Honoring Women Veterans

Military service has an impact on health. That is true for all of our veterans, but women face unique challenges.  Minnesota Governor, Mark Dayton, declared Monday, June 18, Women Veteran’s Day to honor the service of women in Minnesota. In the Summer of 2010 the Center for Leadership Education in Maternal and Child Health published a volume of Health Generations focusing on the Health of Military Families, with attention to stressors that may especially impact women.

To learn more about the issues facing women serving in the military, visit the Service Women’s Action Network

How long-term benefits override upfront costs: using research and evaluation to justify a female condom intervention

In a time where economic interests override public health concerns, a new study published in AIDS and Behavior shows that public health spending can reduce costs in the long run. In general, female condoms are more expensive than male condoms. However, after cost-analyzing an initiative that distributed 200,000 condoms to women in a neighborhood with high rates of HIV-diagnosis in Washington D.C., the authors found that for every $1 spent, $15 was saved.

D.C. has the highest prevalence of HIV in the United States. 1 in every 33 residents is infected with the virus, and 1 in 14 residents in their 40’s have tested positive. The sexual health initiative began two years ago after a report noted these high levels of HIV/AIDS diagnoses.

The campaign, called D.C.’s Doin’ It!, chose to target sub neighborhoods with high HIV-diagnosis rates. Officials justified the distribution using study findings that showed large numbers of African American heterosexuals in the District engaging in risky sexual behaviors: http://doh.dc.gov/doh/frames.asp?doc=/doh/lib/doh/pdf/dc_hiv_heterosexualstudy.pdf. (Something to consider: 92.3% of study’s participants self-identified as black. Is it possible to compare this to the other 7% of the study and make these same conclusions?)

The report also found that women had a higher HIV prevalence than men (6.3% versus 3.9% respectively). To empower and increase women’s autonomy, officials chose female condoms as the intervention. Female condoms give women the power to make healthy choices, even when a partner does not give them this choice.

The campaign dispensed these at convenience stores, beauty salons and community clinics and trained community members to discuss sexual health with peers in informal settings (UMN professor also used this approach, calling it “Barbershop Conversations”- check it out! http://www.advances.umn.edu/2011/06/barbersho/). The initiative plans to continue the project, by distributing between 250,000-300,000 female condoms a year.

Playing with issues of women empowerment, race, socioeconomic status, and class, critics argue that the intervention targeted a subgroup of D.C.  residents. Is this justified/ethical? Can public health interventions target subpopulations, rather than a community at large? Are there any other issues to consider when implementing a similar campaign?

Although there are concerns with the study and intervention, public health should not disregard evaluation results. Upstream care can and should be utilized to promote population health, including within the reproductive health sphere.

MAMA: Motherhood Around the Globe

An online exhibition of global art, voices, and ideas, MAMA: Motherhood around the Globe is an inspiring community for anyone who is a mother, knows one, or works with one (that’s all of you!). Housed through the International Museum of Women, the website includes videos, facts, and figures promoting healthy moms and its significance with delivering healthy babies. Graphic designs describe the status of Millennium Development Goals in related to gender equity, reproductive health and maternal mortality.

Visit the art gallery for paintings, photographs, drawings and sculptures of the beauties and perils of pregnancy, childbirth and motherhood.  Read stories of motherhood from women around the world. Explore global MCH heroes and their novel ideas in preventing maternal mortality and supporting the health of women everywhere.

Do you have an experience (either domestically or globally) working with mothers you would like to share? As a mother, do you have stories you would like to tell others? What did you find most inspiring about the website? Let us know below or send us your anecdotes!

MCH Student Elisabeth Seburg ‘LEND’s an ear at AMCHP

Elisabeth Seburg is a second year MPH student at the University of Minnesota School Of Public Health. She is in the Maternal and Child Health program as well as a fellow in the University of Minnesota Leadership Education in Neurodevelopmental and Related Disabilities (LEND) Program. As a trainee in two MCHB funded programs, Elisabeth tells us about her unique experience at AMCHP this year.

As a MCH graduate student and a LEND trainee, attending the 2012 AMCHP Annual Conference in Washington D.C was an incredibly valuable experience. I had the opportunity to connect with MCH leaders and learn about innovative MCH programs and initiatives across the country. My main take away from the conference is the importance of collaboration in public health work. From developing partnerships with community stakeholders to address local public health issues to sharing best practices between state Title V agencies, collaboration emerged as an essential component of MCH work.

While I attended many interesting and thought-provoking sessions at AMCHP, a power workshop on disability and women’s health stands out in my mind. The workshop, “Identifying Public Health Practices to Reduce Health Disparities in Women with Disabilities,” featured 3 speakers who shared work to address health disparities among women with disabilities. In addition to providing a good overview of disability-related health disparities, the session offered examples of initiatives to decrease these disparities. One example is the Initiative for Women with Disabilities (IWD) at the Elly & Steve Hammerman Health & Wellness Center, a health center for women with physical disabilities. IWD provides accessible health services to women with disabilities. Keeping with its holistic view of health, IWD also offers accessible activities to women with physical disabilities, such as adaptive rowing and belly dancing. I was excited to see a session on disability and health because my master’s project pertains to this topic, but, more broadly, the programs described in this workshop can serve as models for the field of MCH as we work to eliminate health disparities in women with disabilities.

For more information about IWD: http://iwd.med.nyu.edu/

For more information about disability health disparities: http://content.healthaffairs.org.ezp2.lib.umn.edu/content/30/10/1947.full

Global Efforts in MCH- Female Genital Cutting

Female Genital Cutting (FGC) is a practice that completely or partially removes the external female genitalia. FGC has been reported in various cultures and countries across the world, but according to the U.S. Department of Health and Human Services (HHS), almost ½ of all incidents occur in Egypt or Ethiopia. In communities that practice FGC—some Islamic– many proponents believe that FGC is sanctioned by the Quran (also spelled Koran; Islamic religious text); in fact, no religion, including Islam, is associated with FGC (HHS Office on Women’s Health). Debates continue as many do not understand that formal religious endorsement of FGC has never occurred.

Tradition and superstitions, such as cleanliness and family honor, contribute to the continuation of the practice. For communities that practice the tradition, fears drive families to participate: if a girl is not cut, she will be viewed as an outsider to a community and runs the risk of being unwed. Intervention strategies target men to abandon FGC as a norm, focusing on patriarchal belief systems and the subordination of women.

Although some groups point to the issue of cultural competence, human rights groups and the World Health Organization (WHO) argue that the health risks of FGC outweigh this. Article 25 of the Universal Declaration of Human Rights (UDHR) (created by the United Nations General Assembly in 1948) states that every person has the right to health, well-being, and security. Although critics have argued that the UDHR is framed in a Western lens, the document guides issues that compromise the safety and health of humans, especially if inflicted by another being. According to the World Health Organization, health problems related to FGC include: bleeding; hemorrhaging; increased risk of Sexually Transmitted Infection (STI) and HIV infection; infection of the genitals and urethra; painful scarring and menstruation; trauma and emotional distress; infertility; and problems during labor/pregnancy (http://www.who.int/mediacentre/factsheets/fs241/en/).

Other strategies to decrease the incidence of FGC are seen in the below PBS documentary as well as in a New York Times focus. Grassroots social mobilization agents teach the community about the harms of female genital mutilation by moving this taboo topic out into public discourse. Their efforts are based on the belief that “before abandonment, comes communication and awareness.”

For more information on Female Genital Cutting, please visit the WHO’s website: http://www.who.int/mediacentre/factsheets/fs241/en/. The New York Times video report is available at: http://video.nytimes.com/video/2011/10/16/world/africa/100000001115488/the-fight-against-female-genital-cutting.html