The Sweeping Consequences of Abortion Restrictions on Sexual and Reproductive Health

The Sweeping Consequences of Abortion Restrictions on Sexual and Reproductive Health

  “There is more at stake than just protecting a woman’s choice to give birth.” Former First Lady Michelle Obama spoke of this reality during a Michigan campaign event for Vice President Kamala Harris on October 26th.1   This November marks the first presidential election since the overturning of Roe v. Wade and the revocation of a once-established national right to abortion, an essential healthcare service. The resulting hostile restrictions on abortion and their devastating health impacts have propelled the issue to its current political salience.   Restrictions on abortion care are associated with increased maternal morbidity and mortality, with these burdens disproportionately harming Black birthing people.2 Further, a recent JAMA cohort study illustrated the detrimental impact of abortion bans on infant mortality, with researchers identifying an excess of infant deaths in Texas associated with the state’s 2021 abortion ban.3 These restrictions will also exacerbate inequalities and health systems barriers that prevent low-income patients, who are more likely to report an unintended pregnancy, from accessing...
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Peer Navigators for Cervical Cancer Screening Among Women Living With HIV in Tanzania

Peer Navigators for Cervical Cancer Screening Among Women Living With HIV in Tanzania

  Cervical cancer is the fourth most common cancer in women globally and the most common among women in Eastern and Middle Africa. Tanzania has one of the highest incidence rates of cervical cancer in this region: 34.3 cases per 100,000 women.1 Low-and-middle-income countries such as Tanzania bear a disproportionate burden of cervical cancer incidence and mortality. These regions have not demonstrated the same reductions in cervical cancer rates that high-income countries have achieved with the introduction of the Papanicolaou smear and HPV vaccination campaigns. This disparity is largely fueled by resource limitations in screening programs and financial and social challenges to the acquisition, distribution, and acceptability of the HPV vaccine.2   "Low-and-middle-income countries such as Tanzania bear a disproportionate burden of cervical cancer incidence and mortality."   HIV infection imposes complex barriers to cervical cancer screening among women in Tanzania. Tanzanian women living with HIV are more likely to become infected with HPV and develop persistent infection leading to precancerous lesions. Patients living with...
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Postpartum Medicaid Gaps in Arkansas: A Barrier to Maternal Healthcare Continuity

Postpartum Medicaid Gaps in Arkansas: A Barrier to Maternal Healthcare Continuity

Despite national efforts to extend postpartum Medicaid coverage for new mothers, Arkansas remains the only state that hasn’t expanded coverage to 12 months. Postpartum Medicaid, funded largely by the federal government, ensures that low-income women receive uninterrupted healthcare for 60 days after giving birth. However, Arkansas interrupts this coverage at 42 days, transitioning women to different programs, which often leads to gaps in care. An NPR article covered the experience of Maya Gobara, a new mother in Arkansas who falls into the low-income category. She lost her Medicaid coverage about six weeks after an emergency C-section and was transferred to a new health plan without any warning. This significantly disrupted her care and left her without coverage for her own health issues and her twins’ intensive care bills. When questioned about whether Arkansas has plans to expand postpartum Medicaid, Arkansas Governor Sarah Huckabee Sanders opposed this measure, believing that adding more coverage would not address the state’s maternal health issues. For context,...
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Discovering Hands: Empowering Blind Women in the Fight Against Breast Cancer

Discovering Hands: Empowering Blind Women in the Fight Against Breast Cancer

Discovering Hands was founded by Dr. Frank Hoffman in Germany after he identified the need to catch early breast cancer cases that doctors may have missed in regular exams. Hoffman trained blind women, as their heightened sense of touch can potentially detect breast cancer more effectively than doctors. Evidentiary support for this method has shown that trained blind women can detect tissue changes 30% more effectively than doctors. Hoffman also ran a 2023 pilot study which further showed that medical tactile examiners (MTEs) are as accurate as doctors in identifying potentially cancerous lumps.   In her NPR article, Kamala Thiagarajan focuses on one blind woman in particular, Meenakshi Gupta, who is part of this program. Gupta has worked as an MTE at Medanta Hospital in Gurgaon, India, for over two years. Introduced to India in 2017, this program is now part of major hospitals in several Indian cities. MTEs are especially important in these hospitals because of the limited access to mammograms....
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Lenacapavir: A Promising HIV Prevention

Lenacapavir: A Promising HIV Prevention

The HIV epidemic has affected millions globally since the 1980s. While it remains a major public health issue, recent clinical trials of lenacapavir, developed by Gilead Sciences, show significant effectiveness in preventing new HIV infections.   According to an NPR article, the recent PURPOSE 2 trial found lenacapavir to be 96% effective in preventing HIV infections in over 3,200 participants of different genders. In African countries, PURPOSE 1 trials had 100% efficacy in preventing HIV transmission among cisgender women.   Lenacapavir is unique in that it is a twice-a-year injection, as opposed to pre-exposure prophylaxis (PrEP) drugs like Truvada, which need to be taken every day. Despite being shown to be extremely effective in clinical settings, this efficacy has not held up in the real world, primarily due to the social stigma surrounding the oral pill, especially in African countries.   Lenacapavir has also been previously used for HIV treatment; however, Gilead Sciences is ensuring that it can be classified as a prevention drug as well....
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Cervical Cancer Screening and Prevention Health Fairs in Siaya County

Cervical Cancer Screening and Prevention Health Fairs in Siaya County

The Cervical Cancer Screening and Prevention (CCSP) Team hosted a series of health fairs in Gem of Siaya County, Kenya earlier this summer. The purpose of these fairs was to create opportunities for women living in Kenya to have access to human papillomavirus (HPV) screening and education, and to allow school-age girls to receive vaccinations against HPV. Cervical cancer poses a significant global health burden due to limited access to effective screening and prevention measures, especially for women living in low- and middle-income countries (LMICs). Invasive cervical cancer affects more than 661,000 women around the world, resulting in more than 348,000 deaths each year.1 Though cervical cancer is very preventable through HPV vaccination and screening and treatment of cervical precursor lesions, cost and infrastructural barriers prevent many women in LMICs from accessing these essential cervical cancer prevention services.2 The health fairs hosted by the CCSP Team directly address the lack of access to cervical cancer prevention and screening measures that many Kenyan...
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Reflections from the Field: SRT student Afraaz’s End of Summer Reflection

Reflections from the Field: SRT student Afraaz’s End of Summer Reflection

It may have only been a few weeks since we departed Kisumu, but I already miss the peaceful walks to the office, cooking dinner with friends, and working with the best people I know. The summer started with us a bit confused and working on tasks that seemed a mile away, especially since the office was actively conducting surveys in the field and meeting with community leaders. Additionally, we came to Kenya with our focus solely on mSaada, the digital platform designed to boost cervical cancer screening rates. We were fortunate enough to learn about and contribute to several other initiatives concerning vaccination, HPV stigma, and biopsies. As we quickly learned, cervical cancer is just one piece of the puzzle, surrounded by numerous equally important initiatives that collectively drive forward the mission of improving public health.   "As we quickly learned, cervical cancer is just one piece of the puzzle, surrounded by numerous equally important initiatives that collectively drive forward the mission of improving...
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Reflections from the Field: SRT student Skylar’s End of Summer Reflection

Reflections from the Field: SRT student Skylar’s End of Summer Reflection

A few weeks have passed since our departure from Kisumu, and as I reflect on our experience, I’d like to echo some key insights shared by Kelsey and Sahil in their final reflections.   Our work was characterized by its dynamic and multifaceted nature.  Kelsey emphasized the importance of laying foundational groundwork—an often-overlooked aspect that, though not always immediately visible, is crucial for a project's future success. While urgent and important tasks may appear different, they are equally vital for overall success. Sahil highlighted the necessity of workflow improvements, noting that in resource-constrained situations, adapting our tasks and optimizing workflow are not just helpful but essential. This became evident as we managed limited resources and numerous ongoing tasks. Streamlining workflow was critical to enhancing team efficiency and achieving our goals.   A key project where many of these lessons came to fruition was the U54 initiative, which aimed to screen women for HPV and vaccinate young girls across Siaya County through community health fairs....
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Reflections from the Field: SRT student Sahil’s End of Summer Reflection

Reflections from the Field: SRT student Sahil’s End of Summer Reflection

As our summer project in Kisumu drew to a close on July 20, the SRT team reflected on a productive and enlightening experience. Initially focused on the mSaada app, we soon discovered a handful of ongoing projects that broadened the scope of our time in Kisumu. mSaada is a digital platform designed to aid community health promoters (CHPs) in cervical cancer prevention efforts. Features of the app include patient education, screening reminders, and screening result notifications just to name a few.     Beyond mSaada, we contributed to several other initiatives. The U54 project, centered on HPV vaccination and screening, saw us designing promotional materials for health fairs offering free services. We also participated in the Elimisha project, which explored community perceptions of HPV, HIV, and cervical cancer stigma. Our involvement in survey administration was limited due to language barriers, as we lacked proficiency in Swahili and Luo. A personal and team highlight was developing tools to streamline our colleagues' workflows, allowing them to focus...
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CGRH Attends DGHI 2nd Annual Partner’s Meeting in Eldoret, Kenya

CGRH Attends DGHI 2nd Annual Partner’s Meeting in Eldoret, Kenya

The Duke Global Health Institute (DGHI) convened its second annual East Africa Partners’ meeting in Eldoret, Kenya on June 26-28.  With over 50 attendees from Rwanda, Tanzania, Uganda, Kenya and Duke, the meeting focused on three content areas, cardiovascular disease, climate change and cancer, with a focus on community-based research and community health throughout the sessions. Several members of the Center for Global Reproductive Health (CGRH) were able to attend, Dr. Megan Huchko, Dr. Miriam Nakalembe, Dr. Frankie Odhiambo and Christina Makarushka.  The team’s work on community-based cervical cancer prevention and digital health in Kenya and Uganda was highlighted during a panel on East Africa Cancer Research during the second day. They followed this up with a brainstorming session to identify areas of need and ideas for potential future collaboration on research, training and cancer care capacity across the region. During the final day of the multi-country group visited the Cancer Center at the Moi Teaching and Referral Hospital in...
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