Insights & Updates – Page 19 – Global Reproductive Health at Duke

The Irony of the Mexico City Policy

July 3, 2019December 9, 2024 by Molly PaleyNo Comments

In his first days as President of the United States, Donald Trump reinstated the Mexico City Policy. Also known as the Global Gag Rule, the policy “gags” international NGOs receiving U.S. aid by not allowing them to “perform or actively promote abortion as a method of family planning.” First enacted by President Ronald Reagan, U.S. funding for critical reproductive healthcare abroad has been a partisan issue ever since with every Republican President instating the policy and every Democratic repealing it. President Trump’s reinstatement of the policy greatly expanded its parameters and includes a wide range of global health programs such as HIV funding through PEPFAR (President’s Emergency Plan for AIDS Relief). The expansion of the policy diminished the provision of services by international NGOS who weren’t previously affected by the policy and who feared losing critical funding from the U.S. Last week, a study published in the Lancet found that when the Mexico City Policy is instated, rates of abortion...

mSaada User Testing with Community Health Volunteers in Kisumu Kenya

July 2, 2019April 4, 2025 by Jacob StocksNo Comments

Together with Duke SRT students, undergraduate app developers, and Kenya-based members of the Center for Global Reproductive Health, I will be leading a pilot usability study of an integrated digital platform called mSaada. The goal of this platform, placed in the hands of community health volunteers (CHVs) during HPV-based cervical cancer screening, is to help facilitate the successful completion of the cervical cancer prevention cascade. This will be achieved by mSaada’s many features: patient education, protocol and counseling support for CHVs, results notification, service reminders, and patient tracking. Over the course of the summer, we will train CHVs on proper use of mSaada, allow them to use the app in a clinical setting, and gather periodic feedback through quantitative questionnaires and structured in-depth interviews. We aim to gain a strong understanding of user experience, acceptability, and feasibility of the mSaada platform within the context of Western Kenya. My interest in this project is multifactorial. First, by studying and working to combat...

A Qualitative Research Training Session at the Center for Reproductive Health in Kisumu, Kenya

July 2, 2019April 3, 2025 by Emma MehlhopNo Comments

Last week the office at the Duke Center for Reproductive Health in Kisumu held a two-day qualitative research training session led by facilitators Cyrilla Amanya and Muli Emmanuel from ACE, Africa. Attendees included the Duke Reproductive Health Center’s Kisumu staff, a DGHI master’s student, and members of the Duke Global Health Institute’s (DGHI) Student Research Training Program (SRT). The members of SRT (Andrea Chalem, Suzanna Larkin, and I) are here in Kisumu, Kenya for 8 weeks working on two different studies concerning cervical cancer awareness, screening, and prevention. Andrea is working on an mHealth study with Jacob Stocks, a master’s student at DGHI, and Suzanna and I are working on a stigma study. We used the In-Depth Interviews (IDIs) created for the stigma project as a jumping off point for discussion and role play during the qualitative training session. On day one, we learned helpful tips on how to make interviews conversational and comfortable for the participant. These included using the...

Re-building Rwanda’s Access to Ob/Gyn Services

July 2, 2019December 9, 2024 by Stacey DixsonNo Comments

"In 2011 the Rwandan government embarked on a novel medical education program to improve their health care system. Human Resources for Health (HRH) Rwanda, a partnership between the government of Rwanda and a consortium of 22 U.S. academic institutions, was designed as a 7-year training program to produce qualified medical personnel with the aim of increasing quality and access to health care for Rwandans." As one of the earliest ob/gyn specialists to work in Rwanda with HRH, Duke's Dr. Maria Small led an evaluation of the first five years of the program with the aims of 1) examining the number of trained ob/gyn specialists who graduated from the University of Rwanda as beneficiaries of the HRH program, and 2) conducting a geospatial analysis of pregnant women’s access to Rwandan public hospitals with trained Obstetrics and Gynecology providers using a WorldPop data set. Study Results: "In 2011, there were only 14 ob/gyns in the country. By the end of HRH year 5,...

Important New Study Regarding Injectable Contraceptives

June 23, 2019December 9, 2024 by Emily WoodrowNo Comments

There is an unmet need affecting 47% of women in Africa who want modern contraception in order to prevent pregnancy. During the last few years, there has been an increase in the use of injectable contraceptives, such as Depo-Provera, across the continent specifically in Mali, Sierra Leone, Chad, Ethiopia, Kenya, and Uganda. Many African women rely on these types of shots because they are more easily concealable compared to other forms of contraception such as a daily birth control pill. Also, in some health clinics, these shots are the only method of contraception offered. Many women need secret protection due to men refusing condoms and the women wanting to avoid any social, physical, and mental consequences they may endure if they are found trying to keep away from pregnancy. A specialist in HIV at Britain’s Medical Research Council, Dr. Sheena McCormack, stated that African women’s, “husbands or partners, and their families, often want them to have children.” Along with the...

Stakeholders Meeting on Palliative Care and Treatment of Cervical Cancer

June 23, 2019April 4, 2025 by Jacob StocksNo Comments

By: Jacob B. Stocks & Sandra Yvonne Oketch - June 18th, 2019 On May 23rd, 2019, a stakeholders meeting on palliative care and treatment of cervical cancer for partners in Kisumu County was hosted at the KMET Complex in Kisumu. The main objectives of the meeting were 1) to share experiences on palliative care and cervical cancer services in Kisumu County and 2) to identify opportunities for networking and collaboration among partners. The 7-hour meeting began with a discussion of structural barriers to effective referral and treatment of cervical cancer in Kisumu County. The presenter, Brenda Otieno, discussed barriers such as the complexity of intra-facility referrals and client tracking, the lack of centrally located data on cancer patients (i.e. lack of a county-level cancer registry), and the lack of financial protection for clients seeking treatment. Following this session, Dr. Chemtai Mungo, an OB/GYN from UCSF, presented the evidence for cervical cancer screening via HPV testing by citing multiple studies discussing the cost-effectiveness...

Mhealth App User Training

June 17, 2019April 4, 2025 by Jacob StocksNo Comments

In order to ensure participants had a strong understanding of mSaada and the planned pilot usability study, members of the mSaada study team hosted a two-day training, June 6th and 7th, at the Kisumu Office of the Center for Global Reproductive Health. Twelve study participants, four researchers, and two research assistants were in attendance. The first day of the training began with a general overview of research, its importance, those involved, and a lengthy discussion of informed consent. After a tea break, we proceeded with a discussion of HPV and cervical cancer, and prevention, screening, and treatment strategies. In addition to lively audience participation during a session of review questions, each study participant displayed their understanding of the steps necessary to successfully complete HPV self-collection by demonstrating how to explain the process to a female client. Finally, the first day of training concluded with a 2-hour session on mhealth strategies and details of the planned mSaada pilot usability study. Day two of...

Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study

June 13, 2019December 9, 2024 by Stacey Dixson2 Comments

Our very own Sandra Oketch has published a research article in BMC Women's Health about our cervical cancer screening work in western Kenya. Congrats, Sandra! ...

Pelvic Health Physical Therapy

June 12, 2019December 9, 2024 by Kayla Chee1 Comment

Part 3: Mama, LLC In Part 2 of this Pelvic Health Physical Therapy, we were introduced to Dr. Laura Keyser, a physical therapist who specializes in maternal and child health. She also is the co-founder of Mama, LLC. Dr. Keyser was able to share some aspects of her work at Mama, LLC and to inform us of some projects the firm is working on. Mama, LLC is a physical therapy and public health consulting firm that specializes in domestic and international women’s and girl’s health. Mama, LLC partners with humanitarian organizations, professional organizations, educational institutions, and for-profit groups to meet maternal and women’s health needs around the world. The firm’s work includes but is not limited to education efforts, promotion and advocacy, research, and rehabilitation capacity building. When asked about her work at Mama, LLC, Dr. Keyser reports: “We see the health concerns of women and girls around the world as experiences on the same continuum. While women in low income, low resource settings...

New State Abortion Bans

June 10, 2019December 9, 2024 by Molly PaleyNo Comments

Photo Credits: John Benson After the recent passage of restrictive abortion legislation in Georgia and Alabama, abortion continues to be under attack across the country. The abortion bans signal continued attempts by states to undermine a woman’s right to access an abortion. Last week, Louisiana Democratic governor, John Bel Edwards, signed into law a restrictive “heartbeat” bill. The law, like other recent abortion legislation, would prohibit an abortion after an ultrasound detects electric pulsing of what will become a fetus’ heart—which can occur before most women know they are pregnant. Moreover, the Louisiana law does not include exceptions for rape or incest. Although the law will not go into effect immediately, it is likely to be stalled in the courts. In Missouri, only one abortion clinic remains open. If it closes, it would be the first time a state does not have an abortion clinic since 1974—when the Supreme Court ruled on Roe v. Wade. A judge is expected to a settle...

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