2009 Recipients - Liz Corey, Kellie Corcoran
2010 Recipients - Amy Winter, Brenna Rabel, Shreya Rao, Ryan Woodson, Danielle Smith, Roula AbiSambra, Aimee Leidich, Ruth Dawson, and Maria Presley
2011 Recipients - Sarah Fisher, Beth Getachew, Anna Newton-Levinson, Danika Berry, Anissa Dickerson, Darcy White, Lydia Karch, Cayenne Claassen-Lüttner, and Sarah Stein
2012 Recipients - Kavitha Balakumar, Meg Bertram, Jeffrey D. Freeman, Antoinette Nguyen, Amanda Geller, Brianna Keefe-Oates
2013 Recipients - Andrea Catalano, Jaynia Anderson, Danielle Miranda, Cody Sigel, Jose Guillen, Helen Baker
2014 Recipients - Victoria DeMartelly, Erin Berry-Bibee, Katheryn Nistrom, Samantha Luffy, Kaitlyn Stanhope, Yonah Et-Shalom, Bethany Kotlar, Heidi Schroffel, Kristi Allen, Kate Nelson, Kenisha Peters and Cho Hee Shrader
2015 Recipients - Davie Zolowere, Shae Street, John Nepiyala, Cheryl Choice, Sana Charania, Jennifer Holl, Kristina Countryman, Gelsey Hughes, Katherine Michel, Jennifer Swanson, and Ruvani Jayaweera
2016 Recipients - Rachel Shapiro, Helen Baker, and Brianna Poovey
2017 Recipients- Emily Adams, Kate Anderson, Sana Charania, Sarah Jolly, Haley McLeod, Rachel Shapiro, and Tayla Nakash
Liz Corey conducted research in Summer 2009 on the availability of and attitudes towards family planning and Post-Abortion Care in Zambia through her project titled "The current and future role of Trained Traditional Birth Attendants in Rural Zambia."
Kellie Corcoran designed and implemented two distinct questionaires, one for pregnant women and one for health providers which investigated the availability, acceptability and accessibility of postpartum contraception and safe abortions, titled: "A Needs Assessment of Postpartum Contraception and Safe Abortion Among Women Tested with Their Partners for HIV in Lusaka, Zambia."
Amy Winter spent the summer of 2010 working for an organization called SEARCH (Society for Education, Action, Research, and Community Health: http://www.searchgadchiroli.org). One of Amy's tasks was to work with Dr. Rani Bang (one of the organization's founders) and the women's program team to improve the women's health education curriculum. Additionally, she researched rural and tribal women's perceptions of sterilization and the factors associated with female rather than male sterilization within a couple. The preliminary results suggest that many females undergo sterilization because the husband's work is perceived as more financially valuable and there were misperceptions about the time it takes for a man to recover from male sterilization. However, among illiterate couples and in the scheduled tribe, sterilizations are more common among males. These findings have important public health implications, including the need for more accurate information and awareness about male sterilization.
In the summer of 2010, Brenna Rabel also worked with SEARCH in Gadchiroli, India on a project looking at data from a clinic-based study on local women opting for medically terminated pregnancy. Although the results thus far are only preliminary, the findings are remarkable: almost 99% of women receiving a regimen of vaginally-inserted misoprostol successfully completed abortion without severe complication. The current abortion laws in India, which were written before reliable medical (as opposed to surgical) methods were available, stipulate that only government-licensed physicians in government-approved facilities can perform abortions, making it especially difficult to procure a legal abortion in rural areas. The results of this study may help to inform a shift in policy to expand access to MTP in rural areas.
Shreya Rao spent the summer in Leticia, Colombia, conducting a qualitative study to identify the causes and consequences of unwanted pregnancies. The current abortion laws in Columbia are very restrictive, allowing abortions only in the case of rape, fetal malformation, or extreme risk to mother. Through a series of interviews, Shreya observed that unwanted pregnancies, along with large family sizes and early ages of sexual initiation, are common in Leticia. The primary explanations for these patterns included economic instability, barriers to access, and personal irresponsibility as well as the role of poverty in encouraging prostitution and abuse. Although estimations of the frequency of abortion were significantly varied, the subjects expressed an almost unanimous disapproval of the practice, particularly where it involved formal health care providers.
Ryan Woodson conducted a qualitative research study in the Amazon region of Colombia. Through her study, titled "A Qualitative Assessment of Unwanted Pregnancy and Induced Abortion among Women in the Amazon Region of Colombia," Ryan aimed to examine and understand the socio-cultural perceptions and decision-making pathways of unwanted pregnancy and induced abortion among indigenous women of reproductive age.
In Summer 2010, Danielle Smith went to Siaya, Kenya, to research the impact of perceived gender and power norms on family planning decision-making. One aspect of the research was focused on decision-making in the case of unplanned pregnancies, both for young girls and married women.
With funding from the GEMMA Fund and the Global Health Institute (GHI), Roula AbiSambra and Aimee Leidich (Rollins School of Public Health), Ruth Dawson (School of Law), and Maria Presley (Candler School of Theology) spent the summer of 2010 in Mexico City working to counter conservative backlash to sexual and reproductive rights. In 2007, to address maternal mortality and morbidity due to unsafe abortions, the Mexico City Federal District (D.F.) legislature amended the district's penal code to decriminalize abortion in the first trimester, marking a major victory for women's health and rights. However, in response to this legislation, half of Mexico's 31 states subsequently amended their state constitutions to redefine human life as beginning at conception, thus actively criminalizing abortion. The self titled "GHI GEMMA Team" sought to counter this backlash by forming a multidisciplinary team to work collaboratively with three member organizations of Mexico's National Pro-Choice Alliance -- Population Council, Católicas para el Derecho de Decidir (Catholics for Choice, CDD), Grupo de Información en Reproducción Elegida (Reproductive Choice Information Group, GIRE), as well as the Instituto Nacional de Salud Pública (National Institute for Public Health, INSP)
The team's overarching objective was to compile evidence-based recommendations for messaging that might combat the stigma and isolation faced by women who have had or may need an abortion in Mexico. Achieving this objective required a coordinated effort using evidence from the fields of public health research, law, and theology; therefore, an interdisciplinary team of students from those schools worked with Population Council, GIRE, and CDD, respectively. The two Public Health Scholars analyzed quantitative public opinion surveys and qualitative patient interviews, the Law Scholar researched state-specific policy and politics in relation to public opinion, and the Theology Scholar interviewed theological experts and interpreted biblical texts. Each student's findings were instrumental in synthesizing a well-rounded dissemination strategy to combat abortion stigma and uphold the Pro-Choice Alliance's mission to promote and protect sexual and reproductive rights across Mexico.
Sarah Fisher worked with SEARCH (Society for Education, Action and Research in Community Health), an Indian NGO, to research pregnancy-associated deaths in rural Gadchiroli, Maharashtra, India. Sarah analyzed data on 319 deaths among women in 86 villages between the years 1988 to 2004. She assessed the distribution of direct and indirect maternal deaths, as well as of suicide and accidental deaths among the study population. She specifically looked at the distribution of deaths overall and by the pregnancy stage during which the death occurred. Staff at SEARCH plan to use the study results to better target future interventions for pregnant women.
Beth Getachew worked with CARE International to assess the cultural appropriateness of the Gender Equitable Men (GEM) scale and the Sexual Relationship Power Scale (SRPS) related to gender and power norms in the East and West Hararghe regions of Ethiopia. These scales were used to collect data as part of the Results Initiative Baseline Data (RIBD), a joint project between CARE and Emory University, but they have not been validated for use in Ethiopia. To this end, Beth conducted individual in-depth interviews based on the scales used in the RIBD survey for cognitive validation and to understand how social factors such as gender equity and power norms influence the decision-making process towards family planning use. With such an understanding, CARE Ethiopia will be able to formulate and implement an effective program intervention that will improve family planning service uptake in the region.
Anna Newton-Levinson worked with CARE in Ethiopia conducting a qualitative study of the reproductive health needs of widowed and divorced women. Part of her research looked at the consequences of unintended or undesired pregnancy for widowed or divorced women as well as the changes in access to family planning and abortion services in Ethiopia.
Danika Barry worked with the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), a collaboration between Emory University’s Nell Hodgson Woodruff’s School of Nursing and the Ethiopian Federal Ministry of Health, funded by the Bill and Melinda Gates Foundation. She conducted focus groups and in-depth interviews with members of community quality improvement teams, which are comprised of various cadres of community-level health workers, pregnant women and family members, community government representatives, women’s association members, and religious leaders. Her research aimed to understand strategies for pregnancy disclosure, care seeking, and the provision of timely, quality care.
Anissa Dickerson conducted a preliminary investigation of current abortion issues in Paraguay, where abortion is highly restricted and only permitted in cases where a woman’s life is in danger. As a result, abortion is one of the major contributors to maternal mortality in the country. Anissa conducted key informant interviews and gathered background information to support future research.
Rollins MPH students Darcy White and Lydia Karch, along with Religious Studies student Cayenne Claassen-Lüttner and dual degree Law and Women, Gender and Sexuality Studies student Sarah Stein spent the summer working with Mexico’s National Pro-Choice Alliance. Building upon the work of a GEMMA affiliated student group that worked in Mexico in the summer of 2010, this multidisciplinary team received funding from the Emory Global Health Institute (GHI) to design and pilot advocacy messages aimed at de-stigmatizing and increasing access to safe abortion. The team developed two sets of messages specific to the legal, cultural, and religious contexts of Mexico City and Oaxaca de Juárez, and over the course of the summer conducted 27 interviews with health professionals and 6 focus group discussions with community members. The primary deliverable was a series of refined advocacy messages that the team presented to the National Pro-Choice Alliance upon completion of the project. The Alliance plans to incorporate the message proposals into future campaigns.
After returning to Atlanta, the team presented their research at the GHI research symposium, and in October Darcy White traveled back to Mexico City on behalf of the team to present the findings at the IV Research Meeting on Undesired Pregnancy and Unsafe Abortion.
Although the Parliament of Nepal legalized abortion in 2002, maternal mortality due to unsafe abortion remains a major concern, particularly among adolescents. Currently, adolescents account for 19% of Nepal’s maternal deaths. An increase in post abortion complication cases at health posts suggests that they may not be receiving complete doses of medical abortion pills or accurate information about medical abortion. With support from Ipas Nepal, Kavitha conducted in-depth interviews with pharmacists in Kathmandu, Nepal to assess their knowledge of medical abortion, identify the contraceptive and medical abortion needs of adolescents, and the information pharmacists provide at the time of purchase. These interviews also allowed her to explore pathways of referrals from pharmacists to comprehensive abortion care (CAC) providers, along with pharmacists’ attitudes towards providing contraceptives to youth in the community. This information will be used to enhance Ipas youth-centric programming and education initiatives throughout the Kathmandu Valley.
In 2002, Nepal’s parliament passed an amendment legalizing abortion. Formerly one of the few countries worldwide that jailed women for terminating pregnancies, abortions may now be performed during the first 12 weeks of pregnancy, or up to 18 weeks in cases of rape, incest, fetal malformation, or when the woman’s life is endangered. The Government of Nepal’s Ministry of Health and Population has given high priority to strengthening family planning services, and is collaborating with Ipas Nepal to improve post-abortion family planning throughout the country, by providing contraceptive counselling for individual women’s needs and interests. Based on initial findings, Ipas and Meg conducted a quality of care assessment of the current family planning counseling, incorporating structured observations, in-depth interviews with clients, and discussions with providers.
Jeffrey D. Freeman
Recently, South Africa legalized abortion through the Choice on Termination of Pregnancy Act (1996); preliminary investigation reported a 91% decline in hospital based abortion mortality. However, highly variable estimates of maternal and infant mortality suggest incomplete reporting of maternal and infant deaths. Jeffrey became involved in several projects to explore this issue and extended his summer work with the Human Sciences Research Council (HSRC) through December 2012.
Jeffrey worked on South Africa’s National Health Insurance program, and conducted an assessment of the civil registration and vital statistics (CRVS) systems. He coordinated the first Maternal and Infant Morbidity and Mortality Surveillance (MIMMS) stakeholders meeting, drafted a proposal to conduct the 2013 MDG Country Assessment Reports, negotiated a memorandum of understanding between HSRC and the Council for Health Service Accreditation of South Africa (COHSASA) to conduct a nationwide audit of health facilities, and conducted a nationwide health audit and mapping the service infrastructure for civil registration and vital statistics. In the Fall of 2012, Jeffrey provided training on probabilistic vital records linkage to Statistics South Africa.
Because of GEMMA support, the MIMMS project will include senior Marie Stopes South Africa staff and abortion services will be included in a nationwide health facilities audit. This will allow monitoring and evaluation of abortion services during the audit. The nation-wide health facility audit and mapping of the service infrastructure will describe the availability, utilization and quality of abortion services in South Africa. This will assist in measuring the impact of legalizing abortion services and how services should be improved.
Antoinette conducted a survey of knowledge, attitudes, and practice about family planning in the Central Plateau of Haiti. She worked on this project in collaboration with Sarah Rae Strunk and Sandra Zaeh, and under the mentorship of Eva Lathrop, MD. This research study was conducted in May 2012 and included women between the ages of 18 and 45. Of the women who came into the medical facility in the Central Plateau, about 200 participated in the study. The analysis of this survey is ongoing. She is also currently completing her residency in obstetrics and gynecology at Northwestern in Chicago.
Abortion is illegal in every state in Mexico, except Mexico City, with a few legal state exceptions. In the Federal District, abortion is legal only up to 12 weeks. Due to cultural and logistical factors, less than 6% of abortions are provided to adolescent girls, yet teen pregnancy rates remain high. To address this issue, organizations like Fondo Maria and Ddeser act as advocates and “friends” to girls seeking abortions. They help provide young women with transport, information, and faster access to services. Amanda’s primary project was aimed at evaluating teen pregnancy interventions through interviews with researchers, government, and non-governmental agencies. The interviews all included questions about access and provision of abortion to Mexican teens.
Families Talking Together is an evidence-based intervention focused on improving parent-child communication about sexual and reproductive health with the goal of preventing adolescent pregnancies. This intervention was piloted in Paraguay to assess adolescents’ sexual health education and contraceptive needs, the acceptability of implementing a parent-focused pregnancy prevention intervention in the community, and possible future adaptations. Brianna conducted this research with the support of the Paraguayan National Institute of Health and in collaboration with Mil Solidarios, a youth development organization. Following the intervention, she conducted focus groups with the parents and interviews with adolescents to understand where they received information about sexual health topics and their perceptions of parent-child communication. She also interviewed key informants throughout Asunción to gather more insight into the contraceptive and sexual health needs of adolescents, including education and information about abortion. Using the information from the interviews and focus groups and the expertise of the key informants, Brianna made recommendations for implementing the program in Paraguay.
With the help of GFE and GEMMA funding, Andrea was able to design and conduct a research study of unintended pregnancy and abortion in Comayagua, Honduras over the summer of 2013. She trained and oversaw 2 research assistants who were able to collect 209 surveys from ever-pregnant women ages 18-24 present in 4 local health clinics. Other components of the project included in-depth interviews with OB/GYNs and a mixed methods survey for pharmacy workers. The preliminary findings showed a general lack of knowledge and frm attitudes towards abortion. Many participants answered 'maybe' when asked if abortion should be an option in a variety of situations and the majority of pharmacy workers believed that Plan B can cause an abortion. She is currently using the data for her Master's thesis and will also be presenting her research at the Unite for Sight Global Health and Innovation Conference in April. With the help of GFE and GEMMA funding, Andrea was able to design and conduct a research study looking at unintended pregnancy and abortion in Comayagua, Honduras over the summer of 2013. She trained and oversaw 2 research assistants who were able to collect 209 surveys from ever-pregnant women ages 18-24 present in 4 local health clinics. Other components of the project included in-depth interviews with OB/GYNs and a mixed methods survey for pharmacy workers. The preliminary findings showed a general lack of knowledge and frm attitudes towards abortion. Many participants answered 'maybe' when asked if abortion should be an option in a variety of situations and the majority of pharmacy workers believed that Plan B can cause an abortion.
Danielle Miranda, Cody Sigel, Jose Guillen and Helen Baker
Between June and August of 2013 an Emory University GHI team conducted a mixed methods study in Cape Town, South Africa that explored the demand for, and feasibility of, incorporating custom-fitted male condoms into current sexual health interventions. In association with the Human Sciences Research Council and other community-based and government agencies in Cape Town, the project included 22 in-depth qualitative interviews with sex workers to examine interest in custom-fitted condoms; surveys of 130 men to explore condom use experiences, attitudes, and interest in non-standard sized condoms; and interviews with condom distribution and education staff at clinics and sexual health organizations to determine the feasibility of incorporating custom-fitted condoms to existing interventions and practices.
Jaynia’s summer practicum involved working with the Human Sciences Research Council’s Population Health, Health Systems and Innovation section. Her project was GEMMA focused and involved designing and conducting a qualitative study aimed to explore and identify the personal, cultural, social, and structural barriers experienced by women accessing abortion services. This was done through in-depth interviews focused on 4 main delays: delay in recognizing pregnancy, delay in making a decision, delay in accessing a healthcare facility, and delay in accessing adequate medical care. 15 women were interviewed post-abortion procedure at 2 private reproductive health facilities in the Western Cape Province in South Africa.
Victoria’s research focused on abortion in Alabama, using data collected during her work with the Alabama Women’s Access Study. As of July 2014, only three clinics remained in operation in the entire state of Alabama in response to the passing of many laws around this time pertaining to building codes. Additionally, a recent law was passed requiring that women attend a state-mandated counseling session, followed by a wait time between receiving the counseling and the abortion procedure, which was increased from 24 to 48 hours. Victoria recruited women at two of these clinics and conducted phone interviews with 25 women who had to travel a distance greater than 35 miles or 30 minutes in order to arrive at the clinic so that she could better understand the experiences of these women and barriers they faced arriving at the clinic.
In Haiti, abortion is illegal except to save the life of the mother. Anecdotally, however, self-induced illegal abortion is thought to be widely practiced. Funded through a research grant from the National Family Planning Fellowship, Erin’s GEMMA-focused study used mixed methods to investigate the illegal abortion experience in urban Haiti. Together with her team, she conducted 8 focus groups with 64 women in the community and 13 in-depth interviews with key informants in women’s health. Discussions focused knowledge sharing about contraception and abortion, abortion methods used, abortion access, post-abortion care and abortion related stigma. They then surveyed over 260 pregnant women presenting to the public teaching hospital for care about current and past experiences with abortion and contraception. The qualitative phase of the research served as Erin’s Master’s thesis in 2014.
Katherine traveled to Cobán, Guatemala to work with the Women’s International Network for Guatemalan Solutions (WINGS) to assess client satisfaction of the association’s network of volunteer promoters. WINGS focuses its program in the department of Alta Verapaz, where access to reproductive health services is particularly limited due to geographic isolation, lack of education, poverty, and cultural and linguistic issues. Contraception use is low in Alta Verapaz, with only 34.1% of married women using modern family planning methods. WINGS’ volunteer promoters distribute short-term contraceptives at low costs to women and men in rural poor communities. Katherine developed a mixed-method survey that assessed promoter-client interaction, barriers to promoter and contraceptive utilization, client education, and overall client satisfaction. The data Katherine gathered from this evaluation will help WINGS improve its instruction and management of the volunteer promoters. By improving its program, WINGS will be able to help more women and men gain access to modern contraceptives, avert unintended pregnancies, stay in school longer, and reduce poverty in the region.
With assistance from the Global Field Experience (GFE) Fund and the GEMMA Fund, Samantha conducted a qualitative research study on women’s experiences with unintended pregnancy in Ocotal, Nicaragua. She conducted 3 focus group discussions and 10 in-depth interviews in Spanish with young women from neighborhoods throughout Ocotal. Women in Nicaragua do not have access to safe and legal abortion services to terminate an unintended pregnancy. Due to religious and cultural ideologies, the majority of participants supported the country’s total ban on abortion in most circumstances, with the possible exception of rape. Participants also identified other barriers limiting women’s personal sexual and reproductive health decisions, such as criticism by others in the community when receiving family planning services; gender inequality and machismo, violence against women, particularly femicide; a lack of open communication with their partners and parents; and insufficient sexual education. This project could not have been possible without the guidance and expertise provided by Samantha’s in-country mentor, Dochyta Falcon, who has been nurse in Ocotal for over 30 years and is a lifelong advocate for women’s rights and safe abortion access.
In the summer of 2014, the GHI team traveled to Bogotá, Colombia to examine the barriers to safe, legal abortion access that remain in the wake of partial decriminalization. In 2006, the Colombian constitutional court ruled to partially decriminalize abortion services under a right to health and women’s rights frame-work, acknowledging abortion access as a component of women’s rights to health. The team spent two months in Bogotá, Colombia collecting data. The team employed mixed methods and a multidisciplinary perspective. They began their research by meeting with and learning from Colombian activists and advo-cates who have spent years on the front lines of this struggle, facing fervent and sometimes violent opposi-tion. Team members also interviewed anti-abortion scholars and physicians. After gaining a better under-standing of the context surrounding abortion access in Colombia, we qualitatively explored barriers to access from the patient's perspective and conscientious objection from the provider's perspective. The team also conducted a quantitative two-stage cluster survey of public hospital providers, and continued inter-viewing lawyers, legal advocates, and social activists. Our project yielded interesting preliminary and exploratory results. Another team is set to return in summer 2015 and they hope that future generations of GEMMA students will continue to build on this foundation.
Yonah Et-Shalom, Bethany Kotlar & Heidi Schroffel
In October 2012, Uruguay passed Latin America’s most liberal abortion law by decrimi-nalizing abortion up to 12 weeks of gestation and up to 14 weeks for rape victims, allowing later procedures for women facing health risks. A three-person multidisciplinary team conducted three interrelated studies in order to fill the data gap.
Heidi Schroffel, MPH candidate, carried out a satisfaction survey of abortion services with the reproductive health organization Iniciativas Sanitarias in order to evaluate how satisfied women were with the abortion services provided at the Hospital Pereira Rossell and how factors of satisfaction/ dissatisfaction were distrib-uted among the four required patient visits. Yonah EtShalom and Bethany Kotlar worked with Mujer Y Salud, Uruguay to conduct two related studies. Bethany Kotlar, MPH candidate, conducted 11 in-depth interviews with gynecologists to explore the relationship between participants’ religious, spiritual, and moral beliefs and attitudes towards abortion. Yonah EtShalom, MPH/MSN candidate, collected survey data from approxi-mately 45% of gynecologists in Montevideo. Surveys focused on gynecologist training, experience, and comfort in techniques of induced abortion.
Kristi’s summer practicum was with Likhaan Center for Women’s Health Inc. in Manila, Philippines. Likhaan provides free reproductive health services, including contraceptives, through five clinics located around metro Manila. Kristi and her research team conducted in-depth interviews with young people aged 16-20 about their perceptions of and experiences with contraceptive access and use. Sixteen young people, including males and females with and without children and in a relationship or single, were interviewed for the project. The preliminary results were presented to both Likhaan’s management team and Likhaan’s community health workers to inform Likhaan’s efforts to engage with young people and encourage them to seek services.
Between June and August 2015, an Emory University GHI team partnered with the Sex Workers Education and Advocacy Taskforce (SWEAT) in Cape Town, South Africa to conduct various community needs assessments. SWEAT is a nonprofit organization that addresses the health, human rights, and advocacy needs of sex workers in South Africa. In the hopes of reaching new vulnerable sub-populations, SWEAT requested Kate to assess the needs, resources, barriers, and facilitators sex workers face in their role as mothers. Her project included structured observation; 10 in-depth qualitative interviews with sex workers to explore their experiences as mothers; and 5 key-informant interviews to gain expert insight into the sub-population. In relation to GEMMA, experiences with abortion, unintended pregnancy, reproductive health, and contraception were cited almost unanimously during in-depth interviews with both sex workers and key informants. Kate used these findings to guide the development of a social support group entitled Mothers of the Future. This group aims to provide sex workers who are mothers with the social support and parenting education needed to thrive as mothers. Mothers of the Future is now being expanded nationwide with funding from the South African Department of Health, and Kate’s thesis is focused on developing the program’s curriculum to support this expansion.
Kenisha Peters & Cho Hee Shrader
The 2014 research project was a follow-up to research conducted by the 2013 GHI Cape Town team. Working with the Human Research Sciences Council of South Africa, the team designed a sizing tool for men to choose their condom size; identified how newly designed condoms may increase condom use among men and women in South Africa; and identified risk factors for condom non-use and shifts in attitudes toward condoms. Specific tasks involved with achieving each of these goals included: conducting seven focus groups with men; interviewing 13 men and women, at four pre-assigned clinics throughout the City of Cape Town; and administering an online survey to 200 men and women. The survey included questions about men and women's condom preferences, reasons for condom non-use and use, as well as women's knowledge and attitudes toward abortion.
With assistance from the GEMMA Fund and GFE Fund, Jennifer spent the summer of 2015 as a Family Planning and Reproductive Health intern with IMA World Health in the Democratic Republic of the Congo (DRC). She was conducting primary qualitative research to understand contraceptive use and abortion practices among women of reproductive age. She implemented in‐depth interview guides and conducted interviews with both women of reproductive age and reproductive healthcare providers. Interview questions included attitudes about fertility and contraception, the decision‐making process, and community perceptions of contraceptive use. Although abortion is illegal in the DRC, Jennifer also sought to speak directly with the women and healthcare providers to explore their feelings and gain insights into current abortion practices. In total, she facilitated the completion of 42 interviews in four different provinces throughout the DRC (Equateur, Kasai‐Occidental, Maniema, and North Kivu Provinces). This research could not have been as successful without the help of the interviewers (pictured) Shanti and Mlle. Therese in Equateur Province; Mlle. Denise and Dr. Delphin in Kasai‐Occidental Province; Papa Dieudonné and Dr. Cyprien in Mainema Province – Jennifer respects and greatly appreciates their willingness to inquire about such sensitive issues. Jennifer is currently finishing her manuscript-style thesis where she will be analyzing the community perceptions, decision‐making process, barriers to contraceptive use and the consequences of unplanned pregnancies among women of reproductive age in the DRC.
In Kigali, Rwanda, Gelsey designed and led a qualitative study of long-acting reversible contraceptives methods (LARC) uptake among couples enrolled in a CFPC (Couples' Family Planning Counseling) program with an HIV prevention component. Her objective was to determine the reasons why some couples decline free LARC methods offered at clinics despite reporting a desire to delay childbirth. The incorrect or inconsistent use of contraceptives by couples intending to delay childbirth leads directly to unintended pregnancy and thus contributes to abortion-related mortality. LARC methods are extremely effective for the prevention of unintended pregnancy and represent a critical tool in the reduction of unsafe abortion, childbirth complications and other consequences of unintended pregnancies. This is particularly important in contexts like Rwanda where stockouts and other supply-chain interruptions inhibit the efficacy of oral and injectable contraceptives. To accomplish this research, Gelsey conducted in-depth interviews with 14 couples in 6 government clinics throughout Kigali. Gelsey was hosted by Projet San Francisco, a subsidiary of the Rwanda Zambia HIV Research Group, founded and headed by Dr. Susan Allen, MD, MPH.
Ruvani spent the summer working at Advancing New Standards in Reproductive Health (ANSIRH), which is part of the Bixby Center for Global Reproductive Health at the University of California, San Francisco. She developed a monitoring and evaluation plan for the Aunty Jane Hotline, a safe abortion hotline operated by Fortress of Hope Africa (FOHA), a community based organization in Nairobi, Kenya. She trained FOHA staff in evaluation and qualitative research methods, and worked with them to develop evaluation priorities for their organization as well as a focus group discussion (FGD) guide. FOHA staff used this guide to lead seven FGDs with women and girls between the ages of 15 – 29 who live in one of their target communities. The goal of these FGDs was to better understand the barriers women in this community face around sexual and reproductive health information, particularly around information regarding access to safe abortion. The focus groups were recorded, transcribed, and translated into English for analysis. Preliminary results demonstrate that while women and girls are well aware of methods to prevent pregnancy, women in this community engaged in a variety of unsafe methods to end pregnancies, including: insertion of sharp objects into the vagina, ingestion of industrial cleaners, and consumption of traditional herbs. Women were largely unaware that abortions could be safe, demonstrating the need for greater access and information around safe abortion methods. A manuscript further detailing these results is forthcoming.
Kate Michel, Tim Nielsen & Renita Woolford
Beginning in September of 2015, Kate, Time & Renita’s team had the opportunity to design and implement a study on post-abortion contraception. This study aims to understand the financial and social barriers and facilitators to starting a contraceptive method post abortion, with two main endpoints: 1) uptake of a long acting reversible contraceptive at 12 weeks post-abortion or 2) uptake of a method with less than 18% effectiveness at 12 weeks post-abortion. Over 200 women have been enrolled, the majority of which highly rate their contraceptive counseling experience at the clinic. While uptake of LARC methods at 12-weeks post-abortion is low, many women express that they would still prefer to be using a LARC method—further analysis on structural barriers to LARC is ongoing. With assistance from the GEMMA Fund, the research team was to afford tablet computers to administer the in-clinic survey. Clients reported feeling more at ease giving answers to sensitive questions with the tablet compared to face-to-face interview format and the tablets allowed clients to take the survey while moving through the clinic (to billing, ultrasound, etc) without affecting their wait time. The data collected from this study will hopefully inform contraceptive counseling in the southeastern US and will provide immediate feedback for the clinic.
Alongside fellow EGHI team members, Jenny participated in a program evaluation with Sex Worker Education and Advocacy Taskforce (SWEAT) in Cape Town, South Africa. Her role on the team was to better understand the experiences of sex workers in making decisions about, accessing and utilizing health services, and the role that the stigma and discrimination of sex workers plays in each of these. She conducted in-depth interviews with SWEAT service-users and staff to inform SWEAT’s ability to offer tailored services and linkage to sex worker-friendly healthcare. Additionally, Jenny piloted and evaluated Mothers for the Future, a parenting curriculum for sex workers who are mothers, developed by Rollins alum, Ms. Kate Nelson. This entailed facilitating a three-week workshop with mothers at SWEAT and gathering participant feedback through Focus Group Discussions and pre- and post-workshop questionnaires. Data collected will allow SWEAT to integrate a refined Mothers for the Future curriculum into their programming, with the hope of sharing it with mothers at SWEAT sites across the country. Through each of these projects, participants revealed barriers to accessing reproductive health services including family planning, abortion care, and support during childbirth. Many obstacles to care were rooted in fears of stigmatization, difficulty accessing information, and occupational and structural challenges; such as sex work’s fully criminalized status under South African law.
Kristina’s summer practicum was with Projet San Francisco (PSF) in Kigali, Rwanda. PSF is an HIV research organization with Emory’s Rwanda Zambia HIV Research Group (RZHRG). PSF is responsible for creating Couples Voluntary Counseling and Testing (CVCT) for HIV, which is now the national standard in Rwanda. As Rwanda is the most densely populated country in Africa and faces an unmet need for contraception, PSF wished to expand the success of CVCT into the realm of family planning. In 2014, PSF began a pilot program called Couples Family Planning and Counseling (CFPC), where Animateur de Sante (community health workers) counsel couples together on their fertility goals and modern contraceptive methods. Emphasis during these counseling sessions is placed on long-acting reversible contraceptives methods (LARC), specifically the IUD and Implant, as they are the most effective. The pilot was conducted in two rural health clinics just outside of Kigali. The goal of the pilot was to expand CFPC to a larger NIH program involving multiple clinics in Kigali city proper. Kristina’s role was to interview couples that had received CFPC from the Animateur de Sante to gain both their perspectives on the program, and their contraceptive choices post-counseling. She conducted 8 in-depth interviews at both of the pilot clinics with male and female LARC and non-LARC users, for a total of 16 interviews. Kristina also conducted two focus group discussions with both LARC and non-LARC couples. Results show that the Animateur de Sante are extremely well received in the community, and that there is a high demand for family planning by both men and women. Couples were also very supportive of CFPC, and men stated their appreciation in being included. However, many myths and misconceptions still existed about LARC methods, which was preventing some couples from using them. Using the data collected this summer, PSF is currently working on strategies to help dispel these myths, including the use of “Happy Clients”, or current LARC users in the community who discuss their methods with other couples. This will enable CFPC expansion, and help more Rwandan families meet their fertility goals.
Sana Charania, Angel Shae Street, Cheryl Choice, John Nepiyala & Davie Zolowere
Malawi has one of the highest maternal mortality ratios in the world (570/100,000 live births) and abortion contributes significantly (20%). Additionally, there are high rates of unintended pregnancies (54%). The team sought to evaluate the maternal death audit process, describe the experiences of women who undergo unsafe abortion, determine attitudes of healthcare workers towards abortion care and describe community perceptions towards unintended pregnancies. This was accomplished through surveys, focus group discussions and in-depth interviews. Team members also made presentations to healthcare workers on topics related to maternal mortality reduction. Preliminary Findings: The main challenge of the maternal death audit process was a lack of training for committee members to conduct effective audits. Induced unsafe abortion is highly stigmatized in the community but is common. Most health care workers do not approve of abortion. Cultural practices like sexual cleansing predispose women to unintended pregnancies in the district. The final report was sent to the District Health Office, and Ministry of Health.
Rachel Shapiro, Brianna Poovey, and Helen Baker worked on a mixed methods project which was comprised of two parts:
A qualitative analysis of organizational strengths and weaknesses in the National Midwifery Association (ASSAFETO) and a mixed-methods study examining barriers to clinic use for women seeking reproductive health services. The project was completed in partnership with EngenderHealth and AgirPF as well as ASSEFETO. They were a part of a three-person multidisciplinary team, primarily funded through the Emory Global Health Institute.
Rachel and Brianna conducted the research alongside a Togolese intern and under the supervision of Emory Nursing PhD candidate Helen Baker. This project examined the ability of midwives to provide family planning and other essential reproductive health services to women in Lomé, Togo.
Main findings from part one included the need for better organizational delegation, the importance of integrating new midwives within the organizational structure, and the need for more effective communication between members. Main findings from the second section included financial barriers, the importance of midwives/providers’ attitudes towards patient care, and fear of side effects from family planning methods.