Support the best nutrition for babies everywhere: Urge your U.S. Representatives to protect, promote, and support breastfeeding!

Are you aware that representatives from the U.S. sided with commercial infant formula industry interests at the expense of babies during the recent World Health Assembly (WHA) meeting in Geneva?

Screen Shot 2018-07-17 at 4.48.44 PMU.S. officials at the meeting proposed the adoption of language that would have allowed this industry unrestricted ability to aggressively market breast milk substitutes as part of a WHA resolution on infant and young child feeding that included breastfeeding. Finally, the original wording of the resolution was mostly maintained. However, Ecuador had already been forced to withdraw its sponsorship of the resolution due to U.S. threats to withdraw military and commercial support if they didn’t, instilling fear in all other smaller countries of similar retaliation from the U.S. that may persist into the future. Russia stepped up at the end to sponsor the resolution because they said they support breastfeeding!

Support the best nutrition for babies everywhere.

Urge your U.S. Representatives to protect, promote, and support breastfeeding!

Act now by calling or writing your U.S. Representatives. Need the contact information for your representatives?

The issue and the circumstances are well articulated by two articles found in News Deeply and The New York Times.

For more information about IH Section’s Policy and Advocacy Committee activities, contact:
Kevin Sykes, PhD, MPH and Elizabeth Holguin, MPH, MSN, FNP-BC
APHA, International Health Section Policy and Advocacy Committee Co-Chairs

 

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Risk Factors for Global Intimate Partner Violence

This is the second part of a IH Blog series featured this summer, Intimate Partner Violence: Global Burden, Risk Factors and Outcomes.

Written by: Marsha Trego MPH and Dr. Heather de Vries McClintock PhD MSPH MSW

Intimate partner violence (IPV) is a pervasive form of violence (most often against women, although men are victims too) which occurs in all regions of the world. Goal 5 of the 2015 Sustainable Development Goals, Achieving Gender Equality, calls for the elimination of all forms of violence against women and girls. However, not all individuals are equally at risk for physical, emotional, or sexual abuse within their relationships. Understanding risk factors for IPV is imperative for the mobilization of resources to end violence against women. Global research and cooperation has identified risk factors for IPV at all levels of society, including factors within relationships, such as controlling behavior. This work has helped us to identify patterns in IPV perpetration and victimization around the world and how they fit within the context of culture and social change, with the ultimate goal of reducing the global incidence of IPV.

Risk factors at the individual level pertain to both the victim and to the perpetrator and include sex, the presence of sexually transmitted infections, mental health status, and substance abuse. The issue of IPV against men and within same-sex partnerships should not be overlooked even if  the frequency and outcomes of IPV against men are less severe and not well studied. The majority of research has focused on male partners acting against females. Research has identified a relationship between IPV and sexually transmitted infections (STIs). For example, cohort studies have found that women who experienced IPV were significantly more likely to contract HIV. The spread of STIs may be a result of high HIV risk among violent men and limited sexual and reproductive health autonomy among women in violent relationships. Recognition of this relationship may serve as a useful tool for identifying IPV within the healthcare setting.

Mental health is closely tied with IPV, and research has shown that mental health issues, such as depression, are associated with IPV victims in both directions, i.e. that women who are victims of IPV are more likely to have depressive symptoms and women who have depressive symptoms are more likely to experience IPV. Likewise, mental health is an important consideration for perpetration of IPV, such that men and women who struggle with depression, generalized anxiety disorder, or panic disorder are more likely to use violence against an intimate partner. Additionally, substance abuse has been implicated as a risk factor for perpetrators and victims of IPV alike. The western-centric focus of much of the existing IPV research is a limitation, and the role of mental health in identifying risk factors for victims and perpetrators of IPV may vary by country with differing mental health care resources and diagnostic capacity.

It is imperative to acknowledge that individual level factors occur within the context of social norms and traditional gender roles within the relationship and the larger community. Our behaviors are informed by those around us and our past experiences. For example, women who have witnessed parental IPV in childhood or who have previously been victims of violence are over three times as likely to experience current IPV. Furthermore, women who report that wife beating is justified in response to their behaviors, such as burning the food or neglecting the children, are more likely to be victims of abuse. Neither women nor men ever deserve to be abused in their relationships, yet this belief is widely held across many regions, with over 70% of women believing beating is justified in Burkina Faso, Democratic Republic of Congo, Guinea, Mali, Niger, and Uganda.

Violent behaviors may be symptomatic of long-held beliefs about patriarchal family structures. Accompanying power imbalances in the home and community may support or condone the use of violence by men. Our recent research has focused on the relationship between IPV and controlling behavior, characterized by use of jealousy, threats, and accusations to limit a partner’s social contact and financial independence. Controlling behavior may be used in relationships to express or maintain power, and has been identified as a risk factor for IPV. Prior studies of controlling behavior have been limited to the association with one or two types of IPV within single countries or limited geographical regions. We carried out the first known study to examine the role of controlling behavior in IPV in multiple sub-Saharan African countries, including several dimensions of controlling behavior and three types (physical, emotional, and sexual) of IPV. We also considered the cumulative experience of multiple types of IPV and incorporated partner characteristics, such as partner education and occupation. In our study of 37,115 women aged 15 to 49 years in eight sub-Saharan African countries (Cameroon, Democratic Republic of the Congo, Côte d’Ivoire, Namibia, Rwanda, Sierra Leone, Togo, and Zambia), we found that women who reported controlling behavior by their partner were 3.7 (confidence interval = 3.5-4.0) times more likely to have experienced any form of IPV than women whose partners were not controlling, even when accounting for multiple demographic and economic factors. Controlling behavior is not just harmful on its own but may also be indicative of potentially serious marital conflict and violence.

The slow yet steady progress of women’s empowerment around the world has brought traditional social rules into question. Particularly as developing nations increasingly implement policies supporting gender equity and the advancement of women, men may perceive a threat to the traditional, hegemonic expression of masculinity as breadwinner and leader. Potentially due to the evolving role of masculinity and gender in society, a counterintuitive relationship between women’s socioeconomic status has been found, such that women with higher levels of education or who are employed may be more likely to experience IPV. Although poverty has been associated with IPV, people of all socioeconomic gradients are affected by violence in intimate relationships. In cultures where men are expected to be providers, it may be that earning differentials between partners are a greater risk factor for IPV. In fact, relationships in which the woman is the primary earner are especially prone to expression of IPV, and unemployment among males is a risk factor for perpetration of IPV. Despite the challenges of transition and change, we must continuously strive to support gender equality worldwide to give women agency over their bodies and their relationships.

Although global research on IPV is still in progress, one conclusion that can be drawn is that the factors that precede physical, emotional, and sexual violence within an intimate relationship are complex and interwoven. Socialization of IPV within the community and efforts to maintain traditional gender norms and power balances feed into individual and interpersonal risk factors, such as witnessing intergenerational IPV, justification of beating, and controlling behaviors.  Thus, we see that there is no single target for IPV prevention, but rather that risk factors occur on a continuum across all levels of the ecological model. This means that there is no simple recipe for identifying someone at risk for IPV. Yet, given the emerging picture of IPV, interventions that support women’s empowerment while engaging both women and men in discourse on gender equality may prove effective as our world continues to evolve.

A first step in IPV prevention is education, and the World Health Organization provides several useful educational tools on violence and injury prevention, including a free, downloadable intimate partner and sexual violence prevention short course designed to teach people who are actively engaged in policy, prevention, and funding about IPV risk factors and prevention. The 2016 report, Community-Based Approaches to Intimate Partner Violence, by the Global Women’s Institute and the World Bank Group is a methodological guide that outlines how to address IPV risk factors and strategies for adapting IPV prevention programing in different communities around the world. With these tools and others and a genuine collaborative effort between researchers, policy makers, and community members to learn, grow, and share, we will get closer to ending global IPV.

Please stay tuned for Part III in this series: Outcomes of Intimate Partner Violence

Screen Shot 2018-07-11 at 1.19.09 PM.pngMarsha Trego, MPH is a recent graduate from Arcadia University’s MPH program where she completed her master’s thesis on understanding food insecurity among cancer survivors. Marsha began her career path with a B.S. in food science and minor in nutrition from Penn State University. There, she developed an interest in the close relationship between health and food, which ultimately led her to public health research as a way to strengthen our health systems from a fundamental level. Her research interests are varied and include nutrition and chronic disease, women’s health, intimate partner violence, and the leveraging of policy to achieve public health goals. Marsha is currently interning at the Psychology of Eating and Consumer Health Lab at the University of Pennsylvania, where she collaborates on studies of the effects of the Philadelphia beverage tax and food labeling interventions on food and beverage purchasing and consumption. Her global health experience includes travel to San Pedro, Belize with Arcadia University to conduct door-to-door community health screenings. In her free time, she takes a French class and enjoys reading and travel.

McClintock.PictureDr. Heather F. de Vries McClintockis an IH Section Member and Assistant Professor in the Department of Public Health, College of Health Sciences at Arcadia University. She earned her Master of Science in Public Health from the Department of Global Health and Population at the Harvard School of Public Health. Dr. McClintock received her PhD in Epidemiology from the University of Pennsylvania with a focus on health behavior and promotion. Her research broadly focuses on the prevention, treatment, and management of chronic disease and disability globally. Recent research aims to understand and reduce the burden of intimate partner violence in Sub-Saharan Africa. Prior to completing her doctorate she served as a Program Officer at the United States Committee for Refugees and Immigrants and a Senior Project Manager in the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania. At the University of Pennsylvania she led several research initiatives that involved improving patient compliance and access to quality healthcare services including the Spectrum of Depression in Later Life and Integrating Management for Depression and Type 2 Diabetes Mellitus Studies.

Global News Round Up

Politics & Policies

The UN High-level Political Forum on Sustainable Development (HLPF), which will run through 18 July, brings together more than a thousand government, business and civil society leaders.  They will discuss progress already made by dozens of countries towards the Sustainable Development Goals (SDGs) – adopted by 193 Member States in 2015 – in an effort to find out what is and what is not working, based on the UN Secretary-General’s annual progress report.

The federal government’s top disease fighter, who built hs career battling the emergence of HIV/AIDS in the 1980s, says the opioid epidemic will be even worse.

The U.S. opposed a World Health Assembly resolution to encourage breastfeeding because it called for limits on he promotion of infant formula, not because of objections to breastfeeding, President Donald Trump tweeted Monday.

Cannabis Science, Inc., a U.S. company specializing in the development of cannabinoid-based medicines, is pleased to announce Harvard Medical School’s Global Health Catalyst (GHC), American States University (ASU), and Elpasso Farms (South Africa), and Cannabis Science (CBIS) announce the signing of a historic collaboration agreement for development initiatives throughout Africa to strengthen its economic and healthcare infrastructure through education, agriculture, technology, and food security.

The Government of Liberia and partners have launched the National Action Plan for Health Security, the National Action Plan for Antimicrobial Resistance and the One Health Coordinating Platform meeting chaired by the Vice President of the Republic of Liberia, Mrs. Jewel Howard Taylor.

Programs, Grants & Awards

Poor quality health care services are hindering health improvement in countries at all income levels.

The world celebrates World Population Day on July 11th, day when family planning was affirmed as a human right 50 years ago. While it is central to women’s empowerment and achieving sustainable development goals, it is still not a guarantee given the poor access to reproductive resources.
Research

Zika virus (ZIKV) was discovered 70 years ago, and since then small isolated outbreaks occurred without major complications being reported.   When ZIKV hot Brazil, however, a public health emergency was declared, given its link with microcephaly. Knowledge on ZIKV has advanced, but demographic impacts remain poorly understood.

A new study shows that taking insulin or metformin (most commonly used for type 2 diabetes) does no delay or effectively treat diabetes in children and teens ages 10-19.

Diseases, Disasters & Wars

Paraguay has eliminated malaria, the first country in the Americas to do so in almost 50 years, according to the World Health Organization.

If polio is near extinction, why do outbreaks still pop up in places where the disease was thought to be long gone? The answer is complicated.

Eating overripe mangoes, excessive heat, and arduous labor used to be some of the myths concerning the causes of malaria in Ghana’s Ashanti region. “I used to believe I fell ill because I worked for too many hours under the sun,” said Dina Serwa, a mother of five from the gold mining district of Obuasi.

Clinics for men, adolescent-dedicated sections in existing clinics, and increased support for community-based services are all needed to expand the reach of HIV testing in Lesotho, and offer hope of controlling the epidemic in a country where the virus is responsible for one of the shortest life expectancies in the world, according to a report released Thursday by the U.S. Centers for Disease Control and Prevention.

Last week, biologists reported the most detailed structure of the Zika virus to date, a finding that could help the effort to develop vaccines or anti-viral medicines.  And Monday, a nationwide group of researchers reported in Nature Medicine that Zika causes miscarriages and stillbirths in a quarter of pregnancies in non-human primates.

Technology

Cryo-electron microscopy reveals how Plasmodium vivax (malarial parasite) invades human red blood cells.

An electronic self-management system to help with recovery after stroke is ready to be pilot tested, a new study reports.
Environmental Health

Maasai herding communities in Tanzania are at risk of being driven from their lands, to make way for luxury safaris for high-end tourists.

The city of Moradabad, once celebrated as the brass capital in India, has become a center for e-waste processing with more than nine metric tonnes arriving daily.
Equity & Disparities

The past two years have been a challenging time to live through in the United States. The Trump campaign and presidency themselves were founded on spreading racist rhetoric, and also can with a rise in reports of bullying and harassment based on race. All of these factors have impacted the mental health of millions of Americans.

Three in four children born in South Sudan since independence, the youngest country in the world, have known nothing but war.

Women, Maternal, Neonatal & Children’s Health

The Trump administration’s aggressive attempts to water down an international resolution supporting breastfeeding go against decades of advice by most medical organizations and public health experts.  The American Academy of Pediatrics calls human breast milk the “normative standard” for infant feeding, and recommends that mothers breastfeed their babies exclusively for six months.

There’s a reason why a story about 12 boys gets more attention than the world’s 12 million refugees under the age of 18. The more people who are suffering in a crisis, the harder it is for people to become engaged with their stories, says Delafield.
That’s because of a phenomenon known as “psychic numbing,” which psychologist Paul Slovic has written about extensively.

A study reports that infants who were introduced to solids slept longer and woke up less frequently than those infants who were exclusively breastfed to around six months of age.

 

US opposition to UN breastfeeding resolution defies evidence and public health practice

Statement from Georges Benjamin, MD, Executive Director, American Public Health Association

Washington, D.C., July 9, 2018 – “We are stunned by reports of U.S. opposition to a resolution at the World Health Assembly this spring aimed at promoting breastfeeding. According to news stories, U.S. officials attempted to block a resolution encouraging breastfeeding and warning against misleading marketing by infant formula manufacturers.

“Fortunately, the resolution was adopted with few changes, but it is unconscionable for the U.S. or other government to oppose efforts that promote breastfeeding. The consequences of low rates of breastfeeding are even greater for the health of children in resource-poor countries.

“Breastfeeding is one of the most cost-effective interventions for improving maternal and child health. Breastfeeding provides the best source of infant nutrition and immunologic protection. Babies who are breastfed are less likely to become overweight and obese, and have fewer infections and improved survival during their first year of life. Breastfed infants often need fewer sick care visits, prescriptions and hospitalizations. In addition maternal bonding is increased, a benefit to both mother and child.

“The scientific evidence overwhelmingly supports breastfeeding and its many health benefits for both child and mother. The American Public Health Association has long supported exclusive breastfeeding for the first six months and continued breastfeeding through at least the first year of life. APHA also strongly supports policies that encourage breastfeeding at home, maternity hospitals and birth centers and the workplace, and help identify women most in need of support of breastfeeding practices.

“In cases where mothers are unable to breastfeed, there are evidence-based solutions to protect the mom and ensure the baby thrives. The solution to malnutrition and poverty is not infant formula, but improved economic development and access to domestic and international nutrition and food programs.”

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APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a nearly 150-year perspective and brings together members from all fields of public health. Learn more at www.apha.org.

Read the latest issue of the IH newsletter, Section Connection!

The latest issue of Section Connection, the IH Section quarterly e-newsletter, is now available! You can find the latest issue of the newsletter here: http://bit.ly/SectionConnection8.

If you can’t access the newsletter for any reason please email Theresa Majeski, Global Health Connections Chair, at theresa.majeski@gmail.com.