Prism Series
The Health of Women Globally
Library of events in the series.
INTRODUCTORY EVENT : International Women's Day on 8th March, 2023.
This event was held on March 8th, 2023, to celebrate International Women's Day and introduce the Network's new Prism Series on Women's Health Globally, It describes the history of International Women's Day and what the Women's Movement has achieved over the last 120 years or so. This includes a UN Convention on the Elimination of All Forms of Discrimination against Women. It explores this year's theme of Embracing Equity and disentangles the distinctions between Equality and Equity, placing them in the context of Social Justice.
Supporting materials
International Women's Day (Website)
International Women's Day Background (From the UN)
Convention on the Elimination of All Forms of Discrimination against Women, New York, 18 December 1979(From the UN)
The History of Wives under English Law (Lecture tracing the law back as far as AD 654)
Custody rights over children (Very brief summary of the changes in the late 1800s)
Equity versus Equality : What's the Difference (Article from the School of Public Health, George Washington University)
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PRISM SERIES PROGRAMME UNTIL THE END OF 2023
Introduction to the series
Dr John Acres
Half the people living on the planet are women. Some of their health problems might be described as being related to their biological gender e.g. cervical cancer, menopause, pregnancy. Others, however, are related to the power relationships that exist in society, the prevailing belief systems and cultures. Discrimination, lack of opportunity and frank misogyny all play their part.
This Prism Series aims to unpick many of the issues that affect women’s health across the world and it has been made possible by a collaboration between several academics and NHS staff across Wessex. This introduction will give you some context for the series and introduce you to the Collaborating Group from the Universities as well as the other participants who have contributed.
Listener guidance : This short episode has a few slides, but listening to the audio e.g. using a mobile phone, captures the essence of the episode.
Supporting information : Follow this link for information about contributors to this series.
Episode 1
POPULATION CHANGE, THE DEMOGRAPHIC TRANSITION AND HEALTH
Dr John Acres and Dr Rachel Locke, University of Winchester
Homo sapiens struggled to survive for tens of thousands of year and their numbers grew only slowly. Then, just a couple of hundred years ago, the touch-paper of a population explosion was lit and numbers jumped to now reach 8 billion. Why did this happen? Will the population go on growing? What is the impact on health? Why is this relevant to women’s health?
In this episode, John Acres will describe the changes that have taken place and what is behind them. He will also explain how this knowledge can enable you to predict the broad health needs of women in a country without having to visit or take health measurements.
Listener guidance : This episode has several slides. If listening using a mobile phone, then the additional information provided below will probably be helpful in understanding the overall picture.
Supporting Information : Follow this link for information about the main causes of death in a Low Income Country compared to a High Income Country, population change and the Demographic Transition Model.
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Episode 2
"MATERNAL MORTALITY"
Dr Sarah Neal, University of Southampton
We are all delighted at the birth of a new baby, but, for some women, becoming pregnant is a death sentence. Almost 800 women died every day in 2020 from preventable causes related to pregnancy and childbirth. Around 95% of these deaths were in Low and Middle Income Countries with over half being in sub-Saharan Africa. The improvements that were being made are slowing down and, with Afghanistan having maternal mortality rate over 600/100,000, the chances of achieving the Sustainable Development Goal of 70/100,000 live births by 2030 is fading.
Sarah Neal (S.Neal@soton.ac.uk) joins us for this episode and will reveal some of the key issues associated with maternal mortality across the world.
Listener Guidance : This is a sound recording and easy, therefore, to listen to on a mobile phone. There is a slide to view for those who listen via a laptop or other computer.
Supporting information :
Slides from Dr Neal : Slides illustrating the points put over in the conversation
Overview : Key Facts from WHO about maternal mortality
Causes of Death : “Global causes of maternal death: a WHO systematic analysis (2003 – 2012)” The Lancet Global Health
Urban Ruran Differences : "Decomposing the urban–rural inequalities in the utilisation of maternal health care services: evidence from 27 selected countries in Sub-Saharan Africa". Reproductive Health Journal, 30 October 2021
MSc in Global Health : Outline of course in Southampton
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Episode 3
"SEXUAL AND REPRODUCTIVE HEALTH IN ADOLESCENT GIRLS - WHY WE NEED TO TAKE IT SERIOUSLY"
Dr Sarah Neal, University of Southampton
(Released 1st November, 2023)
All over the world, adolescence is an extended period of human growth and experimentation as children learn how to transition to living as independent adults. It is a period of vulnerability, which brings with it a variety of risks, including those to sexual and reproductive health. These risks are higher where education is low, cultures place women in subservient roles, the age of marriage is traditionally low, there is vulnerability through displacement and access to services is poor.
In this episode Sarah Neal will use her research to draw out the issues involved in the sexual and reproductive health of adolescent girls in Sub-Saharan Africa, a part of the world where both the birth rate in 10 – 14 year olds and the incidence of HIV are high.
Listener Guidance : This is a sound recording and easy, therefore, to listen to on a mobile phone. There is a slide to view for those who listen via a laptop or other computer.
Supporting information :
Systematic Reviews :
- A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings
- Interventions and Strategies to Improve Sexual and Reproductive Health Outcomes among Adolescents Living in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis
Impact of Covid : Impact of the COVID-19 Pandemic on Adolescents' Sexual and Reproductive Health in Low- and Middle-Income Countries
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Episode 4
"THE EXPERIENCES OF A UK CONSULTANT IN OBSTETRICS AND GYNAECOLOGY WORKING IN TANZANIA"
Jonny Rust, Consultant in Obstetrics and Gynaecology
Jonny Rust worked at the University Hospital Southampton as a consultant in Obstetrics and Gynaecology. His exposure earlier in life to the terrible experiences of women in Africa who suffered from vaginal fistulae left a shadow in his memory that he could not ignore. He wanted to do something to help. He left his job in Southampton and, with his family, went to live in Tanzania and work in a small town called Karatu,
What is it like to move from the security of a University Teaching Hospital in the UK to a small hospital in a relatively remote part of a lower middle-income country? In this episode, Jonny describes his experiences, the obstetric challenges faced in rural community in Tanzania and what he has learned from working in this new environment.
To contact Jonny Rust, please e-mail the Network Co-ordinator.
Supporting Information : Background information about Tanzania
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Episode 5
"WHAT DOES IT LOOK LIKE FROM THE INSIDE?"
Dr Blessing Zamba, Hampshire Hospitals Foundation Trust
We are probably familiar with the image of UK doctors visiting Low-Income Countries to work as part of a health partnership. Although we have many doctors from Low-Income Countries working in the NHS, we know less about what it has been like for them working back in their home country. Perhaps more than anyone, they can give an insight into the challenges faced.
In this episode, Dr Blessing Zamba describes his remarkable journey into medicine to now working with the Hampshire Hospitals Foundation Trust. Born in a village in a remote part of Zimbabwe, his future could have been expected to be no different from the other boys there. But a chance event changed the course of his life. Blessing will describe his journey, medical training in Zimbabwe and the challenges faced by doctors with limited resources working to provide the best maternal healthcare they can for rural populations.
Supporting information : Background information about Zimbabwe
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Episode 6
THE MATERNITY WAITING ROOM
Lorraine Major and Laura Aspinall, Hampshire Hospitals Foundation Trust
Direct obstetric causes of death form 75% of the reasons women die in pregnancy. Serious complications like bleeding or obstructed labour require fast referral and treatment. It is perhaps not surprising that women living in rural areas have higher mortality rates than those in urban areas and delay in seeking help is one of the delays that result in raised maternal mortality.
What can be done to overcome these challenges? Lorraine Major and Laura Aspinall from Basingstoke Hospital will describe the work of their Health Partnership with Hoima Hospital, Uganda, to create a Maternity/Mothers Waiting Room as a step towards reducing maternal mortality.
Supporting information : Some research that has been carried out on Maternity Waiting Rooms
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Episode 7
MATERNAL HEALTH -
ACCESS, ATTITUDES AND EXPERIENCES IN AFGHANISTAN
Dr Rachel Arnold
The final flights out of Afghanistan took place in August, 2021, and the chaotic scenes as local people struggled at the airport to leave remain vivid in one’s mind. The Taliban has regained power and has reversed the improving health and increasing freedoms experienced by women and girls.
In this episode, Rachel Arnold from Bournemouth University recounts her experiences that took her from working as a nurse in a hospital in Kabul to some of the remotest and most inaccessible parts of the country. The terrain in Afghanistan is harsh, as are the lives of many who live there. So, how do staff find the wherewithal to show empathy and compassion for their patients, if they themselves may not have experienced much of this themselves? Curious to know more, Rachel’s subsequent research enabled her to understand and respect the contributions made by those providing maternal healthcare in overcrowded and extreme conditions.
Follow this link to all the episodes
Supporting paper : Afghanisatan supporting information
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Episode 8
LOW BIRTH WEIGHT IN SRI LANKA
&
THE MAD HATTER
Dr Gaya Abeywickrama
The aim of pregnancy is to produce a live child that will survive and thrive. Low birth weight is a critical factor associated with neonatal and infant deaths, and nutritional and health outcomes at later stages of child development. They are more vulnerable to contracting infections, malnutrition and disability than those of normal weight. It is important, therefore, to know and be able to deal with the factors that lead to low birth weight.
Gaya Abeywickrama, from the University of Winchester, will use her research to explain the factors contributing to low birth weight. Among her findings was a particular set of circumstance that link low birth weight in Sri Lanka with Lewis Carroll’s Mad Hatter in Alice in Wonderland and which have important implications for public health.
Follow this link to all the episodes
Supporting information
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Episode 9
REDUCING HIV/AIDS IN SOUTH AFRICA
Prof. Nuala McGrath
University of Southampton
N.McGrath@soton.ac.uk
HIV/AIDS is the commonest cause of death in South Africa, which is the country with the highest share of the population infected with HIV in the world. Like other sub-Saharan countries, women have a particularly high prevalence of the virus. It causes death in early life and this leads to many children becoming orphaned. As the virus can be transmitted from mother to baby, there are also many children who have suffer from HIV. Although antiviral therapy can avert death, this comes at considerable long-term cost. As unsafe sex is the single biggest risk factor for death, finding ways to improve sexual health has the potential to reduce HIV in women, children and men at much lower long-term cost.
Nuala McGrath from the University of Southampton has been working in South Africa for several years to find ways that are effective in improving safe sexual practices. Nuala will describe her research and its recently published results. Her findings show that the approaches used to tackle HIV transmission are effective and also have wider health benefits.
Follow this link to all the episodes
Supporting information
- South Africa TV news interview with Prof. McGrath.
- Results from the Igugu Lethu Study
- Summary information of HIV/AIDS in South Africa
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Episode 10
HELPING TO REDUCE MATERNAL MORTALITY IN NEPAL
Dr Ollie Ross
Southampton University Hospital
Oliver.Ross@uhs.nhs.uk
Nepal is a landlocked Low Middle Income Country with a geography ranging from productive subtropical lowlands to several of the highest mountains in the world. PoIitical stability has been mainly in the last decade, though it has experienced only slow economic growth. Despite this it has managed to reduce maternal mortality rates, though they still remain relatively high. As most of the population lives in rural areas, access to acute maternity services will remain a challenge to maintaining the fall in mortality for some years to come.
Ollie Ross, Consultant Anaesthetist at Southampton General Hospital has worked for several years with the Nick Simons Institute to support rural health workers. He will describe his work around training for non-doctors anaesthetists who provide most of the anaesthesia services outside the capital, Kathmandu. He will also touch on the attitudinal issues that need to be considered by anyone considering working abroad.
Follow this link to Episode 10
Follow this link to all the episodes
Supporting information
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Episode 11
DEVELOPING SERVICES FOR BREAST CANCER
IN A LOW INCOME COUNTRY
Mr Dick Rainsbury
Consultant Surgeon
As the economy of poor countries improves, mortality rates fall, life expectancy increases and older people form a higher proportion of the population. The disease profile of the population comes to reflect the increase in older people.
The incidence of cancer of the cervix peaks in women’s early 30s, whereas the incidence of breast cancer increases in later life. Cervical cancer tends, therefore, to predominate in very low-income countries, but breast cancer, which is now the most commonly diagnosed cancer in the world, predominates in high-income countries. Transitioning countries are caught in the trap where breast cancer is increasing, but there are not yet sufficient services to treat the disease.
In this episode Dick Rainsbury will describe his work on breast cancer abroad, particularly in Zimbabwe, where he has been advising on the challenges of developing breast cancer services.
Follow this link to Episode 11
Follow this link to all the episodes
Supporting information
- Brief summary of epidemiology of cancers of cervix and breast
- The changing pattern of cancers of the breast and cervix
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Episode 12
CULTURE, BELIEFS AND WOMEN'S HEALTH
Prof. Tamsin Bradley
University of Portsmouth
A society’s culture and beliefs are like a watermark that affects people’s expectations and behaviours without their realising it. They may be beneficial or detrimental to women’s health and Female Genital Mutilation is a stark example of damage that still presents to the NHS. More pervasive are the worldwide beliefs and behaviours relating to power relationships between men and women. These have resulted in the need for the UN Sustainable Development Goal 5 to “Achieve gender equality and empowerment of women and girls”, without which women’s health will always be constrained.
Tamsin Bradley is Professor of International Development Studies at the University of Portsmouth Sociology and has studied these issues across the world. She will provide examples of the impact of different cultures and beliefs, some advice on how practitioners might handle individual situations and the measures that society need to take to achieve a more equitable relationship between men and women.
Prof Bradley can be contacted at Tamsin.Bradley@port.ac.uk
Follow this link to episode 12
Follow this link to all the episodes
Supporting information
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Episode 13
WOMEN'S MENTAL HEALTH
Dr Shanaya Rathod
Consultant Psychiatrist,
Southern Health & University of Portsmouth
The phrase “My heart hurts” may have nothing to do with cardiology. Different cultures express themselves in different ways and healthcare workers in all parts of the world need to be aware of what a patient’s words are really meaning. The patterns of mental illness are different between men and women. The reasons for this include biological differences, psychosocial factors, cultural beliefs and attitudes towards women.
Although mental health services in the UK are stretched, there may be virtually no service in some low-income countries. Those that exist may be difficult to access either through cost, distance or terrain. So how can a low income country develop even the basic services for women with mental health problems?
In this episode, Dr Shanaya Rathod will give us a picture of mental health in women across the world, the factors that play a part in this and ways in which low-income countries can begin to develop a service in an accessible and affordable way.
Follow this link to episode 13
Follow this link to all the episodes
Supporting information :
Mental Health Service Provision in Low- and Middle-Income Countries
Women's Mental Health PowerPoint Presentation (pdf)
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Prism In-Person Event
University of Winchester
5th June, 2024, 09.00 - 16.00
This event is being organised by Wessex Specialty Registrars in Obstetrics and Gynaecology in partnership with the Network. It will bring together speakers who have been involved in several of the episodes of the Prism Series. The audience is expected to be mainly Specialty Registrars in Obstetrics and Gynaecology and Student Midwives, but anyone with an interest is welcome to attend this free event. The event will cover
- Maternal and reproductive health
- Gender bias, women’s rights, inequality and the effect on maternal and neonatal health
- The effect of culture and belief systems on women’s health
- The impact of poverty, education and other key themes affecting women’s health in low- and middle-income countries
- Factors and interventions affecting the mental health of women in developing countries
- How the factors impacting global women’s health might impact care-seeking and health behaviours amongst women who have emigrated to the UK
You can view the programme by following this link.
If you would like to attend, then please contact john.acres@winchester.ac.uk
