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1.
J Interpers Violence ; : 886260520987812, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33480313

RESUMO

Assessing progress toward Sustainable Development Goal (SDG) 5, to achieve gender equality and to empower women, requires monitoring trends in intimate partner violence (IPV). Current measures of IPV may miss women's experiences of economic coercion, or interference with the acquisition, use, and maintenance of financial resources. This sequential, mixed-methods study developed and validated a scale for economic coercion in married women in rural Bangladesh, where women's expanding economic opportunities may elevate the risks of economic coercion and other IPV. Forty items capturing lifetime and prior-year economic coercion were adapted from formative qualitative research and prior scales and administered to a probability sample of 930 married women 16-49 years. An economic coercion scale (ECS) was validated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with primary data from random-split samples (N1 = 310; N2 = 620). Item response theory (IRT) methods gauged the measurement precision of items and scales over the range of the economic-coercion latent trait. Multiple-group factor analysis assessed measurement invariance of the economic-coercion construct. Two-thirds (62.26%) of women reported any lifetime economic coercion. EFA suggested a 36-item, two-factor model capturing barriers to acquire and to use or maintain economic resources. CFA, multiple group factor analysis, and multidimensional IRT methods confirmed that this model provided a reasonable fit to the data. IRT analysis showed that each dimension provided most precision over the higher range of the economic coercion trait. The Economic Coercion Scale 36 (ECS-36) should be validated elsewhere and over time. It may be added to violence-specific surveys and evaluations of violence-prevention and economic-empowerment programs that have a primary interest measuring economic coercion. Short-form versions of the ECS may be developed for multipurpose surveys and program monitoring.

2.
Cult Health Sex ; : 1-16, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33512308

RESUMO

Social norms surrounding sex and relationships remain gendered among young people in Vietnam, with men maintaining a privileged role in heterosexual relationships. This analysis explored how university students in Vietnam perceived prevailing gender norms, and how these norms influenced men's understanding of sexual consent in dating relationships. This analysis drew primarily on in-depth interviews with heterosexual men and secondarily from interviews with women attending two universities in Hanoi in 2018. Thematic analysis of the interviews revealed a broader narrative about how prevailing gender norms shape men's dating behaviour and beliefs about consent. Participants expected young men to be independent and decisive. Men were seen as free to initiate dating and sexual encounters. Some participants expected young women to be accommodating in dating relationships, although acceptable relationships for women were restricted, and premarital sex was a reputational risk. Most participants described cues for consent and non-consent for sex; however, dismissal of women's refusals, and normalised sexual coercion were common. Among university men in Hanoi, gender norms privileging men and growing expectations of premarital sex may be normalising sexual coercion in dating relationships. University educational programmes are needed to promote equitable gender norms, affirmative sexual consent and expanded definitions of sexual coercion.

3.
Soc Sci Med ; 270: 113686, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33453629

RESUMO

OBJECTIVES: The health and social effects of women's microfinance participation remain debated. METHODS: Using propensity-score methods, we assessed effects of microfinance participation on novel measures of agency; intimate partner violence (IPV) exposure; and depressive symptoms in 930 wives in Matlab, Bangladesh interviewed 11/2018-01/2019. RESULTS: Participants, versus non-participants, were married younger (16.7 vs. 17.4 years), more often Muslim (90.7% vs. 86.2%), less schooled (5.4 vs. 6.8 grades), and more often had husbands (27.0% vs. 19.6%) and mothers (63.2% vs. 50.5%) without schooling. Participants and non-participants had similar unadjusted mean scores for prior-week depressive symptoms, prior-year IPV, and intrinsic attitudinal agency (gender-equitable attitudes; non-justification of wife beating). Participants had higher unadjusted mean scores for intrinsic voice/mobility; instrumental agency (using financial services, voice with husband, voice/mobility outside home); and collective agency. Average adjusted treatment effects were non-significant for depressive symptoms, IPV, and attitudinal intrinsic agency, and significantly favorable for other agency outcomes. CONCLUSIONS: Microfinance participation had no adverse health effects and favorable empowerment effects in Bangladeshi wives. POLICY IMPLICATIONS: Microfinance can empower women without adverse health effects. Social-norms programming with men and women may be needed to change gendered expectations about the distribution of unpaid labor and the rights of women.

5.
SSM Popul Health ; 12: 100641, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33304983

RESUMO

Prior studies of the association between intimate partner violence (IPV) and depressive symptoms have typically excluded economic coercion (EC), a prevalent form of IPV worldwide. Here, we used structural equation models (SEM) to estimate the association of EC with depressive symptoms, with and without adjustment for physical/psychological/sexual IPV, among women in rural Matlab, Bangladesh. Data were collected from cross-sectional surveys with married women 15-49 years, conducted between November 2018 and January 2019. Prior-week depressive symptoms were measured using the 10-item Centre for Epidemiologic Studies Depression short-form. Lifetime EC was assessed using a bi-dimensional, 36-item scale developed in Matlab. Lifetime physical/sexual/psychological IPV was assessed using the 20-item WHO Domestic Violence module. Covariates were age, age at marriage, and schooling; partner's schooling; and household wealth. Among 929 women, lifetime experience of EC ranged from 41.9% (control over access to work, schooling, and training) to 50.0% (control over use/maintenance of economic resources), while any lifetime physical/psychological/sexual IPV was 89.5%. Coercion involving the use and maintenance of economic resources had a significant, adjusted association with depressive symptoms (standardized coefficient = 0.491, p<0.001, R2=0.221). The standardized association of any physical/psychological/sexual IPV with depressive symptoms, adjusted for covariates and cluster sampling, was 0.346 (p <0.001, R2=0.143). When further adjusted for the two measures of EC, the association was attenuated and non-significant (0.049, p = 0.817). These findings suggest that EC is prevalent, significantly associated with depressive symptoms, and attenuates the association of other forms of IPV with depressive symptoms. Addressing EC with other forms of IPV may be necessary to reduce depressive symptoms in exposed women.

8.
BMC Pregnancy Childbirth ; 20(1): 503, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873247

RESUMO

BACKGROUND: Sustainable Development Goal (SDG) 5 prioritizes women's empowerment and gender equality, alone and as drivers of other SDGs. Efforts to validate universal measures of women's empowerment have eclipsed efforts to develop refined measures in local contexts and lifecycle stages. Measures of women's empowerment across the reproductive lifecycle remain limited, including in the Arab Middle East. METHODS: In this sequential, mixed-methods study, we developed and validated the Reproductive Agency Scale 17 (RAS-17) in 684 women having a normal pregnancy and receiving prenatal care at Hamad Medical Corporation in Doha, Qatar. Participants varied in age (19-46 years), trimester, gravidity (M3.3[SD2.1], range 1-14), and parity (M2.1[SD1.5], range 0-7). Using qualitative research and questionnaire reviews, we developed 44 pregnancy-specific and non-pregnancy-specific agency items. We performed exploratory then confirmatory factor analyses (EFA/CFA) in random split-half samples and multiple-group CFA to assess measurement invariance of the scale across Qatari (n = 260) and non-Qatari Arab (n = 342) women. RESULTS: Non-Qatari women agreed more strongly than Qatari women that every woman should have university education, and working outside home benefitted women. Qatari women agreed more strongly than non-Qatari women that a woman should be free to sell her property. Qatari women reported more influence than non-Qatari women in decisions about spending their money (M4.6 versus M4.4), food they can eat (M4.4 versus M4.2), and rest during pregnancy (M4.5 versus M4.2). Qatari and non-Qatari women typically reported going most places with permission if accompanied. A 17-item, three-factor model measuring women's intrinsic agency or awareness of economic rights (5 items) and instrumental agency in decision-making (5 items) and freedom of movement (7 items) had good fit and was partially invariant across groups. CONCLUSIONS: The RAS-17 is a contextual, multidimensional measure of women's reproductive agency validated in pregnant Qatari and non-Qatari Arab women. This scale integrates pregnancy-specific and non-pregnancy-specific items in dimensions of intrinsic agency and instrumental agency relevant to Arab women of reproductive age. The RAS-17 may be useful to screen for low reproductive agency as a predictor of maternal and perinatal outcomes. The RAS-17 should be validated in other samples to assess its full applicability across the reproductive life cycle.

9.
BMC Public Health ; 20(1): 1331, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32873262

RESUMO

BACKGROUND: Sexual violence-any sexual act committed against a person without freely given consent-disproportionately affects women. Women's first experiences of sexual violence often occur in adolescence. In Asia and the Pacific, 14% of sexually experienced adolescent girls report forced sexual debut. Early prevention with men that integrates a bystander framework is one way to address attitudes and behavior while reducing potential resistance to participation. METHODS: This paper describes a study protocol to adapt RealConsent for use in Vietnam and to test the impact of the adapted program-GlobalConsent-on cognitive/attitudinal/affective mediators, and in turn, on sexual violence perpetration and prosocial bystander behavior. RealConsent is a six-session, web-based educational entertainment program designed to prevent sexual violence perpetration and to enhance prosocial bystander behavior in young men. The program has reduced the incidence of sexual violence among men attending an urban, public university in the Southeastern United States. We used formative qualitative research and the Centers for Disease Control and Prevention's Map of the Adaptation Process to adapt RealConsent. We conducted semi-structured interviews with college men (n = 12) and women (n = 9) to understand the social context of sexual violence. We conducted focus group discussions with university men and stakeholders (n = 14) to elicit feedback on the original program. From these data, we created scripts in storyboard format of the adapted program. We worked closely with a small group of university men to elicit feedback on the storyboards and to refine them for acceptability and production. We are testing the final program-GlobalConsent-in a randomized controlled trial in heterosexual or bisexual freshmen men 18-24 years attending two universities in Hanoi. We are testing the impact of GlobalConsent (n = 400 planned), relative to a health-education attention control condition we developed (n = 400 planned), on cognitive/attitudinal/affective mediators, prosocial bystander behavior, and sexual violence perpetration. DISCUSSION: This project is the first to test the impact of an adapted, theoretically grounded, web-based educational entertainment program to prevent sexual violence perpetration and to promote prosocial bystander behavior among young men in a middle-income country. If effective, GlobalConsent will have exceptional potential to prevent men's sexual violence against women globally. TRIAL REGISTRATION: U.S. National Library of Medicine Clinicaltrials.gov NCT04147455 on November 1, 2019 (Version 1). Retrospectively registered. Protocol amendments will be submitted to clinicaltrials.gov .

10.
PLoS One ; 15(8): e0237562, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797115

RESUMO

BACKGROUND: To understand better the total burden of interpersonal violence on society, it is useful to assess the prevalence of interpersonal violence among both, men and women. Exposure to multiple forms of interpersonal violence, referred to as polyvictimization, has been associated with more severe health consequences than exposure to any form separately. The aims of this study were to assess the prevalence of emotional, physical and sexual interpersonal violence in childhood, adulthood and at both childhood and adulthood among men and women in Estonia, analyze the patterns of interpersonal violence and socio-demographic correlates of polyvictimization in adulthood by gender. METHODS: The analysis was based on two population-based, cross-sectional, self-administered surveys carried out among men and women in Estonia in 2014. In both surveys, the NorVold Abuse questionnaire was used to measure exposure to interpersonal violence. Men and women aged 18-44 were included to the analysis. RESULTS: Among men 66.6% and among women 54.2% had been exposed to at least one form of interpersonal violence during lifetime. Men had been more often exposed to isolated physical interpersonal violence, among women the distribution of different forms of interpersonal violence was more even and exposure to sexual violence was more common. The prevalence of polyvictimization in adulthood was two times higher among women compared to men and more socio-demographic correlates, were associated with it. Exposure to violence in childhood was associated with polyvictimization in adulthood across gender. CONCLUSIONS: The prevalence of interpersonal violence in Estonia is high among men and women. The most prevalent forms and patterns of interpersonal violence, however, differ by gender, as do the socio-demographic correlates. Screening for interpersonal violence, in childhood and adulthood, and gender-specific interventions are needed, especially for high-risk groups identified in this study. Primary prevention of childhood violence should be a priority, as it was associated with higher risk for exposure to violence later in life across gender.


Assuntos
Vítimas de Crime/psicologia , Violência/classificação , Violência/estatística & dados numéricos , Adolescente , Adulto , Criança , Estudos Transversais , Estônia/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Autorrelato , Caracteres Sexuais , Fatores Socioeconômicos , Adulto Jovem
11.
East Mediterr Health J ; 26(6): 652-659, 2020 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-32621499

RESUMO

Background: Measurement of women's agency in specific sociocultural conditions, particularly in Middle Eastern settings, has received limited attention, making its usefulness as an outcome or predictor of gender equality unclear. Aims: This study aimed to construct and validate a multidimensional and context-specific scale of women's agency in rural Minya, Egypt. Methods: Using data from 608 ever-married women in 2012, confirmatory and exploratory factor analysis were used to construct a scale measuring women's agency in rural Minya. The scale was validated through exploratory structural equation models. Results: The 21-item model consisted of three factors (decision-making, freedom of movement and gender role attitudes), each corresponding to a previously-theorized domain of women's agency. The three factors were positively correlated, supporting women's agency as a multidimensional, context-specific construct. The strongest correlation was between decision-making and freedom of movement (0.410), and then between freedom of movement and gender attitudes (0.307); the weakest correlation was between decision-making and gender attitudes (0.211). Although we hypothesized that each domain would be positively associated with age, only decision-making was significantly and positively associated with women's age. Conclusion: Similarities between the items used here and a study at the national level in Egypt suggest these indicators could be used in various Egyptian settings to monitor progress on the United Nations Sustainable Development Goal 5 on empowering women and girls, and to assess the effect of policies and programmes. Future research should build on the findings to identify the best observable indicators of women's agency in Egypt and elsewhere.

12.
Int Health ; 2020 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-32584982

RESUMO

BACKGROUND: Higher schooling attainment for girls is associated with improved maternal and child health outcomes. In low- and middle-income countries, girls drop out of school at higher rates than boys beginning in early adolescence due to factors such as son preference and lack of access to menstrual supplies. METHODS: Using principal components analysis, we created a gender-equitable school (GES) index with data from 159 secondary schools in Nepal to measure school-level factors that may influence girls' secondary school pass rates. RESULTS: A component describing girls' safety and hygiene was positively associated with school-wide pass rates for girls, and to a lesser degree for boys. CONCLUSIONS: The GES index has diagnostic and programmatic utility in programs aimed at supporting girls' education and health.

13.
J Interpers Violence ; : 886260520928644, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32529939

RESUMO

Sexual violence is a persistent, underreported threat to the well-being of women and girls worldwide. In Vietnam, as elsewhere, myths and misconceptions around rape and other forms of sexual violence present a major barrier to reporting and prevention. Based on qualitative research from a parent study aimed at reducing sexual violence perpetration at universities in Vietnam, we sought to characterize commonly held myths among university students that may contribute to the perpetration and justification of such behaviors. Our analysis drew on focus group discussions with men (n = 69) and semi-structured interviews with men (n = 12) and women (n = 9) recruited from two universities in Hanoi. Conducted in April and May of 2018, interviews covered topics including gender norms, dating relationships, consent, and sexual violence, whereas focus groups conducted in October 2018 were designed to assess reactions to an existing sexual violence prevention program. Thematic analysis of interview and focus group transcripts revealed that myths and misconceptions about sexual violence persist among university-aged men and women. Chief among these were that rape results mainly from men's uncontrollable desire, that victims provoke rape by their "reckless" behavior, such as drinking or dressing provocatively, that "real" rape is characterized by physical force from the perpetrator and "fierce resistance" on the part of the victim, and that rape occurs only under a narrow set of circumstances. Although men and women endorsed most myths equally, justification of rape through victim blaming featured much less in women's narratives than in men's. Myths concerning false rape allegations, observed in Western populations, were not considered relevant to Vietnamese students. Findings informed the development of a contextualized rape myths acceptance scale for testing and use in Vietnam. A nuanced understanding of salient rape myths among male and female students may also inform university-based efforts to prevent sexual violence.

14.
BMC Int Health Hum Rights ; 20(1): 13, 2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471424

RESUMO

BACKGROUND: Violence against women and girls (VAWG) is a human-rights violation with adverse long-term and inter-generational consequences. Redefining VAWG as legally unacceptable is one strategy for social change. The co-occurrence of national laws against VAWG is understudied, and tools to monitor the national legal environment are lacking. We developed the Laws on Violence against Women and Girls Index (LoVI) to measure global progress to develop comprehensive national legislation against child marriage, sexual harassment, domestic violence, and marital rape. METHODS: Using data from 2016 and 2018 for 189 countries from the World Bank Women, Business, and the Law database, we used factor analysis to assess the dimensionality of the LoVI. We examined the distribution of the LoVI across countries and regions, and the relationship of national rankings on the LoVI with those for other indicators from the United Nations, Demographic and Health Surveys, and World Factbook. RESULTS: A single LoVI factor showed good model fit in the factor analysis. National LoVI rankings were positively associated with gender equality in human development and economic rights-related rankings and negatively associated with rates of justifying wife beating and of lifetime and prior-year physical and/or sexual IPV. The LoVI was not associated with national indicators for human development and income inequality. CONCLUSION: The LoVI is a concise, coherent, validated index to monitor the progress of nations on adopting comprehensive legislation to advance 2030 Sustainable Development Goal 5, to eliminate VAWG.

15.
PLoS One ; 15(3): e0229917, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32142530

RESUMO

We tested a feminist social-ecological model to understand community influences on daughters' experience of female genital mutilation/cutting (FGMC) in Egypt, where over 90% of women ages 15-49 are cut. FGMC has potential adverse effects on demographic and health outcomes and has been defined as a human-rights violation. However, an integrated multilevel-level framework is lacking. We theorized that a more favorable community-level gender system, including stronger gender norms opposing FGMC and expanded extra-familial opportunities for women in the village or neighborhood, would be associated with a daughter's lower risk of FGMC and would strengthen the negative association of a mother's opposition to FGMC with her daughter's risk of cutting. Using a national sample of 14,171 mother-daughter dyads from the 2014 Egypt Demographic and Health Survey, we estimated multilevel discrete-time hazard models to test these relationships. Community gender norms opposing FGMC had significant direct, negative associations with the hazard that a daughter was cut, but women's opportunities outside the family did not. Maternal opposition to FGMC was negatively associated with cutting a daughter, and these associations were stronger where community opposition to FGMC and opportunities for women were greater. Results provided good support for a gender-systems framework of the multilevel influences on FGMC. Integrated, multilevel interventions that address gender norms about FGMC and structural opportunities for women in the community, as well as beliefs about the practice among the mothers of at-risk daughters, may be needed for sustainable declines in the practice.


Assuntos
Circuncisão Feminina/efeitos adversos , Demografia , Genitália Feminina/cirurgia , Núcleo Familiar/psicologia , Adolescente , Adulto , Circuncisão Feminina/ética , Circuncisão Feminina/psicologia , Egito/epidemiologia , Feminino , Feminismo , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Mães/psicologia , Religião , Fatores Socioeconômicos , Adulto Jovem
16.
Stud Fam Plann ; 51(1): 3-32, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32103517

RESUMO

Despite long-term efforts to encourage abandonment of female genital mutilation/cutting (FGMC), the practice remains widespread globally. FGMC is situated in specific social and historical contexts, and both prevalence and rates of decline vary widely across practicing countries. However, cross-national comparative research on the determinants of FGMC is sparse. This paper adds to the limited body of rigorous, theoretically grounded quantitative studies of FGMC and takes a step toward advancing cross-national comparative research. We apply an integrated theoretical framework that brings together norms-based and gender-based explanations of community-level influences on FGMC. We test this framework in four francophone West African countries, drawing on comparable nationally representative data from the Demographic and Health Surveys in Burkina Faso (2010), Côte d'Ivoire (2011-2012), Guinea (2012), and Mali (2012-2013). Results show that community-level FGMC norms and community-level gendered opportunities are associated with girls' risk of FGMC, but that the direct and moderating associations vary qualitatively across countries. Our findings highlight the contribution of context-specific social and institutional processes to the decline or persistence of FGMC.

17.
J Sex Res ; : 1-20, 2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31902238

RESUMO

Gender-based violence (GBV) against women and girls is pervasive and has negative consequences for sexual and reproductive health (SRH). In this systematic review of reviews, we aimed to synthesize research about the SRH outcomes of GBV for adolescent girls and young women in low- and middle-income countries (LMICs). GBV exposures were child abuse, female genital mutilation/cutting, child marriage, intimate partner violence (IPV), and non-partner sexual violence. PsycINFO, PubMed, and Scopus searches were supplemented with expert consultations, reference-list searches, and targeted organizational website searches. Reviews had to contain samples of girls and young women ages 10-24, although inclusion criteria were expanded post-hoc to capture adolescent-adult combined samples. Twenty-seven reviews were quality-rated. Study-level data were extracted from the 10 highest quality reviews (62 unique studies, 100 samples). Reviews were mostly from Africa and Asia and published between 2011 and 2015. We found consistent associations between GBV and number of sexual partners, gynecological conditions (e.g., sexually transmitted infections [STIs]), unwanted/unplanned pregnancy, and abortion. Some types of IPV also were associated with greater use of contraception/STI prevention. Addressing GBV is essential to improve SRH for girls and women in LMICs.

18.
Soc Sci Med ; 247: 112803, 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31978705

RESUMO

The 2030 Agenda for Sustainable Development prioritizes women's empowerment in Sustainable Development Goal (SDG) #5: to achieve gender equality and empowerment among all women and girls. Research on the relationships of women's empowerment and nutrition has focused on the child's nutrition. Less is known about how women's empowerment influences their own nutritional status. We examined the pathways by which three domains of women's empowerment (WE)-assets, intrinsic agency, and instrumental agency-may influence women's nutritional status (WNS) in East Africa. We used data from 42,721 married non-pregnant women, 15-49 years old interviewed in Demographic and Health Surveys (DHS) from five east Africa countries (2011-2016). WNS was operationalized through body mass index (BMI) and altitude-adjusted blood-hemoglobin level (Hb). A latent factor for women's human/social assets (assets) measured women's enabling resources. Two additional latent factors measured women's intrinsic agency (power within; women's non-justification of intimate partner violence (IPV) against wives) and instrumental agency (power to; influence in household decision-making). We used structural equation models with latent variables to estimate the strength of the hypothesized pathways from women's assets to WNS through measures of intrinsic and instrumental agency. All three domains of WE had direct, positive associations with women's BMI [(estimate (95% CI) (Assets: [0.17 (0.14,0.20)]; Intrinsic Agency: [0.25 (0.22,0.27)]; Instrumental Agency [0.08 (0.03,0.10)])]. Women's instrumental agency was positively associated with women's Hb [0.12 (0.09,0.14)]. Total associations, including direct and indirect effects, with women's BMI were positive through intrinsic agency & instrumental agency. Total associations with women's Hb were positive through instrumental agency. Direct and indirect effects from assets through both components of agency to BMI were higher in magnitude by household wealth category. Domains of WE were positively associated with WNS. Findings indicate that the process of women's empowerment may be an important driver of their nutritional status.

19.
J Perinat Neonatal Nurs ; 34(1): 38-45, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31996643

RESUMO

Comfort is a fundamental human need to seek relief, ease, and transcendence. Comfort is relevant to women in labor who experience intense pain and mixed emotions. The subjective meaning of comfort in labor for women is not fully understood. This work was part of a phenomenological study of the experience of childbirth, in which the dynamic of keeping-it-together-falling-apart was identified as an essential quality of women's perceptions of childbirth. Comfort was a salient element of keeping-it-together-falling-apart. In this report, the concept of comfort is explored in greater depth, using qualitative descriptive analysis. Eight participants, aged 23 to 38 years, with spontaneous vaginal births, were each interviewed twice about the childbirth experience. Comfort was a holistic experience of relaxation and relief, where the needs of the body and the person were being met. Comfort and pain coexisted with each other, and relief of pain did not always provide comfort. Women had an innate knowledge of comfort, but their capacity for choice was at times restricted by caregivers in the hospital. There are aspects of labor care that do not support comfort, particularly as it relates to mobility and choice. Prioritizing comfort as well as pain relief may contribute to a more holistic, satisfying birth experience for women.


Assuntos
Parto Obstétrico , Saúde Holística/ética , Dor do Parto , Trabalho de Parto , Parto/psicologia , Conforto do Paciente , Adaptação Psicológica , Adulto , Parto Obstétrico/ética , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Humanos , Dor do Parto/fisiopatologia , Dor do Parto/psicologia , Dor do Parto/terapia , Trabalho de Parto/fisiologia , Trabalho de Parto/psicologia , Acontecimentos que Mudam a Vida , Manejo da Dor , Gravidez , Pesquisa Qualitativa
20.
Glob Public Health ; 15(6): 852-864, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31869280

RESUMO

Women comprise two-thirds of the global-health (GH) workforce but are underrepresented in leadership. GH departments are platforms to advance gender equality in GH leadership. Using a survey of graduates from one GH department, we compared women's and men's post-training career agency and GH employment and assessed whether gender gaps in training accounted for gender gaps in career outcomes. Master-of-Public-Health (MPH) and mid-career-fellow alumni since 2010 received a 31-question online survey. Forty-four per cent of MPH alum and 24% of fellows responded. Using logistic regression, we tested gender gaps in training satisfaction, career agency, and GH employment, unadjusted and adjusted for training received. Women (N = 293) reported lower satisfaction with training (M7.6 vs 8.2) and career agency (leadership ability: M6.3 vs 7.4) than men (N = 60). Women more often than men acquired methods-related skills (95% vs 78%), employment recommendations (42% vs 18%), and group membership. Men more often than women acquired leadership training (43% vs 23%), award recommendations (53% vs 17%), and conference support (65% vs 35%). Women and men had similar odds of GH employment. Accounting for confounders and gender-gaps in training eliminated gender gaps in five of six career-agency outcomes. Panel studies of women's and men's career trajectories in GH are needed.

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