Interstices of power: considerations of women’s health and agency through creative nonfiction

The purpose of this thesis is to write a collection of personal narrative, creative nonfiction essays based on my study abroad experiences in India, South Africa, and Brazil. I conducted preliminary, case study, and ethnographic research on women’s and maternal health across these sites. In my essays, I consider the many ways in which subjects embody larger hierarchies of power, how this relates to subject agency, and how this affects health. In particular, I pay attention to 1) the relationship between education and health, 2) how racial identity affects access to resources, and 3) how individual and social agency play a role in securing adequate healthcare and in creating healthy environments. I critically consider the ways in which the creative nonfiction form is a valuable practice for thinking with and through stories and encounters. By writing in this genre, I seek to critically analyze dynamic power relations - both their implications and possible contradictions.

Opportunities and barriers in global women's health training during obstetrics and gynecology residencies in the USA.

OBJECTIVE: To systematically measure the scope and breadth of global women's health (GWH) training opportunities during obstetrics and gynecology residencies in the USA, as described by program directors (PDs). METHODS: In a questionnaire-based study, PDs were asked to complete a web-based survey between January 1 and March 15, 2013. Information about the residency program and GWH opportunities was obtained. RESULTS: Among 236 PDs contacted, 105 (44.5%) responded. Overall, 82 (78.1%) reported that at least one resident had participated in a GWH rotation during the past 5 years, 36 (34.3%) offered formal didactics, and 29 (27.6%) offered a formal rotation in GWH. Among all respondents, 43 (42.2%) reported having at least one faculty member for whom GWH is a dedicated part of their practice. Programs with dedicated GWH faculty were more likely to offer formal GWH didactics (relative risk [RR] 1.84; 95% confidence interval [CI] 1.07-3.14; P=0.03), but were not significantly more likely to offer a formal GWH rotation (RR 1.91; 95% CI 0.97-3.70; P=0.06). CONCLUSION: Many residency programs provide opportunities for GWH training, but few offer formal didactics or a formal rotation.

Foundations for a novel emergency medicine subspecialty: sex, gender, and women's health.

Sex and gender affect all aspects of health and disease, including pathophysiology, epidemiology, presentation, treatment, and outcomes. Sex- and gender-specific medicine (SGM) is a rapidly developing field rooted in women's health; however, inclusion of SGM in emergency medicine (EM) is currently lacking. Incorporating principles of sex, gender, and women's health into emergency care and training curricula is an important first step toward establishing a novel subspecialty. EM is an ideal specialty to cultivate this new field because of its broad interdisciplinary nature, increasing numbers of patient visits, and support from academic medical centers to promote expertise in women's health. This article describes methods used to establish a new multidisciplinary training program in sex, gender, and women's health based in a department of EM. Women's health and SGM program initiatives span clinical care, patient education, clinical research, resident and fellow training, and faculty development.

Back to the future: a history of ACOG in social media's golden age.

PURPOSE OF REVIEW: To chronicle a medical professional society's adoption of innovation and to describe themes pertinent to the adoption. RECENT FINDINGS: In September 2013, the American College of Obstetricians and Gynecologists (ACOG) published a Committee Opinion on Toxic Environmental Agents that included an infographic and social media awareness campaign. To date, it claims one of the highest total audience reaches for an ACOG Facebook post reaching nearly 18 000 viewers. Despite this powerful promise, ACOG's timely and successful social media campaign did not always appear an obvious strategy. Although social media took hold of popular culture in the early 2000s, social media's professional etiquette remained uncharted and rife, with cautionary tales through the latter half of the decade. SUMMARY: Through a thoughtful and dedicated process, the ACOG Fellow and Junior Fellow leadership partnered to navigate the appropriate balance of innovation and prudence that propelled ACOG into social media's golden age, and paved the pathway for more progressive institutional changes.

Harnessing information technology to improve women's health information: evidence from Pakistan.

BACKGROUND: More than half of Pakistani women are illiterate, marginalized, and experience myriad health problems. These women are also disadvantaged in terms of their restricted mobility and limited access to public space. Nonetheless, user-friendly information and communication technologies (ICTs) have opened up new opportunities to provide them with information that is essential for their health and well-being. METHODS: We established an Information and Communication Centre (ICC) in a village in Sialkot (Pakistan) on a pilot basis in 2009. The basic philosophy of the ICC was to provide women with health-related information by exposing them to modern sources of information on their doorstep. By design, the ICC was a community-based and community-managed institution where women could access information through online (e.g., internet, mobile phone etc.) and offline (e.g., CDs, TV etc.) resources. The ICC was managed by a group of local volunteer women who had the capacity and skills to use the devices and tools of modern ICTs. RESULTS: We noted an overwhelming participation and interest from local women in the activities of the ICC. The women wanted to receive information on a wide range of issues, from family planning, antenatal care, and childcare to garbage disposal and prevention of domestic violence. Overall, the ICC was successful in initiating a meaningful "information dialogue" at community level, where much-needed information was retrieved, negotiated, mediated, and disseminated through intimate and trusted relations. CONCLUSION: We conclude that ICTs have the capacity to cross the barriers of illiteracy and can reach out to disadvantaged women living under a conservative patriarchal regime.

Peri-partum and pelvic floor dysfunction.

Pelvic floor muscles (PFM) are the layer of muscles that support the pelvic organs and span the bottom of the pelvis. Weakened PFM mean the internal organs are not fully supported and can lead to difficulties controlling the release of urine, faeces or flatus. Pregnancy and vaginal birth are a recognised cause of PFM weakness; however it has been shown that PFM exercises, if carried out correctly and routinely, can reduce the severity of symptoms. Midwives need to be pro-active in teaching PFM exercises and identifying women who may need to be referred on for more specialist treatment.

Are primary health care workers aware of cervical cancer risk?

BACKGROUND: We here examined the awareness of female health employees (doctors, nurses, midwives) working in primary health care service about cervical cancer and its risk factors. Additionally attitude and behavior for gynecologic examination and pap smear screening were researched. MATERIALS AND METHODS: This cross-sectional, descriptive study concerned female health employees working at primary health care services in two southern cities of Turkey, over a four month period in 2013. Participants were recently or previously sexually active research was explained and verbal informed consent was obtained face to face. The questionnaire consisted of two parts; socio-demographic characteristics and level of knowledge about cervical cancer and its risk factors. RESULTS: The average age of the participants (midwives 43.7%, n=143; nurses 40.4%, n=132; doctors 6.4%, n=21; emergency medical technicians and others, 9.5%, n=31; total, n=327) was 30.9±6.41 years. 64.2% (n=210) were working in Diyarbakir and 35.8% (n=117) in Batman. A large proportion reported low knowledge and inadequate screening practice Conclusions: Health employees should be better informed about the importance of screening for cancers, given their preventive roles for the general population.

Developing future leaders in reproductive health through a scholarly concentration for medical students.

OBJECTIVES: To evaluate the impact of a scholarly concentration for medical students, which aims to develop students' research, clinical and advocacy skills to promote women's reproductive health. STUDY DESIGN: Scholarly concentration programs provide opportunities to engage in scholarship beyond the traditional medical school curriculum. Faculty from the Family Medicine and Obstetrics and Gynecology Departments at Brown University collaboratively developed the Scholarly Concentration in Women's Reproductive Health. Three to five students per class enroll and carry out a 3-year mentored research project, attend monthly seminars, write position papers on reproductive health controversies and complete clinical electives in reproductive health. Students are required to disseminate their work through conference presentations and/or peer-reviewed publications. The program evaluation included measures of scholarly productivity and qualitative analyses of interviews with students and mentors as well as written and verbal feedback from students. RESULTS: Ten students comprised the first 3 classes completing the program, producing 24 national presentations and 9 peer-reviewed publications. Reported program benefits included increased knowledge, scholarship skills and support for career development in reproductive health. Key factors facilitating these results were as follows: effective mentoring relationships, the community of practice that emerged through the monthly seminars and student independence in project work. CONCLUSIONS: A scholarly concentration for medical students provides a unique platform to support the development of talented students as future leaders in women's reproductive health.

[Health prevention workshops for women in the north of Marseille]. / Des ateliers santé-prévention pour les femmes des quartiers nord de Marseille.

The team of the health commission of the Bouches-du-Rhône Secours Populaire is made up of nurses, midwives, child healthcare nurses and doctors. Either retired or still working, all are volunteers and run health education workshops for women in the northern districts of Marseille.

The free perinatal/postpartum contraceptive services project for migrant women in Shanghai: effects on the incidence of unintended pregnancy.

OBJECTIVE: In 2006, the incidence of unintended pregnancy among rural-to-urban migrant women (RUMW) in Shanghai was reported as 12.8 per 100 women-years during the first year postpartum. Among permanent residents of Shanghai, that same rate was 3.8 per 100 women-years. An intervention study was designed to address the unmet need for family planning services among this underserved population of RUMW and reduce their high postpartum unintended pregnancy incidence. STUDY DESIGN: We enrolled 840 migrant women into an intervention study that provided free contraceptive counseling and a choice of methods. Subjects were recruited into the study during hospitalization for childbirth and offered a contraceptive method according to their choice prior to discharge. Counseling and further support were offered at 6 weeks and at 3, 6, 9 and 12 months postpartum via scheduled telephone calls and/or clinic visits. RESULTS: Among all study participants, the median time to contraceptive initiation and sexual resumption was 2 months postpartum, respectively. The overall contraceptive prevalence at 12 months was 97.1%, and more than half of the women were using long-acting contraception. The incidence rate of unintended pregnancy during the first year postpartum was 2.2 per 100 women-years (95% confidence interval: 1.3-3.6). CONCLUSIONS: Integrating free family planning services into existing childbirth delivery services in a maternity setting in Shanghai was effective in addressing the unmet need for family planning and reduced the risk of unintended pregnancy during the first year postpartum. IMPLICATIONS: The maternity setting at the time of early labor and prior to postpartum hospital discharge is a practical venue and an optimal time to provide contraception counseling and for postpartum women to initiate use of contraceptive methods. Supporting services during the first year postpartum are also essential to encourage women to continue contraceptive use and reduce the incidence of postpartum unintended pregnancy.

Do medical students want to learn about global health?

BACKGROUND: One objective of the United Nations Global Strategy for Women's and Children's Health relates to ensuring a sufficiently skilled workforce. To prepare future healthcare professionals for their role in the 21st century as members of this workforce, awareness of global health is essential, but few studies have explored student perspectives on such education. The main objectives of this study were to establish the views of medical students on learning about women's and children's health in low-income countries, to identify the nature and extent of learning already experienced, and to assess the demand for such learning. DESIGN: A questionnaire survey was conducted at three meetings of the International Federation of Medical Students Associations (IFMSA). Questionnaires were distributed to 500 participants from 75 countries and 336 medical schools, and 492 usable questionnaires were returned. Data were analysed using SPSS Version 20 and statistical analysis was undertaken using Fisher's exact test. RESULTS: There were 492 questionnaires included in the analysis. Forty-eight per cent of participants were from low-middle income countries and 52% were from high-income countries. Less than half (43%) of the respondents had received some teaching on women's and children's health in low-income countries. Teaching received was primarily (96%) through lectures in the second year of study. Ninety-one per cent of respondents thought such teaching would be important and stated that group work (66%) would be the preferred method. In total, only 14% thought they had received sufficient teaching on global health and on women's and children's health in low-income countries. CONCLUSIONS: This study has revealed a high demand among medical students for global health teaching, particularly on women's and children's health in low-income countries. The timing and methods of existing teaching on these topics does not match that desired by medical students. To help address this gap, a collaborative approach is proposed which includes students' views in the processes for revitalising medical curricula to meet the needs of the 21st century.

National survey on psychosocial obstetrics and gynecology curriculum in US medical schools.

INTRODUCTION: This study sought to identify how psychosocial topics related to women's health are taught and assessed in the obstetrics/gynecology program of American medical schools, and what issues may prevent or promote their instruction. METHODS: A questionnaire was distributed to the ob/gyn clerkship director of every US medical school. Directors were asked whether each of four recommended topics were covered in their curricula. They were also asked about barriers to instructing topics not taught, and the importance of these topics. RESULTS: Out of 136 US medical schools, 57 questionnaires were returned (response rate = 40.4%). In all, 27 schools (48%) include formal training in pregnancy-related mood disorders, 33 (58%) include pre-menstrual syndrome/pre-menstrual dysphoric disorder, 29 (51%) include female sexual dysfunction and 45 (79%) include violence against women. Six schools (12%) listed none of these topics as taught. All but three of the clerkship directors agreed that psychosocial topics are important. The most common reason given for lack of instruction was insufficient time allotted. CONCLUSIONS: Despite agreement on their importance, many US medical schools do not teach psychosocial aspects of women's health. Addressing the barriers to teaching these topics would help provide medical students with more opportunities to learn about these issues.

Extended use of the intrauterine device: a literature review and recommendations for clinical practice.

There are multiple advantages to "extended use" of the intrauterine device (IUD) use beyond the manufacturer-approved time period, including prolongation of contraceptive and non-contraceptive benefits. We performed a literature review of studies that have reported pregnancy outcomes associated with extended use of IUDs, including copper IUDs and the levonorgestrel intrauterine system (LNG-IUS). Among parous women who are at least 25 years old at the time of IUD insertion, there is good evidence to support extended use of the following devices: the TCu380A and the TCu220 for 12 years, the Multiload Cu-375 for 10 years, the frameless GyneFix® (330 mm²) for 9 years, the levonorgestrel intrauterine system 52 mg (Mirena®) for 7 years and the Multiload Cu-250 for 4 years. Women who are at least 35 years old at the time of insertion of a TCu380A IUD can continue use until menopause with a negligible risk of pregnancy. We found no data to support use of the LNG-IUS 13.5 mg (Skyla®) beyond 3 years. When counseling about extended IUD use, clinicians should consider patient characteristics and preferences, as well as country- and community-specific factors. Future research is necessary to determine the risk of pregnancy associated with extended use of the copper IUD and the LNG-IUS among nulliparous women and women less than 25 years old at the time of IUD insertion. More data are needed on the potential effect of overweight and obesity on the long-term efficacy of the LNG-IUS.

Integrated women's health program.

PROBLEM ADDRESSED: Residents in family medicine residency programs require comprehensive training in women's health best practices and resources. OBJECTIVE OF PROGRAM: To provide a framework for the development and implementation of an integrated women's health curriculum for family medicine residency programs. PROGRAM DESCRIPTION: Objectives for each element of the program were the basis for planning the curriculum. Residents experienced primary care obstetrics clinic and on-call shifts, 24-hour off-service on-call shifts, women's health horizontals, and a women's health workshop, all of which were integrated into a 6-month family medicine block time. Residents worked with family physicians, obstetricians and gynecologists, and multidisciplinary health care team members in clinical settings. Teaching objectives were aligned with CanMEDS-Family Medicine core competencies. Creation of this program and its implementation were accomplished by dedicated teachers, administrators, and faculty members involved in curriculum planning. CONCLUSION: The program design and implementation resulted in an improved comprehensive women's health training experience for residents, which was integrated into a family medicine context. Ongoing evaluation and innovation will serve to continually improve this program.

Translating Latin American/US Latina frameworks and methods in gender and health equity: linking women's health education and participatory social change.

This article applies transdisciplinary approaches to critical health education for gender equity by analyzing textual and political strategies translating/culturally adapting the U.S. feminist health text, Our Bodies Ourselves (OBOS), for Latin American/Caribbean and U.S. Latina women. The resulting text, Nuestros Cuerpos, Nuestras Vidas (NCNV), was revised at multiple levels to reflect different cultural\sociopolitical assumptions connecting individual knowledge, community-based and transnational activist organizations, and strategic social change. Translation/cultural adaptation decisions were designed to ensure that gender-equitable health promotion education crossed cultural borders, conveying personal knowledge and motivating individual actions while also inspiring participation in partnerships for change. Transdisciplinary approaches integrating critical ecosystemic frameworks and participatory methods can help design health promotion education mobilizing engaged, gender-equitable health citizenship supporting both personal and societal change.