Monthly Archives: January 2020

“Never give up hope,” fistula survivor tells Pakistani women

“Never give up hope,” fistula survivor tells Pakistani women

2020-01-09

ISLAMABAD, Pakistan – “Helping women suffering fistula is my mission in life,” Razia Shamshad said about the maternal injury from childbirth that she thought would ruin her life. “No woman deserves to live in misery, especially when it is treatable.”

Ms. Shamshad, 29, was born in a small village in southern Punjab. Her family did not want her to go to school, so she had only received an informal religious education by age 13, when she was married off. Ms. Shamshad was already expecting her first baby within a few weeks of her wedding. Then, when she was six months pregnant, her husband died in a road accident.

Unable to afford proper medical care, Ms. Shamshad was assisted by an unskilled traditional birth attendant who was unable to manage complications. When Ms. Shamshad suffered an obstructed labour, the birth attendant did not summon medical help. Ms. Shamshad was in agony for four days, an ordeal that could have killed her.

In the end, her daughter was stillborn, and Ms. Shamshad suffered serious damage. She developed an obstetric fistula, a hole in the birth canal. Fistula leaves women leaking urine, faeces or both, and often leads to chronic medical problems.

The condition is preventable with timely access to quality medical care, such as Caesarean section. Tragically, it persists among the most marginalized women, with pregnant adolescents and undernourished women facing particularly high risks. And its sufferers are further marginalized, often facing ostracism and discrimination. 

“People would either avoid me or just make fun of me,” she said. “I never felt clean.”

A stroke of good luck

But Ms. Shamshad was able to put her life back together. Her relatives learned about free treatment available at the Koohi Goth Women’s Hospital, which specializes in treating fistula and other conditions related to reproductive health. Two years after her ordeal, her family paid for her to travel to Karachi for care. 

Ms. Shamshad’s condition was complex, and required multiple surgeries between 2010 to 2016. Even so, she has been able to regain her life. 

“Her determination was exceptional. She was resilient and strong and was able to pull through the difficult process successfully,” said Dr. Sajjad Ahmed, who was trained by UNFPA to perform fistula repair surgeries.

Ms. Shamshad went on to meet her current husband. They adopted a little girl. And though she was not expected to be able to get pregnant again, she surprised everyone by conceiving. With regular prenatal care and a C-section, she had a healthy baby girl.

Combating fistula since 2003

In many ways, Ms. Shamshad was lucky. The story is very different for many fistula survivors in Pakistan, who are unaware that there is treatment available.

And many more women and girls are at risk.  Access to reproductive health services remains a challenge for women in Pakistan. Only an estimated 52 per cent of women give birth with the help of a skilled attendant, leaving them vulnerable to complications like prolonged, obstructed labour.

“People would either avoid me or just make fun of me,” she said. “I never felt clean.”

A stroke of good luck

But Ms. Shamshad was able to put her life back together. Her relatives learned about free treatment available at the Koohi Goth Women’s Hospital, which specializes in treating fistula and other conditions related to reproductive health. Two years after her ordeal, her family paid for her to travel to Karachi for care. 

Ms. Shamshad’s condition was complex, and required multiple surgeries between 2010 to 2016. Even so, she has been able to regain her life. 

“Her determination was exceptional. She was resilient and strong and was able to pull through the difficult process successfully,” said Dr. Sajjad Ahmed, who was trained by UNFPA to perform fistula repair surgeries.

Ms. Shamshad went on to meet her current husband. They adopted a little girl. And though she was not expected to be able to get pregnant again, she surprised everyone by conceiving. With regular prenatal care and a C-section, she had a healthy baby girl.

Combating fistula since 2003

In many ways, Ms. Shamshad was lucky. The story is very different for many fistula survivors in Pakistan, who are unaware that there is treatment available.

And many more women and girls are at risk.  Access to reproductive health services remains a challenge for women in Pakistan. Only an estimated 52 per cent of women give birth with the help of a skilled attendant, leaving them vulnerable to complications like prolonged, obstructed labour.

https://www.unfpa.org/news/%E2%80%9Cnever-give-hope%E2%80%9D-fistula-survivor-tells-pakistani-women

Effectiveness of contraceptive counseling strategies

Effectiveness of contraceptive counseling strategies

January 8, 2020

Counseling strategies for modern contraception that target women initiating a method, including structured counseling on side effects, tend to have positive effects on contraceptive continuation, according to a systematic review in BMJ Sexual & Reproductive Health. But in most cases, provider training and decision-making tools for method choice did not have an effect.

On the other hand, additional antenatal or postpartum counseling sessions resulted in an increased rate of postpartum contraceptive use, regardless of their timing in pregnancy or postpartum. But dedicated pre-abortion contraceptive counseling was linked to increased use only when accompanied by a broader contraceptive method provision. The review also found that male partner or couples counseling can be effective at increasing contraceptive use among non-users, or in women initiating contraceptive implants or seeking abortion.

Methods
The investigators, who were from several countries, searched six electronic databases for relevant studies of women or couples published in English since 1990: MedlineEmbaseGlobal HealthPopline, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus and Cochrane Library. A total of 61 studies from 63 publications met the inclusion criteria, for which there was substantial heterogeneity in study settings, interventions, and outcome measures. However, high-quality evidence was absent for the majority of intervention types.

Findings
In summarizing the advantages and disadvantages of different counseling intervention methods, a few studies noted the increased cost of  staffing, resources, and contraceptive products when providing additional and longer patient consultations. Conversely, interventions like digital tools during waiting times prior to consultation can potentially save provider time. However, counseling satisfaction with digital tools alone was low, and best used in conjunction with face-to-face counseling.

While telephone-based interventions provide access to many women at low cost, these interventions are unable to reach women without phones and may require multiple attempts to reach participants with phones.

Counseling up to the time of birth or abortion for women who may not access services later allows for a fuller discussion of different contraceptive methods, yet some women may be reluctant to initiate contraception immediately, thus effective follow-up mechanisms are necessary. Routine postpartum counseling at 3 to 6 weeks may help some women after they have resumed sexual activity.

Including male partners in counseling sessions may also be valuable, if they are the main contraceptive decision-maker. But partner availability poses logistical challenges.

Conclusions
“Our focus on comparing counseling strategies is critical to help identify successful interventions to improve contraceptive services,” the authors wrote. “However, preventing unmet need for contraception and unwanted pregnancies (influenced by multiple other factors) is the ultimate objective from a public health standpoint, and counseling process indicators such as client participation and knowledge are also important.”

Three limitations of the review are that study quality was variable; substantial heterogeneity existed in study settings, interventions and outcomes, thereby limiting comparability of studies; and many of the included studies failed to clearly state whether the intervention targeted women initiating, switching, and/or continuing contraception, plus women switching methods were often grouped with initiators.

Nonetheless, the findings underscore that when feasible, repeated counseling throughout pregnancy and postpartum can contribute to maximum access to information and contraceptive uptake. However, interventions seeking to improve contraceptive counseling need to be tailored to patient flow, record flow, and the contraceptive methods available, while embedded within broader quality-of-care improvements, including clinical training.

The authors noted that further research is needed to determine the effectiveness of many contraceptive counseling interventions, including novel efficacious interventions, among various settings.

What Are The Best Multi-Vitamins For Women?

What Are The Best Multi-Vitamins For Women?

2020-01-06

By Staff ReporterDec 30, 2019 10:57 AM EST

Our modern society is quite unhealthy, with fast food and processed sugars available around every corner. As a direct result of the unhealthy environment they inhabit, many American women are struggling with their long-term health, especially when it comes to ensuring they have enough vitamins and a proper diet. It can be incredibly hard to find authoritative information pertaining to women’s health, too, leading many young women to simply give up altogether.

Rather than ignoring your health, you should be taking proactive steps to bolster it, like consuming healthy supplements. Which are the best multi-vitamins for women, and how else can they remain healthy? Here’s how to ensure your lifestyle is a healthy and prosperous one.

Find authoritative sources

The first thing you should do when searching for the best multi-vitamin for women is find an authoritative source that can give you valid information which you can depend upon. Many blogs exist and will tell you what supplements to take, but the truth of the matter is that these are often hosted by non-professionals who lack formal medical degrees. You should be relying strictly on valid sources of information that have science to back up their arguments. Look for websites that end in .gov, and you’ll generally know you’re in the clear when it comes to the medical data you’re reading.

The U.S. Department of Health and Human Services has anexcellent webpage provided by the Office on Women’s Health, for instance, and it should frequently be reviewed by women who want to maintain healthy lifestyles for themselves. Ensuring you have enough vitamin B9, for instance, is particularly important for pregnant women who may be deprived of valid information to rely on as they prepare for a new chapter in their lives.

Many women have a vitamin B-12 deficiency, too, which is a helpful reminder to talk to your medical professionals about what your body might need that it’s naturally lacking. It’s important to remember thatnutritional supplements are only one source of these vitamins – many people often get enough in their regular diets, though some dietary restrictions may impede your ability to ingest enough of them in your food. When it comes to B-12 deficiencies, for instance, you can try to amend them by increasing the amount of fat-free milk, eggs, poultry, and nutritional yeast you consume on a regular basis.

Many women find themselves suffering from calcium deficiencies, and these can’t always be amended by eating more food groups that are rich in calcium. Young girls who are still growing may be in particular need of calcium supplements because they can be very important when it comes to bone growth and hitting your appropriate height.

Learn about multi-vitamin trends

To find the best multi-vitamins and to determine which are popular and which are fading, it can be helpful to familiarize yourself with multi-vitamin trends across the nation. The past few years have seen ageneral decline in the number of multi-vitamins consumed by American adults, for instance, though it’s not yet clear why people are taking fewer and fewer of them. Americans are taking more vitamin D, for instance, but overall the total amount of supplements they’re taking is going down.

It’s important to speak with your medical providers to ensure that you’re not following national trends which may be popular but nevertheless unhealthy when your specific body is considered. Women of reproductive age in particular are taking fewer supplements,according to data made available by the CDC, though this is often impacted by the age and ethnicity of the individuals in question.

Vitamins A, C, E, and D remain some of the most popular supplements with women even in light of this decline, however. Calcium is also particularly important for developing women of a younger age. Before ingesting any supplements, ensure their sourcing is authentic and that there are no regulatory embargos on the substance you’re consuming. By finding authoritative and well-regulated providers of supplements, you can bolster your health, but taking shady supplements from lackluster sources is highly inadvisable. Never be afraid to talk to your medical professional about taking certain multi-vitamins or a particular supplement you’ve encountered online.  

The biggest wins for LGBT+ rights in the 2010s – and all the battles yet to be won

The biggest wins for LGBT+ rights in the 2010s – and all the battles yet to be won

As the decade ends, we take a look back at the rights won by LGBT+ people across the UK in the 2010s, and the fights that continue on.

1. Legal protections against transphobic discrimination

At the start of the decade, on October 1, 2010, the Equality Act came into force, giving trans people explicit protection against discrimination. Under the law, “gender reassignment” is a protected characteristic, a move that James Morton  of the Scottish Transgender Alliance said has been”really effective in terms of encouraging employers and also service providers to take into account the needs of trans people.”

In 2016, Morton gave evidence for a Parliamentary inquiry on transgender equality, which indicated that protections for trans people “are not universally seen as legally complete and many trans people still face discrimination in employment and in other aspects of their lives.” It called for the act to be updated with a a broader definition of trans identities, one which uses more considerate language.

2. Same-sex couples in Northern Ireland can adopt children.

Same-sex couples in England and Wales have had the right to adopt since 2002, with LGBT+ people in Scotland given their rights in 2009. In Northern Ireland, same-sex adoption wasn’t introduced until 2013, after the ban was ruled to be unlawful.

In 2018 it was reported that just 30 same-sex couples had applied to adopt in Northern Ireland, with just two approved. This makes the success rate one in 15, compared to one in two for the rest of the UK. The Department of Health said that lower success rate may be because the adoption process can take several years to complete.

3. Equal marriage.

While same-sex couples have been able to enter into civil partnerships since 2004, giving them the most of the same rights as married mixed-sex couples, it took another 10 years for full marriage equality to be introduced – and even then, it wasn’t universal.

England and Wales were the first parts of the UK to allow men to marry men and women to marry women, with the first such unions taking place on March 29, 2014.

Scotland followed suit on New Year’s Eve that same year, while Northern Ireland will see its first same-sex weddings take place on Valentine’s Day 2020 after an intervention by the House of Commons.

4. Married trans people can legally transition without having to divorce.

Historically, married people who wanted to change their legal gender marker were forced to divorce in order to do so.

The introduction of same-sex marriage corrected this wrong, meaning that trans people are now able to legally transition while remaining in their marriage. But – and this is a big but – they must have the consent of their spouse before a gender recognition certificate can be awarded, creating an effective ‘spousal veto‘.

5. Men convicted for their sexuality were pardoned.

In 2017, MPs passed the Alan Turing law to right an historic injustice and pardon the thousands of queer men who were convicted for “buggery” and other archaic, homophobic offences.

Almost 50,000 were posthumously pardoned, while those who were living were invited to apply for a statutory pardon through the Home Office’s disregard scheme, introduced in 2012. However in September 2019, it was reported that fewer than 200 wrongful convictions had been erased – a failure rate of 71 percent.

6. LGBT-inclusive education.

The most recent win for Britain’s LGBT+ community is the legal enshrining of an LGBT-inclusive school curriculum.

In March, MPs voted overwhelmingly to introduce new relationships and sex education guidelines which mean that from September 2020, every child in the UK will learn about LGBT+ people, relationships and families

Stonewall’s director of education and youth Mo Wiltshire said that such lessons “have the potential to deliver real change in how LGBT families, people and relationships are taught about. This will help foster greater inclusion, acceptance and understanding in our classrooms, playgrounds and school corridors.”

LGBT+ rights that need to be won in the 2020s

1. Full and free access to PrEP.

Currently, PrEP is only available in England through a limited trial. In Wales, Scotland and Northern Ireland, it can be prescribed by any NHS sexual health clinics.

Debbie Laycock, head of policy at the Terrence Higgins Trust, told PinkNews that restricted access to the drug is putting some men at increased risk of acquiring HIV.

“In parts of the country PrEP trial sites have closed to gay and bisexual men due to being oversubscribed,” she said, calling for a full roll-out of the drug.

Labour, the Liberal Democrats and the Green Party have all committed to giving universal access to PrEP in their election manifestos. The Conservatives and the Brexit Party both failed to make any mention of the drug in theirs.

2. Reform of the Gender Recognition Act.

When the Gender Recognition Act was introduced in 2004, it was a ground-breaking, trail-blazing piece of legislation. But 15 years on, it’s no longer fit for purpose.

In 2018 the government conducted a public consultation on reforms to the act, with most sensible people recommending the introduction of self-identification and legal recognition for non-binary people, among other measures.

Yet, more than a year after the consultation closed, we’re yet to see any results or official response. Again, the Conservatives failed to mention this crucial area of the law in its manifesto, while Labour, the Liberal Democrats and the Greens have all backed reform.

3. A ban on conversion therapy.

In July 2018, then-Prime Minister Theresa May vowed to outlaw the “abhorrent” practice of so-called gay conversion therapy. However such a ban is yet to materialise.

None of the major parties mention the practice in their manifestos, however spokespeople for the Conservatives, Labour, Liberal Democrats and the Green Party have all confirmed that they would end the practice.

4. An end to the blood ban.

In England, Wales and Scotland, men who have sex with men can only donate blood if they have been celibate for three months. In Northern Ireland, the deferral period is still 12 months.

This effectively amounts to a ban for men who are sexually active. Stonewall says that while it is statistically true that “men who have sex with men face higher rates of blood-borne infections, it’s simply untrue to say that every gay and bi man is a high-risk donor.”

The charity is calling for a system based on individualised risk assessment, rather than the current, discriminatory policy.

5. Changes to surrogacy laws

For gay men, the route to parenthood is fraught with complications.

While same-sex couples are able to adopt, the laws around surrogacy are somewhat more complicated. Commercial surrogates – a popular option in the US – is illegal in the UK.

Altruistic surrogacy is permitted, but the birth mother remains the child’s legal parent until a court grants a paternal order, a process which can take months and leaves all parties exposed to the risk that one or the other will change their mind.

It also means that if the child is taken ill after being born, only the surrogate mother is able to make decisions. NGA Law, which has campaigned for surrogacy reform since 2007, wants the law to change so that the intended parents are the child’s legal parents from birth, along with clarifications that surrogates can be financially compensated.