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Let me decide and thrive - Global discrimination and exclusion of girls and young women with disabilities

PLAN INTERNATIONAL
December 2017

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Girls and young women with disabilities have the right to make decisions over their own bodies and live free from violence and fear. Yet, on a global level, they are the people least likely to enjoy their sexual and reproductive health and rights (SRHR). Compelled by this reality, Plan International and the Office of the UN Special Rapporteur on the Rights of Persons with Disabilities have joined forces to ensure young women and girls with disabilities can exercise choice and have control over their bodies. The Let Me Decide and Thrive initiative is supported by in-depth, critical field and desk research and aims to empower girls and young women with disabilities, raise awareness of their plight among stakeholders, and work to secure their sexual and reproductive health and rights.

This research found that the barriers to SRHR confronted by girls and young women with disabilities are overwhelming: infantilisation and disempowerment; forced sterilisation, abortion, and contraception; disproportionate suffering from all forms of violence; substantial barriers in accessing justice; discriminatory attitudes, norms, and behaviours rendering them invisible; and a lack of accessible and appropriate SRHR information and services.

Do experiences and perceptions about quality of care differ among social groups in Nepal? A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

DEVKOTA, Hridaya Raj
MURRAY, Emily
CLARKE, Andrew
GROCE, Nora
December 2017

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Background
Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women’s socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities.

Methods
A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15–49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: ‘Health Facility’, ‘Healthcare Delivery’, ‘Inter-personal’ and ‘Access to Care’ was used to measure women’s perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension.

PLoS ONE 12(12): e0188554
https://doi.org/10.1371/journal.pone.0188554

Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal

DEVKOTA, Hridaya Raj
KETT, Maria
GROCE, Nora
MURRAY, Emily
June 2017

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BACKGROUND:
Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth.

METHOD:
The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes.

Reproductive Health, 2017

Factsheet. Maternal health and rehabilitation

HANDICAP INTERNATIONAL;
March 2017

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Maternal health concerns the health and wellbeing of mothers from before pregnancy (pre-conception), during pregnancy (ante-natal), during and after childbirth (peri- and post-natal). Common impairments and activity limitations from obstetric fistulae, pelvic floor dysfunction, maternal depression and musculoskeletal disorders are outlined and examples of rehabilitation strategies are given. A case study of fistula in Burundi is reported.

Zika Virus Infection as a Cause of Congenital Brain Abnormalities and Guillain–Barré Syndrome: Systematic Review

KRAUER, Fabienne
RIESEN, Maurane
REVEIZ, Ludovic
et al
January 2017

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"The World Health Organization (WHO) stated in March 2016 that there was a scientific consensus that the mosquito-borne Zika virus was a cause of the neurological disorder Guillain–Barré syndrome (GBS) and of microcephaly and other congenital brain abnormalities based on rapid evidence assessments. Decisions about causality require systematic assessment to guide public health actions. The objectives of this study were to update and reassess the evidence for causality through a rapid and systematic review about links between Zika virus infection and (a) congenital brain abnormalities, including microcephaly, in the foetuses and offspring of pregnant women and (b) GBS in any population, and to describe the process and outcomes of an expert assessment of the evidence about causality."

UNICEF 2016-2030 Strategy for Health “at a glance”

UNICEF
2016

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This provides an overview of UNICEF’s 2016-2030 Strategy for Health which "aims to: end preventable maternal, newborn, and child deaths; and promote the health and development of all children. With the first goal, UNICEF commits to maintaining focus on the critical unmet needs related to maternal, newborn and under-5 survival. With the second, UNICEF highlights the importance of also looking beyond survival and addressing the health and development needs of older children and adolescents. The Strategy emphasises the importance of prioritising the needs of the most deprived children and promotes multi-sectoral approaches to enhance child development and address underlying causes and determinants of poor health outcomes. It aims to shift UNICEF from vertical disease programmes to strengthening health systems and building resilience, including calling for better integration of humanitarian and development efforts by encouraging risk-informed programming in all contexts"

Malnutrition and disability: unexplored opportunities for collaboration

GROCE, Nora
CHALLENGER, E
BERMAN-BIELER, R
FARKAS, A
YILMAZ, N
SCHUTLINK, W
CLARK, D
KAPLAN, C
KERAC, M
2014

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There is increasing international interest in the links between malnutrition and disability: both are major global public health problems, both are key human rights concerns, and both are currently prominent within the global health agenda. In this review, interactions between the two fields are explored and it is argued that strengthening links would lead to important mutual benefits and synergies. At numerous points throughout the life-cycle, malnutrition can cause or contribute to an individual's physical, sensory, intellectual or mental health disability. By working more closely together, these problems can be transformed into opportunities: nutrition services and programmes for children and adults can act as entry points to address and, in some cases, avoid or mitigate disability; disability programmes can improve nutrition for the children and adults they serve. For this to happen, however, political commitment and resources are needed, as are better data.

Paediatrics and International Child Health
Volume 34, 2014 - Issue 4: Nutrition and malnutrition in low- and middle-income countries
https://doi.org/10.1179/2046905514Y.0000000156

Maternal and new-born care practices among disabled women, and their attendance in community groups in rural Makwanpur, Nepal

LEONARD CHESHIRE DISABILITY AND INCLUSIVE DEVELOPMENT CENTRE
2013

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This paper presents qualitative and quantitative research that describes the type and severity of disability of married women in the study area, describes their participation in community groups and analyses associations between maternal and new-born care behaviours and disability. Health workers and field researchers were also interviewed about their experience with disabled women in rural Makwanpur
Cross-cutting Disability Research Programme, Background Paper: 01

Access to health care, reproductive health and disability: A large scale survey in Sierra Leone

GROCE, Nora
TRANI, Jean-Francois
BROWN, Joyce Brown
KETT, Maria
BAH, Osman
MORLAI, Teddy
BAILEY, Nicki
2011

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This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services.

Analysing commitments to advance the global strategy for women's and children's health|The PMNCH 2011 report

THE PARTNERSHIP FOR MATERNAL, NEWBORN & CHILD HEALTH (PMNCH)
2011

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"This report seeks to further our collective understanding of the current Global Strategy commitments, facilitating more effective advocacy to advance the Every Woman, Every Child effort, as well as greater accountability in line with the recommendations of the Commission on Information and Accountability for Women’s and Children’s Health. This 2011 report is based on structured interviews with those who made commitments, supplemented by reviews of related documentation. This report analyses the specific nature of each commitment recorded through May 2011 to produce a preliminary picture of the achievements of the Global Strategy commitments to date, as well as to identify opportunities and challenges for advancement"

Priority medicines for mothers and children 2011

WORLD HEALTH ORGANIZATION (WHO)
2011

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This resource presents a list of priority medicines for mothers and children to help countries and partners select and make available those medicines that will have the biggest impact on reducing maternal, newborn and child morbidity and mortality
WHO/EMP/MAR/2011.1

Protect for the future : placing children's protection and care at the heart of the MDGs

DELAP, Emily
et al
July 2010

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This paper argues that, in relation to children, this vital change in approach must go beyond a consideration of survival, health and education rights already specifically referred to in the millennium development goals (MDGs), to encompass rights relating to children’s protection and care. These include recognition of the central importance of family-based care for child wellbeing, and children’s rights to be free from violence, exploitation, abuse and neglect. It is argued that only through a consideration of such rights will it be possible to make wide-reaching and sustainable progress in efforts to alleviate child poverty, increase access to education, improve maternal and child health, and reduce the spread of HIV and AIDS

Sub-Saharan Africa's mothers, newborns, and children : where and why do they die?

KINNEY, Mary V
et al
2010

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"The aim of this paper is to present the current situation in sub-Saharan Africa for mothers, newborns, and children under age 5 years—including the progress towards the MDGs for maternal and child health, why and where deaths occur, what known interventions can be employed to prevent these deaths, and current coverage of these interventions. All data used in this review are from the most recent UN databases, national household surveys, and peer-reviewed papers where appropriate, which are referenced accordingly"
PLoS Medicine, 7(6)

Better off dead? A report on maternal morbidity from the UK All Party Parliamentary Group on Population, Development and Reproductive Health

UK ALL PARTY PARLIAMENTARY GROUP ON POPULATION, DEVELOPMENT AND REPRODUCTIVE HEALTH
May 2009

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This report makes a number of recommendations for the effective reduction of maternal morbidity. The recommendations made, in summary, are: increase political will; increase resources to sexual and reproductive health and rights; encourage equitable health care; work in partnership; improve sexual and reproductive health rights legislation and policies; make governments accountable

The state of the world's children 2009

UNITED NATIONS CHILDREN'S FUND (UNICEF)
December 2008

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The 2009 report ..."examines critical issues in maternal and newborn health, underscoring the need to establish a comprehensive continuum of care for mothers, newborns and children. "The report outlines the latest paradigms in health programming and policies for mothers and newborns, and explores policies, programmes and partnerships aimed at improving maternal and neonatal health. Africa and Asia are a key focus for this report, which complements the previous year's issue on child survival." The report can be downloaded as a PDF or a multi-media version is also available in four languages

Do lay health workers in primary and community health care improve maternal and child health?

FLOTTORP, Signe
August 2008

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"Lay health workers have no formal professional education, but they are usually provided with job-related training. They can be involved in either paid or voluntary care. They perform diverse functions related to health care delivery and a range of terms are used to describe them including village health workers, community volunteers and peer counsellors among others." This summary is based on a 2006 systematic review of lay health workers in primary and community health care, by Simon Lewin et al

The Millennium Development Goals report 2008

UNITED NATIONS (UN)
2008

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This UN Report summarizes progress towards the Millennium Development Goals between 2000 and 2008, for the world as a whole and for various country groupings. It also considers factors that may affect future progress towards achieving the goals by 2015

Taking critical services to the home : scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya

MWANGI, Annie
WARREN, Charlotte
2008

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This publication is the report of a project to scale-up a community-based model, in Kenya, that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. The findings of the project were that community midwifery contributed to increasing the proportion of women assisted by skilled attendants during birth in the four districts in which the scheme was trialed, amounting to just under half of all skilled attended births in the districts. Although the skilled birth attendant rate in these districts was well below the national average of 42 percent, there was a steady increase in the proportion of attended deliveries since CMs were introduced in 2005. The districts also reported an increase in postnatal assessments in the first 48 hours and increase in immunization coverage

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