Attention to health care in the context of instability

In Health Care for Women International we now present critical research and commentary. While I would like to assert that everything we publish is “important,” in this issue scholars are examining suffering among women in terrible situations. We put this issue together to highlight instability that needs our attention. In such situations, women are likely to experience violence up close, personal and at a distance. In consequence, they may choose or be forced to migrate, they may give birth in danger, or they could be raped or killed. If they live, they are prone to depression and substance abuse. Whether we consider them to be caregivers or patients, they are women who experience trauma. I shudder as I read this work, as now as I realize how many women in the world cope with horror that is hidden from my midst.

We begin with a timely commentary by Valentyna Pavlenko et al. about the impact of war in Ukraine on women’s mental health and quality of life. This is followed by a research article by Sheena Currie, et al. concerning obstetrical care in Afghanistan where women give birth in the context of war. Health providers don’t have what they need to assist women in this situation where the risk of mistreatment during childbirth could become normative.

Next, we include the research of Chigozie Nelson Nkalu and Emmanuel O. Nwosu who are presenting data to test the validity of hypotheses about how environmental pollutants impact fertility. While pollutants vary between regional country clusters, women need a better understanding of how methane emissions are affecting their pregnancies.

Serpil Abalı Çetin et al. report on post-partum depression in Turkey. They teach us that women who experience violence before pregnancy are most likely to experience depression after giving birth. Sadly, pregnancy offers no protection to women from spousal violence before, during or after giving birth. In another Turkish study about post-partum depression, by Özge Palancı AY and Songül Aktaş we read that post-partum depression negatively impacts breast-feeding self-efficacy.

The last two research articles are about migration. In the first of these by Nicel Yildiz Silahli et al., the researchers compare perinatal outcomes of migrants to long-term residents of Turkey. The migrants experience extreme stress, also experience less antenatal care, more adolescent pregnancies and more preterm births than do long-term residents. Next, Aya Shinohara et al. study migrants from Vietnam who choose to work in Japan as interns. Even when choosing to migrate temporarily, women may experience menstrual irregularities, resulting from cultural stress and hormonal imbalances. The authors report such women are reluctant to seek help in unfamiliar circumstances.

While I continue to ask readers of this scholarly journal to examine the table of literary contributions, read and learn, somehow, this seems insufficient. I will therefore edit for 2024, in the hope you will read, learn, and then act with compassion.

Table

Health Issue	Authors	International Literature Contribution	Extent of Global Contribution	Research Location
Mental health of war victims	Valentyna Pavlenko et al.	Theoretical contribution: Hypotheses generated from research findings: War associated displacement negatively affects the quality of life and mental health of women. Religious respondents less depressed, less inclined to use substances and more likely to have a higher quality of life.	Data from 1768 university affiliated female informants in Ukraine. Global contribution requires women’s mental health be studied wherever women are victims of war.	Ukraine
Maternity care in the context of conflict	Sheena Currie et al.	Theoretical contribution: Hypothesis: In conflict laden areas, women receive mixed quality care; mistreatment during childbirth becomes normative as healthcare providers work under stressed conditions with insufficient support.	Findings are based on interviews with providers in Afghanistan but are likely to apply to women in in any war zone.	Afghanistan
Effects of environmental pollutants on fertility rates	Chigozie Nelson Nkalu and Emmanuel O. Nwosu	Theoretical contributions: Researchers used case studies in Middle East and North Africa (MENA Region) West African states (ECOWAS Region) and Association of Southeast Asian Nations (ASEAN Region) to test validity of environmental theory. They learned environmental issues effects on fertility rate are more severe in MENA region, followed by the ECOWAS region and less pronounced in the ASEAN region.	Validity of global theory tested with case studies of developing countries in three geographic regions.	MENA, ECOWAS, and ASEAN Regions
Obstetric violence and post-partum depression	Serpil Abalı Çetin et al.	Theoretical contribution: Hypotheses: Educational, economic status, spousal smoking and alcohol use, and presence of violence before pregnancy are risk factors for obstetric violence. Post-partum depression is associated with spousal violence (physical, verbal, and economic abuse) before pregnancy. Pregnancy does not protect women from abuse.	Findings from current study are limited to Turkish sample, but authors compared findings to those in other countries for more global contribution.	Turkey
Post-partum depression and breastfeeding	Özge Palancı AY and Songül Aktaş	Theoretical contribution: Hypotheses: A negative relationship exists between breast-feeding self-efficacy and postpartum depression scores. A positive relationship exists between breast-feeding self-efficacy and maternal functioning scores.	Exploratory study requires replication.	Turkey
Perinatal outcomes	Nicel Yildiz Silahli et al.	Theoretical contribution: Hypotheses: Refugees experience higher adolescent pregnancy rates than residents. Refugees experience lower rates of antenatal care than residents. Refugees experience high rates of pre-term births.	Findings limited to women in Turkey, but study comparing refugees to long-term residents may be replicated elsewhere.	Turkey
Health changes due to migration	Aya Shinohara et al.	Theoretical contribution: Hypotheses: Women interns experience female specific changes due to stress and hormonal imbalance. Migrant interns are reluctant to seek help.	Study limited to Vietnamese migrant women working as interns in Japan, but findings may be tested elsewhere for more global contribution.	Japan

Eleanor Krassen Covan, PhD
Editor-in-Chief
January 1, 2024
[email protected]