, a situation further exacerbated by the ongoing humanitarian crisis. Violence against women and girls (VAWG) is strongly stigmatized in the Yemeni context. In under-resourced, rural settings like Yemen, where gender inequities prevent women and girls from accessing the formal health system, community midwives may be an important resource for women and girls who experience interpersonal violence. This study explored community midwives' knowledge, training, and applied experience working with women and girls who experience interpersonal violence.</p><p><strong>Methods: </strong>We conducted 20 in-depth interviews with community midwives in four Yemeni governorates. A female Yemeni physician and qualitative researcher trained in the ethical conduct of VAWG-related research conducted interviews using a semi-structured interview guide. Participants gave verbal consent for participation in the one-time interview. We used thematic analysis to summarise the findings. Interviews were transcribed in Arabic and English, and differences in interpretation were resolved through consensus.</p><p><strong>Results: </strong>While midwives had limited formal training in supporting women and girls who experience interpersonal violence, they play a critical role in responding to VAWG in Yemen. Community midwives provide psychological support, contraception, violence-related health care, and referrals to more advanced healthcare and protection services, including women-friendly spaces (WFSs) and shelters. Lack of training and treatment guidelines, in addition to a lack of supportive services and VAWG-related stigma, were important barriers for midwives working with VAWG. The stigma associated with sexual violence discouraged women from seeking health care or accessing limited protection services.</p><p><strong>Conclusion: </strong>Community midwives in Yemen are well-placed to support women and girls who experience violence. Midwives should receive context-appropriate training and support to work with women and girls who experience violence. The lack of available services and the stigma associated with experiencing, reporting and supporting VAWG survivors must be carefully considered before designing any intervention.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1450053"},"PeriodicalIF":2.3,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11968663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast self-examination practice and associated factors among pastoralist women in the West Guji Zone, Oromia, Ethiopia: a community-based cross-sectional study.","authors":"Mohammed Aliyi, Yimar Hotessa, Abdisa Haro, Belda Negesa Beyene, Misgana Desalegn, Derese Eshetu Debela","doi":"10.3389/fgwh.2025.1501001","DOIUrl":"10.3389/fgwh.2025.1501001","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer is the most common cancer among women. It is the leading or second cause of female cancer-related deaths in both developed and developing countries, including Ethiopia. Breast self-examination is an effective and efficient screening method used by women for the early detection of breast cancer. There is limited data about breast self-examination practice among pastoralist women in the study area. Therefore, the aim of this study was to assess the magnitude of breast self-examination practice and associated factors among women of childbearing age in the West Guji Zone, South Ethiopia.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted from 1 March to 30 April 2023 on 424 randomly selected women of childbearing age in the West Guji Zone. A systematic sampling technique was employed to select the study participants. Data was collected using pre-tested and structured questionnaires through face-to-face interviews, entered into EpiData version 4.6 and then exported to SPSS version 25 for cleaning and analysis. Bivariable and multivariable analyses were conducted using binary logistic regression to identify factors associated with breast self-examination practice. Statistical significance was declared at a <i>P</i>-value <0.05.</p><p><strong>Result: </strong>In this study, 62 (14.6%) of the women had a good practice of breast self-examination. Maternal age (25-34 years) [adjusted odds ratio (AOR) = 1.98, 95% confidence interval (CI): 1.07-3.70], monthly income (AOR = 3.92, 95% CI: 1.34-11.49), residence (AOR = 2.28, 95% CI: 1.09-4.78), and knowledge about breast self-examination (AOR = 2.15, 95% CI: 1.14-4.05) were factors significantly associated with breast self-examination practice<b>.</b></p><p><strong>Conclusion: </strong>The study's findings indicated a significantly low level of breast self-examination practice among pastoralist women. Women's education should be promoted, income generated, and the practice of breast self-examination should be advocated.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1501001"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and prospects: women's education in contemporary Afghanistan.","authors":"Basir Ahmad Hasin, Mir Mohammad Ayoubi, Nasar Ahmad Shayan","doi":"10.3389/fgwh.2025.1477145","DOIUrl":"10.3389/fgwh.2025.1477145","url":null,"abstract":"<p><p>Since the fall of the republic government in Afghanistan on August 15, 2021, the situation for women's education has regressed drastically. This article explores the multifaceted impact of Afghanistan's Current DeFacto government policies on women's educational opportunities. With a historical overview of women's rights in Afghanistan, this article delves into the current restrictions imposed by the regime, including the ban on women's higher education and the limited scope of semi-higher education. This highlights the significant challenges faced by Afghan women, such as cultural barriers, economic hardships, and restrictive policies on women's rights. The article also discusses potential solutions, including international pressure, infrastructure development, and cultural shifts towards a more inclusive interpretation of Islam. By examining these factors, this article aims to provide a nuanced understanding of the ongoing struggle for women's rights and education in Afghanistan while emphasizing the resilience of Afghan women and the crucial role of global advocacy in supporting their fight for equality.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1477145"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781955","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying barriers and coping strategies for pre-exposure prophylaxis disclosure: experiences of Ugandan adolescent girls engaged in transactional sex-a qualitative study.","authors":"Simon Mwima, Laura M Bogart, Steela Neema, Richard Komo, Stephen Obbo","doi":"10.3389/fgwh.2025.1517448","DOIUrl":"10.3389/fgwh.2025.1517448","url":null,"abstract":"<p><strong>Introduction: </strong>The disclosure of oral pre-exposure prophylaxis (PrEP) use among adolescent girls engaged in transactional sex in Uganda is a complex process shaped by stigma, fear of judgment, misconceptions, and the threat of violence. This qualitative study explores the strategies these adolescents use to navigate these challenges, drawing on resilience theory and asset-based approaches.</p><p><strong>Methods: </strong>Between April 2018 and May 2019, cross-sectional semi-structured interviews were conducted with Ugandan adolescent girls aged 18-24 engaged in transactional sex to explore their experiences of PrEP disclosure. Data were analyzed using a thematic network analysis approach, focusing on how participants managed the social and psychological barriers to disclosure.</p><p><strong>Results: </strong>The study found that stigma, misconceptions about PrEP, and fear of judgment or violence from clients and families were significant barriers to disclosure. However, adolescent girls employed multiple strategies to navigate these challenges. These included relying on peer support, selective disclosure to trusted individuals, and drawing on personal strength and resilience. Support from healthcare providers and access to youth-friendly health services further helped participants manage the risks associated with PrEP disclosure. Many participants used a combination of these strategies, adapting their approach to different social contexts.</p><p><strong>Conclusion: </strong>This study highlights the complex strategies adolescent girls engaged in transactional sex in Uganda use to disclose PrEP use amidst significant barriers. The findings emphasize the need for targeted interventions that focus on strengthening peer support, enhancing the role of healthcare providers, and creating safe spaces for disclosure. By integrating these strategies into PrEP delivery models, public health efforts can empower these vulnerable populations to disclose and adhere to PrEP more confidently, improving HIV prevention outcomes.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1517448"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bias by gender: exploring gender-based differences in the endorsement of ADHD symptoms and impairment among adult patients.","authors":"Noemi M Platania, Daniëlle E J Starreveld, Dora Wynchank, Aartjan T F Beekman, Sandra Kooij","doi":"10.3389/fgwh.2025.1549028","DOIUrl":"10.3389/fgwh.2025.1549028","url":null,"abstract":"<p><strong>Background: </strong>Research on adult attention-deficit/hyperactivity disorder (ADHD) remains limited, particularly regarding the experiences of women.</p><p><strong>Methods: </strong>This exploratory study investigates patient responses to the Diagnostic Interview for ADHD in Adults (DIVA-5), which assesses current (adult) and retrospective (childhood) ADHD symptoms based on criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). We focused on overall endorsement rates of ADHD symptoms, impairments, and specific examples of both, with particular attention to gender differences. Using descriptive statistics and chi-square tests, we analysed existing DIVA-5 data from 2,257 adult patients diagnosed with ADHD at mental health clinics affiliated with the Parnassia Groep in the Netherlands.</p><p><strong>Results: </strong>Our findings indicate that ADHD manifests similarly across men and women, though subtle differences in symptom and impairment patterns emerged. Women more frequently endorsed several inattentive and hyperactive/impulsive symptoms in adulthood, whereas men reported higher endorsement rates of several childhood symptoms. Regarding impairments, gender-specific patterns were observed in areas such as self-esteem and social relationships.</p><p><strong>Conclusion: </strong>While these differences were small, they highlight the need for further investigation into gendered ADHD manifestations. Additionally, we discuss potential measurement limitations and propose recommendations for refining the DIVA-5 and advancing research on gender differences in ADHD.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1549028"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intentions for post-abortion contraceptive use among women who received abortion services in health facilities of Harar city and Dire Dawa city.","authors":"Meron Degefa, Nega Assefa, Merga Deresa, Dawit Abebe, Sinetibeb Mesfin","doi":"10.3389/fgwh.2025.1507022","DOIUrl":"10.3389/fgwh.2025.1507022","url":null,"abstract":"<p><strong>Background: </strong>A woman's specific beliefs about contraceptives influence her engagement and adherence to these methods. The intention to use post-abortion contraceptive methods is a critical aspect of reproductive health, particularly for women who have undergone abortion procedures. The use of less effective contraceptive methods, inconsistent usage, and discontinuation significantly contribute to unintended pregnancies, which are a primary cause of abortion. Studies indicate low contraceptive utilization and a high prevalence of abortion in the study area. Therefore, this study aimed to assess the intention to use post-abortion contraceptives and the associated factors among women visiting health facilities for abortion services, utilizing a behavioral model.</p><p><strong>Objective: </strong>To assess intention to use post abortion contraceptive use and associated factors among women visiting health facilities for abortion services in Harari region and Dire Dawa City Administration, eastern Ethiopia.</p><p><strong>Methods: </strong>An institutional-based cross-sectional study was conducted among 609 women who received abortion services in the Harari region and Dire Dawa city administration health facilities. All women who sought abortion services at these health facilities during the study period were included in the research. Data were collected using a structured, interviewer-administered questionnaire. Binary logistic regression was employed to predict the association between dependent and independent variables. Variables with a <i>p</i>-value of less than 0.05 were considered statistically significant.</p><p><strong>Result: </strong>The overall prevalence of intention to use post abortion contraceptive of women came for abortion service was 74.7% (95% CI: 71.3-78.2). Women who had contraceptive use history [AOR 2.580; 95%CI (1.216-5.473)], no pregnancy plan within the next two years [AOR 2.859; 95%CI (1.451-5.635)], positive attitude [AOR 3.335; 95%CI (1.831-6.077)], high level of subjective (perceived) norm [AOR 3.348; 95%CI (1.805-6.210)], high level of perceived behavioral control [AOR 6.784; 95%CI [(3.650-12.607)] were positively associated with intention to use post abortion contraceptive. Women who were divorced [AOR 0.149; 95%CI (0.039-0.578)] and had wanted pregnancy abortion [AOR 0.336; 95%CI (0.153-0.735)] variables were negatively associated with intention to use post abortion contraceptive.</p><p><strong>Conclusion: </strong>This study revealed that more than two-thirds of the participants expressed an intention to use contraception following an abortion. Healthcare providers should offer comprehensive education and counseling on contraceptive options for women post-abortion. Furthermore, it is essential to provide personalized counseling to address each woman's unique needs and concerns regarding contraceptive choices.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1507022"},"PeriodicalIF":2.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing quality of care among maternity waiting home users and non-users in a rural Rwandan hospital.","authors":"Edwin Tayebwa, Richard Kalisa, Amedee Fidele Ndibaza, Jeroen van Dillen, Young-Mi Kim, Jelle Stekelenburg","doi":"10.3389/fgwh.2025.1382577","DOIUrl":"10.3389/fgwh.2025.1382577","url":null,"abstract":"<p><p>Maternal near-miss (MNM) and maternal death (MD) reviews may improve the quality of obstetric care. We assessed the incidence of severe maternal outcomes (SMO) and process indicators among maternity waiting home (MWH) users and non-users in a rural Rwandan hospital. We conducted a retrospective cohort study among women who were eligible for admission to the MWH (users and non-users) at Ruli Hospital in Rwanda and had delivered between January 2015 to December 2019. Using the adapted sub-Saharan Africa (SSA) MNM approach, data for each woman were collected from admission until discharge or death. There were 8,144 deliveries during the study period and 1,305 of them met the criteria for admission at the MWH. There were 326 users and 905 non-users that had live births, respectively. Overall, SMOs were more frequent among MWH non-users [122/905 (13.4%) vs. 8/326 (2.4%) for MWH users]. The leading cause of SMO was post-partum haemorrhage (PPH) (87.5% among MWH users and 45.1% among non-users), followed by sepsis and hypertensive disorders. The MNM incidence ratio was 24.5 for MWH users and 130.4 for non-users. There were four MDs among non-users (MI of 3.3%) due to coincidental conditions and other obstetric complications, and these occurred without admission to the hospital's high dependency unit (HDU). Management of PPH, sepsis and hypertensive complications was optimal. The incidence of SMO was high among MWH non-users. The quality of care in the management of the major causes of SMO was found to be optimal. However, identification and management of coincidental conditions, unanticipated complications of management, and other obstetric complications were not adequate among MWH non-users. There is a need to train health workers to improve the detection and management of these complications to improve quality of care as well as encourage the utilization of MWHs to reduce the burden due to SMO.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1382577"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of intrapartum and newborn care in public healthcare facilities of Wolkite town, Central Ethiopia: facility-based cross-sectional study.","authors":"Berhanu Semra Mulat, Amare Zewdie, Abebaw Wasie Kasahun, Molla Gashu, Adiam Nega, Tamirat Melis","doi":"10.3389/fgwh.2025.1444184","DOIUrl":"10.3389/fgwh.2025.1444184","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Quality of intrapartum and newborn care is increasingly recognized internationally as a critical aspect of the unfinished maternal and newborn health agenda. Although the world has made significant progress in reducing maternal and newborn mortality, there are still far too many preventable and treatable maternal and newborn deaths globally. Poor-quality intrapartum and newborn care along with inadequate access to basic maternal and newborn healthcare services has contributed to high maternal and child mortality in low- and middle-income countries. However, there is not enough evidence describing the status quality of intrapartum and newborn care in Ethiopia, specifically in the study area. Thus, this study aims to assess the quality of intrapartum and newborn care in public health facilities of Wolkite town, Central Ethiopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A facility-based cross-sectional study design was conducted from March to April 2023 among five public health facilities, and observation of health service provision was employed among 185 mothers. A consecutive random sampling method was applied. Data were collected through document review, interview, health service provision observation, and health facility audit against the standard checklist. Quality of intrapartum and newborn care was measured using standard intrapartum and newborn care criteria. Thus, good-quality care was considered if the mother and newborn scored 75% or more of the intrapartum criteria during childbirth. Data were entered, coded, and cleaned using EpiData version 4 and exported to SPSS version 25 for analysis. Descriptive summary statistics including proportions, mean, and median were computed to describe study variables. Multivariable logistic regression analysis was performed to identify factors significantly associated with the outcome variable. Finally, adjusted odds ratios with 95% confidence intervals and &lt;i&gt;p&lt;/i&gt;-values &lt;0.05 were considered to declare the statistical significance level of a variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;The study revealed that the level of good quality of intrapartum and newborn care was 35.1% and 69.7%, respectively. Input quality (AOR = 4.52; 95% CI 1.31, 14.98), health workers with 5 or more years of experience (AOR = 7.23; 95% CI 1.49, 35.84), received on job training (AOR = 5.82; 95% CI 1.91, 13.61), and friendly maternal and newborn care (AOR = 6.89; 95% CI 1.34, 35.62) were significantly associated with quality of intrapartum care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The quality of intrapartum care is found poor in the study area. Clients are not getting intrapartum care with state-of-the-art knowledge and current clinical best practices. Input quality, the experience of healthcare providers, friendly care, and continuous training were factors associated with the quality of intrapartum care. Improving the availability of essential inputs, enhancing the performance of healthcare providers throug","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1444184"},"PeriodicalIF":2.3,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11959051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of adverse birth outcomes among pregnant women in Kintampo municipal hospital, Ghana.","authors":"Issah Sumaila, Mubarick Nungbaso Asumah, Mustapha Hallidu, Abraham Ndekudugu, Shaibu Issifu, Anthony Twum, Collins Boateng Danquah, Helen Agodzo, Paulina Clara Appiah, Fred Adomako Boateng","doi":"10.3389/fgwh.2025.1444566","DOIUrl":"10.3389/fgwh.2025.1444566","url":null,"abstract":"<p><strong>Objective: </strong>To examine the predictors of adverse birth outcomes (ABOs) among pregnant women attending antenatal clinics at the Kintampo Municipal Hospital (KMH) in Ghana.</p><p><strong>Method: </strong>A case-control study was conducted to enrol 408 pregnant women attending antenatal clinic at KMH into the study. Structured questionnaire was used to elicit information from the respondents. Stata version 15 was used to analyse the data. Multiple regression analysis was conducted to determine factors associated with ABOs. Level of statistical significance was established at <i>p</i> < 0.05.</p><p><strong>Results: </strong>Factors that were significantly associated with ABOs were: receiving of ITN (aOR = 2.03, 95% CI: 1.20, 3.45), at least 8 times visits to ANC (aOR = 0.32, 95%CI: 0.15, 0.69), and partner's education (aOR = 0.53, 95%CI: 0.29, 0.96).</p><p><strong>Conclusion: </strong>Contrary to expectations, this study revealed that receiving ITNs during pregnancy was associated with ABOs. Further research is needed to explain why receiving ITNs increases the likelihood of ABOs.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1444566"},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11955594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can theory-driven implementation interventions help clinician champions promote opioid stewardship after childbirth? Protocol for a pragmatic implementation study.","authors":"Michelle H Moniz, Amy M Kilbourne, Alex F Peahl, Jennifer F Waljee, Shelytia Cocroft, Carey Simpson, Lisa Kane Low, Mark C Bicket, Michael J Englesbe, Molly J Stout, Vidhya Gunaseelan, Althea Bourdeau, May Hu, Carrie Miller, Shawna N Smith","doi":"10.3389/fgwh.2025.1504511","DOIUrl":"10.3389/fgwh.2025.1504511","url":null,"abstract":"<p><strong>Background: </strong>Our objective is to determine the effect of a new national clinical practice guideline (CPG) for pain management after childbirth, as implemented with less vs. more intensive implementation support, on postpartum opioid prescribing.</p><p><strong>Methods: </strong>A quasi-experimental analysis will measure the impact of post-childbirth pain management guidelines on opioid prescribing in a statewide hospital collaborative, overall and among key patient subgroups at risk for inequitable care and outcomes. We will also use a randomized, non-responder design and mixed-methods approaches to evaluate the effects of Replicating Effective Programs (REP), a theory-driven, scalable implementation intervention, and Enhanced REP (E-REP; i.e., REP augmented with facilitation, which is individualized consultation with site champions to overcome local barriers) on the uptake of the CPG. The study will include hospitals within the Obstetrics Initiative (OBI), a perinatal collaborative quality initiative funded by Blue Cross Blue Shield of Michigan that includes 68 member hospitals serving more than 120,000 postpartum people, over approximately 15 months. Hospitals not initially responding to REP-defined by performance <15th percentile of all OBI hospitals for (a) inpatient order for opioid-sparing postpartum pain management (e.g., scheduled acetaminophen and non-steroidal anti-inflammatory drugs when not contraindicated), or (b) amount of opioid prescribed at discharge-will be allocated via block randomization to continue REP or to E-REP. Using interrupted time series analyses, the primary analysis will evaluate the rate of postpartum opioid-sparing prescribing metrics at the time of discharge (primary outcome) and opioid prescription refills and high-risk prescribing (secondary outcomes) before and after CPG implementation with REP. We will evaluate inequities in outcomes by patient, procedure, prescriber, and hospital factors. Exploratory analyses will examine temporal trends in patient-reported outcomes and the effects of continued REP vs. E-REP among slower-responder sites. We will evaluate implementation outcomes (e.g., acceptability, feasibility, costs, needed REP and E-REP adaptations) using clinician and patient surveys and qualitative methods (ClinicalTrials.gov identifier: NCT06285123).</p><p><strong>Discussion: </strong>Findings will inform refinements to the REP and E-REP interventions and add to the literature on the effectiveness of facilitation to promote uptake of evidence-based clinical practices in maternity care.</p>","PeriodicalId":73087,"journal":{"name":"Frontiers in global women's health","volume":"6 ","pages":"1504511"},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11949877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}