Please join Ci3 this Thursday, April 30, at 7pm for a screening of the timely new documentary, “The Hunting Ground“. This film exposes the prevalence of sexual violence on college campuses and profiles the institutional and social injustices faced by victims and their families.
Following the screening, a panel will address three themes in ending sexual violence: the power of narrative and lived experience, transforming rape culture, and enhancing leadership on campus and in our communities.
Ci3 and Game Changer Chicago are seeking high school students ages 14-18 to participate in a paid research study tomorrow night (Tuesday, Nov. 25) from 5-6:30 p.m. on The University of Chicago campus in Hyde Park. The time commitment is approximately 75 minutes, during which teens will play the Hexacago board game with peers and complete two short surveys. Teens will be compensated $15 for the session. Feel free to bring a friend! Please note, parental consent will be required for all participants under 18.
If you are interested, please contact Erin Jaworski through phone (773-834-9965) or by email (ejaworski@bsd.uchicago.edu). You are not officially registered until you received a confirmation email from Erin.
Ci3’s Game Changer Chicago Design Lab is looking for high school students (grades 9-12) to provide feedback on its board, card and digital games.
Playtesting sessions will take place Thursdays from 5-7 p.m. and every other Saturday from 12:30-2 p.m. on The University of Chicago campus in Hyde Park.
On Tuesday, February 11, the University of Chicago’s Institute of Politics and Ci3 (the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health) hosted the first of a series of brown bag lunch talks called “Cookies & Conversation with Ci3”. The series will offer a space where students and professionals from across campus can speak and hear about issues surrounding reproductive and sexual health, rights, and justice. This lunch talk was an informal panel with an amazingly diverse turnout with students represented from the law school, the medical school, the SSA, the GPHAP program and the College, each of whom were passionate about issues intersecting with reproductive and sexual health, rights, and justice, all interested in leveraging the university’s resources to make significant improvements in the sexual and reproductive health of their communities.
Three panelists affiliated with Ci3 led the discussion: Lee Hasselbacher, Andrea Friedman, and Angela Heimburger. Lee Hasselbacher is the Policy Coordinator for the Section of Family Planning and Contraceptive Research here at the University of Chicago. The Section advocates for policies that reduce reproductive health disparities and improve the health of families and is involved in reproductive health advocacy throughout the Midwest and is increasing its national presence. Andrea Friedman is the Senior Policy Advisor with the National Partnership for Women & Families and a consultant with Ci3. Angela Heimburger is the Executive Director of Ci3, and she, like the rest of the Ci3 team, is dedicated to helping faculty develop cutting-edge interdisciplinary research and programming to improve sexual and reproductive health globally.
During this first talk, students worked to identify issues of interest on the University of Chicago Campus in order to leverage the resources of Ci3 to better engage the student body in their research and advocacy. Several ideas for future lunch talks and advocacy were suggested, including: the need for greater information in the University community surrounding the use, availability, efficacy and safety of IUDs, the reproductive rights and sexual health of persons with physical and mental disabilities, sexual assault on and off campus and the availability of emergency contraception throughout the Chicago area, and the politics of the contraception and abortion debate, including the promotion of scientifically accurate information. We also had the opportunity to learn about Ci3’s new and innovate approach to youth sexual education through the Game Changer Chicago Design Lab, an initiative that uses game play and game design to engage youth in problem-based, collaborative learning about sexual and emotional health.
Now is an exciting time to be interested in reproductive rights and sexual health, especially as Ci3 seeks to elevate the voice of the Midwest to be an active player in the national reproductive rights debate. There’s a lot to look forward to!
Section of Family Planning and Contraceptive Research faculty Dr. Amy Whitaker and Section chief Dr. Melissa Gilliam co-authored an article e-published in December 2013 in the journal Contraception that discusses their randomized controlled trial (RCT) designed to compare levonorgestrel intrauterine device (LNG-IUD) use at one year after delivery between women who received the device at the time of cesarean delivery and those who underwent delayed insertion 4-8 weeks after delivery.
Long-acting reversible contraceptives are excellent methods for postpartum use because they allow adequate time between births and do not require repeat visits to a physician or pharmacy. Postplacental IUD insertion refers to the practice of inserting the IUD within 10 minutes of delivery of the placenta, which can occur through the uterine incision during cesarean delivery. Placement immediately after delivery may help to overcome some of the many barriers to insertion which occur during other time periods, and ensures that women receive the IUD even if they do not return for the postpartum visit.
Our trial showed that after twelve months, 60% of women who had the LNG-IUD inserted immediately after their cesarean delivery were still using the device, while 41% of the women who underwent delayed insertion were still using theirs. This difference, however, is not statistically significant. The women in the postplacental arm experienced significantly higher rates of expulsion (20% vs. 0%).
Future researchers can learn from the challenges of conducting a randomized controlled trial in this population. Due to slow enrollment and high losses to follow-up, the trial was stopped early. The fundamental challenge of conducting this type of research stems from the difficulties in studying an intervention that is most likely to benefit women who do not follow- up for a postpartum visit. However, those women may also be less likely to participate in an RCT. Thus, in our study and in similar trials, more women followed up for insertion in the delayed group than would be expected from the observational literature or clinical experience, making comparisons difficult.
Nonetheless, this trial does provide valuable insights for further study in this area. Immediate insertion of an IUD during a cesarean delivery may improve use of highly effective contraception during the postpartum period. Our results show higher expulsion rates after postplacental insertion compared to delayed insertion, but suggest similar IUD use at 12 months.
The 2nd Annual Sexual & Reproductive Justice Graduate Student Working Conference invites submissions on questions concerning sexuality, reproduction, and justice. This conference is co-sponsored by Section partner Ci3 (the Center for Interdisciplinary Inquiry and Innovation in Sexual and Reproductive Health) and the Center for the Study of Gender and Sexuality (CSGS). The purpose of this working conference is to provide a forum for graduate students (including law students and medical students and residents) to receive critical feedback on their ongoing projects from other graduate students across disciplines working on similar questions of sexuality, reproduction, and justice.
Abstract deadline is January 24. The conference will be held April 11 at The University of Chicago’s Center for the Study of Gender and Sexuality.More details here.
Over one million adolescent girls get pregnant in the United States each year.(1) And of all adolescent mothers, roughly 25% give birth to a second child within two years of giving birth to their first.(2) Teenage motherhood has been traditionally associated with high school dropout, lack of college enrollment and limited future job prospects, promoting a predisposition towards poverty.(1) Unarguably, many of these adolescent mothers will experience hardships in maintaining economic stability. However, that is not the outcome for all teen mothers, nor does it have it be.
In contrast to the pervasive media messages of judgment and expected failure toward pregnant teenagers, it has been shown that positive social support of teen mothers has been correlated with maternal competency behaviors, feelings of love towards the infant, and gratification in the maternal role.(3) Teen parents who were able to remain living with their parents or relatives have been more likely to return to school, to obtain a high school diploma, to be employed, and to be free from welfare dependence.(4,5,7) Further, it has been documented that pregnant adolescents who give as well as receive support from their parents report higher levels of childcare mastery and life satisfaction than teens without this bi-directional support.(6) Even more astonishing is that many adolescents who experience pregnancy at a young age manage to not view themselves as pigeonholed into the typical “failure as inevitable” stereotype. On the contrary, many young women viewed pregnancy as a positive force in their life.(4)
In The Postpartum Adolescent Birth Control Study, researchers from The University of Chicago’s Section of Family Planning and Contraceptive Research sought to answer this two-fold question: “What are the future goals of adolescent mothers, and what factors may be influencing those goals?” During the course of the first post-partum year, researchers interviewed teenage mothers five times to examine contraceptive use, health status, social support, and risk of repeat pregnancy. The results were surprising. In addition to viewing pregnancy as an inevitable life event in their teen years, there were also common beliefs that pregnancy would not limit their educational achievement or career goals and was a positive life event. In fact, many teenage mothers reported a belief that having a child would not only not hinder them from desired accomplishments, but would push them to achieve more than they had otherwise planned.(4) In one instance, a study participant stated:
“…People think that once you have a child when you’re a teenager you can’t do nothing else with your life, you can’t have a high school diploma… I [want to] be able to graduate and let my daughter see me.”
Yet another study participant described her desire to escape unsafe living environments in order to provide a better life for her child:
“… Every day you hear about somebody getting killed, robbed … I have a baby and I don’t want none of that for her.”
An ecological framework of the study.
Further study results revealed that an initial desire for financial and residential stability, family members’ professional backgrounds and recent life experiences were significant contributing factors toward shaping both short and long-term goals of these young mothers.(6) Especially poignant were study results which indicated having a child did not deter participants from a strong desire for financial success and educational achievement. Study findings suggest that traditional stereotypes of teenage mothers should be challenged, in part to encourage young women to pursue goals they may have more motivation to work toward as a new mother. Further research should explore how teenage mothers perceptions of their pregnancies are affected by media messages and how they restructure their lives to achieve life goals after becoming parents.
Citations
1. National Campaign to Prevent Teen Pregnancy. Why It Matters.
2. Hofferth SL, Reid L, Mott FL. The effects of early childbearing on schooling over time. Family Planning Perspectives. 2001;33:259-67.
3. Mercer, R.T., Hackley, K.C., & Bostrum, A. (1984). Social support of teenage mothers. Birth Defects, 29, 245-290.
4. Future Goals of Adolescent Mothers. Chicago: Section of Family Planning and Contraceptive Research, The University of Chicago (2011).
5. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy: National Campaign to Prevent Teen Pregnancy; May 2001.
6. Stevenson, W., Maton, K.I., & Teti, D.M. (1999). Social support, relationship quality, and well-being among pregnant adolescents. Journal of Adolescence 22, 109-121.
7. Cooley, M.L., & Unger, D.G. (1991). The role of family support in determining developmental outcomes in children of teen mothers. Child Psychiatry and Human Development, 21(3), 217-234.
On November 16th, GlobeMed at The University of Chicago hosted its first Global Health Film Festival, which featured five documentaries. “The Edge of Joy”, Dawn Shapiro’s touching and compelling account of maternal health in Nigeria, was followed by a conversation with the director. The film alternates between documentary footage, interviews, and animation, and splits it focus between Kano, a Muslim city in the northern dry desert, and Oyo, a luscious metropolis in the Christian south.
Nigeria, the most populous country in Africa, has 140 million people equally distributed between these two areas of the country. But in both North and South, health professionals face daily struggles related to maternal mortality and newborn morbidity. Indeed, Nigeria faces the second highest number of maternal deaths in the world, with 36,000 Nigerian women dying in labor every year (2010).
Shapiro lays her first scene at the Murtala Mohammed Specialist Hospital, where thirty babies are delivered every twenty-four hours. Sakina is in her twenties, and in labor with twins. Already the mother of two, she, like fifty percent of Nigerian women, has never given birth in a hospital. While her first twin is born strong and healthy, the second twin is small and sickly-looking. Yet her newborn is not the only one with his life on the line. His mother is suffering from the leading cause of maternal mortality: post-partum hemorrhage. Sakina needs blood transfusion, but the hospital has no stock of her rare blood type. Fortunately, Sakina’s husband owns a car, but although he visits many hospitals and private blood suppliers across the city, he faces a barrier common to many Nigerians in his situation: one pint of blood costs $68, and the average Nigerian monthly salary is $94. These access and financial barriers cause thousands of preventable deaths every year.
Image courtesy of ‘The Edge of Joy’
In the same ward, we meet Aicha and Kabiru who are expecting their eighth child. Aicha bled a lot when her two previous children were born, so she asked her husband to take her to the clinic. In the North, women’s chances of dying during childbirth are increased because Islam prevents them from traveling without a male escort. When Kabiru’s car breaks down on their way to the hospital, Aicha must wait for her father-in-law’s permission to have another male relative accompany her. When she finally reaches the hospital, she has lost a significant amount of blood. Immediately, doctors strap her into an anti-shock garment. This innovative full-body suit is strapped tightly around the limbs and the stomach, and shoots blood back to vital organs, preventing hemorrhaging women from losing large amounts of blood. A couple minutes later, Aicha’s situation stabilizes and the garment allows her to survive the next five hours it takes Kabiru (who lost his first wife during her seventh delivery, and is the father of thirteen) to find two pints of blood.
Image: openideo.com
The sharia, or Islamic law, dictates the way of life in most conservative Muslim communities. The interplay between Islam and modern medicine is a delicate balance that reproductive health professionals must navigate. Many families perceive the West as imposing ideas on them. Speaking of northern Nigerian men in general, a nurse explains that they have a difficult time understanding that doctors are not asking couples to stop having children, but to space out the births. According to sharia, women should not “take a break” from having children, because Allah disapproves of breaks. Yet, when husbands realize that birth spacing prevents their wives from dying, many consent to the beneficial aspect of contraception and family planning. Preventative community education has been successful as more and more women come to the clinic alone, and depend less on their husbands’ permission to leave home if they get contractions in the middle of the day.
The north of Nigeria is a dangerous and difficult to place to be a woman. If a woman has given birth five times, any birth beyond the fifth is disproportionally dangerous. Moreover, to further decrease maternal mortality, couples are recommended to wait at least two years between pregnancies. Especially for rural families, access to health facilities and emergency care is limited, and the lack of sexual and reproductive health education leads one in five pregnancies to be unplanned in Nigeria every year.
For many rural women like Rachel, who describes herself as “very fertile”, preventing pregnancies has been unsuccessful. After realizing she was pregnant with her fifth child, she tried to give herself an abortion by using local herbs and remedies, but after severe diarrhea and drastic weight loss that put her life in danger, she “accepted her fate” and started the prenatal care recommended by her local midwife.
Source: pulitzercenter.org
In many parts of Nigeria, men perceive contraception as encouraging women’s promiscuity. While most men are eager to improve the reproductive lives of their families, contraception is a man-only dialogue that has not yet expanded to encompass how family income and wealth depends on maternal health. Strategies have been adopted to creating safe forums for discussions, where religious leaders and health professionals conduct pre-natal classes, and provide outlets for women and men to separately express their feelings, concerns, and ask questions. Especially in the southern city of Oyo, where the premier physician for maternal health lost his own mother at age three, nurses and leaders stress the social consequences of poor health and the multitude of challenges that families and children face without a mother.
To remedy this situation, Nigerian doctors have lobbied for separate maternity blood banks. With these new blood refrigerators in place, the wait time for blood has been reduced by 75%, and maternal mortality rates have significantly decreased. Other free maternal services have been deployed to allow women to travel without male escorts to nearby hospitals. The anti-shock garment has also contributed to 50% less blood loss and 64% fewer deaths in the maternity wards that use them.
After the screening of her inspiring documentary, director Dawn Shapiro spoke about the idea that sparked her interested in maternal health –specifically, the anti-shock garment led her to focus on Nigeria, where it is presently the most widely tested. She mentions how Nigerian hospitals are now very focused on training professional staff and local birth attendants, increasing access to transportation, making technologies like the anti-shock garment or the Odón device (engineered by an Argentinian car mechanic, and pictured below) more accessible, and blood donations more widespread.
Source: bergamosera.com
The lesson that Shapiro encourages young global health-oriented students to keep in mind when working abroad is that the best way to understand women’s challenges is by getting community buy-in from health professionals and local leaders. Only in this way can one really come to understand the underlying moral values and ancestral traditions that shape attitudes, decisions, and priorities. And the messages Shapiro wants us to take home with us? “Saving one mother’s life saves a family’s life.”
Jeanne Chauffour is a third-year in the College studying History, Philosophy, and Social Studies of Science and Medicine (HIPSS) and Human Rights. Jeanne is Director of Campaigns for GlobeMed at The University of Chicago, and a Volunteer at Ci3 and the Center for Global Health at The University of Chicago.
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