Pregnancy-Associated Deaths from Homicide, Suicide, and Drug Overdose: Review of Research and the Intersection with Intimate Partner Violence.

The leading causes of pregnancy-associated deaths, as defined by the Centers for Disease Control and Prevention, are homicide, suicide, and drug overdose. Intimate partner violence during pregnancy has been shown to contribute to maternal mortality from pregnancy-associated deaths. In this article, we discuss these leading causes of pregnancy-associated deaths. We review the prevalence, demographic characteristics, and possible factors leading to each cause of death, as well as evidence-based methods of identification, prevention, and intervention. The review also will include data showing racial and ethnic inequities. In addition, we identify gaps and guiding questions for further research, as well as suggestions for immediate changes in practice and policy.

Violence screening and viral load suppression among HIV-positive women of color.

Recent research suggests intimate partner violence (IPV) is commonly experienced by many people living with HIV/AIDS, which can complicate their care. We introduce a novel approach to screening for history of violence among 102 women of color living with HIV and receiving care at an outpatient public health clinic. Using a composite measure composed of data from a variety of screening tools, we were able to determine that 70.6% of the women had a history of violence using the composite measure, and that 43% screened positive using multiple screening tools. Although overall viral load suppression rate was high at 81.4%, women with a history of violence were less likely to be virally suppressed when compared to those without such a history (76.4% versus 93.3%, p<0.05). Our findings suggest using a variety of screening questions at entry and at follow-up care appointments may be key to identifying and supporting women survivors who may not disclose violence when first asked. Future research should foster further development, analysis, and use of a variety of screening tools such as those used in this study.

Women as health care decision-makers: implications for health care coverage in the United States.

Women in the United States make approximately 80% of the health care decisions for their families, yet often go without health care coverage themselves. The implementation of the Affordable Care Act provides an historical opportunity for women to gain health care coverage for themselves and their families. The focus of this commentary is on women's leadership roles in the context of health care decision- making and Affordable Care Act education and outreach, and implications for reaching broader health and social goals.

The HIV/AIDS women of color initiative improving access to and quality of care for women of color.

In September 2009, the Health Resources and Services Administration, (HRSA) HIV-AIDS Bureau funded 11 programs to engage and retain women of color (WoC) living with HIV in care. This field report describes the rationale for this Special Project of National Significance (SPNS) initiative, the 11 programs in terms of their theoretical frameworks as well as the contexts and mechanism of care, and outlines some factors that may influence engaging and retaining WoC in care.

Text4baby: development and implementation of a national text messaging health information service.

Text4baby is the first free national health text messaging service in the United States that aims to provide timely information to pregnant women and new mothers to help them improve their health and the health of their babies. Here we describe the development of the text messages and the large public-private partnership that led to the national launch of the service in 2010. Promotion at the local, state, and national levels produced rapid uptake across the United States. More than 320,000 people enrolled with text4baby between February 2010 and March 2012. Further evaluations of the effectiveness of the service are ongoing; however, important lessons can be learned from its development and uptake.

Findings and recommendations from the interim evaluation of the Bright Futures for Women's Health and Wellness Physical Activity and Healthy Eating tools.

The Bright Futures for Women's Health and Wellness Initiative (BFWHW) Physical Activity and Healthy Eating tools encourage patient-provider discussion in the primary care setting, and promote patient self-management, goal setting, and behavior change. An interim evaluation of the BFWHW tools with 274 female adult patients, 18 providers, and 4 site administrators was conducted at 4 health care sites in the United States. Results suggest that patients, particularly overweight women, were interested in discussing healthy eating and physical activity with their provider during the health care visit and that the tools were helpful for goal setting. Nearly three quarters of providers reported that the materials strengthened their discussion of healthy eating with patients; 67% reported an enhanced conversation about physical activity. Site administrators reported several common themes, including the need for flexibility to adopt new routines and using a patient self-management approach. Barriers to implementation included lack of time in the clinical visit and lack of reimbursement. Recommendations for new approaches to address multiple structural, financial, and literacy barriers in order to facilitate the integration of gender-specific health promotion materials into primary care settings are discussed.