Search

Background: Gender inequality influences access to and demand for healthcare services including vaccines. The gender gap in the COVID-19 vaccine coverage doesn't account for the skewed male-female ratio in India. The pandemic response has failed to recognize the barriers faced by women in accessing healthcare. These barriers are intensified in the case of pregnant women who are considered as a high-risk group for COVID-19 infection. The present study was aimed to examine the factors influencing the uptake of the COVID-19 vaccine in pregnant women., Methods: The study was carried out in the Department of OBGY, GMCH, Aurangabad, Maharashtra. Pregnant women above 18 years who had at least one antenatal visit were considered for the purpose of the study. Women who consented to participate in the study were administered a survey questionnaire by a healthcare provider which included a demographic, socio-economic, and obstetric profile of pregnant women, knowledge and attitude toward vaccines, and gender-related barriers. The chi-square test and independent t test were done to identify the factors influencing the uptake of the vaccine., Results: About 22% of the women had not taken the vaccine (100 out of 444). Factors like age, residence, and education of women were not found to be associated with the uptake of vaccines. Husband's education was found to be significantly associated ( p  < 0.05) with vaccine uptake. The presence of complications during pregnancy also significantly deterred women from taking the vaccine. Concerns about the safety of the vaccine, side effects for the fetus, and negative opinions of family members about the vaccine were also found to be associated with non-uptake of the vaccine by pregnant women., Conclusion: Healthcare providers during antenatal care can play an important role by addressing concerns regarding the safety of the COVID-19 vaccine in pregnant women., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Federation of Obstetric & Gynecological Societies of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Healthcare providers (HCPs) can support women affected by violence, providing a safe way for women to disclose experiences of violence and mitigating violence against women (VAW) through the identification of cases in routine clinical practice. We conducted in-depth interviews and focus group discussions with HCPs in three tertiary facilities in Maharashtra, India, who had participated in training using the World Health Organization curriculum, adapted for the Indian context. n = 21 HCPs participated in in-depth interviews and n = 10 nurses participated in two focus group discussions. The respondents indicated that the training approach and content were acceptable and that the skills learned during the training were feasible to implement. A shift in perspective from viewing VAW as a private issue to understanding it as a health issue facilitated HCPs' response. The training enabled HCPs to recognize barriers faced by women in disclosing violence and their role in supporting disclosure. HCPs reported barriers to providing care for survivors of violence, including a lack of human resources, the time during regular clinical practice, and a lack of strong referral networks. These data can be utilized to inform other efforts to train HCPs in facilities in this setting and provide evidence for ways to improve health systems' responses to VAW in low-and middle-income country settings.

Background: Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth - the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India., Methods: We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs' motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs' perspectives on content and delivery of training and service delivery., Results: The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services., Conclusions: In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts., Plain Language Summary: Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence against women in low and middle-income countries focuses on the impact of these interventions. This practical implementation report focuses on the interventions themselves, describes the processes of developing and adapting the intervention, and thus provides important insights for donors, policy-makers and researchers., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Background: Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India., Methods: The study used a pre-post intervention design with assessment of HCPs' (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up., Results: Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude., Conclusions: This package of interventions, including training of HCPs, improved HCPs' knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women., (© 2021. The Author(s).)

Background: Globally, including in low- and middle-income [LMIC] countries, there is increased attention to and investment in interventions to prevent and respond to violence against women; however, most of these approaches are delivered outside of formal or informal health systems. The World Health Organization published clinical and policy guidelines Responding to intimate partner violence and sexual violence against women in 2013. Further evidence is needed concerning implementation of the Guidelines, including how health care providers perceive training interventions, if the training approach meets their needs and is of relevance to them and how to ensure sustainability of changes in practice due to training. This manuscript describes a study protocol for a mixed methods study of the implementation of the Guidelines and related tools in tertiary hospitals in two districts in Maharashtra, India., Methods: The study will employ a mixed-methods study design. A quantitative assessment of health care providers' and managers' knowledge, attitudes, and practices will be conducted pre, post, and 6 months after the training. Qualitative methods will include a participatory stakeholders' meeting to inform the design of the training intervention design, in-depth interviews [IDIs] and focus-group discussions [FGDs] with health care providers and managers 3-6 months after training, and IDIs with women who have disclosed violence to a trained health care provider, approximately 6 months after training. The study will also validate two tools: a readiness assessment of health facilities and a health management information system form in a facility register format which will be used to document cases of violence., Discussion: The multiple components of this study will generate data to improve our understanding of how implementation of the Guidelines works, what barriers and facilitators to implementation exist in this context, and how current implementation practices result in changes in terms of health services and providers' practices of responding to women affected by violence. The results will be useful for governmental and non-governmental and United Nations Agency efforts to improve health systems and services for women affected by violence, as well as for researchers working on health systems responses to violence against women in India and possibly other contexts., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Access to abortion is desperately needed when pregnancy is the result of rape, both within and outside marriage, and especially when a girl has been raped. The availability of services remains highly restricted because of the way abortion providers interpret the law. This paper presents the experiences of 40 rape survivors, including two children, denied an abortion following rape. The cases were recorded by CEHAT (Centre for Enquiry into Health and Allied Themes) in the course of building capacities of public hospitals to respond to violence against women in Mumbai, India, since 2000. We found that enormous damage is inflicted on women and girls by misinterpretation of the laws on abortion and rape, combined with a lack of understanding of the serious damage rape does, particularly repeated rape, and alongside other forms of assault and abuse. Domestic laws in India place a clear legal responsibility on health professionals to offer immediate care and treatment to rape survivors, including timely access to abortion. It is past due time for both the government and the courts to begin to hold themselves and health professionals accountable for ensuring this care is provided., Competing Interests: Competing interests: None declared., (Copyright © 2019 Bhate-Deosthali and Rege.)

The provision of care for survivors of sexual violence is a medico-legal emergency. However, due to social issues, healthcare providers face several ethical and legal dilemmas when administering care to such survivors at hospitals. Added to these are the compulsions under mandatory reporting laws, which oblige healthcare providers to abide by the ethical commitments of care and treatment, and make it mandatory for them to report cases of sexual violence to the police, failing which they face legal sanctions. This article draws on global evidence related to mandatory reporting of violence against women and children and the lessons learnt from it. While doing so, it presents the current status of mandatory reporting by healthcare providers in India and the challenges faced by them in operationalising the survivors' autonomy, ensuring confidentiality and overcoming obstacles that may impede treatment and care.

B was a frail 15-year-old girl who was brought to the hospital by the police. She had met a 22-year-old boy on a social networking site a few months earlier. They had fallen in love and she had started living with him. On finding his daughter missing, B's father reported the matter to the police station. The police caught the couple and brought them to the police station. The boy was arrested. The father sent B to a shelter home lest she run away from home again. The police registered a complaint of rape.

There are an estimated 7 million burn injuries in India annually, of which 700,000 require hospital admission and 140,000 are fatal. According to the National Burns Programme, 91,000 of these deaths are women; a figure higher than that for maternal mortality. Women of child bearing age are on average three times more likely than men to die of burn injuries. This paper reviews the existing literature on burn injuries in India and raises pertinent issues about prevalence, causes and gaps in recognising the gendered factors leading to a high number of women dying due to burns. The work of various women's groups and health researchers with burns victims raises several questions about the categorisation of burn deaths as accident, suicide and homicide and the failure of the health system to recognise underlying violence. Despite compelling evidence, the health system has not recognised this as a priority. Considering the substantial cost of burns care, prevention is the key which requires health systems to recognise the linkages between burn injuries and domestic violence. Health systems need to integrate awareness programmes about domestic violence and train health professionals to identify signs and symptoms of violence. This would contribute to early identification of abuse so that survivors are able to access support services at an early stage., (Copyright © 2016. Published by Elsevier B.V.)

The contradiction between the socialized nature of the modern health-care system (inclusive of both clinical and social medicine) versus the narrow control over it is obvious in private health-care. However, this contradiction is present to some extent, in its own way, even in the public health facilities in India. To formulate a program for health-care for all in India, it is necessary to grasp these contradictions in both private and public health-care and accordingly conceptualize a strategy to overcome, resolve these contradictions.

The recently declared National Rural Health Mission has aroused significant interest, being both welcomed and closely scrutinized, since there is a long overdue and outstanding need to strengthen weak and dysfunctional public health systems in rural India. In this setting, Jan Swasthya Abhiyan (JSA) has been involved in analysing various aspects of the Mission. The concern has been that it should develop in a manner that actually strengthens public health systems in an integrated manner, and that it should empower communities to be involved in the planning and utilization of these systems in a Rights-based framework. In this article, one will draw upon and reflect on a few of the major concerns about NRHM that have emerged during the insightful discussions in JSA.

Accreditation has been recommended as a mechanism for assuring the quality of private sector health services in low-income countries, especially where regulatory systems are weak. A survey was conducted in Mumbai, India, in 1997-98 to elicit the views of the principal stakeholders on the introduction of accreditation and what form it should take. There was a high level of support for the classical features: voluntary participation, a standards-based approach to assessing hospital performance, periodic external assessment by health professionals, and the introduction of quality assurance measures to assist hospitals in meeting these standards. Hospital owners, professional bodies and government officials all saw potential - though different - advantages in accreditation: for owners and professionals it could give them a competitive edge in a crowded market, while government officials reckoned it could increase their influence over an unregulated private market. Areas of disagreement emerged; for example, hospital owners were opposed to government or third party payment bodies having a dominant role in running an accreditation system. The growing strength of a health service user representative lobby in Mumbai is an additional reason why this would be a suitable place for piloting such a system. The biggest obstacle to introducing accreditation in poorly resourced settings, such as India, is in how to finance it. The provisional support of the principal stakeholders for such a development, demonstrated in this study, will require a commitment from government and policymakers if the potential benefits of accreditation to the health of the population are to be realised.