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.

[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.

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.

Needs and priorities in women's health training: perspectives from an internal medicine residency program.

BACKGROUND: Few studies have examined residents' perspectives on the adequacy of women's health (WH) training in internal medicine (IM). This study sought residents' opinions regarding comfort level managing 13 core WH topics, their perceived adequacy of training in these areas, and the frequency with which they managed each topic. The association between reported comfort level and perceived adequacy of training and management frequency was also assessed. METHODS: A 67-item questionnaire was administered from April to June 2009 to 100 (64%) of the 156 residents from the traditional, primary care, and IM-pediatrics residency programs at a single institution. Descriptive and correlation statistics were used to examine the relationships between self-reported comfort level, perceived adequacy of training opportunities, and frequency managing WH issues. Data was stratified by sex, IM program, and post-graduate year (PGY). RESULTS: The majority of residents reported low comfort levels managing 7 of 13 topics. Over half of residents perceived limited training opportunities for 11 of 13 topics. With the exception of cardiovascular disease in women, greater than 75% of residents reported managing the 13 topics five or more times in the prior 6 months. Correlation analysis suggested a linear relationship between low comfort levels and limited training opportunities, and between low comfort levels and low frequency managing WH topics (r=0.97 and r=0.89, respectively). Stratified analyses by sex, IM program, and PGY showed no significant differences. CONCLUSIONS: Key gaps remain in WH training. Our results emphasize the importance of reinforcing WH training with hands-on management opportunities. Understanding institution-specific strengths and weaknesses may help guide the development of targeted initiatives.

Embedding concepts of sex and gender health differences into medical curricula.

Sex, a biological variable, and gender, a cultural variable, define the individual and affect all aspects of disease prevention, development, diagnosis, progression, and treatment. Sex and gender are essential elements of individualized medicine. However, medical education rarely considers such topics beyond the physiology of reproduction. To reduce health care disparities and to provide optimal, cost-effective medical care for individuals, concepts of sex and gender health need to become embedded into education and training of health professionals. In September 2012, Mayo Clinic hosted a 2-day workshop bringing together leading experts from 13 U.S. schools of medicine and schools of public health, Health Resources and Services Administration Office of Women's Health (HRSA OWH), the National Institutes of Health (NIH) Office of Research on Women's Health (ORWH), and the Canadian Institute of Health and Gender. The purpose of this workshop was to articulate the need to integrate sex- and gender-based content into medical education and training, to identify gaps in current medical curricula, to consider strategies to embed concepts of sex and gender health into health professional curricula, and to identify existing resources to facilitate and implement change. This report summarizes these proceedings, recommendations, and action items from the workshop.

[What patients need to know about the risk of bone fracture and its prevention]. / Ce que les patientes doivent savoir sur le risque osseux et sa prévention.

Post-menopausal osteoporosis is one of the classic complications of prolonged estrogen deficiency associated with menopause. It is defined as a state of the skeleton characterized by decreased bone strength with an increased risk of fracture. The natural history of osteoporosis and, in particular, the rapid increase in fracture recurrence after a first major fracture should justify a priori an approach for early detection of women at higher risk from the early postmenopausal phase. It is more of a chronic disease that requires support in the long term, in the absence of a truly curative treatment. Indeed, currently available therapies can at best reduce the incidence of fractures by about 50%, especially at the vertebral site, but do not cancel the disease. Moreover, duration of treatment is currently recommended for 5 to 10 years, which does not allow to consider that a single molecule could be taken "for the whole life". The fracture risk assessment based on the combination of densitometric measurement by DXA and the search for clinical risk factors is a prerequisite to any therapy. The first choice of treatment is especially important for a relatively young woman with high fracture risk. In early menopause (generally within the first decade of post-menopausal) and in the absence of contraindication, menopausal hormone therapy should remain the preferred option for first-line whenever possible. Raloxifene is an interesting alternative, due to its mechanisms of action and multiplicity of targets with, in particular, its preventive effect on the risk of estrogen receptor-positive breast cancer. It is only when there are contraindications to one or the other of these two molecules, that other osteoporosis treatments can be discussed. They should nevertheless be considered only in women whose 10-year-fracture risk is significantly increased. Indeed, it is mainly in this high risk of fracture, particularly because of an age greater than 65 years and a history of vertebral fracture, that their antifracture efficacy has been validated. In addition, it is mostly beyond this age that the question of the prevention of hip fracture has to be considered.

A demographic explanation for the recent rise in European fertility.

Between 1998 and 2008 European countries experienced the first continent-wide increase in the period total fertility rate (TFR) since the 1960s. After discussing period and cohort influences on fertility trends, we examine the role of tempo distortions of period fertility and different methods for removing them. We highlight the usefulness of a new indicator: the tempo- and parity-adjusted total fertility rate (TFRp*). This variant of the adjusted total fertility rate proposed by Bongaarts and Feeney also controls for the parity composition of the female population and provides more stable values than the indicators proposed in the past. Finally, we estimate levels and trends in tempo and parity distribution distortions in selected countries in Europe. Our analysis of period and cohort fertility indicators in the Czech Republic, Netherlands, Spain, and Sweden shows that the new adjusted measure gives a remarkable fit with the completed fertility of women in prime childbearing years in a given period, which suggests that it provides an accurate adjustment for tempo and parity composition distortions. Using an expanded dataset for ten countries, we demonstrate that adjusted fertility as measured by TFRp* remained nearly stable since the late 1990s. This finding implies that the recent upturns in the period TFR in Europe are largely explained by a decline in the pace of fertility postponement. Other tempo-adjusted fertility indicators have not indicated such a large role for the diminishing tempo effect in these TFR upturns. As countries proceed through their postponement transitions, tempo effects will decline further and eventually disappear, thus putting continued upward pressure on period fertility. However, such an upward trend may be obscured for a few years by the effects of economic recession.

What do women know about government services and benefits?

This article examines how much women know about government services and benefits and discusses why this type of knowledge matters. Using data from a survey as well as focus groups conducted in Montreal and Toronto, we show that the women who are most likely to need information about these programs are often the least likely to be aware of them. This is especially true of low-income women, older women, and women who came to Canada as immigrants. We end by suggesting some steps that could be taken to address these knowledge gaps.

"Hunnish scenes" and a "Virgin birth": a 1920s case of sexual and bodily ignorance.

When, in June 1921, a clairvoyant informed Christabel Russell, to her great surprise, that she was pregnant, her husband denied paternity and petitioned for divorce on grounds of adultery. The Hon. John Russell claimed that on the very few occasions that they had slept in the same bed in their two and half years of marriage, his method of birth control (which she referred to disapprovingly as "Hunnish scenes") had made pregnancy impossible. What added to the sensational nature of the case was the revelation that whilst pregnant, Christabel's hymen was unbroken ­ hence the claims of a "virgin birth." Two divorce trials and two appeals followed. The first trial ended inconclusively, the second trial was won for John Russell by the eminent barrister Sir Edward Marshall-Hall, but on the second appeal, in the House of Lords, it was ruled that evidence questioning the legitimacy of a child born in wedlock was inadmissible. The decree nisi was rescinded and the baby was legitimized.

From comprehensive medicine to public health at the University of Cape Town: a 40-year journey.

We explore the history of the School of Public Health at the University of Cape Town and its relationship to changes in the understanding of the role of public health both nationally and internationally. We draw from primary and secondary sources to trace the emergence, growth and development of the School, and to situate these processes within the socio-political, clinical and public health contexts in South Africa and internationally.

Care workers, care drain, and care chains: reflections on care, migration, and citizenship.

In this article, we discuss a case study that deals with the care chain phenomenon and focuses on the question of how Poland and the Ukraine as sending countries and Poland as a receiving country are affected and deal with female migrant domestic workers. We look at the ways in which these women organize care replacement for their families left behind and at those families' care strategies. As public discourse in both countries is reacting to the feminization of migration in a form that specifically questions the social citizenship obligations of these women, we also look at the media portrayal of the situation of nonmigrating children. Finally, we explore how different aspects of citizenship matter in transnational care work migration movements.

Outdoor brothel culture: the un/making of a transsexual stroll in Vancouver's West End, 1975­1984.

In the mid-1970s, following a series of police raids on prostitution inside downtown nightclubs, a community of approximately 200 sex workers moved into Vancouver's West End neighborhood, where a small stroll had operated since the early 1970s. This paper examines the contributions made by three male-to-female (MTF) transsexuals of color to the culture of on-street prostitution in the West End. The trans women's stories address themes of fashion, working conditions, money, community formation, violence, and resistance to well-organized anti-prostitution forces. These recollections enable me to bridge and enrich trans history and prostitution history ­ two fields of inquiry that have under-represented the participation of trans women in the sex industry across the urban West. Acutely familiar with the hazards inherent in a criminalized, stigmatized trade, trans sex workers in the West End manufactured efficacious strategies of harm reduction, income generation, safety planning, and community building. Eschewing the label of "victim", they leveraged their physical size and style, charisma, contempt towards pimps, earning capacity, and seniority as the first workers on the stroll to assume leadership within the broader constituency of "hookers on Davie Street". I discover that their short-lived outdoor brothel culture offered only a temporary bulwark against the inevitability of eviction via legal injunction in July 1984, and the subsequent rise in lethal violence against all prostitutes in Vancouver, including MTF transsexuals.

Isolated in a technologically connected world?: Changes in the core professional ties of female researchers in Ghana, Kenya, and Kerala, India.

Using panel data gathered across two waves (2001 and 2005) from researchers in Ghana, Kenya, and Kerala, India, we examine three questions: (1) To what extent do gender differences exist in the core professional networks of scientists in low-income areas? (2) How do gender differences shift over time? (3) Does use of information and communication technologies (ICTs) mediate the relationship between gender and core network composition? Our results indicate that over a period marked by dramatic increases in access to and use of various ICTs, the composition and size of female researchers core professional ties have either not changed significantly or have changed in an unexpected direction. Indeed, the size of women's ties are retracting over time rather than expanding.

Black women talk about workplace stress and how they cope.

Black women face the same struggles as White women; however, they have to face issues of diversity on top of inequality. The purpose of this study was to explore work-related stressors that affect the lives of Black women and how they cope with them. Using an exploratory design with grounded-theory methods, five basic themes emerged that identify when racism and sexism are experienced as stressors for African American women in the workplace. The themes are: (1) being hired or promoted in the workplace, (2) defending one's race and lack of mentorship, (3) shifting or code switching to overcome barriers to employment, (4) coping with racism and discrimination, and (5) being isolated and/or excluded. The results from this study indicate African American women use emotion- and problem-focused coping responses to manage stress (e.g., racism and sexism) in the workplace. The article concludes with a discussion of practice implications of these findings.