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يصف هذا الكتاب الاستراتيجات والتكتيكات العملية التي استخدمتها منظمة بايلور للرعاية الصحية \"مبرص\" للتشغيل العملياتي لتوصيل الرعاية الصحية بطريقة (ستيب) أي بأمان وفي الوقت المناسب وبفاعلية وكفاءة وبعدالة بحيث يكون مركزها هو المريض والتزمت منظومة (مبرص) بتوصيل رعاية صحية بجودة مرتفعة منذ تأسست المنظمة في 1903 باعتبارها المصحة التذكارية المعمدانية\" في تكساس.

This paper examines men's lifetime physical intimate partner violence (IPV) perpetration across eight low- and middle-income countries to better understand key risk factors that interventions can target in order to promote gender equality and reduce IPV. We use data from men (n = 7806) that were collected as part of the International Men and Gender Equality Survey (IMAGES) in Bosnia and Herzegovina, Brazil, Chile, Croatia, Democratic Republic of Congo (DRC), India, Mexico, and Rwanda. Results show that there is wide variation across countries for lifetime self-reported physical violence perpetration (range: 17% in Mexico to 45% in DRC), men's support for equal roles for men and women, and acceptability of violence against women. Across the sample, 31% of men report having perpetrated physical violence against a partner in their lifetime. In multivariate analyses examining risk factors for men ever perpetrating physical violence against a partner, witnessing parental violence was the strongest risk factor, reinforcing previous research suggesting the inter-generational transmission of violence. Additionally, having been involved in fights not specifically with an intimate partner, permissive attitudes towards violence against women, having inequitable gender attitudes, and older age were associated with a higher likelihood of ever perpetrating physical IPV. In separate analyses for each country, we found different patterns of risk factors in countries with high perpetration compared to countries with low perpetration. Findings are interpreted to identify key knowledge gaps and directions for future research, public policies, evaluation, and programming.

Immigration- and enforcement-related policies and laws have significantly and negatively impacted the health and well-being of undocumented immigrants. We examine barriers and facilitators to healthcare and social services among undocumented Latino(a)/Latinx immigrants specifically in the post 2016 US presidential election socio-political climate. By grounding our study on the perspectives of frontline providers, we explore their challenges in meeting the needs of their undocumented clients. These include client access to healthcare and social services, the barriers providers face in providing timely and effective services, and avenues to reduce or overcome factors that impede service provision to improve quality of care for this population. Data are from 28 in-depth interviews with frontline healthcare and social service providers. Based on data analysis, we found that the domains of the Three Delays Model used in obstetric care provided a good framework for organizing and framing the responses. Our findings suggest that these undocumented clients encounter three phases of delay: delay in the decision to seek care, delay in identifying and traveling to healthcare facilities, and delay in receiving adequate and appropriate care at healthcare facilities. Given the current socio-political climate for immigrants, healthcare and social services organizations that serve undocumented clients should adapt existing services or introduce new services, including those that are not site-based.

Background Given the anti-immigrant rhetoric and policy proposals by President Donald Trump during the 2016 presidential campaign and afterwards, his election to president in November 2016 and subsequent policy changes has affected immigrant families. In this study, we aim to better understand how post-election policy change may have impacted the health and well-being, including health and social service utilization, of Latino immigrants in Southeastern Michigan. Methods We conducted 28 in-depth interviews with frontline staff at two Federally Qualified Health Centers and a non-profit agency. These staff had intimate knowledge of and insights into the lived experiences of the mixed-status immigrant families they serve. The interviews were audio recorded, transcribed, and analyzed thematically. Results Our findings show three major themes: (1) An increased and pervasive fear of deportation and family separation among mixed-status immigrant clients, (2) The fear of deportation and family separation has resulted in fractures in community cohesion, and (3) Fear of deportation and family separation has had an impact on the healthcare utilization and health-related behaviors of mixed-status families. Staff members report that these three factors have had an impact on physical and mental health of these immigrant clients. Conclusions These results add to previous literature on the effect of immigration policies on the health and provide key insights for interventions to improve the health of immigrants within this socio-political environment.

Prior research has shown that immigration law enforcement contributes to poor health outcomes-including reproductive health outcomes-among Latinos. Yet no prior research has examined how immigration enforcement might inhibit reproductive justice and limit individual's reproductive autonomy. We utilized data from an existing study that consisted of a partnership with a Latino community in Michigan in which an immigration raid resulted in multiple arrests and deportations midway through data collection. Using cross-sectional survey data (n = 192) where no one was re-interviewed, we used ordinal logistic regression to compare desired pregnancy timing of individuals surveyed prior to and after the raid to determine the impact of an immigration raid on desired timing of next pregnancy. We then used qualitative data-including 21 in-depth interviews and participant observation-collected in the community after the raid to contextualize our findings. Controlling for socio-demographic characteristics, we found that Latinos surveyed in the aftermath of the raid were more likely to report a greater desire to delay childbearing than Latinos surveyed before the raid occurred. Our qualitative data showed that an immigration raid has financial and psychological effects on immigrant families and that a raid may impact reproductive autonomy because people are fearful of these impacts. These finding suggest that current immigration enforcement efforts may influence reproductive decision-making, impede Latinos reproductive autonomy, and that family-friendly immigration policy reform is needed.

Background Climate change is a growing threat to human health, particularly in regions facing overlapping environmental hazards and social inequities. Puerto Rico—a U.S. territory with a colonial history—offers a unique case for examining how multiple disasters, including Hurricane Maria, ongoing earthquakes, and the COVID-19 pandemic, interact with structural vulnerabilities to affect maternal and child health. Despite increasing attention to climate-related health outcomes, little is known about the reproductive health impacts of cumulative disaster exposure in colonial contexts. Methods We used U.S. National Vital Statistics System data (2017–2021) to assess associations between disaster exposure and six maternal and newborn outcomes: preterm birth, low birthweight, term low birthweight, gestational hypertension, gestational diabetes, and excessive weight gain. Disaster exposure was defined based on the timing of hurricanes and the pandemic, using a three-month lag period. We analyzed data from Puerto Rico and used Florida and Texas as comparison sites. Multivariable log-binomial regression models estimated adjusted prevalence ratios. Effect modification was tested for (1) region within Puerto Rico and (2) colonial status, comparing Puerto Rico (territory) to Florida and Texas (states). Simulations were conducted to account for potential live-birth bias. Results Across 104,560 births in Puerto Rico, disaster periods were consistently associated with worse maternal health outcomes. For example, during the late post-hurricane period, gestational diabetes increased (RR = 1.19, 95% CI: 1.08, 1.31), while term low birthweight surprisingly appeared to decline (RR = 0.90, 95% CI: 0.83, 0.98). Associations with newborn health were mixed and may have been underestimated due to sharp declines in live births after disasters. Simulations suggested stronger disaster-related risks than observed in primary analyses. Effect modification by region and colonial status showed inconsistent but notable differences, particularly elevated maternal health risks in certain regions of Puerto Rico and compared to U.S. states. Conclusions Our findings suggest that multiple disasters negatively affect reproductive health in Puerto Rico and that structural factors, including colonialism, may exacerbate these impacts. Public health responses must account for cumulative disaster exposure and systemic inequities to better support maternal and child health in marginalized settings, especially as climate change continues to intensify. Plain english summary This study looks at how disasters and broader social conditions have affected the health of pregnant people and newborns in Puerto Rico. The U.S. territory experienced several major events—including a hurricane, a series of earthquakes, and the COVID-19 pandemic—that caused widespread disruption. These events coincided with long-standing inequalities in health, infrastructure, and emergency support compared to U.S. states. We analyzed over 100,000 birth records from Puerto Rico that occurred between 2017 and 2021 and compared them with similar data from Florida and Texas. We looked at health conditions during pregnancy such as gestational diabetes, excessive weight gain, early births, and low birthweight, and how these varied based on the timing of the birth relative to disasters. Our findings showed that disaster periods were associated with higher rates of gestational diabetes and high blood pressure, but that the effects on newborns were less clear, partly because fewer people gave birth during disaster periods. We also found some differences depending on the region of Puerto Rico and when we compared Puerto Rico to U.S. states, with people living in Puerto Rico (vs. Texas and Florida) and people in more vulnerable parts of the island (vs. the capital) were more likely to experience poor maternal health. Our results suggest that repeated disasters, combined with social and political factors like colonialism, can harm maternal health. Understanding these effects can help inform better policies and support systems for future emergencies—especially for communities that face structural disadvantages.

Various safer conception methods to limit HIV transmission risks can be offered in resource-constrained settings. However, implementation of safer conception services remains limited in many countries, including Botswana. Understanding perceptions about safer conception methods and the benefits and challenges to use can help with the development of policies, interventions, and service delivery models. Forty-five women living with HIV in the greater Gaborone, Botswana area participated in focus group discussions. Themes were analyzed using interpretive phenomenology. Despite low knowledge of specific safer conception methods that can be used to prevent transmission of HIV when trying to achieve pregnancy, there was noted interest in pre-exposure prophylaxis and vaginal insemination. Challenges to greater uptake were noted including a lack of knowledge about a range of SC methods, limited partner support and communication, provider stigma, health systems barriers, current policies, and the cultural acceptability of methods. Interventions will need to address these challenges and be responsive to the needs and reflect the realities of WLHIV who desire pregnancy in order for safer conception uptake to become a common practice.

Background Niger has the highest prevalence of child marriage in the world. While child marriage in Niger is clearly normative in the sense that it is commonly practiced, the social and contextual factors that contribute to it are still unclear. Methods Here, we tested the importance of village-level factors as predictors of young age at marriage for a group of married adolescent girls ( N  = 1031) in the Dosso district of rural Niger, using multi-level and geographic analyses. We aggregated significant individual level factors to determine whether, independent of a girl’s own sociodemographic characteristics, the impact of each factor is associated at the village level. Finally, we tested for spatial dependence and heterogeneity in examining whether the village-level associations we find with age at marriage differ geographically. Results The mean age of marriage for girls in our study was 14.20 years (SD 1.8). Our statistical results are consistent with other literature suggesting that education is associated with delayed marriage, even among adolescent girls. Younger ages at marriage are also associated with a greater age difference between spouses and with a greater likelihood of women being engaged in agricultural work. Consistent with results at the individual level, at the village level we found that the proportion of girls who do agricultural work and the mean age difference between spouses were both predictive of a lower age at marriage for individual girls. Finally, mapping age at marriage at the village level revealed that there is geographical variation in age at marriage, with a cluster of hot spots in the Hausa-dominated eastern area where age at marriage is particularly low and a cluster of cold spots in the Zarma-dominated western areas where age at marriage is relatively high. Conclusions Our findings suggest that large-scale approaches to eliminating child marriage in these communities may be less successful if they do not take into consideration geographically and socially determined contextual factors at the village level.

Structural racism causes stark health inequities and operates at every level of society, including the academic and governmental entities that support health research and practice. We argue that health research institutions must invest in research that actively disrupts racial hierarchies, with leadership from racially marginalized communities and scholars. We highlight synergies between antiracist principles and community-based participatory research (CBPR), examine the potential for CBPR to promote antiracist research and praxis, illustrate structural barriers to antiracist CBPR praxis, and offer examples of CBPR actions taken to disrupt structural racism. We make recommendations for the next generation of antiracist CBPR, including modify health research funding to center the priorities of racially marginalized communities, support sustained commitments and accountability to those communities by funders and research institutions, distribute research funds equitably across community and academic institutions, amplify antiracist praxis through translation of research to policy, and adopt institutional practices that support reflection and adaptation of CBPR to align with emergent community priorities and antiracist practices. A critical application of CBPR principles offers pathways to transforming institutional practices that reproduce and reinforce racial inequities. (Am J Public Health. 2023;113(1):70–78. https://doi.org/10.2105/AJPH.2022.307114 )