The association between Afghan Women's autonomy and experience of domestic violence, moderated by education status.

This study examines the association between Afghan women's autonomy (WA) and experience of domestic violence (physical, sexual, and emotional) in the previous 12 months, and whether this association is moderated by education status. We used data from 19,098 married women aged 15-49, who completed the 2015 Afghanistan Demographic and Health Survey- the first and only national survey administered in the country. WA was measured across 5 domains (healthcare, visiting family, household purchases, spending, and contraceptive use). Adjusted odds ratios and 95% confidence intervals for the association between domestic violence in the past 12 months (any vs. none) and WA were estimated using multiple logistic regression and adjusted for covariates. Interaction terms between education status and WA were also assessed. We found that the experience of physical, emotional, and sexual violence was 45% 30%, and 7%, and at least 1 in 2 had no autonomy. After adjustment, compared to women without autonomy, WA in healthcare decisions, spending, visiting families, and household purchases significantly decreased the odds of physical violence. Similarly, WA in healthcare decisions and spending significantly decreased the odds of sexual violence. Lastly, WA in spending and not using contraception was associated with reduced odds of emotional violence. We also found a greater protective effect of WA in visiting family among women with any education across each domestic violence outcome. These findings provide insights into areas for intervention to address gender inequalities (Sustainable Development Goal 3) and mitigate adverse health outcomes for mothers and their children (Goal 5).

United States Government-Supported Family Planning and Reproductive Health Outreach in the Democratic Republic of the Congo: Lessons Learned and Recommendations.

Background: In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants' perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations. Methods: Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis. Results: The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects. Implications: Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women's feedback about the FP outreach program and our recommendations can inform future policies and interventions.

A United States national reference for foetal growth for Asian American ethnicities.

The purpose of this study was to calculate 10th, 50th, and 90th percentiles of birth weight for gestational age for the total US population and the Asian-American ethnicities. Using the US Natality data files for the years 1992-2020, estimated growth curves were determined across gestational ages and for each Asian American ethnic group-Chinese, Asian Indians, Japanese, Koreans, Filipino, and Vietnamese. Average weight at the 10th, 50th and 90th foetal growth percentiles by race/ethnicity and sex were calculated. Overall, for the 10th, 50th and 90th percentiles, Asian American average birth weight was 18, 90 and 144 g lower than the national average, respectively. We also found that Asian Indians consistently had the lowest birthweight, while Koreans had the highest birthweight among Asian Americans. Updated racial/ethnic-specific weight percentiles by gestational age can be a useful reference for accurate small and large-for-gestational age classifications among different Asian American sub-populations.Impact statementWhat is already known on this subject? Foetal growth is an important determinant of infants' immediate and long-term health outcomes and foetal growth reference curves have been developed to provide average birth weights for each week of gestation and identify growth-restricted as well as excess-weighing foetuses.What the results of this study add? Using the U.S. Natality data files for the years 1992-2020, estimated growth curves were determined across gestational ages and for each Asian American ethnic group-Chinese, Asian Indians, Japanese, Koreans, Filipino, and Vietnamese. Average weight at the 10th, 50th and 90th foetal growth percentiles by race/ethnicity and sex were calculated.What the implications are of these findings for clinical practice and/or further research? Updated racial/ethnic-specific weight percentiles by gestational age can be a useful reference for accurate small and large-for-gestational age classifications among different Asian American sub-groups.

Spousal Violence and Contraceptive Use among Married Afghan Women in a Nationally Representative Sample.

OBJECTIVE: Afghanistan is one of the countries with the highest prevalence of spousal violence (56%) and a low prevalence of contraceptive use (23%), yet there is no study assessing how spousal violence is related to contraceptive use, and what methods are most used by women. Therefore, this study examined the association between the number of types of spousal violence and contraceptive use. METHOD: Using data from 18,985 Afghan married women, aged 15 to 49, who responded to the 2015 Afghanistan Demographic and Health Survey, the current contraceptive method was grouped into five categories: male-involved methods, pills, injectables, long-acting reversible contraception, female sterilization, and Lactation Amenorrhea Method. The number of types of spousal violence in the past 12 months was categorized as none, one type, or two or more types, based on women's experiences with verbal, physical, and sexual violence. For analysis, binary and multinomial logistic regression were used. RESULTS: After adjusting for the covariates, the experience of any spousal violence was associated with contraception use (adjusted odds ratio (aOR) = 1.93, 95% CI: 1.64-2.27, p = 0.0001). Among those using contraception, experiencing two or three types of spousal violence was associated with using pills (adjusted risk ratio (aRRR) = 2.12, 95% CI: 1.63-2.77, p = 0.0001), injections (aRRR = 1.75, 95% CI: 1.26-2.41, p = 0.001), and LAM (aRRR = 3.27, 95% CI: 2.05-5.20, p = 0.0001), compared to male-involved methods. CONCLUSIONS: The findings of this study may inform policymakers and program implementers in designing interventions to address the pervasive problem of violence against women, and make pills and injectables more accessible to Afghan women, since these methods are under women's control and more often used in Afghanistan.

Incidence and risk of stillbirth among various Asian-American subgroups.

BACKGROUND: Striking racial/ethnic disparities exist in pregnancy outcomes among various racial/ethnic. OBJECTIVE: To determine the incidence and risk factors associated with stillbirth in Asian-American women. STUDY DESIGN: We conducted this retrospective cohort study using the United States Birth and Fetal Death data files 2014-2017. We used the fetuses-at-risk approach to generate stillbirth trends by gestational age among Non-Hispanic (NH)-White and Asian-American births during the study period. We calculated the adjusted risk of stillbirth for Asian-Americans, overall, and for each Asian-American subgroup: Asian Indians, Koreans, Chinese, Vietnamese, Japanese and Filipinos, with NH-Whites as the referent category. RESULTS: Of the 715,297 births that occurred among Asian-Americans during the study period, stillbirth incidence rate was 3.86 per 1000 births. From the gestational age of 20 weeks through 41 weeks, the stillbirth rates were consistently lower among Asian-Americans compared to NH-Whites. Stillbirth incidence ranged from a low rate of 2.6 per 1000 births in Koreans to as high as 5.3 per 1000 births in Filipinos. After adjusting for potentially confounding characteristics, Asian-Americans were about half as likely to experience stillbirth compared to NH-White mothers [adjusted hazards ratio (AHR) = 0.57, 95% confidence interval (CI) = 0.51-0.64]. This intrauterine survival advantage was evident in all Asian-American subgroups. CONCLUSION: The risk of stillbirth is twofold lower in Asian-Americans than in NH-Whites. It will be an important research agenda to determine reasons for the improved intrauterine survival among Asian-Americans in order to uncover clues for reducing the burden of stillbirth among other racial/ethnic minority women in the United States.

Risk of Stillbirth Among Foreign-Born Mothers in the United States.

The objective of this study is to assess the impact of maternal nativity on stillbirth in the US. We utilized the US Birth Data and Fetal Death Data for the years 2014-2017. Our analysis was restricted to live and stillbirths (N= of 14,867,880) that occurred within the gestational age of 20-42 weeks. The fetuses-at risk approach was used to generate stillbirth trends by gestational age. Adjusted Cox proportional hazards regression model was utilized to estimate the association between maternal nativity and stillbirth. Overall, the gestational week-specific prospective risk of stillbirth was consistently higher for native-born than their foreign-born mothers. Foreign-born mothers were 20% less likely to experience stillbirth than their native-born counterparts (AHR = 0.80; 95% CI = 0.78-0.81). Delineating the factors influencing the observed effect of maternal nativity on birth outcomes should be a research priority to inform strategies to address adverse birth outcomes in the US.

Trends in childhood viable pregnancy and risk of stillbirth in the United States.

There is limited data on the trends of childhood viable pregnancy and the risk of stillbirth in the United States. Our study assessed the trends in childhood viable pregnancy and associated stillbirth rates over the previous three decades, as well as the risk of stillbirth in these highly vulnerable child mothers aged 10-14 compared with teen mothers aged 15-19. We conducted a population-based retrospective cohort study that used birth datasets, fetal death datasets, and the US population census data: 1982-2017. To assess the association between various sociodemographic and maternal comorbidities and stillbirth, we generated adjusted hazard ratios (AHR) from Cox proportional hazards regression models. From 1982 to 2017, viable pregnancy rates declined among children (from 0.3/1000 to 0.06/1000 population) and teens (from 40.5/1000 in 1982 to 18.1/1000). Overall, there were declines in the stillbirth rates in both teens (15-19 years old) and child mothers aged 10-14 years, but the rate remained consistently higher among child mothers vs. teen mothers (14 per 1000 vs. 8 per 1000 viable pregnancies). Compared to teen mothers, childhood pregnancy was modestly associated with an elevated risk for stillbirth (AHR = 1.09; 95% CI = 1.05-1.12). Other factors significantly associated with increased risk of stillbirth included maternal race, preterm birth, arterial hypertension, diabetes, and eclampsia (P<0.0001).Conclusion: Childhood pregnancy may be a risk factor for stillbirth. This is the first study to assess the trends in childhood viable pregnancy and the associated stillbirth rates in the United States. These findings further underscore the need for sustained efforts and policies to prevent pregnancies in the early years of reproductive development. What is Known: • Childhood pregnancy, defined as pregnancy among 10-14 year-old females, may be associated with a number of pregnancy complications and adverse pregnancy outcomes, including preterm delivery, low birth weight, and infant mortality. • Structural disparities in socioeconomic status and access to healthcare place some teenagers at high risk of teen pregnancy. What is New: • Our study shows the trends in childhood pregnancy over the previous three decades; overall, there were declines in the stillbirth rates in both child mothers aged 10-14 years and teen (15-19 years old) mothers, but the rate remained consistently higher among child mothers. • Child mothers aged 10-14 were more likely to experience stillbirth than teenagers, and Black mothers had an increased risk of stillbirth than White mothers-all of which underscores the effects of structural health disparities.

Impact of Maternal Age on the Foreign-Born Paradox.

To examine the effect of maternal age on the risk of preterm birth and its phenotypes in foreign-born compared to native-born mothers. The 2014-2017 US Birth and Fetal Death data were analyzed (N = 14,867,880). Log-binomial regression models were used to estimate adjusted prevalence ratios (APR), quantifying the association between mother's nativity and preterm birth and its phenotypes, stratified by maternal age. Foreign-born mothers had a 13% lower probability of preterm birth compared to their native-born counterparts (APR, 0.87 [95% CI 0.86-0.87]). This protective effect persisted across all preterm phenotypes. Stratification by maternal age showed a slightly elevated risk in preterm and moderate-to-late preterm for adolescent mothers. Our study supports the existence of the "foreign-born paradox" whereby foreign-born mothers experienced lower levels of preterm birth despite the disadvantages of living in an alien socio-cultural environment. This favorable birth outcome was present primarily in foreign-born mothers aged ≥ 20 years.

Association of Domestic Physical Violence With Feto-Infant Outcomes in Afghanistan.

Our study aimed to investigate the association between domestic physical violence in pregnancy and feto-infant outcomes among Afghan women. Our study design was a cross-sectional study that utilized secondary data from the 2015 Afghanistan Demographic and Health Survey conducted in 33 provinces of Afghanistan (n = 19 676). We used multiple logistic regression models to evaluate the relationship between domestic violence and early-pregnancy loss, perinatal, and neonatal mortality, with adjustments for confounders. Our results indicate that approximately 16.66% (n = 3278) of Afghan women experienced domestic violence while pregnant. In the adjusted models, we found that domestic physical violence in pregnancy was significantly associated with early-pregnancy loss (adjusted odds ratio [AOR] = 1.58, 95% confidence interval [CI] = 1.32-1.88), but not with perinatal mortality (AOR = 1.12, 95% CI = 0.96-1.32) and neonatal mortality (AOR = 1.10, 95% CI = 0.95-1.28). The higher odds of adverse birth outcomes among victims of domestic violence underlines the necessity for interventions to address violence against women in Afghanistan.

Covid-19 and Neuro-Behavioral Economics: A Conceptual Framework to Improve Physical and Mental Health among Remote Workers.

Long-term home confinement during the ongoing COVID-19 can have negative mental and physical health consequences, which in turn can reduce productivity among those working remotely. We sought to delineate factors related to neuro-behavioral economics that employers should consider for their employees who are teleworking during the current Covid-19 pandemic. Physical and mental well-being are intertwined and are strongly correlated to high productivity at workplace. By integrating the factors of neuro-behavioral economics into the work culture, companies will alleviate work-related stress leading to improved mental and physical functioning; thus leading to increased productivity.

Expected Surge in Maternal Mortality and Severe Morbidity among African-Americans in the Era of COVID-19 Pandemic.

Prior to the COVID-19 pandemic, African-American mothers were three times as likely to die from pregnancy-related causes compared to white mothers. The impact of the pandemic among African-Americans could further worsen the racial disparities in maternal mortality (MM) and severe maternal morbidity (SMM). This study aimed to create a theoretical framework delineating the contributors to an expected rise in maternal mortality (MM) and severe maternal morbidity (SMM) among African-Americans in the era of the COVID-19 pandemic due to preliminary studies suggesting heightened vulnerability of African-Americans to the virus as well as its adverse health effects. Rapid searches were conducted in PubMed and Google to identify published articles on the health determinants of MM and SMM that have been or likely to be disproportionately affected by the pandemic in African-Americans. We identified socioeconomic and health trends determinants that may contribute to future adverse maternal health outcomes. There is a need to intensify advocacy, implement culturally acceptable programs, and formulate policies to address social determinants of health.

COVID-19 Devastation of African American Families: Impact on Mental Health and the Consequence of Systemic Racism.

African Americans are bearing a disproportionate burden of morbidity and mortality due to COVID-19 pandemic. To our knowledge, no previous study has delineated inequities potentially incentivized by systemic racism, and whether synergistic effects impose an abnormally high burden of social determinants of mental health on African American families in the era of COVID-19 pandemic. We applied the social ecological model (SEM) to portray inequities induced by systemic racism that impact the mental health of African American families. In our model, we identified systemic racism to be the primary operator of mental health disparity, which disproportionately affects African American families at all levels of the SEM. Programs tailored towards reducing the disproportionate detrimental effects of COVID-19 on the mental health of African Americans need to be culturally appropriate and consider the nuances of systemic racism, discrimination, and other institutionalized biases.

Using Nominal Group Technique to Elucidate a COVID-19 Research Agenda for Maternal and Child Health (MCH) Populations.

As the global impact of the COVID-19 pandemic continues to evolve, robust data describing its effect on maternal and child health (MCH) remains limited. The aim of this study was to elucidate an agenda for COVID-19 research with particular focus on its impact within MCH populations. This was achieved using the Nominal Group Technique through which researchers identified and ranked 12 research topics across various disciplines relating to MCH in the setting of COVID-19. Proposed research topics included vaccine development, genomics, and artificial intelligence among others. The proposed research priorities could serve as a template for a vigorous COVID-19 research agenda by the NIH and other national funding agencies in the US.

Pre-pregnancy maternal obesity, macrosomia, and risk of stillbirth: A population-based study.

OBJECTIVE: An examination of the synergistic effects of maternal obesity and macrosomia on the risk of stillbirth is lacking. The purpose of this study was to determine the association between fetal macrosomia, maternal obesity, and the risk of stillbirth. METHODS: This retrospective cross-sectional study used the CDC's Birth Data and Fetal Death Data files for 2014-2017 [n = 10,043,398‬ total births; including 48,799 stillbirths]. The exposure was fetal macrosomia stratified by obesity subtypes (I-III). The outcome was the risk of stillbirth. We also controlled for potential and known confounding factors in adjusted models. Adjusted Relative Risks (ARR) were estimated with log-binomial regression models. RESULTS: The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without (6.55 vs. 0.54 per 1000 total births). After controlling for confounding, women with obesity types II and III were at increased risk for stillbirth [Obesity II ARR = 2.37 (2.07-2.72); Obesity III ARR = 9.06 (7.61-10.78)]. CONCLUSIONS FOR PRACTICE: Obesity-related fetal overgrowth is a significant risk factor for stillbirth, especially among women with type II and type III obesity. This finding highlights the need for more effective clinical and public health strategies to address pre-pregnancy obesity and to optimize gestational weight gain.

Racism, Psycho-Social Stress, and Health-related Quality of Life.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress.

Phenotypes of fetal macrosomia and risk of stillbirth among term deliveries over the previous four decades.

OBJECTIVES: To evaluate the association between macrosomia and stillbirth over the previous four decades and to determine the consistency of the relationship. METHODS: This was a population-based retrospective cohort study using United States Natality and Fetal Death Data from 1982 to 2017 and restricted to the gestational age range of 37-41 weeks inclusive. Macrosomia was defined as birthweight ≥4000 g and subdivided into its grades as previously recommended: grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g). We calculated temporal trends of stillbirth among fetuses with macrosomia over the years using joinpoint regression. We generated odds ratios from adjusted binomial logistic regression models to examine the association between macrosomia and risk of stillbirth stratified by grades using normal-weight infants (2500-3999 g) as referent. RESULTS: Within the fetal macrosomia group, the rate of stillbirth declined from 2.04/1000 in 1982 to 1.05/1000 by the end of the study period (2017), representing a drop of about 48.5%. For the normal-weight fetuses, stillbirth rate declined from 1.95/1000 to 0.83/1000, equivalent to a decline of 57.4%. Macrosomia was significantly associated with elevated risk for stillbirth: grade 2 (OR = 1.27; 95% CI = 1.22-1.32) and grade 3 (OR = 5.97; 95% CI = 5.69-6.22). CONCLUSIONS: Fetal macrosomia is a significant risk factor for fetal demise with the worst intrauterine survival observed among those classified as grade 3. Fetal macrosomia is a heterogeneous rather than a homogeneous entity in terms of risk profiles, and this needs to be considered in future policy guidelines.

Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971-2017.

PURPOSE: Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28-42 weeks inclusive. METHODS: This was a retrospective cohort study covering the period 1971-2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000-4499 g), Grade 2 (4500-4999 g) and Grade 3 (≥ 5000 g). RESULTS: A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain. CONCLUSION: This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.