Papers by Deborah Billings
Health Care for Women International, Jan 4, 2019
We conducted a qualitative study to examine the critical pathways of 23 women survivors of sexual... more We conducted a qualitative study to examine the critical pathways of 23 women survivors of sexual assault who navigated health care-based services in six states in Guatemala. We also captured the components of quality health care that were important to them, including the experience of the waiting room, being able to make active decisions, providing informed consent, and receiving emotional support. Our results from the in-depth, semi-structured interviews indicate the importance of creating and strengthening mechanisms for social support and trauma-informed, competent, and sensitive health services to accompany women as they move toward rebuilding their lives post-sexual violence.
Unsafe abortion constitutes a significant public health problem throughout the world. WHO defines... more Unsafe abortion constitutes a significant public health problem throughout the world. WHO defines unsafe abortion as a procedure either by persons lacking the necessary skills or in an environment lacking the minimal medical standards or both. Approximately 20 million women undergo an unsafe abortion each year; and estimated 70000 women die from related complications such as uterine perforation sepsis or poisoning and countless others suffer short and long-term consequences such as chronic pain and infertility. Globally 13-14% of all pregnancy-related deaths are attributable to unsafe abortion while in some settings this figure rises to as high as 60%. This translates into 75-80000 women each year who dies because of restrictive abortion legislation lack of implementation of existing legislation allowing abortion under certain conditions and lack of accessible safe services. In developing countries 65% of all women face legal restrictions related to abortion while in developed count...
Contraception, Oct 1, 2016
Support did not emerge as a theme in the interviews. However, 98.1% of survey participants felt v... more Support did not emerge as a theme in the interviews. However, 98.1% of survey participants felt very or somewhat supported prior to the abortion, and 85.3% felt very or somewhat supported postabortion. All interviewees and 57.9% of survey respondents reported positive experiences with abortion care, and many interviewees and 62% of survey respondents said their abortion care provider was better than their usual source of care. Most interviewees and 75.8% of survey respondents reported their pain experiences as low to moderate, and the majority of participants reported it was the same as or less than they expected. The most common recommendations to improve experiences were to ensure women had travel and financial support and to decrease wait times at clinics. Few outcomes varied by region. Conclusions: Although women seeking second-trimester abortions generally appear to receive adequate support and high-quality care, there remain opportunities to improve women's experiences.
Unsafe abortion is a serious public health problem in Bolivia, accounting for up to 25 percent of... more Unsafe abortion is a serious public health problem in Bolivia, accounting for up to 25 percent of maternal mortality. Postabortion care (PAC) was recognized as a priority public health action in Bolivia in 1994 in the country's preparatory statement for the ICPD. In 1999, PAC services, known as the "treatment of complications of hemorrhage during the first half of pregnancy," were included in Bolivia's revised national health plan, the Seguro Básico de Salud (SBS). Inclusion in the SBS makes PAC services free of charge to women and aims to: 1) increase women's access to services; 2) reduce the cost of service delivery and hospital length of stay; and 3) improve the quality of care. The operations research (OR) project carried out from May 1999 through August 2001 and summarized in this report was undertaken at the request of the Ministry of Health (MSPS) to help guide the improvement of PAC services as the SBS was implemented. A non-experimental design with pre-and post-intervention measurements was implemented in three major maternity hospitals-Hospital de la Mujer (La Paz), Maternidad Percy Boland (Santa Cruz) and Hospital "Jaime Sánchez Porcel" (Sucre). Given the differences in infrastructure, size, and characteristics of the population served, comparisons are made between pre-and post-intervention results within but not between hospitals. A variety of data collection methods were used, including interviews, observations and record reviews. Data were collected from women treated for incomplete abortion, male partners (with women's consent and only in the Sucre site), and physicians. Three-month follow-up interviews were conducted with women in the Sucre site. The intervention consisted of reorganization of services to ambulatory care, PAC training, refresher training, and supportive supervision.
Sexual and Reproductive Health Matters, 2019
Identifying how activists frame the topic of abortion is key to unpacking their understanding of ... more Identifying how activists frame the topic of abortion is key to unpacking their understanding of "abortion" in Peru. It is important to explore how and why certain frames are privileged in attempts to shift policy and social norms. In 2016, the authors conducted qualitative interviews with 10 activists in Lima, Peru to develop a deep understanding of these issues. Activists worked through different approaches and lenses, including law, medicine, sociology, psychiatry, journalism, non-governmental organisational management, LGBTQ rights, and indigenous rights. Four common frames emerged through the analysis and those frames shifted based on whether activists were speaking to the general public or to policymakers. Understanding Peru's activist framing of abortion can contribute to a deeper analysis of regional and global movements to legalise abortion, which also take into account local specificities.
Journal of Pediatric and Adolescent Gynecology, 2016
Qualitative health research, 2015
In this article we describe the knowledge frameworks that 61 physicians, nurses, social workers, ... more In this article we describe the knowledge frameworks that 61 physicians, nurses, social workers, and psychologists from five public-sector health care facilities in Mexico used to conceptualize postpartum depression. We also demonstrate how providers applied social and behavioral antecedents in their conceptualizations of postpartum depression. Using grounded theory, we identify two frameworks that providers used to conceptualize postpartum depression: biochemical and adjustment. We highlight an emerging model of the function of social and behavioral antecedents within the frameworks, as well as the representation of postpartum depression by symptoms of distress and the perception among providers that these symptoms affected responsibilities associated with motherhood. The results provide a foundation for future study of how providers' conceptualizations of postpartum depression might affect detection and treatment practices and might be useful in the development of training mat...
Journal of Midwifery & Women's Health, 2002
Thank you for the article by Miller, Billings and Clifford on Midwives and Post-Abortion Care (PA... more Thank you for the article by Miller, Billings and Clifford on Midwives and Post-Abortion Care (PAC) (JMWH July/August 2002). It is so important to have articles and information on expanded midwifery skills that effect women's health, and, in the case of PAC, mean life or death for so many women across the globe. Access to post-abortion care is a key aspect of safe motherhood, and placing it squarely on the agenda of nurse-midwifery will increase access and quality of care more than most any other tactic. Let's have more articles like this.
Journal of Midwifery & Women's Health, 2002
Midwifery practice may not include caring for women experiencing complications from unsafe aborti... more Midwifery practice may not include caring for women experiencing complications from unsafe abortion, despite the importance of this care for the health and lives of millions of women around the world. This article summarizes data collected from midwives from 41 countries who attended the 25th Triennial Congress of the International Confederation of Midwives in 1999, focusing on their experiences with, and attitudes toward, the provision of postabortion care. Barriers to provision of postabortion care and factors for changes in postabortion care-related policies were explored. Midwives from developing countries, where complications from unsafe abortion present a serious public health problem, were cognizant of the need to authorize, train, and equip midwives in postabortion care, including the use of uterine evacuation of incomplete abortion with manual vacuum aspiration. Changes in policy and practice are needed throughout the world so that women will have access to quality, compassionate postabortion care services regardless of where they live. Ensuring that midwives are able to provide such services will help to reduce abortion-related morbidity and mortality.
International Family Planning Perspectives, 2002
BACKGROUND As is true with any new and progressive law, implementing the Choice on Termination of... more BACKGROUND As is true with any new and progressive law, implementing the Choice on Termination of Pregnancy Act posed challenges to national and provincial authorities, 4 such as a large demand for the new services throughout the country, opposition among some health care professionals to abortion services and to those who provide them, and a lack of health care personnel trained to provide abortions.
International Family Planning Perspectives, 2003
Women experiencing complications from a spontaneous or unsafely induced abortion have the right t... more Women experiencing complications from a spontaneous or unsafely induced abortion have the right to receive highquality health care services. Mexico affirmed this right with its endorsement of the 1994 International Conference on Population and Development (ICPD) Programme of Action, which recognizes unsafe abortion as a public health problem that all governments have the responsibility to address. Most important, the document states that "In all cases women should have access to quality services for the management of complications arising from abortion. Postabortion counseling, education and family planning services should be offered promptly, which will also help to avoid repeat abortions." In this article, we present the results of an operations research project carried out between April 1997 and August 1998 in six Mexican Institute of Social Security (IMSS) hospitals located in the Mexico City metropolitan area. The study examined the implementation of postabortion care as defined in the ICPD Programme of Action, using a quality of care framework 2 for the analysis.* BACKGROUND Abortion is the fourth leading cause of maternal mortality in Mexico, accounting for 8% of all registered maternal deaths. In part, this situation reflects limited access to safe and legal abortion services. Given restrictive legislation and the small number of public health care providers and institutions that offer such services, † many women turn to unsafe practices and practitioners to end unwanted pregnancies. Complications of spontaneous abortions (miscarriages) that are not treated appropriately also contribute to abortion-related mortality. Throughout Mexico, approximately 120,000 women receive abortion-related care every year in public-sector facilities. In 1997, slightly more than 56,000 of these women were treated at IMSS facilities-the most women served among any of the three major social security systems in Mexico. 5 ‡
Population …, 2005
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. (Clara, 26 años, Ecuador) Cons... more ... 11 ✓ Colombia (urbanas) Page 5. ... así como menstruación
. (Clara, 26 años, Ecuador) Construyen su experiencia: como algo que las liberó; ... RECOMENDACIONES Profundizar en el estudio del aborto con medicamentos y las posibles relaciones de la experiencia con ...
American Journal of Public Health, 2000
Health Policy and Planning, 2005
Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. P... more Unsafe abortion contributes significantly to maternal mortality and morbidity in Latin America. Postabortion care (PAC) using preferred technologies and a woman-centred approach to treat the complications of unsafe abortion can save women's lives and improve their reproductive health, as well as reduce costs to health systems. This article reviews results from 10 major PAC operations research projects conducted in public sector hospitals in seven Latin American countries, completed and published between 1991 and 2002. The studies show that following relatively modest interventions, the majority of eligible patients were being treated with manual vacuum aspiration (MVA), a method preferred for safety and other reasons over the method conventionally used in the region, sharp curettage (SC). A number of studies showed improvements in contraceptive counselling and services when these were integrated with clinical treatment of abortion complications, resulting in substantial increases in contraceptive acceptance. Finally, data from several studies showed that, in most settings, reorganizing services by moving treatment out of the operating theatre and reclassifying treatment as an ambulatory care procedure substantially reduced the resources used for PAC, as well as the cost and average length of women's stay in the hospital. These studies suggest that comprehensive PAC can and should be available to all women in Latin America. Such efforts should be coupled with work to improve primary prevention, including better contraceptive services to prevent unwanted pregnancy and safe, legal abortion services to reduce the number of clandestine and unsafe abortions.
American Journal of Men's Health
Vasectomy is one of the few options men have to manage their reproductive capacity and take on a ... more Vasectomy is one of the few options men have to manage their reproductive capacity and take on a more equitable role in pregnancy prevention. While the method is underused throughout the United States, the southern states have a lower prevalence rate compared to the rest of the country. Existing survey research does not assess what men know or think about the procedure as a means of understanding why this is the case. We created and conducted an exploratory survey to assess men’s knowledge, attitudes, and information-seeking behaviors about vasectomy in the Southern United States. We used targeted Facebook advertising to recruit men ages 25–70 years living in 7 southern states to complete an online survey ( n = 397). Using regression analyses, we identify that participants who had a vasectomy knew more about the procedure than participants who had not. Participants who had not had a vasectomy had less positive attitudes about the procedure across all six attitude subscales compared ...
Journal of American college health : J of ACH, Jan 28, 2018
Explore the ways in which a sample of college women interpret racially/ethnically-coded vignettes... more Explore the ways in which a sample of college women interpret racially/ethnically-coded vignettes to understand their perceptions of responsibility and trauma experienced by a hypothetical female sexual assault survivor and her need for social support. Convenience sample of college women (N = 51) attending a large, predominately white university in the Southeastern United States recruited between January-March 2013. Participants were randomly assigned 1 of 3 vignettes describing a hypothetical date rape scenario. Vignette scenarios were identical except for discrete statements coded to signify either an African American, Latina, or White female student. Participants responded to open-ended questions that gauged their interpretations of responsibility, trauma, and social support. Qualitative analysis of open-ended responses revealed six overarching themes, including overt victim blaming/shaming, justification of the sexual assault, and perceived need for social support. Findings poin...
PloS one, 2018
To describe the comprehensive sex education (CSE) coverage and to evaluate a set of indicators re... more To describe the comprehensive sex education (CSE) coverage and to evaluate a set of indicators related to knowledge, attitudes, and practices associated with the seven components of the CSE framework among Mexican high-school students. We conducted a cross-sectional survey of a nationally representative sample of students in public and private high schools in Mexico. Questions about CSE coverage and about knowledge, attitudes, and practices related to sexual health were included. We present descriptive statistics for demographic characteristics, exposure to CSE, and sexual health outcomes. We fitted a series of multivariate logistic regression models to examine the association between each CSE component exposure and sexual health outcomes, adjusting for age and sex. There were significant associations between being exposed to each CSE components and the related sexual health outcomes. The strongest one was for identifying effective contraceptives among those exposed to the Sexual an...
Psychology of Men & Masculinity
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Papers by Deborah Billings