Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis.

INTRODUCTION: In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women's functionality and healthcare utilisation including use of SBAs' services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. MATERIALS AND METHODS: This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). RESULTS: The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51-0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88-0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03-2.22), or higher education (OR = 4.40, 95% CI = 3.81-5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29-3.73) had higher likelihood of skilled birth attendance. CONCLUSION: These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.

Impact of Key Workplace Breastfeeding Support Characteristics on Job Satisfaction, Breastfeeding Duration, and Exclusive Breastfeeding Among Health Care Employees.

Background: Although national breastfeeding rates have improved across recent decades, women continue to face barriers to achieving recommended breastfeeding targets. Returning to work presents a unique set of challenges for breastfeeding continuation, even in health care settings tasked with promoting breastfeeding among patients. This study examined the association between key workplace breastfeeding support characteristics, job satisfaction, and breastfeeding outcomes among health care employees. Materials and Methods: We used data from a cross-sectional survey of employees in a large integrated health care system. The study sample included female employees who had breastfed in the past 3 years (n = 165). The Employee Perceptions of Breastfeeding Support Questionnaire (EPBS-Q) measured organization, manager, and coworker support for breastfeeding. Regression analyses tested the association between workplace support factors and breastfeeding duration, breastfeeding exclusivity, and job satisfaction. Results: Managerial support increased median job satisfaction by 0.39 standard deviations (p < 0.001), and increased the odds of prolonging exclusive breastfeeding (odds ratio [OR] 1.47; confidence interval [CI] 1.03-2.09). Organizational support increased median job satisfaction by 0.27 standard deviations (p < 0.001), and increased the odds of exclusive breastfeeding by nearly twofold (OR 1.80; CI 1.05-3.09). No significant associations were found between workplace support factors (organizational, managerial, and co-worker support) and overall breastfeeding duration. Conclusions: Organizational and managerial support are key aspects of workplace lactation support, which may positively impact job satisfaction, rates of exclusive breastfeeding, and duration of exclusive breastfeeding among female health care employees. This intersection of outcomes salient for the business community and public health practitioners highlights opportunities for collaborations to improve workplace and breastfeeding outcomes.

Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces.

OBJECTIVES: The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women. METHODS: Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument. RESULTS: A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04). CONCLUSION: The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods. PROSPERO REGISTRATION NUMBER: CRD42018084802.

Comparisons for Effectiveness of Aromatherapy and Acupressure Massage on Quality of Life in Career Women: A Randomized Controlled Trial.

OBJECTIVES: This study was aimed to compare the effectiveness of aromatherapy and acupressure massage intervention strategies on the sleep quality and quality of life (QOL) in career women. DESIGN: The randomized controlled trial experimental design was used in the present study. One hundred and thirty-two career women (24-55 years) voluntarily participated in this study and they were randomly assigned to (1) placebo (distilled water), (2) lavender essential oil (Lavandula angustifolia), (3) blended essential oil (1:1:1 ratio of L. angustifolia, Salvia sclarea, and Origanum majorana), and (4) acupressure massage groups for a 4-week treatment. The Pittsburgh Sleep Quality Index and Short Form 36 Health Survey were used to evaluate the intervention effects at pre- and postintervention. RESULTS: After a 4-week treatment, all experimental groups (blended essential oil, lavender essential oil, and acupressure massage) showed significant improvements in sleep quality and QOL (p < 0.05). Significantly greater improvement in QOL was observed in the participants with blended essential oil treatment compared with those with lavender essential oil (p < 0.05), and a significantly greater improvement in sleep quality was observed in the acupressure massage and blended essential oil groups compared with the lavender essential oil group (p < 0.05). CONCLUSIONS: The blended essential oil exhibited greater dual benefits on improving both QOL and sleep quality compared with the interventions of lavender essential oil and acupressure massage in career women. These results suggest that aromatherapy and acupressure massage improve the sleep and QOL and may serve as the optimal means for career women to improve their sleep and QOL.

An inventory for assessment of female workers' health promotion behaviour based on the integrated model of planned behaviour and self-efficacy.

This study aimed to develop and assess the psychometric properties of an Inventory for Iranian Female Workers' Health Promotion Assessment (IWAHPA). In the first phase of the study a content analysis approach was applied to explore the meaning of health promoting behaviours among female workers. A 120-item questionnaire was developed, based on the integrated model of planned behaviour and self-efficacy. In the second phase the instruments' psychometric properties were assessed. Scale level content validity index was 0.93. Confirmatory factor analysis showed confirmatory factor index 0.97, goodness of fit index 0.95 and root mean square error of approximation 0.05. Concurrent validity versus the Health-Promoting Lifestyle Profile II showed r = 0.60. Cronbach alpha ranged from 0.70 to 0.93 across the subscales. Test-retest reliability revealed no significant differences. The IWAHPA is a culturally sensitive instrument, with a satisfactory level of validity and reliability, that can be used for planning female workers' health services.

Profiles of eight working mothers who practiced exclusive breastfeeding in Depok, Indonesia.

Exclusive breastfeeding practice is generally low because of multifaceted factors internally within mothers themselves and also the surroundings. In addition, studies have consistently found that maternal employment outside the home is related to shorter duration of exclusive breastfeeding. With all these challenges, it is interesting that there are some mothers who manage to exclusively breastfeed their infants. Therefore, this report aims at exploring the characteristics of working mothers who are able to practice exclusive breastfeeding. The original study population was non-working and working mothers who have infants around 1 to 6 months old. The study design is an observational study with a mixed methods approach using a quantitative study (survey) and qualitative methods (in-depth interview) in sequential order. In addition, in-depth interviews with family members, midwives, supervisors at work, and community health workers were also included to accomplish a holistic picture of the situation. The study concludes that self-efficacy and confidence of the breastfeeding mothers characterize the practice of exclusive breastfeeding. Good knowledge that was acquired way before the mothers got pregnant suggests a predisposing factor to the current state of confidence. Home support from the father enhances the decision to sustain breastfeeding.

Working-class Filipino women's perspectives on factors that facilitate or hinder prenatal micronutrients supplementation to prevent congenital anomalies.

The study was conducted to plan for a community-health campaign to inform working-class Filipinos about the causes and prevention of orofacial clefting. Prenatal micronutrients may play a role in preventing orofacial clefting. Therefore, women's practices and perspectives on barriers to and facilitators of micronutrient supplementation were elicited. A total of 43 women and 22 health care workers were interviewed. Barriers to taking supplements included side effects, late prenatal care, the view that micronutrients are medications, inadequate supply, and health care workers who were unaware that prenatal vitamin supplements prevent congenital anomalies. The main facilitator was women's understanding that prenatal micronutrients improve the physical well-being of both mother and child. Given that women view having healthy babies as a reason to take micronutrients and that the health care workers lacked knowledge related to the use of micronutrients to prevent congenital anomalies, uptake of prenatal micronutrient supplementation programs may improve by specifically promoting the health benefit of preventing congenital anomalies.

Sexually transmitted infections among female sex workers in Hong Kong: the role of migration status.

OBJECTIVES: Female sex workers (FSW) have been considered reservoirs and vectors of sexually transmitted infections (STI) in the community. This study estimated the prevalence of STI/human immunodeficiency virus (HIV) among FSW of various migration and residential status in Hong Kong and identified possible risk factors. METHODS: An outreach "Well-women" clinic was set up at Ziteng, a non-governmental organization working with FSW. Details of their lifestyle and health risk behavior were gathered before screening tests were performed, and the data were analyzed according to their place of origin. RESULTS: A total of 503 FSW were screened for STI/HIV between 2005 and 2007. Syphilis, gonorrhea, chlamydia, and HIV accounted for 1.8, 1.8, 4.6, and 0.2%, respectively. After adjusting for confounders, having ≥ 2 sexual partners (odds ratio [OR] 8.33, 95%CI: 2.17-33.46), residence status (OR 0.38, 95%CI: 0.17-0.89), and daily frequency of douching (OR 3.02, 95%CI: 1.23-7.35) were identified as significant predictors. CONCLUSIONS: This study provides important insights on the screening and associated risk factors of STI among FSW working in Hong Kong. The contextual factors identified reflect the social and geographical context in which these women are operating and how they protect their health using their own means. These findings encourage policymakers and health professionals to redirect their focus and resources to a more holistic approach to sexual health when planning and implementing effective STI/HIV prevention programs.

Work as a nurse and a midwife and adverse pregnancy outcomes: a Finnish nationwide population-based study.

OBJECTIVE: To assess whether work as a nurse and a midwife during pregnancy increases the risk of adverse pregnancy outcomes. METHODS: We identified from the 1990-2006 Finnish Medical Birth Registry all singleton births to nurses (n=109,542), midwives (n=3,009), and teachers (n=23,454) (referents). The main outcomes were sexual differentiation, low and high birth weight, preterm and postterm delivery, small and large for gestational age, and perinatal death. RESULTS: The prevalence of low birth weight (2.9% vs. 2.5%), preterm delivery (4.4% vs. 4.1%), postterm delivery (4.7% vs. 4.1%), small for gestational age (1.8% vs. 1.4%), perinatal death (0.45% vs. 0.41%) and stillbirth (0.30% vs. 0.25%) was higher among the newborns of nurses than those of teachers. The adjusted odds ratio (OR) from generalized estimating equations was 1.17 (95% confidence interval [CI] 1.07-1.26) for low birth weight, 1.09 (95% CI 1.02-1.16) for preterm delivery, 1.11 (95% CI 1.03-1.18) for postterm delivery, 1.17 (95% CI 1.05-1.30) for small for gestational age, 1.12 (95% CI 0.90-1.35) for perinatal death, and 1.27 (95% CI 0.98-1.56) for stillbirth. For midwives, the risk of small for gestational age (OR=1.25, 95% CI 0.95-1.55) was elevated, but the 95% CI included unity. There was no substantial difference in the sex distribution. CONCLUSIONS: This study provides evidence that work as a nurse may reduce fetal growth and duration of pregnancy. The inference is based on the newborns of teachers as the reference group. However, the prevalence of most of the outcomes was higher among the newborns of all other working women combined than in the newborns of both nurses and teachers.

The impact of a small steady stream of income for women on family health and economic well-being.

Our primary aim to evaluate the impact of a small steady stream of income on family health and well-being among rural women employed part-time in a health project in Sarlahi district, Nepal. All 870 women applying for the job of distributing nutritional supplements in their villages completed a questionnaire prior to selection for employment, 350 of whom were hired and 520 who were not. A total of 736 women completed a second questionnaire 2 years later, 341 (97.4%) of whom had been continuously employed during this period, and 395 (76.0%) who had never been employed by the project. Changes in health and well-being over 2 years were compared between women who were and were not hired. Women who were hired were younger and better educated, but were similar in other regards. After adjusting for selection differences, employed women were more likely to save cash, buy jewellery, and buy certain discretionary household goods over 2 years than those who were not hired. Expenditures on children's clothing increased more for employed women, and their children were more likely to be in private schools at follow-up, but there was no impact on health and survival of children. Women with a small steady stream of income did improve their personal economic situation by savings and increased expenditures for children and the household. Longer follow-up may reveal impacts on health access and expenditures, although these were not evident in 2 years of employment.

Mind over matter: exploring job stress among female blue-collar workers.

Although overall health has been defined holistically as the integration of a person's optimal mental, physical, social, intellectual, and spiritual well-being, a mental health focus remains on the fringe of many public health efforts. This report describes recent efforts by the Centers for Disease Control and Prevention (CDC) to explore job stress among female blue-collar workers. Using a more holistic approach to understand its impact on blue-collar women's overall health, health-related quality of life (HRQOL) was used to assess optimal human performance. Attempting to encapsulate how overall health affects one's ability to participate and fulfill daily personal/professional tasks, HRQOL yields a broader understanding of the interaction between psychological well-being (mind) and physical functioning (matter). Embedding CDC HRQOL-4 measures into a questionnaire used as part of a larger mixed methods project, blue-collar women responded to questions about their health, including both mental and physical. For these female workers, mental health appeared to be of greater consequence, which could be interpreted as mind being more significant than matter. This paper highlights the findings related to HRQOL issues experienced by these female blue-collar workers and summarizes recommendations for effective individual and organizational approaches to address job stress.

Time to pregnancy and occupation in a group of Italian women.

BACKGROUND: It is estimated that 10-15% of all couples have experienced an infertility problem. The objective of this study was to evaluate the effect of occupation on the time interval between when a couple starts unprotected intercourse and a clinically recognizable pregnancy time to pregnancy (TTP). METHODS: Data from 622 women who successfully delivered in the week preceding the interview were analysed using the Cox proportional hazards regression. Thirty independent variables were included in the full model. RESULTS: Eleven per cent of women had to wait more than one year before conceiving (mean TTP = 6.7 months). The regression analysis showed that the most important determinants of TTP are the age of the woman (rate ratio = 0.44 for age 35+) and her parity (rate ratio = 1.39). TTP also increased significantly with maternal smoking (rate ratio = 0.77), and decreased with coital frequency (rate ratio = 1.24 for > or = 6 per month) and consumption of coffee (rate ratio = 1.29). None of the female occupational exposures has been found to have an independent statistically significant effect, while male occupation in industry and exposure to welding fumes were associated with an increase of TTP (rate ratio = 0.73 and 0.78, respectively). CONCLUSIONS: Female occupational exposures seem to have only a small effect on TTP compared with biological and lifestyle factors. The present data also suggest that work-related factors may have a bigger influence on male fecundity.