Law meant to limit access to abortion in the Ohio state legislature

Story by Amelia Steinbach, T '21 State legislators in Ohio are currently debating House Bill 565, a piece of proposed legislation that imposes strict limitations on access to abortion. The law changes the definition of person to include “any unborn human,” which results in the criminalization of abortion. If the law is signed into law, it would effectively criminalize abortion. Any woman who undergoes the procedure, as well as any doctor who performs it, would face charges for murder. Because the death penalty is permitted in the state of Ohio, women and doctors could also be sentenced to death because of their role in the procedure. Despite the fact that many modern abortion regulations include exemptions of pregnancies resulting from rape or incest, as well as those that pose a threat to the pregnant woman’s life, House Bill 565 includes no such provisions. Notably, the group of legislators sponsoring and co-sponsoring the bill is overwhelmingly male, with only two out of sixteen...
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Community Impacts of Maternal Child Health Care in Kigali, Rwanda

Community Impacts of Maternal Child Health Care in Kigali, Rwanda

Guest Blog by Suzanna Larkin, T21 The Iranzi Clinic is a pioneering medical clinic in Kigali, Rwanda that focuses entirely on maternal and child health services. As an intern through DukeEngage-Rwanda this past summer, I worked directly alongside the midwives, doctors, and administrative staff that have made Iranzi Clinic their home. Only opened one year ago, the clinic is situated on the edge of the impoverished Nyabisindu neighborhood. Many of the women who visit the clinic are unable to pay for their services, and thus the clinic relies primarily on support from the Christian Life Assembly Church and donors. The commitment that the midwives and staff hold for their patients and clinic is clear. Every Monday, the clinic has a devotions session followed by a tea time, and the scene is joyous­–any observer can notice the deep and genuine friendships that grew between the staff members as they built the clinic from the ground up. Their anecdotes about the clinic’s history, from...
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Oregon, a champion of women’s health, is one of states with abortion challenge on ballot

Oregon, a champion of women’s health, is one of states with abortion challenge on ballot

Guest Blog by Suzanna Larkin, T '21 Oregon, my home state, is a unique champion in women’s right to abortion. While more than 400 abortion restrictions have passed in 33 states in the past 7 years, Oregon remains a key state in support for reproductive health rights. It was the first state to allow pharmacists to prescribe birth control directly to women in 2015. More recently, Governor Kate Brown signed the Reproductive Health Equity Act in August 2017, which expands coverage of abortion and other reproductive health services to thousands of Oregonians by allocating nearly $500,000 of Oregon’s general fund to expand cost-free reproductive and abortion services for those who are ineligible for Medicaid. It also requires all private insurance companies to cover abortions for free. There is one caveat to this legislation: Providence Health Plan, a large health insurance provider in Oregon, is insurer exempt from providing abortion services—the only insurance provider in the state with an exemption. This is because...
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Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Embracing My Role as a Researcher – Sharing My Small Slice of the HPV Research Pie

Guest Blog: Carissa Novak Throughout my recently completed Masters in Global Health Science, Duke’s Global Health Institute faculty regularly stressed the importance and potential impact of disseminating research findings. Therefore, I felt presenting the research findings from my thesis at the 32nd International Papillomavirus Conference inSydney, Australia, this fall was not only appropriate but necessary. Due to ongoing conversations regarding HPV vaccination coverage and HPV screening for cervical cancer communities are witnessing a tremendous increase in screening rates, especially in low-resource settings, where cervical cancer is most common. However, most programs still face significant challenges in addressing HPV positive women’s low rates of follow-up and treatment. My attendance at the conference was an opportunity to share the findings of my thesis work, in which we found that in western Kenya, a setting where resources were limited for all HPV positive women, stigma and isolation were the main differentiating features between women who accessed follow-up and those who did not. Interestingly, I presented...
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Partner Updates: Uganda

Partner Updates: Uganda

Our Ugandan colleagues at the Makerere College of Health Sciences have been busy over the past few months. Center members’ work has focused on various aspects of cervical cancer, from prevention to diagnosis and treatment. Dr. Miriam Nakalembe is still leading the NCI-funded effort to evaluate community-based strategies for cervical cancer detection, in partnership with Dr. Megan Huchko. Building on this work, she is a co-investigator on a recently funded two-year project through the Fogarty International Center. The grant seeks to develop a portable imaging technique, called a smartphone confocal endoscope. The new technology would visualize cellular details of human cervix in vivo without taking a biopsy, and after validation would be adapted to provide a low-cost diagnostic tool for other diseases in both resource poor and resource rich settings. Dr. Jane Namugga continues her work with Dr. Paula Lee. The pair have completed data collection for a project to determine rates of completion and adverse events associated with receiving chemotherapy...
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Director’s Blog: Fall 2018

A month into the start of the new school year is a good time to reflect on the value the Center can bring to an academic setting like Duke. More salient is the recognition of the value that students and learners bring to Center. This is my third semester teaching Global Sexual and Reproductive Health, one of the core Center courses. The undergraduates continue to impress me with the experience and passion they bring to the classroom, to their research assignments and to their lives in the Duke community. Every year, I learn new things and gain new perspective from the discussions and viewpoints in brought forth in the course. This year, I’m leading two additional student research initiatives in which I already recognize that I’ll learn much more than I will teach the students. I have been working with students through the Big Data for Reproductive Health project since May, when Amy Finnegan and I helped manage a Data Plus...
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Teammate Spotlight: Sandra Oketch

Sandra Yvonne Oketch has been working with Dr. Megan Huchko and the FACES team the Nyanza Region of western Kenya for the past ten years. She has 10 years’ work experience in both health research and program set up in maternal reproductive health and HIV/ AIDS care and prevention. She started as a Clinical and Community Health Advisor at FACES, where she became interested in the cervical cancer screening and prevention program. After going back to school to complete her degree, she is now the study coordinator of a cluster randomized trial testing two implementation strategies for HPV testing. Her roles include managing the study team, partnering with the reproductive health team to implement study activities and evaluating some of the study data. The work of enrolling and following up almost ten thousand women is not without challenges. In addition to the inherent challenges of coordinating a study that size, Oketch has had to deal with flooding, flyaway tents, political...
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Health Systems Barriers to Cervical Cancer Prevention in Kenya

Health Systems Barriers to Cervical Cancer Prevention in Kenya

Blog by Charlotte Page, Ob/Gyn Resident: This is a follow-up post to “Patient Barriers to Cervical Cancer Prevention in Kenya”. I’ve realized while in Kenya that there are a lot of things I take for granted in bathrooms in the US: running water, a toilet that flushes, toilet paper, soap, and electricity. If you’re missing one of these things, the restroom is that much more uncomfortable – or perhaps even unfunctional. Similarly, small systems issues here in Kenya can inhibit women from receiving the healthcare they need. For the HPV-positive women in the study I’m working on, such problems can significantly increase the amount of time and effort required to get treated with cryotherapy, to the point that some women don’t obtain treatment at all. To paint a picture: yesterday I was at Migori County Referral Hospital (MCRH), one of the sites where cryotherapy is provided in our study. This procedure uses compressed gas to freeze precancerous cells on the cervix, thereby preventing them...
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CDC Report Finds Increased Risk of Birth Defects and Developmental Problems in Infants Born to Zika-Exposed Mothers

CDC Report Finds Increased Risk of Birth Defects and Developmental Problems in Infants Born to Zika-Exposed Mothers

The world’s public health experts have been actively addressing the Zika crisis since it was discovered two years ago. Travel warnings, diagnostics testing, pregnancy guidelines and vector control have prevented substantial numbers of infants born with the devastating impacts of microcephaly. The CDC followed up 1450 US children born to mothers who had suspected or confirmed Zika, and released the findings from their one year follow-up. In addition to microcephaly, the infants had an increased rate of birth defects and neurodevelopmental delays. The study also found that the majority of children had not undergone neuroimaging or an eye examination, leading to missed opportunities to detect and possibly address problems at an early age. The authors recommended increased screening among pediatric providers and referral to specialists for children of zika-exposed mothers. The CDC will continue to follow these infants, and is currently following up a Brazilian cohort through the ZODIAC study. As we await the results of these longer-term studies, these...
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Gaining Insight into Kenyan Community Health

Gaining Insight into Kenyan Community Health

Blog by Amber Fleck, MS2, University of Colorado: In the United States, health education is seemingly everywhere: ads online reminding women of the importance of pap smears, TV commercials advising against smoking, or posters in bar bathrooms providing safe sex advice. With this abundance of exposure to health education, it is a striking difference to visit a country where many communities don’t have regular access to this kind of information, especially if that information regards sexual or reproductive health. In an effort to bridge this gap and enhance community health education the Kenya Ministry of Health began using lay workers, also known as community health volunteers (CHVs). CHVs travel door-to-door in their assigned communities to educate individuals about disease management, including reproductive and maternal health, and provide referrals to the clinic when necessary. In theory, this is an excellent way to increase access to health information and care; however, these programs have had some significant challenges. One challenge is that these are...
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