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  1. Article ; Online: The COVID-19 Pandemic in the Nawalparasi District of Nepal: a mixed methods assessment of increased alcohol use and violence against women.

    Cornell, Alia / Mitchell, Ashley / Puri, Mahesh / Diamond-Smith, Nadia

    BMC public health

    2023  Volume 23, Issue 1, Page(s) 524

    Abstract: Background: In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of violence against women (VAW). This paper explores pandemic-driven economic insecurity and increased alcohol use as instigators of VAW and ... ...

    Abstract Background: In Nepal and across the globe, the COVID-19 pandemic has primed an environment for increased rates of violence against women (VAW). This paper explores pandemic-driven economic insecurity and increased alcohol use as instigators of VAW and Intimate Partner Violence (IPV) within newly married households in the rural, Nawalparasi region of Nepal.
    Methods: This study is a secondary analysis of data obtained from the Sumadhur Intervention pilot study that has been previously described and demonstrates successful implementation of group-based, household-level intervention for women's empowerment and sexual and reproductive health education (1). Our three sets of data were collected before and during the COVID-19 pandemic. The first set is from a Longitudinal Cohort of 200 newly married women who were surveyed twice a year from February 2017 through July 2020. The second data set is a subset cohort of newly married women, their husbands, and their mothers-in-law (31 women, 31 husbands and 31 mothers-in-law) who participated in Sumadhur in January 2021. The third data set was obtained through in-depth interviews in July 2021 from 15 households following Sumadhur. The interviews were thematically coded, and subthemes were identified. A t-test of the January 2021 survey data set was run to look at correlations between income loss, alcohol consumption and experience of IPV among newly married women. All other survey data was analyzed for change over time.
    Results: At three months after the onset of the pandemic (July 2020), the Longitudinal Cohort survey data from newly married women reported increased rates of husbands' alcohol use as well as personal experiences of IPV as compared to pre-pandemic averages. There was a statistically significant difference (p < 0.001) in the effects of income loss on increased alcohol use and experience of IPV. Qualitative results iterated the common theme of alcohol use and economic insecurity as upstream instigators of VAW in the community.
    Conclusions: In the Nawalparasi district of Nepal, the pandemic has led to unstable economic situations that have instigated alcohol use among men, and increased rates of IPV among young, newly married women, and reports of VAW in the community. We have demonstrated a need for urgent programmatic and policy responses aimed at reducing VAW and IPV and protecting women during times of uncertainty and crisis.
    MeSH term(s) Male ; Humans ; Female ; Pandemics ; Nepal/epidemiology ; Pilot Projects ; COVID-19/epidemiology ; Violence ; Intimate Partner Violence ; Alcohol Drinking/epidemiology ; Risk Factors
    Language English
    Publishing date 2023-03-18
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-023-14997-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: The COVID-19 Pandemic in the Nawalparasi District of Nepal: A Mixed Methods Assessment of Increased Alcohol Use and Intimate Partner Violence.

    Cornell, Alia / Diamond-Smith, Nadia / Mitchell, Ashley / Puri, Mahesh

    Research square

    2022  

    Abstract: ... ...

    Abstract Background
    Language English
    Publishing date 2022-07-14
    Publishing country United States
    Document type Preprint
    DOI 10.21203/rs.3.rs-1786122/v1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Patient perspectives on barriers in obtaining timely abortion care in Los Angeles, California.

    Jung, Christina / Fiastro, Anna / Cornell, Alia / Steward, Rachel / Rible, Radhika / Gipson, Jessica D

    Contraception

    2022  Volume 117, Page(s) 50–54

    Abstract: Objectives: Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing ... ...

    Abstract Objectives: Although California is a state with supportive abortion policies, recent evidence suggests people may still encounter barriers to obtaining timely abortion care. To provide an in-depth understanding of these barriers and augment existing literature focusing on restrictive and hostile states, we sought to understand the patient perspectives of barriers to timely abortion care in Los Angeles, California.
    Study design: We recruited participants from two, high-volume urban clinical sites and conducted semi-structured interviews with 17 individuals who visited three or more clinics and/or encountered more than 2 weeks between seeking and obtaining their abortion. Using thematic analysis, we analyzed deidentified transcripts by first developing and applying codes, then identifying overarching themes to describe barriers to timely abortion care.
    Results: Participants described three primary barriers leading to abortion care delay: (1) difficulties in ensuring insurance coverage or securing authorization for abortion care from private/employer-sponsored insurance, (2) inadequate screening resulting in multiple appointments where desired care could not be provided, and (3) difficulties with expeditious referrals to appropriate clinical sites. Participants also described accumulated fatigue from facing layers of resistance when pursuing avenues for care.
    Conclusions: Even in supportive abortion policy states, barriers to abortion care from insurance, screening, and referral-related issues may result in delayed or unaccessed care, negatively impacting patient experience. Understanding and mitigating reasons for delays are critical to improving patient experience with abortion care.
    Implications: Standardized telephone triage at local clinic facilities and streamlined MediCal authorization of abortion services may mitigate barriers to timely abortion care.
    MeSH term(s) Pregnancy ; Female ; Humans ; Health Services Accessibility ; Los Angeles ; Abortion, Induced ; Ambulatory Care Facilities ; Insurance Coverage
    Language English
    Publishing date 2022-08-30
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 80106-9
    ISSN 1879-0518 ; 0010-7824
    ISSN (online) 1879-0518
    ISSN 0010-7824
    DOI 10.1016/j.contraception.2022.08.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Impact of Sumadhur intervention on fertility and family planning decision-making norms: a mixed methods study.

    Mitchell, Ashley / Puri, Mahesh C / Dahal, Minakshi / Cornell, Alia / Upadhyay, Ushma D / Diamond-Smith, Nadia G

    Reproductive health

    2023  Volume 20, Issue 1, Page(s) 80

    Abstract: Background: Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and ... ...

    Abstract Background: Mindful of social norms shaping health among women pressured to prove early fertility in Nepal, a bi-national research team developed and piloted a 4-month intervention engaging household triads (newly married women, their husbands, and mothers-in-law) toward advancing gender equity, personal agency, and reproductive health. This study evaluates the impact on family planning and fertility decision-making.
    Methods: In 2021, Sumadhur was piloted in six villages with 30 household triads (90 participants). Pre/post surveys of all participants were analyzed using paired sample nonparametric tests and in-depth interviews with a subset of 45 participants were transcribed and analyzed thematically.
    Results: Sumadhur significantly impacted (p < .05) norms related to pregnancy spacing and timing, and sex preference of children, as well as knowledge about family planning benefits, pregnancy prevention methods, and abortion legality. Family planning intent also increased among newly married women. Qualitative findings revealed improved family dynamics and gender equity, and shed light on remaining challenges.
    Conclusions: Entrenched social norms surrounding fertility and family planning contrasted with participants' personal beliefs, highlighting needed community-level shifts to improve reproductive health in Nepal. Engagement of influential community- and family-members is key to improving norms and reproductive health. Additionally, promising interventions such as Sumadhur should be scaled up and reassessed.
    MeSH term(s) Pregnancy ; Child ; Female ; Humans ; Family Planning Services ; Contraception Behavior ; Fertility ; Sex Education ; Family Characteristics
    Language English
    Publishing date 2023-05-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 2149029-6
    ISSN 1742-4755 ; 1742-4755
    ISSN (online) 1742-4755
    ISSN 1742-4755
    DOI 10.1186/s12978-023-01619-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The development and feasibility of a group-based household-level intervention to improve preconception nutrition in Nawalparasi district of Nepal.

    Diamond-Smith, Nadia / Mitchell, Ashley / Cornell, Alia / Dahal, Minakshi / Gopalakrishnan, Lakshmi / Johnson, Mallory / Weiser, Sheri / Puri, Mahesh

    BMC public health

    2022  Volume 22, Issue 1, Page(s) 666

    Abstract: Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential.: Objective: The objectives of this ... ...

    Abstract Background: In a setting such as Nepal with malnutrition and persistent poor maternal and infant health outcomes, developing interventions to improve the nutrition of preconception and pregnant women is essential.
    Objective: The objectives of this paper are to describe the full design process of an intervention for newly married women, their husbands, and mothers-in-law to improve maternal nutrition and gender norms, and findings from the feasibility and acceptability pilot.
    Methods: In this paper we describe the three phases of the design of an intervention in rural Nepal. We first conducted a mixed methods formative phase which included in depth interviews with newly married women, their husbands and mothers-in-law (N=60) and a longitudinal study for 18 months with 200 newly married women. We then designed of a household level, group, intervention, in close partnership with community members. Finally, we conducted a pilot intervention with 90 participants and collected both pre/post survey data and in-depth qualitative interviews with a subset (N= 30). All participants from all phases of the study lived in Nawalparasi district of Nepal. Qualitative data was analyzed using a thematic analysis, with inductive and deductive themes and quantitative data was analyzed using descriptive statistics.
    Results: Our formative work highlighted lack of awareness about nutrition, and how women eating last, limited mobility, household and community inequitable gender norms and poor household-level communication contributed to low quality diets. Thus we designed Sumadhur, an intervention that brought groups of households (newly married wife, husband, and mother-in-law) together weekly for four months to strengthen relationships and gain knowledge through interactive content. We found Sumadhur to be highly feasible and acceptable by all respondents, with most (83%) attending 80% of sessions or more and 99% reporting that they would like it to continue. Pre/post surveys showed a decrease in the proportion of women eating last and increase in knowledge about nutrition in preconception and pregnancy. Qualitative interviews suggested that respondents felt it made large impacts on their lives, in terms of strengthening relationships and trust, understanding each other, and changing behaviors.
    Conclusions: We show how a designing an intervention in close partnership with the target recipients and local stakeholders can lead to an intervention that is able to target complicated and culturally held practices and beliefs, positively benefit health and wellbeing, and that is very well received.
    Trial registration: ClinicalTrials.gov NCT04383847 , registered 05/12/2020.
    MeSH term(s) Family Characteristics ; Feasibility Studies ; Female ; Humans ; Longitudinal Studies ; Marriage ; Nepal ; Pregnancy
    Language English
    Publishing date 2022-04-06
    Publishing country England
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2041338-5
    ISSN 1471-2458 ; 1471-2458
    ISSN (online) 1471-2458
    ISSN 1471-2458
    DOI 10.1186/s12889-022-12980-w
    Database MEDical Literature Analysis and Retrieval System OnLINE

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