Chimaraoke O. Izugbara, Eleanor Krassen Covan (Hrsg.): Women´s Health in Africa
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This edited book includes new policy-relevant research on women´s health issues in Africa. Scholars explore critical topics from different disciplinary traditions using a variety of research methodologies and data sources. The range of women´s health issues is vast, including the HIV epidemic and its impacts; domestic violence; the persistence of homebirths; and abortion. In addition, the book investigates emerging health concerns such as cardiovascular diseases and cancers. Readers will learn that, while old health issues have persisted and assumed new dimensions, never concerns have materialized and are now gaining momentum. The inability of health systems to tackle these issues complicates matters in Africa, creating a sense of desperation that can only be successfully confronted through strong political will and strategic planning, grounded in further research.
Editors and Authors
Chimaraoke Izugbara is Director of the Research Capacity Strengthening Division and Head of Population Dynamics and Reproductive Health at the African Population and Health Research Center, Nairobi, Kenya. Eleanor Krassen Covan is Professor Emerita in the School of Public Health and Applied Human Sciences at the University of North Carolina, Wilmington, USA. She is the Editor-in-Chief of the journal Health Care for Women International. Elizabeth Fugate-Whitlock is Interim Coordinator of the Gerontology Program at the University of North Carolina, Wilmington, USA.
The authors of the 33 scientific articles are African scholars with an in-depth knowledge of their home contexts; who can furnish nuanced interpretations of local health issues and trends, international researchers, who bring vigorous viewpoints; emerging scholars adding to scientific knowledge; and more established researchers with a deep global knowledge of women´s health issues. The chapters in this book were originally published in the journal Health Care for Women International.
Introduction: In more recent decades, women´s health has become a global priority enjoying both worldwide attention and massive political support. Women´s health status is a foremost barometer of development levels in a society. In Africa, women´s health indicators are vastly deplorable. Progress towards the attainment of the Millennium Development Goals (Md Gs) that directly concern women´s health and wellbeing has been slowest in Africa. The region hosts only 12% of the world´s population but currently contributes 50% of all global maternal deaths (Africa Progress Panel, 2010). Globally, African governments continue to rank among the sloppiest in the formulation and execution of policies and programs to deliver quality health services to women. Critical social, political, economic and environmental issues drive Africa´s tragic women´s health profile. Pervasive poverty and feelings of alienation and exclusion have also cultivated religious and other forms of fundamentalism hinged on practices that degrade women´s health. Intractable wars, terrorism, and political instability continue to devastate the health and safety of women and girls in Africa, as most recently demonstrated by the abduction of school girls in Northern Nigeria by the extremist group Boko Haram. Corruption and weak local and global accountability arrangements are responsible for much of the inefficiency that diverts scarce resources meant to improve public health in Africa. There is also globalization which, among other things, has unleashed far-reaching lifestyle changes that have exposed women and girls to new health issues, including cardiovascular diseases, cancers and early sexuality activity. The 33 chapters of the book show new and important policy-relevant research on a variety of women´s health issues and from a number of African countries. About half of the articles are from Ghana, Nigeria and South Africa. Research by Africans on Africa´s development questions can support scientific and technological innovations that are sensitive to the cultures, aspirations, and levels of progress in the region. Taken together, the papers hold forth a solid optimism for a healthier future for women and girls in Africa. While the authors clearly recognize that Africa is disadvantaged in terms of of women´s health, they are unswervingly showing that solutions are both possible and urgent.
Part I: HIV Conflict
Elijah Onsomu et al.: Association Between Domestic Violence and HIV Serostatus Among Married and Formerly Married Women in Kenya.
The prevalence of both domestic violence (DV) and HIV among Kenyan women is known to be high. But the relationship between them is unknown. Nationally representative cross-sectional data from married and formerly married women responding to the Kenya Demographic and Health Survey 2008/2009 (n = 2227) were analyzed adjusting for complex survey design. The overall HIV-status was positive for 10.7% of the study participants and differed remarkably between currently married (7.0% HIV+) and formerly married (34.2% HIV+). Prevalence of any form of domestic violence was 44%, 42% and 43% among these groups of women, respectively. Married women who experienced physical violence had a two times higher positive testing for HIV than those without physical violence. The patriarchal nature of African society is known to support a notion of masculinity that perpetuates control over women by their male partners. In many African societies, including Kenya, women are expected to accept and to tolerate male dominance to the extent of rationalizing severe forms, such as domestic violence. Furthermore, age differences in sexual partnerships have long been associated with increased risk of intergenerational HIV transmission., especially between older men and younger women. Younger wives experiencing domestic violence are unlikely to ask their husbands about their HIV status and other previous or current sexual partners, leaving them more vulnerable to HIV infection.
Additional articles in this chapter:
Gladis Asiedu & Karen Myers-Bowman: Gender Differences in the Experiences of HIV/AIDS-Related Stigma: A Qualitative Study in Ghana. Oladapo Okareh et al.: Management of Conflicts Arising from Disclosure of HIV Status Among Married Women in Southwest Nigeria. Sandra Bhatasara and Manase Kudzai Chiweshe: Universal Access to HIV Treatment in the Context of Vulnerability: Female Farm Workers in Zimbabwe. Samaya VanTyler and Laurene Sheilds: Stories of African HIV+ Women Living in Poverty. Winnie Chilemba et al.: Experiences of Emotional Abuse Among Women Living With HIV and AIDS in Malawi.
Part II: Family Violence
Evalina van Wijk and Tracie Harrison: Relationship Difficulties Postrape: Being a Male Intimate Partner of a Female Rape Victim in Cape Town, South Africa.
The authors of this article report on the lived experience of male intimate partners (MIP) postrape in Cape Town. The study was conducted by applying a hermeneutic phenomenological design using longitudinal interviews with nine men over a 6-month period. Over time, the MIP discussed the evolution of their feelings toward their partners. This evolution allowed the researchers to witness as the MIPs struggled with how the rape impacted the foundation for their connection to their partners. The researchers provide insight into the minds of the men as they discussed their relationship with the women in their lives after they were raped. The following themes best relate how these discussions were interpreted: fear of infection, the sex act, given a blind eye, and connecting with her emotions. The prospective study design allowed the researchers to capture changes in meaning, which were subtle but clearly evident as the men moved from a focus of individual needs to the needs of the couple. The findings highlighted how future research should consider the experience of the MIP in the couples´healing postrape.
Additional articles in this chapter:
Anjalee Kohli et al.: Risk for Family Rejection and Associated Mental Health Outcomes Among Conflict-Affected Adult Women Living in Rural Eastern Democratic Republic of Congo. Dorothy Ngozi Ononokpono & Ezinwanne Christiana Azfredrick: Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria.
Part III: Evidence-Based Practice: Birth
Ruth Jackson: The Place of Birth in Kafa Zone, Ethiopia.
The goal of this qualitative study with an ethnographic approach is to provide an understanding about the place of birth in rural and semiurban Kafa Zone, Ethiopia. Kafa Zone covers an area of 11000 square km and has about 900000 inhabitants. 92% of the inhabitants live in rural areas. In this region are three physicians, five health officers and 150 nurses with certificates or diplomas. The author interviewed 22 women about birth and home and asked what it means for women if they are transferred to a health facility when there is a serious problem during childbirth. The selection of interviewed women was based on snowballing techniques after the author was introduced to women through her interpreter and her family. Of these 22 women, five of them had had one pregnancy and eight of the women had had over seven pregnancies. One women had been pregnant 14 times. The following five topics were in the main focus in the interviews: (1) Where does birth take place? (2) Going to a health facility (3) Why do women give birth at home? (4) The mother-daughter relationship (5) Decision making. An important study result shows that women are not a considered part of the decision-making process about health-seeking behavior. Decisions to travel to a health facility are primarily made by a women´s husband, close relatives, and neighbors. Another result shows that when stoicism is combined with the normalization of prolonged labor at home, it means calling on God or Maryam to assist and just „hoping the baby will come“. When childbirth is at home, the importance of close relationships with neighbors, family members, and local communities is manifested as these peoples support the birthing women, sometimes in secret, other times more openly. The development of health services aimed at reducing maternal mortality implies that the place of birth must change from home to health facility. From a distance, it appears straightforward to employ skilled birth attendants and to refer a women to health facilities if there are problems during a difficult birth in developing countries. In places such as Kafa Zone, however, „roads“ are in mountainous terrain. In the rainy season, it is slippery and muddy and sometimes there are rivers that are impossible to cross. For women being carried on a stretcher, the topography and lack of transportation also contribute to the delays, and many women do die on the way. Future research using ethnographic methods could explore whether women´s fear that they will die „on the way“ to a health facility contribute to delays in seeking maternal health care services.
Additional articles in this chapter:
Gail Webber & Bwire Chirangi: Women´s Health in Women´s Hand: A Pilot Study Assessing the Feasibility of Providing Women With Medication to Reduce Postpartum Haemorrhage and Sepsis in Rural Tanzania. Ikeola Adeoye et al.: What are the Factors That Interplay From Normal Pregnancy to Near Miss Maternal Morbidity in a Nigerian Tertiary Health Care Facility? Kathleen Miller and Michael McLoughlin: Comparison Between an Independent Midwifery Program and a District Hospital in Rural Tanzania: Observations Regarding the Treatment of Female Patients. Ama de-Graft Aikins: Food Beliefs and Practices During Pregnancy in Ghana: Implications for Maternal Health Interventions. Emmanuel Banchani and Eric Tenkorang: Occupational Types and Antenatal Care Attendance Among Women in Ghana.
Part IV: Evidence-Based Policy
Kavita Singh et al.: Gender Equality as a Means to Improve Maternal and Child Health in Africa.
In this article is examined whether measures of gender equality, household decision making and attitudes towards gender-based violence are associated with maternal and child health outcomes in Africa. Pooled data from the Demographic and Health Surveys in eight African countries were used to run multilevel logistic regression on two maternal health outcomes (low body mass index and facility delivery) and two child health outcomes (immunization status and treatment for an acute respiratory infection). The included countries are Democratic Republic of Congo, Egypt, Ghana, Liberia, Mali, Nigeria, Uganda and Zambia. The pooled sample used in the analysis comprised 50246 currently married women with a birth in the past five years. The gender equality measure was based on questions on the decision-making process in the family and attitudes regarding inequalities in gender roles. The results show protective associations between the gender equality measures and the outcomes studied, indicating that gender equality is a potential strategy to improve maternal and child health in Africa. In the countries studied, a combination of programs aimed at providing women with an independent means or support along with those seeking to influence a change toward more equitable gender norms should raise levels of women´s empowerment and eventually impact maternal and child health outcomes positively.
Additional articles in this chapter:
Debra Anne Kauai Singh et al.: Modernization and Development: Impact on Health Care Decision-Making in Uganda. Mabel Ezeonwo: Policy Strategies to Improve Maternal Health Sevice Delivery and Outcomes in Anambra State, Nigeria. Ellen Brazier et al.: Rethinking How to Promote Maternity Care-Seeking: Factors Associated With Institutional Delivery in Guinea.
Part V: Adolescents Issues
Nokuthula Hlabangane: Teenage Sexuality, HIV Risk, and the Politics of Being „Duted“: Perceptions and Dynamics in a South African Township.
The article is an attempt to solicit the voices of young people and explore their everyday encounters with the reality of HIV/AIDS. The author recognizes and highlights the myriad risk embedded in the lives of the young people in Soweto, Johannesburg. They, more than their Whites counterparts, inspire labels such as „Black youths at risk“, „the lost generation“, and „youth crying out for help“. They reflect the brutal history of South Africa. The Nelson Mandela Human Science Research Council´s (NMHSRC) household survey conducted in South Africa in 2002 highlighted the vulnerability of teenagers to HIV infection, with 10 % of the study population already living with HIV/AIDS (boys 4.8 % and girls 15.5 %). The author carried out a qualitative study in Soweto in 2009 including twelve focus group discussions. The informants of the study are 14-19-year-old boys and girls who reside in Soweto. Data were interpreted through the paradigma espoused by grounded theory (Glaser 1992). The author highlights in particularly the gender-based assessment and management of HIV risk. The male perception of women as potential carriers of HIV infection and the resultant lack of trust were highlighted. This male dynamic was also attributed to the weakening of the traditional male hold on women. Women who did not confirm to particular expectations of acceptable female comportment were viewed with suspicion. The female study participants, however, were not helpless victims of this assessment. They actively wrestled for an active and equal position with their male counterparts. For instance, they pointed to the irony that rape, while posing HIV danger for them, may equally pose danger to the male perpetrators. Their overall attitude to the male/female relationship was summed up as „who is fooling who?“ The disproportional vulnerable social position of women in general was not, however, in the process, discounted. The argument around „being duted with out-of-order things“ explains not only the agency of young people in deciding which risks to take or not to take, it also explains the hierarchical assessment of risk in the research setting in Soweto. The author conclude that her study clearly shows that HIV infection may be a culmination of vulnerability to all sorts of other risks and may not be the sole and paramount concern of growing people in South Africa. Therefore, it is imperative for research and interventions to work with a dynamic and complex frame of risk to HIV infection.
Additional articles in this chapter: Joanna Chrichton et al.: Emotional and Psychosocial Aspects of Menstrual Poverty in Resource-Poor Settings: A Qualitative Study of the Experiences of Adolescent Girls in an Informal Settlement in Nairobi. Reshma Sathiparsad et al.: Effects of a Teenage Pregnancy Prevention Program in KwaZulu-Natal, South Africa.
Part VI: Child Bearing Age: Cancer Screening
Daphne Munyaradzi et al: Breast Cancer and Cervical Cancer Screening among Women of Child Bearing Age. Immaculee Mukakalisa et al.: Cervical Cancer in Developing Countries: Effective Screening and Preventing Strategies With an Application in Rwanda.
Part VII: Child Bearing Age: Family Planning
Samantha van Reenen and Esmé van Rensburg: Coping With an Unplaned Caesarean Section. Sarah Finocchario-Kesler et al.: „I May Not Say We Really Have a Method, Its a Gambling Work“: Knowledge and Acceptability of Safer Conception Methods Among Providers and HIV Clients in Uganda. Georgina Yaa Oduro and Mercy Nana Akua Otsin: „Abortion – It is My Own Body“: Women´s Narratives About Influence on Their Abortion Decisions in Ghana. Yewande Sofolahan-Oladeinde and Collins Airhihenbuwa: „He Doesn´t Love Me Less. He Loves Me More“: Perceptions of Women Living With HIV/AIDS of Partner Support in Childbearing Decision-Making. Kathy Goggin et al.: „Our Hands are Tied Up“: Current State of Safer Conception Services Suggests the Need for an Integrated Care Model.
Part VIII: Aging Issues
Enid Schatz and Leah Gilbert: „My Legs Affect me a Lot … I Can No Longer Work to the Forest to Fetch Firewood“: Challenges Related to Health and the Performance of Daily Tasks for Older Women in a High HIV Context.
Magen Mhaka-Mutepfa et al.: Grandparents Fostering Orphans: Influences of Protective Factors on Their Health and Wellbeing.
In a book about Women´s Health in Africa the reader would expect more about the understanding, what health means for African women. Most of the 33 included scientific articles are dealing with special health problems and a variety of frequent diseases and ilnesses in the African Region. What are important physical, psycho-social and ecological factors that can improve the health in the sense of the WHO-definition of health under the WHO-strategy „Health for All“? Which positive health resources play a role for improving women´s health in Africa, such as for example social cohesion, family support or African healthy nutritional traditions?
Health and Social Scientists and Policy Makers with a Focus on Women´s Current and Future Health in Africa.
The book includes new policy-relevant research on women´s health issues in Africa. Scholars explore in 33 scientific articles critical topics from different disciplinary traditions using a variety of research methodologies and data sources. The range of women´s health issues include among others the HIV epidemic and its impacts; family violence; the persistence and problems of home births; gender equality issues; and a variety of health issues for adolescents, women in childbearing age and the elderly female population.
Prof. Dr. Uwe Helmert
Alle 101 Rezensionen von Uwe Helmert anzeigen.
Uwe Helmert. Rezension vom 20.07.2015 zu: Chimaraoke O. Izugbara, Eleanor Krassen Covan (Hrsg.): Women´s Health in Africa. Routledge (New York) 2015. ISBN 978-1-138-85498-7. In: socialnet Rezensionen, ISSN 2190-9245, https://www.socialnet.de/rezensionen/18941.php, Datum des Zugriffs 06.04.2020.
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