Publications by authors named "Alissa Koski"

16 Publications

  • Page 1 of 1

Child marriage in Canada: A systematic review.

PLoS One 2020 3;15(3):e0229676. Epub 2020 Mar 3.

Assistant Professor, McGill University Department of Epidemiology, Biostatistics and Occupational Health and the Institute for Health and Social Policy, Montreal, Quebec, Canada.

Child marriage, defined by the United Nations as marriage before the age of 18, is considered a violation of human rights with negative consequences for girls' health. We systematically reviewed existing academic literature and news media to learn what is known about the frequency of child marriage in Canada and its effects on health. Approximately 1% of 15-19-year-olds in Canada were married or in common law unions in 2016. News reports document cases of child marriage among religious minority communities but no nationwide estimates of the frequency of marriage before the age of 18 were identified. Sources consistently show girls are more likely to marry as teens than boys. Information on married teens between 15 and 19 years of age suggests similarities in marriage patterns among this age group in Canada and child marriage practices globally. Further research is needed to measure Canada's progress toward eliminating child marriage.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0229676PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053727PMC
June 2020

Defining global health as public health somewhere else.

BMJ Glob Health 2020 7;5(1):e002172. Epub 2020 Jan 7.

Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.

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http://dx.doi.org/10.1136/bmjgh-2019-002172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011020PMC
January 2021

Cash transfer programs have differential effects on health: A review of the literature from low and middle-income countries.

Soc Sci Med 2020 Jan 25;247:112806. Epub 2020 Jan 25.

Biomedical Ethics Unit & Department of Social Science and Medicine, McGill University, Montreal, Quebec, Canada. Electronic address:

Background: Cash transfer programs have grown increasingly popular and are now used as interventions to target a wide array of health outcomes across many diverse settings. However, cash transfer experiments have yielded mixed results, highlighting gaps in our understanding of how these programs work. In particular, we do not yet know whether cash transfers are more effective for certain health outcomes compared to others, or are more effective for some population subgroups compared to others. Here, we ask whether the effects of cash transfers on health outcomes differ across study subgroups.

Methods: We reviewed the literature on cash transfer experiments conducted in low and middle income countries, published in English between 1985 and 2015. We documented whether the investigators reported either i) stratum-specific estimates or ii) the interaction term between subgroups and exposure to the intervention. For studies that presented stratum-specific estimates without statistical tests for heterogeneity, we assessed heterogeneity across subgroups with a Cochran Q test.

Results: Of the 56 studies we reviewed, 40 reported effects on study subgroups. The majority of the cash transfer interventions had different magnitudes of effects on health across subgroups. This heterogeneity was often underreported or not formally analyzed. We find substantial heterogeneity of cash transfers on child health and on adult health yet little heterogeneity of cash transfers on sexual and reproductive health.

Conclusions: Accounting for the heterogeneous impacts of cash transfers during program design and evaluation is necessary to better target cash transfer programs and generate more precise data on their effects.
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http://dx.doi.org/10.1016/j.socscimed.2020.112806DOI Listing
January 2020

The Lived Experience of Child Marriage in the United States.

Soc Work Public Health 2019 12;34(3):201-213. Epub 2019 Feb 12.

b Department of Epidemiology, Biostatistics and Occupational Health, Institute for Health and Social Policy , McGill University , Montreal , Canada.

Despite international and domestic calls to end child marriage, 48 U.S. states permit the marriage of minors younger than age 18 as of August 2018. In developing nations, child marriage is associated with a wide range of adverse economic, health, and mental health outcomes, yet little research has been done to understand its effects on developed nations such as the United States. This study is the first to interview adults who were married as children in the United States, to investigate the reasons why the marriages occurred, and qualitatively understand the experiences of married American children. 21 participants (20 females and 1 male) self-selected into this study to complete an online questionnaire and be interviewed by phone. Participants were married between ages 13 and 17. Most participants (n = 18) reported physical, sexual, financial, or emotional abuse during their marriage as well as unwanted and/or unplanned pregnancies. This study shows some important social justice issues related to consent and the qualitative differences inherent in deciding to marry during childhood. Notably, this study did not find that pregnancy was the reason most participants married as minors, as some policy debates across the U.S. report.
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http://dx.doi.org/10.1080/19371918.2019.1575312DOI Listing
April 2020

Changes in support for the continuation of female genital mutilation/cutting and religious views on the practice in 19 countries.

Glob Public Health 2019 05 13;14(5):696-708. Epub 2018 Nov 13.

b WORLD Policy Analysis Center, UCLA Fielding School of Public Health , Los Angeles , USA.

Campaigns to end female genital mutilation/cutting (FGM/C) have been ongoing for decades. Many countries have adopted legislation that criminalises the practice and programmatic interventions aim to reduce support for it by presenting it as a violation of human rights and by highlighting associated health risks. We used Demographic and Health Survey data from 19 countries to measure national-level trends in the prevalence of FGM/C, reported support for the continuation of the practice, and the belief that it is a religious requirement among men and women. Levels and patterns in each of these outcomes vary markedly between countries. More than half of men and women born in recent years in Guinea and Mali support the continuation of the practice and believe that it is a religious requirement. Support for the continuation of FGM/C has fallen in Benin, Burkina Faso, Chad, Egypt, Ethiopia, Kenya, Senegal, and Tanzania, but has risen in Guinea, Niger, Nigeria, and Sierra Leone. The belief that FGM/C is a religious requirement is common, particularly in countries with high prevalence of cutting. Changes in support for cutting mirror those in the belief that it is a religious requirement.
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http://dx.doi.org/10.1080/17441692.2018.1542016DOI Listing
May 2019

The impact of eliminating primary school tuition fees on child marriage in sub-Saharan Africa: A quasi-experimental evaluation of policy changes in 8 countries.

PLoS One 2018 24;13(5):e0197928. Epub 2018 May 24.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.

Background: Child marriage harms girls' health and hinders progress toward development goals. Randomized studies have shown that providing financial incentives for girls' education can effectively delay marriage, but larger-scale interventions are needed in light of slow progress toward curbing the practice. Many sub-Saharan African countries eliminated primary school tuition fees over the past two decades, resulting in massive increases in enrolment. We measured the effect of these policies on the probability of primary school completion and of marriage before 15 and 18 years of age.

Methods: We used Demographic and Health Surveys to assemble a dataset of women born between 1970 and 2000 in 16 countries. These data were merged with longitudinal information on the timing of tuition fee elimination in each country. We estimated the impact of fee removal using fixed effects regression to compare changes in the prevalence of child marriage over time between women who were exposed to tuition-free primary schooling and those who were not.

Results: The removal of tuition fees led to modest average declines in the prevalence of child marriage across all of the treated countries. However, there was substantial heterogeneity between countries. The prevalence of child marriage declined by 10-15 percentage points in Ethiopia and Rwanda following tuition elimination but we found no evidence that the removal of tuition fees had an impact on child marriage rates in Cameroon or Malawi. Reductions in child marriage were not consistently accompanied by increases in the probability of primary school completion.

Conclusions: Eliminating tuition fees led to reductions in child marriage on a national scale in most countries despite challenges with implementation. Improving the quality of the education available may strengthen these effects and bolster progress toward numerous other public health goals.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0197928PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967724PMC
December 2018

Child Marriage in the United States: How Common Is the Practice, And Which Children Are at Greatest Risk?

Perspect Sex Reprod Health 2018 06 17;50(2):59-65. Epub 2018 Apr 17.

Dean, University of California, Los Angeles, Fielding School of Public Health.

Context: Marriage before the age of 18, commonly referred to as child marriage, is legal under varying conditions across the United States. The prevalence of child marriage among recent cohorts is unknown.

Methods: American Community Survey data for 2010-2014 were used to estimate the average national and state-level proportions of children who had ever been married. Prevalence was calculated by gender, race and ethnicity, and birthplace, and the living arrangements of currently married children were examined.

Results: Approximately 6.2 of every 1,000 children surveyed had ever been married. Prevalence varied from more than 10 per 1,000 in West Virginia, Hawaii and North Dakota to less than four per 1,000 in Maine, Rhode Island and Wyoming. It was higher among girls than among boys (6.8 vs. 5.7 per 1,000), and was lower among white non-Hispanic children (5.0 per 1,000) than among almost every other racial or ethnic group studied; it was especially high among children of American Indian or Chinese descent (10.3 and 14.2, respectively). Immigrant children were more likely than U.S.-born children to have been married; prevalence among children from Mexico, Central America and the Middle East was 2-4 times that of children born in the United States. Only 20% of married children were living with their spouses; the majority of the rest were living with their parents.

Conclusions: Child marriage occurs throughout the country. Research on the social forces that perpetuate child marriage is needed to inform efforts to prevent it.
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http://dx.doi.org/10.1363/psrh.12055DOI Listing
June 2018

Thirty-year trends in the prevalence and severity of female genital mutilation: a comparison of 22 countries.

BMJ Glob Health 2017 25;2(4):e000467. Epub 2017 Nov 25.

WORLD Policy Analysis Center, UCLA Fielding School of Public Health, Los Angeles, California, USA.

Introduction: Female genital mutilation (FGM) harms women's health and well-being and is widely considered a violation of human rights. The United Nations has called for elimination of the practice by 2030.

Methods: We used household survey data to measure trends in the prevalence of FGM in 22 countries. We also examined trends in the severity of the practice by measuring changes in the prevalence of flesh removal, infibulation and symbolic 'nicking' of the genitals. We evaluated the extent to which measurement error may have influenced our estimates by observing the consistency of reports for the same birth cohorts over successive survey waves.

Results: The prevalence of all types of FGM fell in 17 of 22 countries we examined. The vast majority of women who undergo FGM have flesh removed from their genitals, likely corresponding to the partial or total removal of the clitoris and labia. Infibulation is still practised throughout much of sub-Saharan Africa. Its prevalence has declined in most countries, but in Chad, Mali and Sierra Leone the prevalence has increased by 2-8 percentage points over 30 years. Symbolic nicking of the genitals is relatively rare but becoming more common in Burkina Faso, Chad, Guinea and Mali.

Conclusion: FGM is becoming less common over time, but it remains a pervasive practice in some countries: more than half of women in 7 of the 22 countries we examined still experience FGM. The severity of the procedures has not changed substantially over time. Rigorous evaluation of interventions aimed at eliminating or reducing the harms associated with the practice is needed.
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http://dx.doi.org/10.1136/bmjgh-2017-000467DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717946PMC
November 2017

Recent Trends in Premarital Fertility across Sub-Saharan Africa.

Stud Fam Plann 2017 03 30;48(1):3-22. Epub 2017 Jan 30.

The rising age of first marriage across sub-Saharan Africa over the past 25 years has led many scholars to predict a concurrent increase in premarital childbearing. We examine whether this anticipated increase has materialized using data from 27 countries. Our results reveal considerable heterogeneity. Although levels of premarital fertility have risen by up to 13 percent in recent years in some African countries, other countries have experienced a 7 percent decline. Adolescent premarital childbearing, in particular, has shown marked decline in several countries. Furthermore, although the rising age of marriage exerts clear upward pressure on premarital fertility, decomposition analyses indicate that in half of the countries examined, other factors such as delayed sexual debut and use of contraception counteract this effect. These results temper concerns about the rising numbers of unwed mothers and demonstrate that countries can simultaneously delay marriage and achieve relatively stable, or even declining, levels of premarital childbearing.
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http://dx.doi.org/10.1111/sifp.12013DOI Listing
March 2017

Increased Duration of Paid Maternity Leave Lowers Infant Mortality in Low- and Middle-Income Countries: A Quasi-Experimental Study.

PLoS Med 2016 Mar 29;13(3):e1001985. Epub 2016 Mar 29.

Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, United States of America.

Background: Maternity leave reduces neonatal and infant mortality rates in high-income countries. However, the impact of maternity leave on infant health has not been rigorously evaluated in low- and middle-income countries (LMICs). In this study, we utilized a difference-in-differences approach to evaluate whether paid maternity leave policies affect infant mortality in LMICs.

Methods And Findings: We used birth history data collected via the Demographic and Health Surveys to assemble a panel of approximately 300,000 live births in 20 countries from 2000 to 2008; these observational data were merged with longitudinal information on the duration of paid maternity leave provided by each country. We estimated the effect of an increase in maternity leave in the prior year on the probability of infant (<1 y), neonatal (<28 d), and post-neonatal (between 28 d and 1 y after birth) mortality. Fixed effects for country and year were included to control for, respectively, unobserved time-invariant confounders that varied across countries and temporal trends in mortality that were shared across countries. Average rates of infant, neonatal, and post-neonatal mortality over the study period were 55.2, 30.7, and 23.0 per 1,000 live births, respectively. Each additional month of paid maternity was associated with 7.9 fewer infant deaths per 1,000 live births (95% CI 3.7, 12.0), reflecting a 13% relative reduction. Reductions in infant mortality associated with increases in the duration of paid maternity leave were concentrated in the post-neonatal period. Estimates were robust to adjustment for individual, household, and country-level characteristics, although there may be residual confounding by unmeasured time-varying confounders, such as coincident policy changes.

Conclusions: More generous paid maternity leave policies represent a potential instrument for facilitating early-life interventions and reducing infant mortality in LMICs and warrant further discussion in the post-2015 sustainable development agenda. From a policy planning perspective, further work is needed to elucidate the mechanisms that explain the benefits of paid maternity leave for infant mortality.
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http://dx.doi.org/10.1371/journal.pmed.1001985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811564PMC
March 2016

Accessibility and potency of uterotonic drugs purchased by simulated clients in four districts in India.

BMC Pregnancy Childbirth 2014 Nov 13;14:386. Epub 2014 Nov 13.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Background: Surveillance of drug quality for antibiotics, antiretrovirals, antimalarials and vaccines is better established than surveillance for maternal health drugs in low-income countries, particularly uterotonic drugs for the prevention and treatment of postpartum hemorrhage. The objectives of this study are to: assess private sector accessibility of four drugs used for uterotonic purposes (oxytocin, methylergometrine, misoprostol, valethamate bromide); and to assess potency of oxytocin and methylergometrine ampoules purchased by simulated clients.

Methods: The study was conducted in Hassan and Bagalkot districts in Karnataka state and Agra and Gorakhpur districts in Uttar Pradesh state. A sample of 877 private pharmacies was selected (using a stratified, systematic sampling with random start), among which 847 were successfully visited. The target sample size for assessment of accessibility was 50 pharmacies per drug, per district. The target sample size for potency assessment was 100 purchases each of oxytocin and methylergometrine across all districts. Successful drug purchases varied by state.

Results: In Agra and Gorakhpur, 90%-100% of visits for each of the drugs resulted in a purchase. In Bagalkot and Hassan, only 29%-52% of visits for each drug resulted in a purchase. Regarding potency, the percent of active pharmaceutical ingredient was assessed using United States Pharmacopeia monograph #33 for both drugs; 193 and 188 ampoules of oxytocin and methylergometrine, respectively, were assessed. The percent of oxytocin ampoules outside manufacturer specification ranged from 33%-40% in Karnataka and from 22%-50% in Uttar Pradesh. In Bagalkot and Hassan, 96% and 100% of the methylergometrine ampoules were outside manufacturer specification, respectively. In Agra and Gorakhpur, 54% and 44% were outside manufacturer specification, respectively.

Conclusion: Private sector accessibility of uterotonic drugs in study districts in Karnataka warrants attention. Most importantly, interventions to assure quality oxytocin and particularly methylergometrine are needed in study districts in both states.
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http://dx.doi.org/10.1186/s12884-014-0386-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4240854PMC
November 2014

Direct observation of uterotonic drug use at public health facility-based deliveries in four districts in India.

Int J Gynaecol Obstet 2014 Oct 12;127(1):25-30. Epub 2014 Jun 12.

Department of Population, Family Planning and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.

Objective: To describe intrapartum uterotonic drug use and related behaviors in public health facility-based deliveries and to describe drug storage conditions in associated pharmacies.

Methods: A descriptive study was conducted between August and November 2011 to document practices related to uterotonic administration and storage based on direct observation of deliveries at public health facilities in four Indian districts (n=97, n=89, n=91, and n=89) with contrasting maternal health and socioeconomic indicators.

Results: Uterotonic drug use before and after delivery was common among the 366 study participants. Labor augmentation rates ranged from 53.5%-93.0% of deliveries across districts, with many receiving multiple uterotonics and administration via intramuscular injection or intravenous push. Uterotonic use following delivery ranged from 78.6%-99.1% across districts, with correct use of uterotonics for postpartum hemorrhage prevention varying from 6.0%-8.8% in Uttar Pradesh and 41.2%-76.4% in Karnataka. Active management of the third stage of labor following Indian guidelines was less than 10% in all districts. Storage of uterotonics at room temperature was common.

Conclusion: Given that labor augmentation is nearly routine and at odds with Indian guideline recommendations, rigorous research is needed to assess maternal and fetal outcomes of current versus guidelines-based practice. Active management of the third stage of labor as per Indian guidelines was minimal.
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http://dx.doi.org/10.1016/j.ijgo.2014.04.014DOI Listing
October 2014

Knowledge, attitudes, and practices related to uterotonic drugs during childbirth in Karnataka, India: a qualitative research study.

PLoS One 2013 29;8(4):e62801. Epub 2013 Apr 29.

PATH, New Delhi, India.

Background And Objectives: India has the highest annual number of maternal deaths of any country. As obstetric hemorrhage is the leading cause of maternal death in India, numerous efforts are under way to promote access to skilled attendance at birth and emergency obstetric care. Current initiatives also seek to increase access to active management of the third stage of labor for postpartum hemorrhage prevention, particularly through administration of an uterotonic after delivery. However, prior research suggests widespread inappropriate use of uterotonics at facilities and in communities-for example, without adequate monitoring or referral support for complications. This qualitative study aimed to document health providers' and community members' current knowledge, attitudes, and practices regarding uterotonic use during labor and delivery in India's Karnataka state.

Methods: 140 in-depth interviews were conducted from June to August 2011 in Bagalkot and Hassan districts with physicians, nurses, recently delivered women, mothers-in-law, traditional birth attendants (dais), unlicensed village doctors, and chemists (pharmacists).

Results: Many respondents reported use of uterotonics, particularly oxytocin, for labor augmentation in both facility-based and home-based deliveries. The study also identified contextual factors that promote inappropriate uterotonic use, including high value placed on pain during labor; perceived pressure to provide or receive uterotonics early in labor and delivery, perhaps leading to administration of uterotonics despite awareness of risks; and lack of consistent and correct knowledge regarding safe storage, dosing, and administration of oxytocin.

Conclusions: These findings have significant implications for public health programs in a context of widespread and potentially increasing availability of uterotonics. Among other responses, efforts are needed to improve communication between community members and providers regarding uterotonic use during labor and delivery and to target training and other interventions to address identified gaps in knowledge and ensure that providers and pharmacists have up-to-date information regarding proper usage of uterotonic drugs.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0062801PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3639256PMC
November 2013

Uterotonic use during childbirth in Uttar Pradesh: accounts from community members and health providers.

Midwifery 2013 Aug 15;29(8):902-10. Epub 2013 Feb 15.

Johns Hopkins Bloomberg School of Public Health, 455 Massachusetts Ave. NW, Washington, DC 20001, USA.

Objective: this qualitative study aimed to document provider and community practices regarding uterotonic use during labour and delivery in Uttar Pradesh, India, as well as the knowledge, attitudes, and values that underlie such use.

Methods, Setting, And Participants: a total of 140 in-depth interviews were conducted between May and July 2011 in Agra and Gorakhpur districts, with clinicians, nurses, recently delivered women, mothers-in-law with at least one grandchild, traditional birth attendants, unlicensed village doctors, and pharmacist assistants at chemical shops.

Findings: interviews reveal that injectable uterotonic use for the purposes of labour augmentation is widespread in both clinical and community settings. However, use of uterotonics for postpartum haemorrhage prevention and treatment appears to be relatively limited and was rarely discussed by respondents. Key beliefs underlying uterotonic use were identified, including high valuation of labour pain, rapid delivery, and biomedical intervention, particularly administration of medicines. Other factors promoting the use of uterotonics for labour augmentation included lack of knowledge about adverse effects, provider beliefs that prolonged labour poses risks to the baby, community perceptions that modern women are less able to have spontaneous delivery, and financial incentives for uterotonic administration.

Conclusions And Implications: major challenges to overcome in minimising uterotonic misuse include entrenched use for labour augmentation in both institutional and community deliveries, perceptions of injectable uterotonics as curative agents symbolic of biomedical care, and the widespread availability of these drugs. The findings demonstrate a need for programmes that reduce inappropriate use of uterotonics, promote appropriate use for postpartum haemorrhage prevention and treatment, and ensure adherence to evidence-based guidelines.
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http://dx.doi.org/10.1016/j.midw.2012.11.004DOI Listing
August 2013

Uterotonic drug quality: an assessment of the potency of injectable uterotonic drugs purchased by simulated clients in three districts in Ghana.

BMJ Open 2012 3;2(3). Epub 2012 May 3.

Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

Objectives: Given use of uterotonics for postpartum haemorrhage and other obstetric indications, the importance of potent uterotonics is indisputable. This study evaluated access to and potency of injectable uterotonics in Ghana.

Design: Study design involved research assistants simulating clients to purchase oxytocin and ergometrine from different sources. Drug potency was measured via chemical assay by the Ghana Food and Drugs Board.

Setting: The study was conducted in three contrasting districts in Ghana.

Outcome Measure: The per cent of active pharmaceutical ingredient was measured to assess the quality of oxytocin and ergometrine.

Results: 69 formal points of sale were visited, from which 55 ergometrine ampoules and 46 oxytocin ampoules were purchased. None of the ergometrine ampoules were within British Pharmacopoeia specification for active ingredient, none were expired and one showed 0% active ingredient, suggestive of a counterfeit drug. Among oxytocin ampoules purchased, only 11 (26%) were within British Pharmacopoeia specification for active ingredient and two (4%) were expired. The median percentages of active ingredients were 64% and 50% for oxytocin and ergometrine, respectively.

Conclusions: The quality of injectable uterotonics in three contrasting districts in Ghana is a serious problem. Restrictions regarding the sale of unregistered drugs, and of registered drugs from unlicensed shops, are inadequately enforced. These problems likely exist elsewhere but are not assessed, as postmarketing drug quality surveillance is generally restricted to well-funded disease-specific programmes relying on antiretroviral, antimalarial and antibiotic drugs. Maternal health programmes must adopt and fund the same approach to drug quality as is standard in programmes addressing infectious disease.
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http://dx.doi.org/10.1136/bmjopen-2011-000431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3346944PMC
October 2012

Physical violence by partner during pregnancy and use of prenatal care in rural India.

J Health Popul Nutr 2011 Jun;29(3):245-54

Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD 21205, USA.

The role of physical violence during pregnancy on receipt of prenatal care is poorly understood, particularly for South Asian countries that have high levels of both fertility and domestic violence. Data from the 1998/1999 Indian National Family Health Survey and a 2002/2003 follow-up survey that re-interviewed women in four states were analyzed, examining the association between physical violence during pregnancy and the uptake of prenatal care. Women who experienced physical violence during pregnancy were less likely to receive prenatal care, less likely to receive a home-visit from a health worker for a prenatal check-up, less likely to receive at least three prenatal care visits, and less likely to initiate prenatal care early in the pregnancy. This study highlighted the constraining effect that the experience of physical domestic violence during pregnancy had on the uptake of prenatal care for women in rural India. Maternal health services must recognize the unique needs of women experiencing violence from their intimate partners.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3131125PMC
http://dx.doi.org/10.3329/jhpn.v29i3.7872DOI Listing
June 2011