Choices and services related to contraception in the Gaza strip, Palestine: perceptions of service users and providers

Perceived barriers and opportunities of providing quality family planning services among Palestinian midwives, physicians and nurses in the West Bank: a qualitative study

BACKGROUND

Despite advancements in family planning (FP) services, several barriers persist in the Occupied Palestinian territory (oPt), blocking women's access to suitable, high-quality and equitable FP services. The aim of this study was to understand how healthcare providers perceive their abilities, barriers and opportunities in providing good quality FP services. Furthermore, it seeks to explore knowledge and training regarding FP among healthcare providers engaged in providing FP services.

METHODS

A qualitative study was undertaken from August to September 2022 in seven Primary Health Care (PHC) clinics distributed in three governorates and operating under the Palestinian Ministry of Health (MoH) in the West Bank. Semi-structured, in-depth face-to-face interviews were conducted with 13 health providers (Physicians, midwives and nurses), using an interview guide in Arabic language. Transcripts were subsequently analyzed using the six phases of reflexive thematic analysis.

RESULTS

FP services face various challenges, including shortages in resources such as staff, supplies, infrastructures and FP methods. Midwives possess significant potentials to offer accessible, high-quality, efficient and equitable FP services, yet, their capacities remain underutilized, representing a missed opportunity for a country like Palestine. The study provided a current overview of FP services while illustrating the need for quality FP services and the need for an updated continuous education and training, updated standardized guidelines and protocols and supportive supervision are needed across all levels of healthcare providers. Finally, providers reported a wide range of structural barriers to FP services.

CONCLUSIONS

It is crucial to meticulously address both community-related and health system factors to enhance the fulfillment of FP needs and reduce unintended and closely spaced pregnancies. Policymakers should invest in the development of laws and regulations regarding FP services, promoting a comprehensive and holistic approach to FP services. This includes formulating supportive policies, capacity building of human resources and maintaining security of FP commodities.

What do women need to know about long-acting reversible contraception? Perspectives of women from culturally and linguistically diverse backgrounds

AIM

To identify components of an online education intervention to improve preference for, and uptake of, long-acting reversible contraception in women from culturally and linguistically diverse backgrounds (CALD).

ISSUE ADDRESSED

Women from culturally and linguistically diverse (CALD) backgrounds have greater rates of unintended pregnancies than those born locally and are less likely to use long-acting reversible contraceptives (LARCs), which are highly effective at reducing unintended pregnancy. Increasing the uptake of LARC in women from CALD backgrounds may reduce the burden of unintended pregnancy in this high-risk group. An online education intervention has been shown to be effective at increasing preference for and uptake of LARC in young women. We aimed to describe what women from CALD backgrounds thought were the potentially effective components of an online education intervention to increase preference for, and uptake of, long-acting reversible contraception.

METHODS

This qualitative study involved semi-structured interviews with six Australian English-speaking women from each of Chinese, Indian, and Middle Eastern cultural backgrounds. Women were recruited through targeted Facebook advertising. Data were analysed using Braun and Clarke thematic analysis.

RESULTS

A total of 18 participants were interviewed. We have demonstrated the importance of messages tailored to cultural values, translating the video, widening the target audience to both men and women and using specific social media platforms. For all women, the video needs to highlight the covertness of contraceptive methods, alongside stating cost and approach to access. For Indian women, the video needs to highlight the effect of LARC methods on the menstrual period for Indian women and include basic information on women's health. For Middle Eastern women the video should be explicit about LARC not equating to abortion and emphasise the low efficacy of natural contraceptive methods. For Chinese women, the video should address the misconception that hormones damage the body. Regarding delivery of the video, it should be translated and delivered by a female doctor from the same culture. For Chinese women, the video should include women from the same culture sharing anecdotes and use WeChat and Chinese schools as a platform for dissemination. For Middle Eastern and Indian women government websites should be used for dissemination. The video should be made available to all decision-makers in the reproductive planning process including male partners of Middle Eastern women, parents and peers of Chinese women, and for Indian women the male partner, family, and community leaders.

CONCLUSIONS

There is a wide range of cultural adaptations that can be made to the online education videos about LARCs to improve uptake of LARCs and hence reduce the burden of unintended pregnancy in women from CALD grounds. SO WHAT?: Our findings will be used to modify an online education video about LARCs so that it is culturally appropriate for women from CALD backgrounds.

Awareness of Palestinian Women About Breast Cancer Risk Factors: A National Cross-Sectional Study

PURPOSE

This study aimed to assess awareness of Palestinian women about breast cancer (BC) age-related and lifetime risks and its risk factors and to identify factors associated with good awareness.

MATERIALS AND METHODS

Adult women were recruited from government hospitals, primary health care centers, and public spaces in 11 governorates in Palestine. Recognition of 14 BC risk factors was assessed using a translated-into-Arabic version of the validated BC awareness measure. The level of BC risk factor awareness was determined on the basis of the number of risk factors recognized: poor (0-4), fair (5-9), and good (10-14).

RESULTS

Of 6,269 potential participants approached, 5,434 agreed and completed the questionnaire (response rate = 86.7%). A total of 5,257 questionnaires were included: 2,706 from the West Bank and Jerusalem and 2,551 from the Gaza Strip. Only 173 participants (3.3%) recognized the age-related risk of BC. More than one quarter (n = 1,465; 27.9%) recognized the lifetime risk of BC. The most recognized modifiable risk factor was not breastfeeding (n = 4,937; 93.9%), whereas the least recognized was having children later on in life or not at all (n = 1,755; 33.4%). The most recognized nonmodifiable risk factor was radiation exposure (n = 4,579; 87.1%), whereas the least recognized was starting the periods at an early age (n = 1,030; 19.6%). In total, 2,024 participants (38.4%) demonstrated good BC risk factor awareness. Participants from the Gaza Strip had a higher likelihood than participants from the West Bank and Jerusalem to have good awareness (42.0% v 35.2%). Age ≥ 40 years, postsecondary education, and visiting hospitals and primary health care centers were all associated with an increase in the likelihood of having good BC risk factor awareness.

CONCLUSION

The awareness of BC risk factors was suboptimal. These findings highlight the need for implementing health education programs combined with consistent use of ad hoc opportunities to raise awareness by health care providers.

Awareness of ovarian cancer risk and protective factors: A national cross-sectional study from Palestine

INTRODUCTION

Having a good awareness of ovarian cancer (OC) risk and protective factors could facilitate early diagnosis. This study aimed to assess Palestinian women's awareness about OC risk and protective factors and to identify the factors associated with having good awareness.

METHODS

A cross-sectional study was conducted from July 2019 to March 2020 in the two main areas of Palestine: the West Bank and Jerusalem (WBJ) and the Gaza Strip. A translated-into-Arabic version of the validated OC awareness measure was utilized. Adult women attending hospitals, primary healthcare centers, and public spaces at 11 governorates were invited to participate. The awareness level was categorized based on the number of factors recognized: poor (0 to 5), fair (6 to 10) and good (11 to 15).

RESULTS

Of the 6095 women approached, 5618 agreed and completed the questionnaire (response rate = 92.1%). The final analysis included 5411 questionnaires. The most identified modifiable OC risk factor was 'being a smoker' (n = 4024, 74.4%), whereas the least identified was 'having in vitro fertilization treatment' (n = 1652, 30.5%). The most identified non-modifiable OC risk factor was 'having ovarian cysts' (n = 3136, 58.0%), whereas the least identified was 'having endometriosis' (n = 1880, 34.7%). The most identified OC protective factor was 'breastfeeding' (n = 4770, 88.2%), whereas the least identified was 'using the pill for a long time' (n = 930, 17.2%). Only 820 women (15.2%) displayed good awareness of OC risk and protective factors. Women from the Gaza Strip were slightly more likely than women from the WBJ to have good awareness (16.4% vs. 14.2%). In contrast, post-secondary education, higher monthly income, being married, and knowing someone with cancer were associated with an increase in the likelihood of displaying good awareness.

CONCLUSION

The overall awareness of OC risk and protective factors in this study was low. Educational interventions are needed to improve Palestinian women's awareness.

The Barrier to Contraceptive Use among Multiparous Women in Indonesia

Background

The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives.

Objective

This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia.

Methods

This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15-49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers.

Results

Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45-49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest.

Conclusions

Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.

Knowledge of ovarian cancer symptoms among women in Palestine: a national cross-sectional study

INTRODUCTION

Ovarian cancer (OC) is often diagnosed at advanced stages. This study aimed to assess the Palestinian women's knowledge about OC symptoms and determine the factors associated with having good knowledge.

METHODS

A cross-sectional study was conducted from July 2019 to March 2020 in the two main areas of Palestine: the West Bank and Jerusalem as well as the Gaza Strip. A translated-into-Arabic version of the validated OC awareness measure (OCAM) was utilized for data collection. Stratified convenience sampling was used to recruit adult women attending hospitals, primary healthcare centers, and public spaces at 11 governorates. The knowledge level was categorized into three categories based on the number of symptoms recognized: poor (0 to 4), fair (5 to 8), and good (9 to 11).

RESULTS

Of 6095 approached, 5618 participants completed the Arabic OCAM (response rate = 92.1%).A total of 5411 questionnaires were included in the analysis: 2278 from the Gaza Strip and 3133 from the West Bank and Jerusalem. Participants living in the West Bank and Jerusalem were older, of higher monthly income, and with more chronic diseases than those living in the Gaza Strip. The most frequently identified symptoms were 'extreme generalized fatigue' (n = 3821, 70.6%), 'unexplained weight loss' (n = 3607, 66.7%), and 'increased abdominal size on most days' (n = 3252, 60.1%). On the other hand, the least recognized symptoms were 'feeling full persistently' (n = 1553, 28.7%) and 'difficulty eating on most days' (n = 1971, 36.4%). Only 943 participants (17.4%) displayed good knowledge of OC symptoms. Participants from the Gaza Strip had a higher likelihood than participants from the West Bank and Jerusalem to have a good level of knowledge (21.0% vs. 14.8%). Being married, knowing someone with cancer, and visiting hospitals were all associated with a higher likelihood of having good knowledge level. However, living in the West Bank and Jerusalem was associated with a lower likelihood of having good knowledge.

CONCLUSION

The overall knowledge of OC symptoms in this study was low. Educational interventions are needed to improve Palestinian women's knowledge about OC symptoms.

Reproductive factors and breast cancer risk in Palestine: A case control study

BACKGROUND

Early age at menarche, late age at menopause, and late age at first full-term pregnancy are linked to a modest increase in the risk of developing breast cancer (breast ca). This study aims to investigate the reproductive determinants of breast cancer among women in the West Bank of Palestine. A structured questionnaire was used to collect data in a case-control study (237 registered cases and 237 controls). A multivariate analysis model was used to adjust for the association between women's reproductive factors and breast ca risk. This study was approved by Al Quds University Ethical Research Committee and the Ministry of Health research unit.

RESULTS

In the multivariate analysis, menarche after 13 years of age, use of oral contraceptives for more than two months, and hormonal contraceptives use significantly doubled the risk for breast ca (Adjusted Odds Ratio (AOR) = 2.03, 95 % CI: 1.21-4.37, p < 0.011 and AOR = 2.2, 95 % CI: 1.24-4.01, p = 0.008, respectively). Women who used hormone replacement therapy (HRT) were significantly associated with higher odds (5 folds) of having breast ca versus those who did not use them (AOR 5.02, 95 % CI: 1.93-13.06, p = 0.001). Similarly, nulliparous women showed 6 times the odds of breast ca compared with women with one or more children (p = 0.005). Also, parental consanguinity marriage (AOR 2.59, 95 % CI: 1.53-4.36, p = 0.001) and positive family history (AOR 3.88, 95 % CI: 2.19-6.87, p = 0.001) of the condition can be strong determinants for breast ca in this study.

CONCLUSION

This study provides clear evidence that the use of reproductive hormones, whether as a birth control tool or for therapeutic purposes, must be rationalized worldwide and in Palestine in particular.

Contraceptive knowledge, practice, and associated factors among currently married women of reproductive age group: A community-based study in Puducherry, India

In the present cross-sectional study, the researchers aimed to assess the contraceptive knowledge, practice, and associated factors among 2228 women in Puducherry, India. National Family Health Survey questionnaire was adopted for data collection and about 1924 women participated. Current use of any contraceptive was 78.6% and female sterilization was 62%. The majority (99.8%) knew female sterilization, but below average for other contraceptive methods. About 10.4% were aware of more than three contraceptive methods. Age group, homemaker, with children or one son, aware of less than three methods, residing nearby to health facility were associated with the higher practice of contraceptive methods.

Undergraduate medical students' attitudes towards medical errors and patient safety: a multi-center cross-sectional study in the Gaza Strip, Palestine

BACKGROUND

In undergraduate medical education, patient safety concepts and understanding of medical errors are under-represented. This problem is more evident in low-income settings. The aim of this study was to explore undergraduate medical students' attitudes towards patient safety in the low-income setting of the Gaza Strip.

METHODS

A cross-sectional, descriptive study included medical students of the two medical schools in the Gaza Strip with 338 medical students completing the Attitudes to Patient Safety Questionnaire-IV (APSQ-IV), which examines patient attitudes in 29 items over 10 domains. Results are represented as means ± standard deviations for each item and domain as well as percentage of positive responses to specific items.

RESULTS

Medical students reported slightly positive patient safety attitudes (4.7 ± 0.5 of 7) with the most positive attitudes in the domains of situational awareness, importance of patient safety in the curriculum, error inevitability and team functioning. While no negative attitudes were reported, neutral attitudes were found in the domains of professional incompetence as a cause of error and error reporting confidence. Study year and gender had no significant association with patient safety attitudes, except for disclosure responsibility, where male students displayed significantly more positive attitudes. The study university was significantly associated with three of the 10 examined domains, all of which involved understanding of medical errors, for which students of University 2 (who had undergone limited patient safety training) held significantly more positive attitudes, compared with students of University 1 (who did not have structured patient safety training).

CONCLUSION

Medical students' patient safety attitudes were very similar among students from both universities, except for understanding of medical error, for which students, who had received structured training in this topic, displayed significantly more positive attitudes. This underlines the power of the 'hidden curriculum', where students adjust to prevalent cultures in local hospitals, while they do their clinical training. Furthermore, it highlights the need for a systematic inclusion of patient safety content in local undergraduate curricula.

Access to primary health care family planning services and contraceptive use in disadvantaged women: a qualitative study

OBJECTIVES

The study aimed to provide a deeper understanding of the gender-related determinants and organisational structure of primary health care that shape contraceptive use among disadvantaged women living in a developing Islamic country where family planning services are affected by health care reforms.

METHODS

A qualitative study was conducted in three disadvantaged neighbourhoods in the metropolitan district of Bornova, Izmir. A purposive sampling method with maximum diversity was used to obtain a study sample of 43 women. Data were collected through in-depth interviews and analysed using a coding paradigm of grounded theory.

RESULTS

Three themes emerged from the analysis, namely, factors affecting participants' number of children, experiences with using contraceptive methods, and use of family planning services at family health centres. Despite a desire to limit their number of children and a positive view of contraception, women in the study faced gender-related barriers to accessing family planning services. Their statements indicate significant deficiencies in terms of provision of contraception and family planning consultations at family health centres.

CONCLUSION

For disadvantaged women living in conservative areas, family planning is a fragile exercise. Gender-sensitive primary care services are essential to ensure access to everyone in the community.