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Women’s Health

Fearing COVID, struggling Malawian women forgo prenatal care



BLANTYRE, Malawi (AP) – Prenatal care at the health clinic was free, but the motorcycle taxi was more than Monica Maxwell could afford. Just four weeks before her baby was born, she cobbled together 1,400 kwacha ($ 1.75) for the 50-kilometer round trip. It was only her third visit – less than her first two pregnancies. The money she made selling tomatoes in the local market dried up due to the pandemic. Her husband’s income from the sale of goat meat also fell.

“It was the most difficult time of our life. We had no money to survive, ”said Maxwell, 31, while she and other women waited outside to be seen by a medical midwife. “We stayed at home most of the time.”

In a country where hospitals are so empty that women are expected to bring their own razor blades to cut their babies’ umbilical cords, the increasing poverty caused by the pandemic continues to put women’s lives at risk.

Officials say far fewer pregnant women in Malawi are getting the medical care they need amid the pandemic, with many foregoing medical visits and relying solely on traditional obstetricians for emotional support and traditional herbal treatments, but technical from the government Babies are prohibited due to their lack of formal training. Many families cannot afford hospital visits or, like Maxwell, transportation there; They also fear that they will contract the coronavirus in a medical facility.

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At risk are the gains Malawi – a largely rural part of a country of 18 million people – has made over the past decade in fighting the poor record of maternal mortality. According to the United Nations Population Fund, Malawi women have a 1 in 29 risk of life-long death from pregnancy or childbirth. The country has 439 such deaths per 100,000 live births – a number that had to be reduced from 984 per 100,000 in 2004 as women gained better access to medical care, especially in emergencies.

Still, Malawi’s rate is the third highest in southern Africa. The rates are 19 per 100,000 births in the United States and 7 per 100,000 in the United Kingdom.


This story is part of a year-long series on the impact of the pandemic on women in Africa, worst in the least developed countries. The series of AP is funded by the European Journalism Center’s European Development Journalism Grants program, supported by the Bill & Melinda Gates Foundation. AP is responsible for all content.


Malawian hospitals also suffered from staff shortages when nurses were mobilized to treat coronavirus patients – resulting in a certain lack of skilled labor for childbirth, said Young Hong of the United Nations Population Fund.

“The pandemic not only affected the availability of labor, but also put great pressure on the entire health system, including the shortage of certain drugs, equipment and basic medical supplies such as surgical gloves,” said Hong, who found eight Malawian women die every day Pregnancy complications far higher than the COVID-19 toll. “This had a huge impact on the quality of maternal health care during the pandemic.”

At the Ndirande Health Center, a little northeast of the country’s commercial capital, Blantyre, around 100 women came daily for prenatal services before the pandemic. When COVID-19 surfaced, that number fell by half and is now only 15 to 20 patients, said Jacqueline Kolove, a nurse at the clinic.

Sometimes even the women who come for prenatal care are afraid of giving birth in the clinic during the pandemic and prefer to give birth at home. Malawian women are encouraged to give birth without medical intervention, and many here consider emergency measures such as a caesarean section to be shameful and a sign of weakness. The decision to give birth at home, however, can be fatal – most women live too far away to make it in time if a dangerous complication occurs.

“We explain to them why such a decision could have dire consequences … sometimes even calling their husbands and parents to try to talk to them,” said Kolove.

At Ndirande and other clinics, nurses, assistants, and medical midwives give pregnant women ultrasounds and use equipment to hear the vital signs of mother and baby. A woman can have a caesarean section if necessary, and medication is available to stop heavy bleeding. Clinical staff take medical courses, observe simulated births, and become licensed.

Traditional obstetricians learn from elders who pass knowledge down through the generations and use little to no medical equipment – for example, they listen to women’s bellies by placing their ears there and collect herbs to induce labor. They say that certain herbs cooked to a dark green liquid can treat situations like coccyx babies who need to change their position.

In 2007 the government banned the use of traditional obstetricians, but the practice continued and the ban was rarely enforced. Some servants do not ask for anything and they have seen more women come to them during the pandemic. Caregivers like 56-year-old Lucy Mbewe, who has given birth to an estimated 4,000 babies since 1983, say her job is key for women who can’t afford anything else.

Even the brightly colored African cloth often used to swaddle babies, carry them on mother’s back, or make makeshift diapers can be a potential obstacle to care, Mbewe noted. “The state hospitals recommend that a woman giving birth must have at least 10 items of clothing with her, which will put off those who cannot even afford to put food on the table,” she said.

In government institutions, Malawian women are even expected to bring a blanket for the delivery bed, buckets for water, and sometimes candles or flashlights. Mbewe provides clothes and soap when helping women with childbirth. She pays for the home transport. Some women are so grateful that they come back to pay them; She uses that money to look after other customers in need, she said.

However, medically trained midwives say the increased use of caregivers has led to an increase in complicated births, with women only going to the hospital when it’s too late to rescue them. Mbewe says the complications are not caused by the traditional caregivers, but rather due to expectant mothers becoming pregnant at a younger age – a trend confirmed by a government report.

Midwives and health officials also say they are fighting misinformation about the virus and vaccines that are preventing women from getting adequate medical care. Malawi did not have a full social lockdown and saw a dramatic increase in coronavirus cases, part of a surge in southern Africa. Experts believe cases are under-counted and concerns about the vaccine are widespread.

The Malawian government has given fewer than 213,000 doses of the AstraZeneca vaccine. And officials destroyed about 20,000 expired doses of COVAX, the UN-sponsored program to ship vaccines to poor countries. Across Africa, only 1% of the population of 1.3 billion people in 54 countries has received a dose of the vaccine, according to the Africa Centers for Disease Control and Prevention.

Nurses and midwives say some women fear they will be secretly receiving the vaccine if they give birth in a medical facility.

“They feel like we, as health workers, are giving them the COVID-19 vaccine instead of oxytocin,” said Kolove, the Ndirande Health Center nurse, referring to medications that increase labor and reduce the risk of bleeding. “They feel that we are cheating on them. As a result, there are some cases where women refuse. “

Medical staff also know that they and the women they treat are at a higher risk of contracting the coronavirus. The medically trained midwives are trying to educate women and they are taking all possible precautions against the virus even though their job of giving birth makes it impossible to maintain physical distance, said Keith Lipato, president of the Malawian Midwives Association.

“We ensure that all midwives are screened and tested so that those with signs and symptoms are released from work and receive the necessary medical treatment so they don’t infect clients and patients,” said Lipato.

However, the precautionary measures do not convince many expectant mothers. Five months after her pregnancy, Margret Kosamu has to go to a clinic. Instead, the 30-year-old turned to a traditional obstetrician for just two visits. Her family’s farm income has fallen, but it’s not just about money; She fears that going to a medical facility might kill her, not save her life.

“You are more likely to get infected with the virus in the hospital than here,” she said of the care of the nursing staff.

Lipato and other health professionals fear the pandemic will have long-term implications for the health of women in Malawi and beyond.

Patricia Gunde, 26, did not receive any prenatal benefits during her first pregnancy. Instead, she prefers to preserve the herbs, which her caregiver says will stay healthy and speed up labor. Gunde has no plans to get a COVID-19 vaccine.

“I’m scared,” she said. “I’ve heard a lot of stories about it.”

She feels comfortable with the traditional obstetrician because the women are seen individually.

When the nurse brings Gunde to the nursing home, nobody wears a mask.


AP authors Krista Larson in Dakar, Senegal, and Andrew Meldrum in Johannesburg contributed to this.


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Women’s Health

Plant-based food consumption associated with lower CVD risk



August 04, 2021

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Choi does not report any relevant financial information. Glenn reports that she has received grants from the Banting & Best Diabetes Center Tamarack Graduate Award in Diabetes Research, the Nora Martin Fellowship in Nutritional Sciences, the Ontario Graduate Scholarship, and the Peterborough KM Hunter Charitable Foundation Graduate Award; Consulting fees from Solo GI Nutrition; and fees from the Soy Nutrition Institute. Please refer to the study for all relevant financial information from the other authors.


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According to two studies published in the Journal of the American Heart Association, a more plant-centered diet was associated with a lower risk of cardiovascular disease in both young adults and postmenopausal women.

“Previous research has focused on individual nutrients or individual foods, but there is little data on a plant-centered diet and long-term risk of cardiovascular disease.” Yuni Choi, PhD, Postdoctoral fellow in the Department of Epidemiology and Community Health and the Department of Food Science and Nutrition at the School of Public Health at the University of Minnesota, Minneapolis, said in a press release.

a bowl of lettuce and chickpeas

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Young adults

The multicenter, prospective cohort study by Choi and colleagues included 4,946 adults, initially 18 to 30 years of age, without CVD. All participants were observed through 2018 and their diets were assessed using a validated nutritional history conducted through interviews. The quality of a plant-centered diet was assessed by the A Priori Diet Quality Score, with higher values ​​indicating higher consumption of nutrient-rich plant foods and lower consumption of high-fat meat products and less healthy plant foods.

The researchers observed 289 cases of CVD during the 32-year follow-up. A lower risk of cardiovascular disease was associated with long-term consumption and a switch to a plant-based diet. Those in the highest quintile of the time-varying mean diet scores had a reduced incidence of CVD compared to the lowest quintile (HR = 0.48; 95% CI 0.28-0.81). In the following 12 years in analysis of changes, an increase in diet scores over 13 years was also associated with a lower risk of CVD (HR = 0.33; 95% CI, 0.16-0.68).

Compared to the lowest quintile, the highest quintile of the 13-year diet change was associated with a 61% lower subsequent 12-year risk of CVD (HR = 0.39; 95% CI, 0.19-0.81). In addition, the researchers found strong inverse associations for CHD (HR = 0.21; 95% CI, 0.06-0.75) and CVD-related to hypertension (HR = 0.34; 95% CI, 0.16-0.75) , 74) with a time-varying average or diet change firmly favor those with a healthy plant-centered diet.

“A nutritious, plant-centered diet is beneficial for cardiovascular health. A plant-centered diet is not necessarily vegetarian, ”Choi said in the press release. “People can choose between plant-based foods that are as natural as possible and not heavily processed. We believe that from time to time individuals may ingest in moderation animal products such as unroasted poultry, unroasted fish, eggs, and low-fat dairy products. “

Post menopausal women

In another study, Andrea J. Glenn, MSc, from the University of Toronto’s Department of Nutrition Sciences, the Clinical Nutrition and Risk Factor Modification Center, and the Toronto 3D Knowledge Synthesis and Clinical Trials Unit, and colleagues prospectively followed a cohort of 123,330 postmenopausal women without CVD from the Women’s Health Initiative from 1993 to 2017 Participants were evaluated to assess the relationship between compliance with a portfolio diet score and CVD scores.

The primary endpoints were CVD, CHD, and total stroke, and secondary endpoints included HF and atrial fibrillation.

The researchers observed a total of 13,365 CVD events, 5,640 CAD events, 4,440 stroke events, 1,907 HF events, and 929 AF events during a mean follow-up of 15.3 years.

There was an association between women adhering to the Portfolio Diet Score and a lower risk of CVD (HR = 0.89; 95% CI, 0.83-0.94), CHD (HR = 0 , 86; 95% CI, 0.78-0.95) and HF (HR = 0.83; 95% CI, 0.71-0.99 when comparing the highest quartile of adherence to the lowest. Es however, there was no association between adherence to the portfolio diet score and stroke (HR = 0.97; 95% CI 0.87-1.08) or AF (HR = 1.1; 95% CI 0.87) -1.38).

These results remained statistically significant even after several sensitivity analyzes.

“These results provide the strongest evidence yet of the long-term benefit of portfolio dieting in primary prevention of CVD, although our portfolio diet score in other cohorts / populations must be assessed to confirm these results,” the researchers wrote.

According to the researchers, the results of the PortfolioEX study, which looked at the effects of the Portfolio Diet plus exercise on a surrogate marker of atherosclerotic CVD risk, are ongoing.



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Women’s Health

You should be relaxing your pelvic floor, not just strengthening it



We as women often talk about our pelvic floor muscles in terms of whether they are weak or not (Image: Getty Images / iStockphoto)

It’s a pounding, spasmodic feeling in the space two or three inches below my belly button, deep under the layers of skin and fat where my uterus sits.

The pain comes quickly in waves, so strong that I lose my train of thought or can no longer concentrate on my surroundings. Everything in me feels tense and tense, but as hard as I try, I can’t let go or relax.

It hurts so much that all I can do is sit in the aching sensation, so I have to go to bed.

I usually wake up an hour or two later and the feeling is less intense but still there. I still have to find a way to completely drive it off without simply spending the day waiting for a clean start in the morning. Painkillers are pointless and do nothing to reduce the strong grip that grips my body and squeezes everything inside me so tightly that I feel passed out.

It started in the depths of the lockdown last year – easily dismissed as a coincidence or a one-off, I remember feeling incredible discomfort and going straight to bed. At that time I traced it back to being a woman and forgot about it. But soon it happened again and then again. Sometimes the pain bled for the next day and the day after, and sometimes it went away as quickly as it appeared.

As someone in the women’s health field, I was at a loss when I tried to match my symptoms against one of the online resources available. I searched for “pelvic pain” and couldn’t pinpoint what was happening to my body with any of the disorders or syndromes reported on the NHS website. I had blood tests and everything seemed fine so why did I (seemingly random) pass out for days?

Help came unexpectedly from Clare Bourne, someone I once interviewed for an article and later followed on Instagram who worked as a pelvic health physiotherapist (a what? I hear you say. Yes, there is).

I explained what was going on and her first reaction was to ask her how I was feeling emotionally. It seemed like an odd question since the focus of our conversation was on my pelvic health, but I answered anyway.

I was stressed, I said, even though I didn’t feel stressed. I knew I was due to an increase in tension headaches and a general inability to relax.

As someone who has struggled with mental health in the past, I found it strange that my emotions felt balanced and even calm during one of the most difficult periods in history that many of us will go through.

Clare’s response was to see a pelvic health physiotherapist as it sounded like I had a hypertonic pelvic floor. ‘What does that mean?’ I asked. “It means,” she said, “that your pelvic floor muscles forgot to relax.”

As women, we often talk about our pelvic floor muscles in terms of whether they are weak or not. I remember squirming with embarrassment in an exercise class in 7th or 8th grade when all the girls were told to do kegel exercises, where you contract your pelvic floor muscles to strengthen them.

The health benefits of this type of exercise are well known as a strong pelvic floor is known to help with continence, increase the enjoyment of sex, and if you want to give birth one day, it will reduce the time for your body to recover.

It will take years to undo centuries of work in which the male body was privileged at the center of medical research

It seems strange now to think that at the age of 12, I took the time to squeeze and tone those muscles, as none of these issues were particularly relevant at the time. But still it can’t hurt, can it?

The problem is that in everything we as women talk about strengthening our pelvic floor, we talk much less about relaxation. It may sound so simple, but for some of us it is anything but.

As it turns out, knowing how to relax your pelvic floor is just as important as knowing how to strengthen it. Those who are unable to do so can experience all sorts of uncomfortable secondary problems, from pain to incontinence and problems with penetrative sex. And yet, when I look up the NHS website, there is little or no guidance for women who may be suffering from these problems, and even lower abdominal pain does not list it as a possible cause.

The problem is that symptoms increase during periods of acute stress, as I don’t know, during a pandemic. When it comes to research by women’s health journalist Sarah Graham, my experiences are unfortunately not unique. So why don’t we talk about it anymore? And why are so many of us so ill informed about how to care for our pelvic health?

As always, a general lack of research and information on women’s reproductive health is at the heart of the problem. The government recently attempted to address this with a women’s health strategy that called for evidence earlier this year. I hope it touches on some of the many ways in which women’s agony is systematically ignored and the many areas in which medical treatment centered (and evolved) on the male body has met different challenges or does not take into account realities that women face.

It will take years to undo centuries of work in which the male body was privileged at the center of medical research.

But in the meantime, it seems to me that the most important thing we can do is talk to each other, to our friends, to our mothers and to our children about our experiences and how we can maintain our pelvic health.

I was fortunate to have the resources because of my job to find a way to understand what was going on and then get access to treatment – but a lot of women didn’t want to.

Despite this benefit, it took over a year from the onset of symptoms to the first visit to a pelvic health physiotherapist through the NHS. During this time I canceled work (and lost money), was late delivering items, spent entire weekends on the sofa and – during the limited time I was actually allowed to socialize – had to go to dinner or meet up with friends renounce because of the pain.

I know I’m not the only one going through this because I’ve connected with a lot of other women through social media who have had the same experience.

The good news is that there is a solution, but it takes time and working closely with a professional to learn how to loosen your pelvis and relax completely. It’s frustrating to think how long I would have had to experience all of these ailments if I hadn’t known exactly what to say to the GP (who told me that pelvic health physiotherapy is a scarce resource for women who are born and what not Case is).

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To me, it’s just another example of how we are expected to tolerate and endure so much pain as women. It is encouraging to see politicians finally being promised to address this. I hope the government’s strategy will help address any shortcomings in our current health service related to women and reduce the gender health gap.

However, what it cannot and cannot do – for me and the millions of other women who have suffered the impossible obstacle course of getting a diagnosis for chronic health problems that are specific to the female body – is to give us the time back that is already over lost in an unimaginable amount of physical (and emotional) agony. Don’t we all deserve better?

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Women’s Health

Kristina Timanovskaya: Belarusian Olympic sprinter boards Vienna-bound flight out of Tokyo



The 24-year-old athlete was scheduled to compete in the women’s 200m at the Tokyo Olympics on Monday, but said team officials tried to force her back to Belarus against her will after criticizing sports authorities. Her dire plight has dominated global headlines around the Games, and while her comments were not overtly political, her case has fueled fears for the safety of those speaking out against Belarusian officials.

Timanovskaya arrived at Narita Airport on Wednesday morning with luggage and wearing blue jeans and a blue sweatshirt. Later she boarded the Austrian Airlines flight OS52.

The athlete was to travel to Warsaw, Poland, where the country’s prime minister had offered her safe refuge and a humanitarian visa. It is unclear whether she wants to change trains in Vienna on the way to Poland, stay in Austria or travel somewhere else.

In an Instagram post, Timanovskaya said team officials forced her to pack her things and said she would be cut out of the Olympic team and flown back to Minsk. She was taken to Haneda Airport on Sunday but refused to board the flight from Japan as she feared for her safety and would be detained in her home country.

Timanovskaya said she was threatened by team officials for speaking out against a decision to include her in the 4 × 400 meter relay without her consent – an event she had not previously attended. She said her coaches didn’t tell her who made the decision to send her home.

Speaking to CNN on Tuesday, Timanovskaya said she was upset that she was denied her chance to participate in the Olympics.

“I was ready for the games, especially for the 200 meters. They took away my dream of the Olympics. They took this chance,” she said.

International Olympic Committee spokesman Mark Adams said Wednesday that the IOC would set up a “disciplinary committee” to clarify the facts of the case and, as part of it, hear national coach Yuri Moisevich and Belarusian sports official Artur Shumak. Adams also said that the National Olympic Committee of Belarus had submitted a written report on the situation.

On Tuesday, the IOC opened a formal investigation into the incident.

The Belarusian NOK said Timanovskaya had been withdrawn from the games because of her “emotional and psychological state”.

However, Timanovskaya refutes this claim, saying that she has not been examined by a doctor and that she has no health or psychological problems.

Timanovskaya told CNN that she realized she might be in danger when she called her grandmother before being taken to the airport by team officials.

“She said that I should not go back to Belarus because it was not safe for me there. She said that they said bad things about me on (state) television: that I was sick, that I had mental health problems,” said Timanovskaya said.

“My parents understood that if they said things like that about me on TV, most likely I would not be able to return to my home in Belarus… I don’t know where they would take me. Maybe to jail or maybe to a psychological hospital. “

At the airport, Timanovskaya said she used a translation app on her phone to type that she needed help and showed it to a Japanese police officer.

Although their Instagram post was not explicitly political, Belarusian athletes were faced with retaliatory measures last year after mass protests against the strong President Alexander Lukashenko, who has ruled the Eastern European country since 1994, and were arrested and expelled from national teams for criticizing the government in Bei During the protests, people were arrested and brutally suppressed by the authorities amid widespread reports of ill-treatment and torture. As the Timanovskaya case developed, a Belarusian activist was found dead on Tuesday in a park in the Ukrainian capital, Kiev. Vitaliy Shishov was the head of the Kiev-based Belarusian House in Ukraine (BDU) organization, which helps Belarusians escape persecution.

The activist was found hanged in a wooded area of ​​a park near his home on Tuesday. Ukrainian police opened criminal proceedings and said they would investigate whether Shishov’s death was suicide or “willful murder that was supposed to look like suicide”.

What’s next with Timanovskaya?

It is unclear where Timanovskaya will land, but several offers have been made to the athlete. Her husband, Arseni Zdanewich, left Belarus and entered Ukraine on Monday.

Poland’s Prime Minister Mateusz Morawiecki said he had spoken to Timanovskaya and assured her that she could count on Poland’s support. Deputy Foreign Minister Marcin Przydacz told Sky News that she expected her to visit Poland and “stay there for at least a few days”.

He said Poland gave her the opportunity to continue her sporting career in the country but “of course it’s up to her,” he said.

Kristina Timanovskaya at the Austrian Airlines gate at Narita International Airport on August 4th.

“We know that your training center is in Austria and your trainer is also stationed in Austria. She is waiting for her husband to come to Warsaw. So it will probably be her decision whether to stay in Poland or continue somewhere else. “Travel to any other European country and she is very welcome to stay in Poland.”

Przydacz said it was “most important” that Poland intervened and prevented Belarus from “kidnapping people to force them to return home against their will”.

“We gave them the opportunity to come and live in Poland safely and securely,” he said.

Poland has received 120,000 visa applications from Belarus since President Lukashenko’s controversial election victory last August, said Przydacz.

CNN’s Nick Paton Walsh, Amy Cassidy, Antiona Mortensen and Gawon Bae contributed to the coverage.

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