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Obstetric violence refers to the mistreatment of women in pregnancy and childbirth care by their health providers. It is linked to poor quality of care, lack of trust in health systems, and adverse maternal and neonatal outcomes. Evidence of interventions to reduce and prevent obstetric violence is limited. We developed a training intervention using a participatory theatre technique called Forum Play inspired by the Theatre of the Oppressed for health providers in Sri Lanka. This paper assesses the potential of the training method to increase staff awareness of obstetric violence and promote taking action to reduce or prevent it. We conducted four workshops with 20 physicians and 30 nurses working in three hospitals in Colombo, Sri Lanka. Participants completed a questionnaire before and three-to-four months after the intervention. At follow-up, participants more often reported that they had been involved in situations of obstetric violence, indicating new knowledge of the phenomenon and/or an increase in their ability to conceptualise it. The intervention appears promising for improving the abilities of health care providers to recognise obstetric violence, the first step in counteracting it. The study demonstrates the value of developing further studies to assess the longitudinal impacts of theatre-based training interventions to reduce obstetric violence and, ultimately, improve patient care. This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

In a recent Viewpoint in the Lancet , some of us shared our experience of censorship in donor-funded evaluation research and warned about a potential trend in which donors and their implementing partners use ethical and methodological arguments to undermine research.1 Reactions to the Viewpoint—and lively debate at the 2018 Global Symposium on Health Systems Research —suggest that similar experiences are common in implementation and policy research commissioned by international donors to study and evaluate large-scale, donor-funded health interventions and programmes, which are primarily implemented in low resource settings. ‘We all have the same stories’, was one of the first comments on the Viewpoint, followed by many private messages divulging instances of personal and institutional pressure, intimidation and censorship following attempts to disseminate unwanted findings. Such pressure comes from major donors and from international non-governmental organisations (NGOs) obliged to have an external assessment but who then maintain a high degree of confidentiality and control. That such experiences are widespread reflects the deeply political nature of the field of ‘global health’ and the interconnections between priority setting, policy making and project implementation, which sit within a broader set of deeply entrenched power structures.2 3 Researchers in this field routinely find themselves working within—and studying—complex power relations and so experience challenges in negotiating their own position between interests of commissioning agencies and funders, implementers and country governments, as well as those of their own research institutions and their partnerships with other researchers spanning high-income, middle-income and low-income countries.4–7 They often receive research funding from major donor agencies like the UK Department of International Development (DFID), the US Agency for International Development (USAID), the Agence Francaise de Developpement (AFD), UNITAID and the Bill and Melinda Gates Foundation,8 who commission evaluations for their own funded projects, even though they have …

Background : Globally, knowledge of health sector options to respond to domestic violence during pregnancy is increasing, but this topic is under-investigated in Nepal. This gap affects the provision of adequate antenatal care services and understanding of factors that influence women’s willingness and ability to use available services. It is critical to know more about the social norms in a community that promote and prevent women experiencing domestic violence from seeking antenatal care. Objective : To explore community perceptions of domestic violence against pregnant women. Methods : A qualitative study was conducted in Dhulikhel municipality, involving 41 men and 76 women in 12 focus group discussions in different gender and family role separated groups. The interviews were recorded, transcribed in verbatim, and analyzed using content analysis. A socio-ecological model was used as a theoretical framework to illustrate linkages between individual, relationship, community, and societal influences on perceptions of domestic violence during pregnancy. Results : The community recognized different forms of violence during pregnancy threatening women’s physical and psychological health and presenting obstacles to seeking antenatal care. Some types of culturally specific violence were considered particularly harmful, such as pressure to give birth to sons, denial of food, and forcing pregnant women to do hard physical work during pregnancy, which may leave daughters-in-law vulnerable to domestic violence in extended families. A culture where violence is normalized and endurance and family reconciliation are promoted above individual health was perceived to cause women to tolerate and accept the situation. Participants suggested actions and strategies to address continuing violence, which indicated a societal transition toward increased awareness and changing attitudes and practices. Conclusions : Domestic violence during pregnancy needs to be addressed at different levels in Nepal, where women are often dependent on others for access to health care. Social norms were perceived to be shifting toward reduced acceptance of violence against women, but restrictions on women’s life options, movement, and decision-making authority were still considered impediments to pregnant women’s health. Keywords: domestic violence; pregnant women; perception; focus groups; Nepal (Published: 22 November 2016) This paper is part of the Special Issue: Gender and Health Inequality – intersections with other relevant axes of oppression. More papers from this issue can be found at www.globalhealthaction.net Citation: Glob Health Action 2016, 9 : 31964 - http://dx.doi.org/10.3402/gha.v9.31964

Journal article The risks associated with gestational diabetes mellitus (GDM) are well recognized, and there is increasing evidence to support treatment of the condition. However, clear guidance on the ideal approach to screening for GDM is lacking. Professional groups continue to debate whether selective screening (based on risk factors) or universal screening is the most appropriate approach. Additionally, there is ongoing debate about what levels of glucose abnormalities during pregnancy respond best to treatment and which maternal and neonatal outcomes benefit most from treatment. Furthermore, the implications of possible screening options on health care costs are not well established. In response to this uncertainty there have been repeated calls for well-designed, randomised trials to determine the efficacy of screening, diagnosis, and management plans for GDM. We describe a randomised controlled trial to investigate screening uptake rates and the clinical and cost effectiveness of screening in primary versus secondary care settings. HRB Ireland peer-reviewed

Journal article Background: Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Lifestyle intervention can prevent progression to type 2 diabetes in high risk populations. We designed a randomised controlled trial (RCT) to evaluate the effectiveness of an established lifestyle intervention compared to standard care for delaying diabetes onset in European women with recent GDM. Recruitment into the RCT was more challenging than anticipated with only 89 of 410 (22%) women agreeing to participate. This paper identifies factors that could enhance participation of the target population in future interventions.Methods: We hypothesised that women who agreed to participate would have higher diabetes risk profiles than those who declined, and secondly that it would be possible to predict participation on the bases of those risk factors. To test our hypothesis, we identified the subset of women for whom we had comprehensive data on diabetes risks factors 3-5 years following GDM, reducing the sample to 43 participants and 73 decliners. We considered established diabetes risk factors: smoking, daily fruit and vegetable intake, participation in exercise, family history of diabetes, glucose values and BMI scores on post-partum re-screens, use of insulin during pregnancy, and age at delivery. We also analysed narrative data from 156 decliners to further understand barriers to and facilitators of participation.Results: Two factors differentiated participants and decliners: age at delivery (with women older than 34 years being more likely to participate) and insulin use during pregnancy (with women requiring the use of insulin in pregnancy less likely to participate). Binary logistic regression confirmed that insulin use negatively affected the odds of participation. The most significant barriers to participation included the accessibility, affordability and practicality of the intervention.Conclusions: Women with recent GDM face multiple barriers to lifestyle change. Intervention designers should consider: (i) the practicalities of participation for this population, (ii) research designs that capitalise on motivational differences between participants, (iii) alleviating concerns about long-term diabetes management. We hope this work will support future researchers in developing interventions that are more relevant, effective and successful in recruiting the desired population. HRB Ireland peer-reviewed

Journal article Universal screening using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria has identified a prevalence of gestational diabetes mellitus (GDM) of 12.4% in women living in Ireland. Women with prior GDM are at increased risk of developing type 2 diabetes later in life. A number of risk factors linked to the development of type 2 diabetes are potentially modifiable through lifestyle and behaviour changes, and medical management. No previous Irish studies have adequately investigated the efficacy of lifestyle intervention programmes in reducing these risk factors in women with prior GDM. Through a two-group, parallel randomised controlled trial (RCT), this study aims to assess the clinical impact, cost-effectiveness and psychological experience of the Croí MyAction intensive lifestyle modification programme for women with prior GDM. HRB Ireland (Health Research Board) peer-reviewed

Report This review examines the current body of literature on risk communication related to communicable diseases, focusing on: (i) definitions and theories of risk communication; (ii) methodologies, tools and guidelines for risk communication research, policy and implementation; and (iii) implications, insights and key lessons learned from the application of risk communication principles in real-world settings. non-peer-reviewed

Introduction: Ill mental health and low quality of life among caregivers of children with intellectual disabilities have been associated with lack of financial stability, the severity of disability of the child, and inadequate health care facilities, amongst other factors. While increased stress, anxiety, and depression among such caregivers is evident globally, it is higher in low-income countries (LICs) because of lack of government relief for caregivers, life stressors related to impoverishment, stigma associated with disability and mental health, etc. Data on caregivers and their health, in general, is scarce in Nepal. We aimed to estimate the prevalence of anxiety, depression, stress, and perceived family quality of life (FQOL) in a population of primary caregivers of children with intellectual disability (CWID) in urban and rural areas of Province 3 in Nepal. Methods: A total of 215 primary caregivers of CWID, who send their children to daycare centers, participated in this cross-sectional study. Socio-demographic and health-related data were collected through phone interviews. The health-related data included the prevalence of symptoms of anxiety and depression, assessed using the Hopkins Symptoms Checklist-25 (HSCL-25). The caregivers’ level of stress and satisfaction of their quality of life were calculated using the Perceived Stress Scale (PSS) and Beach Centre Family Quality of Life (FQOL) scale, respectively. A correlation matrix was tabulated using Cramer’s V to estimate the associations between mental distress and several covariates such as family income, severity of disability, employment, and more. Results: The prevalence of anxiety and depression was 6% (N=13) and 5.6% (N=12), respectively. 98.1% (N=211) of the caregivers experienced stress, and 3.7% (N=8) reported having less than acceptable family life satisfaction. Strong associations were not observed between the dependent variables and covariates. Anxiety and depression had associations with the residency of caregivers (rural or urban), employment status, family income, and the caregivers’ health conditions. Association between FQOL and stress of caregivers was also observed while there was no association between FQOL and stress with any covariates. Conclusion: The findings suggest low anxiety and depression, high levels of stress, and satisfaction with their FQOL among the caregivers. Given that associations between FQOL and perceived stress were observed, prevalence of stress and broader impacts of mental illness should be dealt with targeted interventions. A larger study with caregivers of CWID who do not attend schools may be warranted to capture prevalences in a population more representative of the entire country. Additionally, it seems important to explore the factors that seem to be protective against anxiety and depression despite stress in this particular population. Keywords: caregivers; mental health; depression; anxiety; stress; family quality of life