A new study by researchers in the University of Iowa College of Public Health examines the complex relationships between water and sanitation access and social conditions on birth outcomes among women in India.
Globally, preterm birth (PTB) and low infant birth weight (LBW) are leading causes of maternal and child illnesses and death. In low-income countries, the challenges women face to meet their basic water, sanitation, and hygiene (WASH) needs may be a major contributor to adverse health outcomes.
“Many homes in low-income countries have no private drinking water source. Women and girls are tasked with fetching water from outside the home, which can be physically stressful,” says Kelly Baker, assistant professor of occupational and environmental health, who co-authored the study. “In addition, homes often lack private toilet facilities, meaning women must use shared or public latrines or manage their sanitation needs in open spaces.”
The lack of water and sanitation in the home forces women to navigate challenging, and sometimes personally threatening, social and environmental public conditions to collect water and to find a safe, private place to defecate, bathe, or manage menstruation, leading to psychosocial stress.
“Determining whether WASH-related stress—both physical and psychosocial—affects birth outcomes for women in low- and middle-income countries is critical for understanding whether the global prevalence of preterm birth and low infant birth weight could be reduced by improving the social and environmental conditions in which pregnant women seek clean water and proper sanitation,” says study co-author William Story, assistant professor of community and behavioral health.
For the study, which was published online Oct. 8, 2018, in PLOS ONE, the researchers used data from the India Human Development Survey . The survey asked women about their drinking water source, walking time to that source, time spent fetching water, sanitation (toilet) access, harassment of women and girls, local crime, whether community problems are solved collectively or individually, the amount of conflict within the community, as well as education, household wealth, and other characteristics.
The researchers examined the effect of pre-birth WASH and social conditions on self-reported PTB status and LBW status for 7,926 women who gave birth between 2004/2005 and 2011/2012. Of these women, 14.9 percent experienced premature birth and 15.5 percent delivered a low birth weight baby.
The study found that increased time daily spent fetching household water increased women’s risk of delivering a low birth weight baby. Open defecation and using a shared latrine within a woman’s building or compound were also associated with higher odds of low birth weight and preterm birth, respectively, compared to having a private household toilet.
Harassment of women and girls in the community also was associated with both low birth weight and preterm birth. The data also showed a possible association of local crime with low birth weight.
“This study contributes to the limited evidence related to environmental causes of PTB and LBW by demonstrating that lack of household WASH infrastructure and social factors, like crime and harassment of women and girls, are risk factors for adverse birth outcomes in women in low- and middle-income countries,” the researchers write. “Additionally, the findings suggest that gender norms that sanction harassment of women and girls and place the burden of household water fetching on women are key determinants of vulnerability to PTB and LBW among Indian women.”
Interventions that reduce domestic responsibilities related to water and sanitation and that change social norms related to gender-based harassment may reduce rates of PTB and LBW in India, the authors note.
Additional contributors to the study include Evan Walser-Kuntz and Bridget Zimmerman from the UI Department of Biostatistics. The paper is available online at https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0205345.
The study was funded by a pilot grant from the University of Iowa College of Public Health. Funding for the original IHDS study was provided to the University of Maryland and the National Council of Applied Economic Research, New Delhi, by the National Institutes of Health.
Cultural and Religious Influences on the Risk of HIV Infection among Women in Western Kenya
Global Visiting Scholar Nema Aluku
Monday, Oct. 15
12:30 to 1:30 p.m.
Lunch will be provided.
Nema Aluku, PhD, MPH, is a research associate at Tangaza University College in Nairobi, Kenya. Dr. Aluku’s research is focused on the influences of religion and culture on HIV/AIDS and maternal and child health outcomes. In addition to her work at Tangaza University College, Dr. Aluku continues to provide technical assistance to a variety of NGOs in East Africa related to gender, religion, and health. She previously worked with World Renew and served as their Health and HIV Program Manager for East and Southern Africa.
A new study published in the Journal of Perinatology, suggests that blood tests can be used to predict the risk of preterm births among pregnant women with and without preeclampsia.
The researchers found that screening for specific biomarkers along with understanding certain demographic information about the patient could identify the risk of most of the women in the study during their second trimester of pregnancy.
Senior author Kelli Ryckman, associate professor of epidemiology at the University of Iowa College of Public Health, says that knowing which women are in the high risk group would allow providers to suggest additional monitoring and even offer an opportunity for intervention.
“For example, our test identified about 95 percent of women who had a preterm birth with preeclampsia before 32 weeks,” Ryckman says. “These women could be offered low-dose aspirin as a way to help lower their risk for preeclampsia.”
The test, developed and studied in 400 women during their second trimester, screened for 25 biomarkers or substances in the blood that were signs of inflammation and immune system activation, as well as certain protein levels, indicative of a possible preterm birth risk.
While the results of the study are encouraging, Ryckman notes that the test is still in very early stages of development, and more research is needed to determine its accuracy and safety.
Additional authors of the study are Laura L. Jelliffe-Pawlowski, Larry Rand, and Mary E. Norton, University of California San Francisco School of Medicine; Bruce Bedell and Jeffrey C. Murray, University of Iowa Carver College of Medicine; Rebecca J. Baer and Scott P. Oltman, University of California San Diego; and Gary M. Shaw and David K. Stevenson, Stanford University School of Medicine.
Funding for the study was provided by the Bill & Melinda Gates Foundation, NIH/NHLBI, the March of Dimes Prematurity Center at Stanford University School of Medicine, the Stanford Child Health Research Institute at Stanford University School of Medicine, the Stanford Clinical and Translational Science Award CTSA to Spectrum, the March of Dimes Prematurity Center—Ohio Collaborative, March of Dimes, and the California Preterm Birth Initiative at the University of California San Francisco Benioff Children’s Hospital.
Related Media Coverage
All are invited to two public panels featuring a medical and anthropology delegation from the National University of Singapore and the National Museum of Denmark, who will speak about an international and inter-disciplinary project to study the hurdles which women across Asia face in early presentation, diagnosis, and treatment of breast cancer.
Breast Cancer Meanings: Journeys across Asia
Monday, April 23 | 3:30 – 5 pm | 1117 University Capitol Centre
Breast cancer is now the most common and fast-growing cancer among women in most Asian countries. This University of Iowa Anthropology Seminar with panelists (see below) will present conversations across Asia with breast cancer patients, their caregivers, traditional healers as well as ordinary people on the subject of breast cancer meanings.
Choosing to Die: A Global Look at the Impact of Cultural Norms on the Choices Women Make in Cancer Treatment
Tuesday, April 24 | 3 – 4:30 pm | 1117 University Capitol Centre
Panelists will discuss details of their recent international, interdisplinary pilot study focused on the hurdles women across Asia seem to face when diagnosed with breast cancer. Moderated by Dr. Resmiye Oral, UI Carver College of Medicine.
Senior consultant in division of general surgery (breast surgery) at National University Hospital and head of Breast Cancer Prevention Program of the School of Public Health, National University of Singapore
Wong Mee Lian
Professor of public health, School of Public Health and School of Medicine, National University of Singapore
Manager of the Breast Cancer Prevention Program, School of Public Health, National University of Singapore
Miriam Koktvedgaard Zeitzen
Anthropologist, modern history and world cultures, National Museum of Denmark
Professor of Anthropology and C. Maxwell and Elizabeth M. Stanley Family Chair of Asian Studies, University of Iowa
Sponsored by International Programs, Center for Asian and Pacific Studies, the Department of Anthropology, and the Stanley-UI Foundation Support Organization
Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to participate in this program, please contact Sarolta Petersen at email@example.com (319) 335-3862
Maternal Mental Health Disparities and Patient Engagement in Research
Karen Tabb Dina, PhD
University of Illinois School of Social Work
Thursday, April 12
Abstract: Women’s mental health during the perinatal period is critically important. Currently there are no best practices for screening for depression and addressing mental health needs in public health clinics. Clinic staff are often responsible for performing depression screening, however, few studies examine staff perceptions on feasibility and acceptability of using perinatal screening for mood disorders in ethnically diverse public health clinics. We conducted focus group interviews with public health staff (n=25) to learn how a multidisciplinary clinical staff addresses mental health in their clinic. Most participants identified multiple barriers to universal depression screening in a public health clinic, but at the same time found value in the practice of screening low-income women for depression. The findings from the focus group study established the foundation for a university-community partnership to improve maternal health outcomes at the county level in Illinois. The partnership has grown into a local initiative and is now in the early stages of developing a patient centered outcomes research community.
Sponsored by the Iowa Institute of Public Health Research and Policy and the Iowa Perinatal Health Research Collaborative
Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires a reasonable accommodation in order to participate in this program, please contact the College of Public Health in advance at 319-384-1500.
A University of Iowa research paper on intimate partner violence during pregnancy and the risk for adverse infant outcomes has been awarded the David Liu Prize by the Royal Academy of Obstetricians and Gynaecologists.
The paper appeared in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) in 2016.
Researchers analyzed 50 studies into the effects of domestic violence by a partner or ex-partner on risk of preterm birth, low birth weight (less than 2500g) and small-for-gestational-age babies. The combined results evaluated more than 5 million women from 17 countries, 15,000 of whom had experienced domestic violence.
Overall, the results found that domestic violence doubled the risk of preterm birth and low birth weight. This risk further increased for women who experienced two or more types of domestic violence during their pregnancy.
The research team included Audrey Saftlas, professor of epidemiology; Brittney Donovan, doctoral student in epidemiology; Kelli Ryckman, associate professor of epidemiology; Cassie Spracklen, doctoral student in epidemiology; and Marin Schweitzer, assistant professor of internal medicine.
Mr. David T. Y. Liu, author of the classic text Labour Ward Manual and pioneer in chorion villus sampling, generously funds this prize to encourage research and publication in obstetrics and prenatal diagnosis.
The award recipient is chosen annually from papers in the field that have been published in BJOG over the previous 12 months. Contending articles are appraised on their validity, the likelihood of the findings being adopted into practice regionally and internationally, whether the paper is explained sufficiently for replication, and the quality of outcomes relevant for patients.