Dr. Lisa R. Roberts - Virginia Henderson and Acknowledgements »Key Personnel: ~Dr. Lisa R. Roberts...
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Item type Presentation
Format Text-based Document
Title The Critical Role of Fathers to Reduce Stillbirth in India
Authors Roberts, Lisa R.; Montgomery, Susanne
Downloaded 8-Jul-2018 09:54:00
Link to item http://hdl.handle.net/10755/621662
The Critical Role of Fathers to Reduce Stillbirth in India
Dr. Lisa R. Roberts
Disclosures and Acknowledgements»Key Personnel:
~ Dr. Lisa R. Roberts (PI) and Dr. Susanne
Montgomery (Co-investigator)
»Disclosures:
~ No conflict of interest to declare
»Funding:
~ LLU School of Nursing Seed Fund and the Rambo
Committee
»Acknowledgements:
~ Christian Hospital Mungeli nurses and health care
professionals who collaborated with us, local Mitanins
who facilitated village visits, community stakeholders,
and the participants.
Purpose»To explore how men and women experience stillbirth in
India and their respective needs
~ To inform locally sustainable interventions
Background»MDG 4 cannot be achieved without reducing stillbirths
»Globally 3.3 million stillbirths per year1
~ India has the highest number of stillbirths in the world2
Stillbirths in India
»National average stillbirth rate (SBR) 4-8
~ 27/1000 live births
»Estimates of variance in SBR rate
~ from 20 to 66 by region
»Certain subpopulations 75-78
»SBR in Chhattisgarh 64
»SBR as high as 103/1000 in some communities
»Usually third trimester SB
~ Most potentially avoidable
Stillbirths risks in India
»Medical and sociocultural factors6
~ Lifelong malnutrition
~ Girls/women receive less food; food of less quality
~ Young mothers (due to early marriage)
~ Advanced maternal age
~ Lack of reproductive health choice and resources
~ Son preference
~ Maternal socioeconomic disadvantage
~ Short birth intervals
~ Lack of antenatal care
~ Lack of skilled birth attendants
Perinatal Grief
»Acute perinatal grief
~ Significant psychosocial burden on women’s health
»Complicated grief > 6 months
~ Impairment of social, occupational, other functioning
»Sequelae
~ Depression
~ Anxiety
~ Somatic symptoms
~ Decreased functioning
~ Domestic violence
~ Stigma, abandonment or isolation7,8
Confluence of Risk factors
Medical
Socio-cultural
Previous stillbirth
Quest for sons
Stillbirth
9-11
Fathers’ experiences
Western Context:12
»Psychological symptoms
~ Increased with more time
before next pregnancy
~ Pressure to be strong
Indian Context:13
~ Son preference
~ Fertility expectations
Mixed-Methods, 2 parallel studies:
~ Evaluation of a short
mindfulness-based pilot
intervention for women
• N = 22
• 5-week intervention
• 6-week and 12-month follow-up
assessments
~ Formative work exploring men’s
SB experiences
• 5 key informant interviews
• 23 structured interviews
Overview of Results
Women
~ History of 1 – 3 stillbirth
~ Reductions:
• Anxiety, depression
• Perinatal grief
~ Increases:
• Mindfulness
• Resilience
~ Still using skills at 1 year
~ Reported benefits:
• Increased calmness
• Sense of peace
• Positive energy
Men
~ Medical/reproductive decision power and burden
~ Lack of knowledge, readiness
~ Fertility issues/solutions
~ With history of stillbirth
• > anxiety/depression
• Perceived less support
• More egalitarian attitude
• More abusive
• Grieving seen as ‘normal’
• Frustration
~ Supportive of MBI for women
Qualitative themes among men
»Reproductive rights determined by men:
~ #’s of children
~ Obtaining prenatal care
~ Facility birth or home delivery
~ Timing of attempt to conceive again after stillbirth
»Family obligations expected of men
~ Caring for elderly parents
~ Financial solvency, shelter
~ Enforcing family piety
Husband of a woman with SB history
“I alone had to decide. Everybody was telling
(me) make a decision. Last time we went to the
private doctor and even after so much money we
spent the baby was born dead. This time we
went to the government hospital. . . it was also
stillborn. I think my wife is not alright yet but
everyone is telling to have another baby.”
Items of perpetration endorsed by all men (N = 28)
0
5
10
15
20
25
30
35
1-10 times in the last 3 months
Stillbirth
No stillbirth0
5
10
15
20
25
30
35
40
45
10-20 times in the last 3 months
Stillbirth
No stillbirth0
0.5
1
1.5
2
2.5
3
3.5
4
More than 20 times in the last 3 months
Stillbirth
No stillbirth
Predictors of mental health among men
with a history of stillbirth experienceVariable β B 95% CI
Constant 8.79 2.54, 15.04
Time since stillbirth 0.19 0.001 -0.002, 0.004
Gender of stillborn 0.40 0.24* 0.006, 0.47
Where stillbirth occurred -0.08 -0.06 -0.77, 0.53
Wife had antenatal care 0.31 0.18 -0.06, 0.41
Birth attendant 0.42 0.15* 0.04, 0.26
Number of stillbirths -1.49 -1.16* -1.85, -0.47
Ethnicity -0.99 -0.30* -0.52, -0.09
Attitude Towards Women -0.15 -0.20 -0.07, 0.03
Social Provision of Support -0.32 -0.42 -0.13, 0.04
Physical abuser -1.20 -0.70* -1.00, -0.40
Emotional abuser -0.16 -0.11 -0.35, 0.12
Life satisfaction -0.72 -0.13* -0.22, -0.04
Positive religious coping -0.26 -0.18 -0.49, 0.13
Negative religious coping -0.56 -0.25 -0.55, 0.05
*p < 0.05
Significant Predictors of mental health among men with history of stillbirth
» Gender of baby (male)
» Skilled birth attendant (no)
» Number of stillbirths (more)
» Ethnicity (lower caste)
» Physical abuser (no)
» Life satisfaction (low)
Comparing men and women
Conclusion»MBI for women effective in reducing perinatal grief
»Men often unaware of need or intervention offered
»Fathers of stillborns have unmet needs
~ Some positive outcomes:
• Gained insight
• Personal growth
• Developed empathy
~ Support needed
»Opportunities
~ Community engagement
~ Education
~ Community-based intervention
“When women thrive, all of
society benefits and
succeeding generations are
given a better start in life.”
~ Kofi Annan
References1. Yoshida, S., et al., Setting research priorities to improve global
newborn health and prevent stillbirths by 2025. Journal of global
health, 2016. 6(1).
2. Blencowe, H., et al., National, regional, and worldwide estimates
of stillbirth rates in 2015, with trends from 2000: a systematic
analysis. The Lancet Global Health, 2016.
3. Worldmapper. The new Worldmapper: Mapping your world as
you've never seen it before; Available from:
http://www.worldmapper.org/.
4. Bhati, D.K., Stillbirths: A high magnitude public health issue in
India. South East Asia Journal of Public Health, 2014. 3(1): p. 3-9.
5. International Institute of Population Studies, National Health and
Family Survey 3, Chhattisgarh Report. 2006, International Institute
of Population Studies: Mumbai.
6. McClure, E.M., et al., Stillbirth rates in low-middle income countries 2010-2013: a population-based, multi-country study from the Global Network.Reproductive health, 2015. 12(Suppl 2): p. S7.
7. Burden, C., et al., From grief, guilt pain and stigma to hope and pride - a systematic review and meta-analysis of mixed-method research of the psychosocial impact of stillbirth. BMC Pregnancy & Childbirth, 2016. 16: p. 1-12.
8. Lawn, J., et al., Stillbirths: rates, risk factors, and acceleration towards 2030. The Lancet, 2016.
9. Ahankari, A.S., et al., Banning of fetal sex determination and changes in sex ratio in India. The Lancet Global Health, 2015. 3(9): p. e523-e524.
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11.Straus, M.A. and E.L. Mickey, Reliability, validity, and prevalence of partner violence measured by the conflict tactics scales in male-dominant nations. Aggression & Violent Behavior, 2012. 17(5): p. 463-474.
12.Cacciatore, J., K. Erlandsson, and I. Rådestad, Fatherhood and suffering: A qualitative exploration of Swedish men's experiences of care after the death of a baby. International Journal of Nursing Studies, 2013. 50(5): p. 664-670.
13.Kozuki, N. and N. Walker, Exploring the association between short/long preceding birth intervals and child mortality: using reference birth interval children of the same mother as comparison. BMC public health, 2013. 13(3): p. 1.