Johanne Sommerchild Sundby

• Miltenburg, Andrea Solnes; Kiritta, Richard; Kidenya, Benson R.; Amoakoh, Hannah Brown; Schielen, Peter C.J.I. & Manyogote, Felix [Vis alle 15 forfattere av denne artikkelen] (2026). PRESHA — Preventing severe hypertensive adverse events in pregnancy and childbirth: a study protocol for establishing a prospective cohort study and biobank in urban Tanzania. Frontiers in Global Women's Health. 7. doi: 10.3389/fgwh.2026.1812275. Fulltekst i vitenarkiv
• Miltenburg, Andrea Solnes; Kvernflaten, Birgit; Meguid, Tarek & Sundby, Johanne Sommerschild (2023). Towards renewed commitment to prevent maternal mortality and morbidity: learning from 30 years of maternal health priorities. Sexual and Reproductive Health Matters (SRHM). 31(1), s. 1–11. doi: 10.1080/26410397.2023.2174245. Fulltekst i vitenarkiv
• Njie, Hassan; Wangen, Knut Reidar; Chola, Lumbwe; Gopinathan, Unni; Mdala, Ibrahimu & Sundby, Johanne Sommerschild [Vis alle 7 forfattere av denne artikkelen] (2022). Willingness to pay for a national health insurance scheme in The Gambia: A contingent valuation study. Health Policy and Planning. ISSN 0268-1080. 38(1), s. 61–73. doi: 10.1093/heapol/czac089. Fulltekst i vitenarkiv Vis sammendrag

  In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted ‘The National Health Insurance Bill, 2021’. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians’ willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman’s modified ordered probit model and linear regression were applied to estimate respondents’ WTP as well as identify factors that influence their WTP. More than 90% of the respondents—677 (94.4%) were willing to join and pay for the scheme. Half of these respondents—398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.

• Ousman, Seman Kedir; Gebremariam, Mekdes; Sundby, Johanne Sommerschild & Magnus, Jeanette H. (2022). Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey. PLOS ONE. 17(8). doi: 10.1371/journal.pone.0273146. Fulltekst i vitenarkiv Vis sammendrag

  Background Women exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association. Methods The analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates. Results About 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found. Conclusion Exposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

• Miltenburg, Andrea Solnes; Pelt, Sandra van; Lindskog, Benedikte V; Sundby, Johanne Sommerschild & Meguid, Tarek (2022). Understanding women's decision-making process for birth location in Tanzania based on individual women's reproductive pathways: a life-course perspective. Global health action. ISSN 1654-9716. 15(1). doi: 10.1080/16549716.2022.2040149. Fulltekst i vitenarkiv Vis sammendrag

  Background Determinants for women’s care seeking for birth in low-income setting are multifactorial and remain poorly understood. A life course approach can assist to structure the interplay of the different factors that lead to women seeking care or not. Objective In this study we aimed to explore individual women’s reproductive pathways, and increase understanding of how important life events including previous pregnancy and birth experiences can help us to understand individual choices made for care seeking during childbirth. Methods The study took place in Tanzania between 2015 and 2017. 14 women were followed throughout their pregnancy, birth and postpartum period through participant observation and in-depth interviews. In total 94 in-depth interviews were held (between 5–7 interviews per woman). Analysis occurred continuous throughout the data collection period resulting in detailed narratives of crucial events across women’s life course, with specific attention to their current pregnancy. Results Of the 14 women, seven had a facility birth, six a home birth and one woman gave birth at the home of a local birth attendant. Four different story plots were identified: expected home birth, expected facility birth, unexpected facility birth and unexpected home birth. Birth narratives of four women representative of the different story plots are presented. Narratives illustrate women’s individual reproductive pathways including the various factors influencing women’s expectations and justifications for their actions during their pregnancy and birth. Conclusion Women’s agency, including women’s perception of self, the self in relation to the social environment and reflection on risks associated with the range of options, influences the final decision made for birth. Women’s narratives suggest that quality of care can function as a primary pull factor for facility birth. As long as home birth is by some perceived to be a better alternative, achieving skilled care for all will be difficult to achieve.

• Ottesen, Hanna; Sørbye, Ingvil; Lindskog, Benedikte V; Vangen, Siri; Sundby, Johanne Sommerchild & Owe, Katrine Mari (2022). Keisersnitt blant utenlandsfødte kvinner med ulike utdanningsnivåer. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.22.0256. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Studier har vist at innvandrerkvinner, spesielt kvinner født i Afrika sør for Sahara, har høy forekomst av akutt keisersnitt. Samtidig varierer risikoen for planlagt og akutt keisersnitt med mors utdanningsnivå. Blant kvinner født i land i Afrika sør for Sahara og andre lav- og mellominntektsland er det en høyere andel med lav eller ingen utdanning sammenlignet med kvinner født i Norge. Vi ønsket derfor å undersøke sammenhengen mellom mors fødested, utdanningsnivå og risikoen for keisersnitt. MATERIALE OG METODE Studien tok utgangspunkt i alle fødsler i Norge registrert i Medisinsk fødselsregister i perioden 2008–17 koblet til data fra Statistisk sentralbyrå. Mors fødested, inndelt i fire kategorier, var eksponeringen. Endepunktet var planlagt eller akutt keisersnitt. Vi benyttet multinomial logistisk regresjon og stratifiserte analysene etter utdanningsnivå. Norskfødte kvinner utgjorde referansegruppen. RESULTATER Av 572 349 fødsler sto utenlandsfødte kvinner for 26,6 %. Keisersnitt utgjorde 15,1 % av alle fødslene. 9,6 % av alle fødslene var akutte keisersnitt. Norskfødte kvinner hadde den høyeste andelen planlagte keisersnitt (5,7 %), mens kvinner født i Afrika sør for Sahara hadde den høyeste andelen akutte keisersnitt (16,3 %). Blant kvinner med høyere utdanning var andelen akutte keisersnitt 8,3 % blant norskfødte kvinner og 18,1 % blant kvinner født i Afrika sør for Sahara (justert relativ risiko 2,41, 95 %-konfidensintervall 2,18 til 2,66). FORTOLKNING Utdanningsnivå påvirket risikoen for keisersnitt ulikt hos innvandrerkvinner og norskfødte kvinner.

• Jatta, Fatou; Sundby, Johanne Sommerchild; Vangen, Siri; Lindskog, Benedikte V; Sørbye, Ingvil & Owe, Katrine Mari (2021). Association between Maternal Origin, Pre-Pregnancy Body Mass Index and Caesarean Section: A Nation-Wide Registry Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(11). doi: 10.3390/ijerph18115938. Fulltekst i vitenarkiv Vis sammendrag

  Aims: To explore the association between maternal origin and birthplace, and caesarean section (CS) by pre-pregnancy body mass index (BMI) and length of residence. Methods: We linked records from 118,459 primiparous women in the Medical Birth Registry of Norway between 2013 and 2017 with data from the National Population Register. We categorized pre-pregnancy BMI (kg/m2) into underweight (<18.5), normal weight (18.5–24.9) and overweight/obese (≥25). Multinomial regression analysis estimated crude and adjusted relative risk ratios (RRR) with 95% confidence intervals (CI) for emergency and elective CS. Results: Compared to normal weight women from Norway, women from Sub-Saharan Africa and Southeast Asia/Pacific had a decreased risk of elective CS (aRRR = 0.57, 95% CI 0.37–0.87 and aRRR = 0.56, 0.41–0.77, respectively). Overweight/obese women from Europe/Central Asia had the highest risk of elective CS (aRRR = 1.42, 1.09–1.86). Both normal weight and overweight/obese Sub-Saharan African women had the highest risks of emergency CS (aRRR = 2.61, 2.28-2.99; 2.18, 1.81-2.63, respectively). Compared to women from high-income countries, the risk of elective CS was increasing with a longer length of residence among European/Central Asian women. Newly arrived migrants from Sub-Saharan Africa had the highest risk of emergency CS. Conclusion: Women from Sub-Saharan Africa had more than two times the risk of emergency CS compared to women originating from Norway, regardless of pre-pregnancy BMI.

• Miltenburg, Andrea Solnes; Pelt, Sandra van; Kiritta, Richard; Meguid, Tarek & Sundby, Johanne Sommerschild (2021). Symphysis-fundal height, gestational age and its value for identification of foetuses at risk in rural Tanzania: A qualitative follow-up study. African Journal of Reproductive Health. ISSN 1118-4841. 25(5), s. 140–149. doi: 10.29063/ajrh2021/v25i5.15. Fulltekst i vitenarkiv
• Bains, Sukhjeet; Skråning, Susanne; Sundby, Johanne Sommerschild; Vangen, Siri; Sørbye, Ingvil & Lindskog, Benedikte V. (2021). Challenges and barriers to optimal maternity care for recently migrated women - a mixed-method study in Norway. BMC Pregnancy and Childbirth. 21(1), s. 1–14. doi: 10.1186/s12884-021-04131-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Migrant women are at increased risk for complications related to pregnancy and childbirth, possibly due to inadequate access and utilisation of healthcare. Recently migrated women are considered a vulnerable group who may experience challenges in adapting to a new country. We aimed to identify challenges and barriers recently migrated women face in accessing and utilising maternity healthcare services. Methods: In the mixed-method MiPreg-study, we included recently migrated (≤ fve years) pregnant women born in low- or middle-income countries and healthcare personnel. First, we conducted 20 in-depth interviews with migrant women at Maternal and Child Health Centres (MCHC) and seven in-depth interviews with midwives working at either the hospital or the MCHCs in Oslo. Afterwards, we triangulated our fndings with 401 face-to-face questionnaires post-partum at hospitals among migrant women. The data were thematically analysed by grouping codes after careful consideration and consensus between the researchers. Results: Four main themes of challenges and barriers faced by the migrant women were identifed: (1) Navigating the healthcare system, (2) Language, (3) Psychosocial and structural factors, and (4) Expectations of care. Within the four themes we identifed a range of individual and structural challenges, such as limited knowledge about available healthcare services, unmet needs for interpreter use, limited social support and conficting recommendations for pregnancy-related care. The majority of migrant women (83.6%) initiated antenatal care in the frst trimester. Several of the challenges were associated with vulnerabilities not directly related to maternal health. Conclusion: A combination of individual, structural and institutional barriers hinder recently migrated women in achieving optimal maternal healthcare. Suggested strategies to address the challenges include improved provision of information about healthcare structure to migrant women, increased use of interpreter services, appropriate psycho-social support and strengthening diversity- and intercultural competence training among healthcare personnel

• Sørbye, I.K.; Bains, Sukhjeet; Vangen, Siri; Sundby, Johanne Sommerschild; Lindskog, Benedikte V & Owe, Katrine Mari (2021). Obstetric anal sphincter injury by maternal origin and length of residence: a nationwide cohort study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 129(3), s. 423–431. doi: 10.1111/1471-0528.16985. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To estimate the association between maternal origin and obstetric anal sphincter injury (OASI), and assess if associations differed by length of residence. Design: Population-based cohort study. Setting: The Medical Birth Registry of Norway. Population: Primiparous women with vaginal livebirth of a singleton cephalic fetus between 2008 and 2017 (n = 188 658). Methods: Multivariable logistic regression models estimated adjusted odds ratios (aORs) for OASI with 95% CI by maternal region of origin and birthplace. We stratified models on length of residence and paternal birthplace. Main outcome measures: OASI. Results: Overall, 6373 cases of OASI were identified (3.4% of total cohort). Women from South Asia were most likely to experience OASI (6.2%; aOR 2.24, 95% CI 1.87–2.69), followed by those from Southeast Asia, East Asia & the Pacific (5.7%; 1.59, 1.37–1.83) and Sub-Saharan Africa (5.2%; 1.85, 1.55–2.20), compared with women originating from Norway. Among women born in the same region, those with short length of residence in Norway (0–4 years), showed the highest odds of OASI. Migrant women across most regions of origin had the lowest risk of OASI if they had a Norwegian partner. Conclusions: Primiparous women from Asian regions and Sub-Saharan Africa had up to two-fold risk of OASI, compared with women originating from Norway. Migrants with short residence and those with a foreign-born partner had higher risk of OASI, implying that some of the risk differential is due to sociocultural factors. Some migrants, especially new arrivals, may benefit from special attention during labour to reduce morbidity and achieve equitable outcomes.

• Bains, Sukhjeet; Sundby, Johanne Sommerchild; Lindskog, Benedikte V; Vangen, Siri; Diep, Lien My & Owe, Katrine Mari [Vis alle 7 forfattere av denne artikkelen] (2021). Satisfaction with maternity care among recent migrants: an interview questionnaire-based study. BMJ Open. 11(7). doi: 10.1136/bmjopen-2020-048077. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To examine factors associated with recently migrated women’s satisfaction with maternity care in urban Oslo, Norway. Design: An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire. Setting: Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020. Participants: International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries. Primary outcome: Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences. Secondary outcome: Negative healthcare experiences and their association with reason for migration. Results: A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification. Conclusions: Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

• Bains, Sukhjeet; Sundby, Johanne Sommerchild; Lindskog, Benedikte V; Vangen, Siri & Sørbye, Ingvil (2021). Newly Arrived Migrant Women’s Experience of Maternity Health Information: A Face-to-Face Questionnaire Study in Norway. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 18(14). doi: 10.3390/ijerph18147523. Fulltekst i vitenarkiv Vis sammendrag

  Limited understanding of health information may contribute to an increased risk of adverse maternal outcomes among migrant women. We explored factors associated with migrant women’s understanding of the information provided by maternity staff, and determined which maternal health topics the women had received insufficient coverage of. We included 401 newly migrated women (≤5 years) who gave birth in Oslo, excluding migrants born in high-income countries. Using a modified version of the Migrant Friendly Maternity Care Questionnaire, we face-to-face interviewed the women postnatally. The risk of poor understanding of the information provided by maternity staff was assessed in logistic regression models, presented as adjusted odds ratios (aORs), with 95% confidence intervals (CI). The majority of the 401 women were born in European and Central Asian regions, followed by South Asia and North Africa/the Middle East. One-third (33.4%) reported a poor understanding of the information given to them. Low Norwegian language proficiency, refugee status, no completed education, unemployment, and reported interpreter need were associated with poor understanding. Refugee status (aOR 2.23, 95% CI 1.01–4.91), as well as a reported interpreter need, were independently associated with poor understanding. Women who needed but did not get a professional interpreter were at the highest risk (aOR 2.83, 95% CI 1.59–5.02). Family planning, infant formula feeding, and postpartum mood changes were reported as the most frequent insufficiently covered topics. To achieve optimal understanding, increased awareness of the needs of a growing, linguistically diverse population, and the benefits of interpretation services in health service policies and among healthcare workers, are needed.

• Ahmed, Seid Mussa; Sundby, Johanne Sommerschild; Aragaw, Yesuf Ahmed & Nordeng, Hedvig Marie Egeland (2021). Medicinal plants used among pregnant women in a tertiary teaching hospital in Jimma, Ethiopia: A cross-sectional study. BMJ Open. 11(8). doi: 10.1136/bmjopen-2020-046495. Fulltekst i vitenarkiv
• Aukrust, Camilla Grøver; Kamalo, Patrick Dongosolo; Prince, Ruth Jane; Sundby, Johanne; Mula, Chimwemwe & Manda-Taylor, Lucinda (2021). Improving competencies and skills across clinical contexts of care: a qualitative study on Malawian nurses' experiences in an institutional health and training programme. Nursing Open. 8, s. 3170–3180. doi: 10.1002/nop2.1030. Fulltekst i vitenarkiv Vis sammendrag

  Aim To explore what competencies and skills Malawian nurses gained after participating in an institutional health and training programme in Norway and how they viewed these competencies applicable upon return to Malawi. Furthermore, to examine facilitators and challenges experienced on the exchange programme and opportunities and obstacles to make the competencies usable in own local hospital context. Design Qualitative study with an explorative design. Methods Fourteen interviews and one focus group discussion were conducted at Queen Elizabeth Central Hospital, Blantyre, Malawi, from August to September 2018. Results Competencies gained in Norway included clinical skills, teamwork, coordination and strengthened professionalism. The main finding was that the exchange programme was a transformative experience. Upon return to Malawi, the competencies gained on the exchange were helpful. However, the return was characterized by mixed emotions due to the considerable difference between the two clinical settings.

• Ahmed, Seid Mussa; Sundby, Johanne; Aragaw, Yesuf Ahmed & Nordeng, Hedvig Marie Egeland (2020). Medication-related problems among hospitalized pregnant women in a tertiary teaching hospital in Ethiopia: a prospective observational study. BMC Pregnancy and Childbirth. 20(1). doi: 10.1186/s12884-020-03433-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Studies on medication-related problems (MRPs) among pregnant women are scarce, despite the potential consequences for both mother and child. This study aimed to describe the prevalence, clinical significance, and risk factors for MRPs among hospitalized pregnant or postpartum women at Jimma University Medical Centre (JUMC) in Ethiopia. Methods A prospective follow-up and clinical audit of 1117 hospitalized pregnant or postpartum women in the maternity and gynaecology wards at JUMC was carried out between February and June 2017. Patients were followed throughout their stay in the hospital to assess the presence and development of MRPs. Pre-tested data extraction form and an interview-guided structured questionnaire were used to collect data. Descriptive statistics were used to describe MRPs. Logistic regression analysis was used to identify factors associated with MRPs. Results One or more MRPs occurred among 323 (28.9%) study participants, mostly in relation to lack of iron supplementation. A total of 278 (70.6%) of all MRPs were considered to be of moderate to high clinical significance. When excluding MRPs due to iron from the analysis, chronic disease (adjusted OR 1.91; 95% CI 1.02, 3.58), medication use prior to admission (adjusted OR 2.38; 95% CI 1.24, 4.56), nulliparity (adjusted OR 1.99; 95% CI 1.22, 3.24) and multiparity (adjusted OR 1.91; 95% CI 1.17, 3.12) were significantly associated with experiencing an MRP. Conclusions Nearly 3 out of 10 hospitalized pregnant women at JUMC had one or more MRPs. The need for additional iron therapy was by far the most common type of MRP. Improved adherence to guidelines on iron supplementation are required. Multidisciplinary approaches including physicians, nurses, anesthesia professionals and clinical pharmacists in the maternity and gynaecology wards could possibly prevent MRPs and promote patient safety for women and children.

• Wai, Myint Myint; Bjertness, Espen; Htay, Thein Thein; Liabsuetrakul, Tippawan; Myint, Aye Nyein Moe & Stigum, Hein [Vis alle 7 forfattere av denne artikkelen] (2020). Dynamics of contraceptive use among married women in North and South Yangon, Myanmar: findings from a cross-sectional household survey. Contraception: X. 2. doi: 10.1016/j.conx.2019.100015. Fulltekst i vitenarkiv
• Teshay, Yohannes Ejigu; Magnus, Jeanette H.; Sundby, Johanne & Magnus, Maria Christine (2020). Differences in Growth of HIV-exposed Uninfected Infants in Ethiopia According to Timing of In-utero Antiretroviral Therapy Exposure. The Pediatric Infectious Disease Journal. ISSN 0891-3668. 39(8), s. 730–736. doi: 10.1097/INF.0000000000002678. Fulltekst i vitenarkiv Vis sammendrag

  Background: There are concerns about the adverse effect of in-utero exposure to antiretroviral therapy (ART) on the growth of HIV exposed-uninfected (HEU) infants. We compared growth of HEU-infants according to the timing and type of ART exposure. Methods: A retrospective cohort study was conducted by abstracting clinical data from HIV-infected mothers and HEU-infants in Addis Ababa, Ethiopia between February 2013 and October 2016. Mixed-effects linear models were used to compare changes in weight and length and cox proportional hazard models were used to evaluate stunting (length-for-age z score <−2.0) and underweight (weight-for-age z score <−2.0). Results: A total of 624 HEU-infants were included in the analyses. Infants exposed to ART from conception had a lower rate of change in length [β = −0.54, 95% confidence interval (CI): −1.00 to −0.08] the first 3 months of life, as compared with infants exposed from late pregnancy. Risk of stunting was 51.9 per 100 person-years and risk of underweight was 26.7 per 100 person-years. Exposure to ART from conception was associated with a higher rate of stunting as compared with exposure from late pregnancy (adjusted hazard ratio = 1.95, 95% CI: 1.27–2.99). Infants born to mothers with advanced disease had a higher incidence of underweight compared with infants born to mothers with early-stage disease adjusted hazard ratio = 1.99, 95% CI: 1.32–3.03). Conclusions: In HEU-infants, exposure to ART from conception was associated with decrease growth during early infancy and higher incidence of stunting compared with treatment exposure later in pregnancy. Close monitoring of HEU-infants’ growth and prompt nutritional intervention is essential.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Schei, Berit; Sundby, Johanne & Bjertness, Espen (2020). Domestic violence victimisation and its association with mental distress: A cross-sectional study of the Yangon Region, Myanmar. BMJ Open. 10:e037936(9), s. 1–13. doi: 10.1136/bmjopen-2020-037936. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women. Design We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test. Setting Urban and rural areas of the Yangon region, Myanmar. Participants Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours. Conclusions Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.

• Ahmed, Seid Mussa; Sundby, Johanne; Aragaw, Yesuf Ahmed & Abebe, Fekadu (2020). : Self-medication and safety profile of medicines used among pregnant women in a tertiary teaching hospital in Jimma, Ethiopia: a cross-sectional study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. doi: 10.3390/ijerph17113993. Fulltekst i vitenarkiv
• Wangamati, Cynthia Khamala & Sundby, Johanne (2020). The ramifications of COVID-19 on maternal health in Kenya. Sexual and Reproductive Health Matters (SRHM). 28(1). doi: 10.1080/26410397.2020.1804716. Fulltekst i vitenarkiv
• Osman, Seman Kedir; Magnus, Jeanette H.; Sundby, Johanne & Gebremariam, Mekdes Kebede (2020). Uptake of Skilled Maternal Healthcare in Ethiopia: A Positive Deviance Approach. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(5). doi: 10.3390/ijerph17051712. Fulltekst i vitenarkiv Vis sammendrag

  Risk factor approaches are often used when implementing programs aimed at enforcing advantageous health care behaviors. A less frequently-used strategy is to identify and capitalize on those who, despite risk factors, exhibit positive behaviors. The aim of our study was to identify positive deviant (PD) mothers for the uptake of skilled maternal services and to explore their characteristics. Data for the study came from two waves of the Ethiopian Demographic and Health Surveys conducted in 2011 and in 2016. PD mothers were defined as those reporting no formal education but with adequate use of antenatal care (ANC) and/or institutional delivery services. Two-level multilevel regression analysis was used to analyze the data. Factors associated with PD for the use of ANC services were: partner’s education status, involvement in household decision making, exposure to media, and distance to the health facility. Factors associated with PD for health facility delivery were: partner’s education, woman’s employment status, ANC visit during index pregnancy, exposure to media, and perceived challenge to reach health facility. Rural-urban and time-related differences were also identified. The positive deviance approach provides a means for local policy makers and program managers to identify factors facilitating improved health behaviour and ultimately better health outcomes while acknowledging adverse risk profiles.

• Wai, Myint Myint; Bjertness, Espen; Stigum, Hein; Htay, Thein Thein; Liabsuetrakul, Tippawan & Myint, Aye Nyein Moe [Vis alle 7 forfattere av denne artikkelen] (2019). Unmet Need for Family Planning among Urban and Rural Married Women in Yangon Region, Myanmar-a Cross-Sectional Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(19). doi: 10.3390/ijerph16193742. Fulltekst i vitenarkiv Vis sammendrag

  Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for family planning (FP) among urban and rural married women in Myanmar and their demand for and satisfaction with FP. A cross-sectional survey using adapted Demographic and Health surveys questions was conducted in south and north Yangon from September 2016 to November 2016. A total of 1100 currently married women of 18–49 years participated. The contraceptive prevalence was 67.2% in total, 63% urban, and 70% rural. About 19.4% (95% CI: 16.7%–22.4%) of the studied women had an unmet need for FP, significantly higher in urban than rural women (22.6% versus 16.6%). Rural women also showed significant lesser odds (adjusted OR: 0.63; 95% CI: 0.461–0.849) of unmet need than the urban counterparts. About 86% of the women had demand for contraception and 77% of them satisfied their demand. The study population revealed a fairly good contraceptive coverage; however, a considerable proportion of women had an unmet need for FP, especially the urban women. The demand for contraception is increasing, and contraceptive services need to expand coverage to marginalized groups in order to reduce the risk of unsafe abortions.

• Wangamati, Cynthia Khamala; Sundby, Johanne; Chimaraoke, Izugbara; Nyambedha, Erick Otieno & Prince, Ruth Jane (2019). Challenges in Supporting Survivors of Child Sexual Abuse in Kenya: A Qualitative Study of Government and Non-governmental Organizations. Journal of Interpersonal Violence. ISSN 0886-2605. doi: 10.1177/0886260519846864. Fulltekst i vitenarkiv
• Tsehay, Yohannes Ejigu; Magnus, Jeanette H.; Sundby, Johanne & Magnus, Maria Christine (2019). Pregnancy outcome among HIV-infected women on different antiretroviral therapies in Ethiopia: A cohort study. BMJ Open. 9(8). doi: 10.1136/bmjopen-2018-027344. Fulltekst i vitenarkiv Vis sammendrag

  Objective The objective of the study was to compare pregnancy outcomes according to maternal antiretroviral treatment (ART) regimens. Design A retrospective cohort study. Participants and settings Clinical data was extracted from ART exposed pregnancies of HIV-infected Ethiopian women attending antenatal care follow-up in public health facilities in Addis Ababa between February 2010 and October 2016. Outcomes The primary outcomes evaluated were preterm birth, low birth weight and small-for-gestational-age. results A total 1663 of pregnancies exposed to ART were included in the analyses. Of these pregnancies, 17% resulted in a preterm birth, 19% in low birth weight and 32% in a small-for-gestational-age baby. Compared with highly active antiretroviral therapy (HAART) initiated during pregnancy, zidovudine monotherapy was less likely to result in preterm birth (adjusted OR 0.35, 95% CI 0.19 to 0.64) and low birth weight (adjusted OR 0.48, 95% CI 0.24 to 0.94). We observed no differential risk of preterm birth, low birth weight and small-for-gestational-age, when comparing women who initiated HAART during pregnancy to women who initiated HAART before conception. The risk for preterm birth was higher in pregnancies exposed to nevirapine-based HAART (adjusted OR 1.44, 95% CI 1.06 to 1.96) compared with pregnancies exposed to efavirenzbased HAART. Comparing nevirapine-based HAART with efavirenz-based HAART indicated no strong evidence of increased risk of low birth weight or small-for-gestationalage. Conclusions We observed a higher risk of preterm birth among women who initiated HAART during pregnancy compared with zidovudine monotherapy. Pregnancies exposed to nevirapine-based HAART also had a greater risk of preterm births compared with efavirenz-based HAART.

• Changole, Josephine; Thorsen, Viva Combs; Trovik, Jone; Kafulafula, Ursula & Sundby, Johanne (2019). Coping with a disruptive life caused by obstetric fistula: Perspectives from Malawian women. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16:3092(17), s. 1–14. doi: 10.3390/ijerph16173092. Fulltekst i vitenarkiv Vis sammendrag

  Background: The main symptom of obstetric fistula is urinary and or fecal incontinence. Incontinence, regardless of the type is debilitating, socially isolating, and psychologically depressing. The objective of this study was to explore the strategies that women with obstetric fistula in Malawi use to manage it and its complications. Methods: A subset of data from a study on experiences of living with obstetric fistula in Malawi was used to thematically analyze the strategies used by women to cope with their fistula and its complications. The data were collected using semi-structured interviews. Nvivo 10 was used to manage data. Results: Participants used two forms of coping strategies: (1) problem-based coping strategies: restricting fluid intake, avoiding sexual intercourse, using homemade pads, sand, corn flour, a cloth wreathe and herbs, and (2) emotional-based coping strategies: support from their families, children, and through their faith in God. Conclusion: Women living with incontinence due to obstetric fistula employ different strategies of coping, some of which conflict with the advice of good bladder management. Therefore, these women need more information on how best they can self-manage their condition to ensure physical and emotional comfort.

• Ousman, Seman Kedir; Mdala, Ibrahimu; Thorsen, Viva Combs; Sundby, Johanne & Magnus, Jeanette H. (2019). Social determinants of antenatal care service use in ethiopia: Changes over a 15-year span. Frontiers in Public Health. 7. doi: 10.3389/fpubh.2019.00161. Fulltekst i vitenarkiv Vis sammendrag

  Background: Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time. Methods: The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro International, USA in 2005, 2011, and 2016. A negative binomial with random effects at cluster level was used to model the number of ANC visits whereas a multilevel binary logistic regression modeled binary responses relating to whether a woman had at least 4 ANC visits or not. The model estimates were obtained with the statistical software Stata SE 15 using the restricted maximum likelihood method. Results: Although the median number of ANC visits significantly increased between 2005 and 2016, the majority of the women do not obtain the four ANC visits during pregnancy as recommended. The odds of having at least four ANC visits were significantly lower among women: below 20 years, those living in the rural areas, having higher birth order, or Muslim. In contrast, higher educational attainment, higher socio-economic status, exposure to mass media, and self-reporting decision empowerment were significantly associated with having at least four ANC visits. Conclusion: The use of ANC visits is driven mostly by the social determinants of health rather than individual health risk. The importance of the various SDHs needs to be recognized by Ministry of Health policy and program managers as a key driving force behind the country's challenges with reaching targets in the health agenda related to maternal health, particularly related to the recommended number of ANC visits.

• Druce, Philippa; Bogatyreva, Ekaterina; Gates, Scott; Siem, Frederik François; Kaade, Hanna & Sundby, Johanne [Vis alle 14 forfattere av denne artikkelen] (2019). Approaches to protect and maintain health care services in armed conflict - Meeting SDGs 3 and 16. Conflict and Health. 13:2, s. 1–4. doi: 10.1186/s13031-019-0186-0. Fulltekst i vitenarkiv Vis sammendrag

  The escalation of conflict in the Middle East coincides with an emerging trend of attacks on healthcare. Protection of health personnel, health services and humanitarian workers is no longer respected. This compromises the achievement of the United Nations Sustainable Development Goals 3 – towards health for all, and 16 – towards justice and peace. The Centre for Global Health at the University of Oslo, the Peace Research Institute Oslo and the Norwegian Red Cross co-organised a meeting exploring how conflict impacts health systems and potential solutions to protect and maintain health care services.

• Lafontan, Sara Rivenes; Kidanto, Hussein; Ersdal, Hege Langli; Mbekenga, Columba K. & Sundby, Johanne (2019). Perceptions and experiences of skilled birth attendants on using a newly developed strap-on electronic fetal heart rate monitor in Tanzania. BMC Pregnancy and Childbirth. 19:165, s. 1–10. doi: 10.1186/s12884-019-2286-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Regular fetal heart rate monitoring during labor can drastically reduce fresh stillbirths and neonatal mortality through early detection and management of fetal distress. Fetal monitoring in low-resource settings is often inadequate. An electronic strap-on fetal heart rate monitor called Moyo was introduced in Tanzania to improve intrapartum fetal heart rate monitoring. There is limited knowledge about how skilled birth attendants in low-resource settings perceive using new technology in routine labor care. This study aimed to explore the attitude and perceptions of skilled birth attendants using Moyo in Dar es Salaam, Tanzania. Methods A qualitative design was used to collect data. Five focus group discussions and 10 semi-structured in-depth interviews were carried out. In total, 28 medical doctors and nurse/midwives participated in the study. The data was analyzed using qualitative content analysis. Results The participants in the study perceived that the device was a useful tool that made it possible to monitor several laboring women at the same time and to react faster to fetal distress alerts. It was also perceived to improve the care provided to the laboring women. Prior to the introduction of Moyo, the participants described feeling overwhelmed by the high workload, an inability to adequately monitor each laboring woman, and a fear of being blamed for negative fetal outcomes. Challenges related to use of the device included a lack of adherence to routines for use, a lack of clarity about which laboring women should be monitored continuously with the device, and misidentification of maternal heart rate as fetal heart rate. Conclusion The electronic strap-on fetal heart rate monitor, Moyo, was considered to make labor monitoring easier and to reduce stress. The study findings highlight the importance of ensuring that the device’s functions, its limitations and its procedures for use are well understood by users.

• Wangamati, Cynthia Khamala; Yegon, Gladys; Sundby, Johanne & Prince, Ruth Jane (2019). Sexualised violence against children: A review of laws and policies in Kenya. Sexual and Reproductive Health Matters (SRHM). 27(1), s. 1586815–1586815. doi: 10.1080/26410397.2019.1586815. Fulltekst i vitenarkiv Vis sammendrag

  Child sexual abuse (CSA) is a major global health challenge. Extant literature shows that CSA is prevalent in Kenya. As a signatory of the United Nations Convention on the Rights of the Child and the African Charter on the Rights and Welfare of the Child, the Kenyan government is mandated to ensure that children are protected from sexual abuse through sound laws and policies. This paper reviews existing laws and policies on CSA and highlights their strengths and weaknesses. Our findings indicate that laws on child protection exist and are protective to a large extent, as harsh penalties are outlined for sexual offences. Survivors of CSA are entitled to free legal and medical services. However, there are no reparations offered to survivors in criminal proceedings. Moreover, there is no legislation on age-appropriate comprehensive sexuality education which plays an important role in cultivating positive gender norms and describing what constitutes CSA and reporting procedures. The national standard operating procedures for the management of sexual violence against children lack CSA screening procedures. There is urgent need for review of these laws and policies and development of multisectoral protocols at the national and county level, that outline roles and responsibilities for various service providers, supervisory and accountability measures and referral networks.

• Chol, Ri Hak; Madar, Ahmed Ali; Slettedal, J.K; Bjertness, Kjersti B.; Sundby, Johanne & Bjertness, Espen (2019). Drivers of health transition in the DPRK. The Lancet Planetary Health. 3 (3), s. 118–119. doi: 10.1016/S2542-5196(19)30013-0. Fulltekst i vitenarkiv
• Teshay, Yohannes Ejigu; Magnus, Jeanette H.; Sundby, Johanne & Magnus, Maria Christine (2019). Health outcomes of asymptomatic HIV-infected pregnant women initiating antiretroviral therapy at different baseline CD4 counts in Ethiopia. International Journal of Infectious Diseases. ISSN 1201-9712. 82, s. 89–95. doi: 10.1016/j.ijid.2019.02.019. Fulltekst i vitenarkiv Vis sammendrag

  Objective To compare health outcomes following initiation of antiretroviral therapy (ART) for asymptomatic HIV-infected pregnant women at different CD4 levels. Methods We analyzed data from 706 asymptomatic HIV-infected Ethiopian women initiating ART during pregnancy between February 2012 and October 2016. The outcomes evaluated were CD4 gain, CD4 normalization (CD4 count ≥750 cells/mm3) and occurrence of HIV-related clinical events after twelve months of treatment. Result On average, CD4 count (cells/mm3) increased from 391 (95% CI: 372–409) at baseline to 523 (95% CI: 495–551) after twelve months of treatment. Rate of CD4 gain was higher among women with baseline CD4 between 350 and 499 compared to CD4 ≥500 (207 versus 6, p < 0.001). But women with baseline CD4 between 350 and 499 could not catch up with women with CD4 ≥500. Women with baseline CD4 ≥500 had significantly higher likelihood of achieving CD4 normalization as compared to those with CD4 between 350 and 499 (AOR = 0.32, 95% CI: 0.13–0.76). No strong evidence of differential risk in the occurrence of HIV-related clinical events. Conclusion Starting ART for asymptomatic HIV-infected women with CD4 count ≥500 cells/mm3 was beneficial to preserve or recover immunity after 12 months of treatment in a resource limited setting.

• Lafontan, Sara Rivenes; Sundby, Johanne; Kidanto, Hussein L.; Mbekenga, Columba & Ersdal, Hege Langli (2018). Acquiring knowledge about the use of a newly developed electronic fetal heart rate monitor: A qualitative study among birth attendants in Tanzania. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 15(12). doi: 10.3390/ijerph15122863. Fulltekst i vitenarkiv Vis sammendrag

  In an effort to reduce newborn mortality, a newly developed strap-on electronic fetal heart rate monitor was introduced at several health facilities in Tanzania in 2015. Training sessions were organized to teach staff how to use the device in clinical settings. This study explores skilled birth attendants’ perceptions and experiences acquiring and transferring knowledge about the use of the monitor, also called Moyo. Knowledge about this learning process is crucial to further improve training programs and ensure correct, long-term use. Five Focus group discussions (FGDs) were carried out with doctors and nurse-midwives, who were using the monitor in the labor ward at two health facilities in Tanzania. The FGDs were analyzed using qualitative content analysis. The study revealed that the participants experienced the training about the device as useful but inadequate. Due to high turnover, a frequently mentioned challenge was that many of the birth attendants who were responsible for training others, were no longer working in the labor ward. Many participants expressed a need for refresher trainings, more practical exercises and more theory on labor management. The study highlights the need for frequent trainings sessions over time with focus on increasing overall knowledge in labor management to ensure correct use of the monitor over time.

• Wangamati, Cynthia; Sundby, Johanne & Prince, Ruth Jane (2018). Communities’ perceptions of factors contributing to child sexual abuse vulnerability in Kenya: a qualitative study. Culture, Health and Sexuality. ISSN 1369-1058. 20(12), s. 1394–1408. doi: 10.1080/13691058.2018.1438666. Fulltekst i vitenarkiv
• Lafontan, Sara Rivenes; Sundby, Johanne; Ersdal, Hege Langli; Abeid, Muzdalifat; Kidanto, Hussein & Mbekenga, Columba K. (2018). "I was relieved to know that my baby was safe": women's attitudes and perceptions on using a new electronic fetal heart rate monitor during labor in Tanzania. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 15(2). doi: 10.3390/ijerph15020302. Fulltekst i vitenarkiv Vis sammendrag

  To increase labor monitoring and prevent neonatal morbidity and mortality, a new wireless, strap-on electronic fetal heart rate monitor called Moyo was introduced in Tanzania in 2016. As part of the ongoing evaluation of the introduction of the monitor, the aim of this study was to explore the attitudes and perceptions of women who had worn the monitor continuously during their most recent delivery and perceptions about how it affected care. This knowledge is important to identify barriers towards adaptation in order to introduce new technology more effectively. We carried out 20 semi-structured individual interviews post-labor at two hospitals in Tanzania. A thematic content analysis was used to analyze the data. Our results indicated that the use of the monitor positively affected the women’s birth experience. It provided much-needed reassurance about the wellbeing of the child. The women considered that wearing Moyo improved care due to an increase in communication and attention from birth attendants. However, the women did not fully understand the purpose and function of the device and overestimated its capabilities. This highlights the need to improve how and when information is conveyed to women in labor.

• Abathun, Asresash Demissie; Sundby, Johanne & Gele, Abdi (2018). Pupil's perspectives on female genital cutting abandonment in Harari and Somali regions of Ethiopia 11 Medical and Health Sciences 1117 Public Health and Health Services. BMC Women's Health. 18. doi: 10.1186/s12905-018-0653-6. Fulltekst i vitenarkiv Vis sammendrag

  Background: Female Genital Cutting (FGC) is a harmful traditional practice that affects the physical and mental health of girls and women in many ways. In Ethiopia, although both governmental institutions and None-GovernmentalInstitutions (NGOs) launched different campaigns against FGC, their effects on the peoples’ attitudes towards the practice have not been deeply investigated yet. Hence, this study particularly aimed to investigate the pupils’ perspectives on FGC abandonment in the Harari and the Somali Regional States of Ethiopia where the prevalence of the practice was thought to be high. Methods: A school-based cross-sectional study was conducted in the Somali and the Harari Regional States of eastern Ethiopia from October to December 2015. While purposive sampling was implemented to select the study areas from the two Regional States, stratified random sampling method was used to select 480 study subjects from those areas. Results: The findings showed that the participants who received information through multiple information channels were more likely to support the abandonment of FGC than those who received information from a single source (p<0.05). Similarly, the findings indicated that school-based awareness campaigns and TV-based media communications were the main sources of information that influenced a high proportion of young people to support the abandonment of the practice. The findings revealed that the majority of the participants strongly supported the abandonment of FGC. Conclusions: Multiple information channels that include school-based awareness campaigns were found to be the best way to support the abandonment of FGC. Although the study shows an impressive improvement among the school girls and boys in recognizing the harmful effects FGC, complete abandonment of the practice might not be easily achieved due to its deep-rooted nature. Thus, to quicken the perpetuation of FGC in the stated Regional States, awareness creating campaigns that change the attitudes of youths towards the practice should be delivered through various sources. In this regard, school-based education, school mini-media, social media, and using the co-curricular activities to uncover the danger of this harmful practice could play significant roles in changing the pupils’ attitudes towards the practice.

• Ahmed, Seid Mussa; Nordeng, Hedvig Marie Egeland; Sundby, Johanne; Aragaw, Yesuf Ahmed & Boer, Hugo de (2018). The use of medicinal plants by pregnant women in Africa: A systematic review. Journal of Ethnopharmacology. ISSN 0378-8741. 224, s. 297–313. doi: 10.1016/j.jep.2018.05.032. Fulltekst i vitenarkiv
• Miltenburg, Andrea Solnes; Pelt, Sandra van; Meguid, T & Sundby, Johanne (2018). Disrespect and abuse in maternity care: Individual consequences of structural violence. Reproductive Health Matters: An international journal on sexual and reproductive health and rights. ISSN 0968-8080. 26(53), s. 88–106. doi: 10.1080/09688080.2018.1502023. Fulltekst i vitenarkiv Vis sammendrag

  Disrespect and abuse of patients, especially birthing women, does occur in the health sector. This is a violation of women’s fundamental human rights and can be viewed as a consequence of women’s lives not being valued by larger social, economic and political structures. Here we demonstrate how such disrespect and abuse is enacted at an interpersonal level across the continuum of care in Tanzania. We describe how and why women’s exposure to disrespect and abuse should be seen as a symptom of structural violence. Detailed narratives were developed based on interviews and observations of 14 rural women’s interactions with health providers from their first antenatal visit until after birth. Narratives were based on observation of 25 antenatal visits, 3 births and 92 in-depth interviews with the same women. All women were exposed to non-supportive care during pregnancy and birth including psychological abuse, physical abuse, abandonment and privacy violations. Systemic gender inequality renders women excessively vulnerable to abuse, expressed as a normalisation of abuse in society. Health institutions reflect and reinforce dominant social processes and normalisation of non-supportive care is symptomatic of an institutional culture of care that has become dehumanised. Health providers may act disrespectfully because they are placed in a powerful position, holding authority over their patients. However, they are themselves also victims of continuous health system challenges and poor working conditions. Preventing disrespect and abuse during antenatal care and childbirth requires attention for structural inequalities that foster conditions that make mistreatment of vulnerable women possible.

• Miltenburg, Andrea Solnes; Kiritta, Richard Forget; Meguid, Tarek & Sundby, Johanne (2018). Quality of care during childbirth in Tanzania: identification of areas that need improvement. Reproductive Health. 15(14). doi: 10.1186/s12978-018-0463-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Making use of good, evidence based routines, for management of normal childbirth is essential to ensure quality of care and prevent, identify and manage complications if they occur. Two essential routine care interventions as defined by the World Health Organization are the use of the Partograph and Active Management of the Third Stage of Labour. Both interventions have been evaluated for their ability to assist health providers to detect and deal with complications. There is however little research about the quality of such interventions for routine care. Qualitative studies can help to understand how such complex interventions are implemented. This paper reports on findings from an observation study on maternity wards in Tanzania. Methods The study took place in the Lake Zone in Tanzania. Between 2014 and 2016 the first author observed and participated in the care for women on maternity wards in four rural and semi-urban health facilities. The data is a result of approximately 1300 hours of observations, systematically recorded primarily in observation notes and notes of informal conversations with health providers, women and their families. Detailed description of care processes were analysed using an ethnographic analysis approach focused on the sequential relationship of the ‘stages of labour’. Themes were identified through identification of recurrent patterns. Results Three themes were identified: 1) Women’s movement between rooms during birth, 2) health providers’ assumptions and hope for a ‘normal’ birth, 3) fear of poor outcomes that stimulates intervention during birth. Women move between different rooms during childbirth which influences the care they receive. Few women were monitored during their first stage of labour. Routine birth monitoring appeared absent due to health providers ’assumptions and hope for good outcomes. This was rooted in a general belief that most women eventually give birth without problems and the partograph did not correspond with health providers’ experience of the birth process. Contextual circumstances also limited health worker ability to act in case of complications. At the same time, fear for being held personally responsible for outcomes triggered active intervention in second stage of labour, even if there was no indication to intervene. Conclusions Insufficient monitoring leads to poor preparedness of health providers both for normal birth and in case of complications. As a result both underuse and overuse of interventions contribute to poor quality of care. Risk and complication management have for many years been prioritized at the expense of routine care for all women. Complex evaluations are needed to understand the current implementation gaps and find ways for improving quality of care for all women.

• Myint, Aye Nyein Moe; Liabsuetrakul, Tippawan; Htay, Thein Thein; Wai, Myint Myint; Sundby, Johanne & Bjertness, Espen (2018). Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study. BMJ Open. 8. doi: 10.1136/bmjopen-2018-022380. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: (1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure. Design, setting and participants: A community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure. Outcome measures: Poverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure. Results: Of 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs. Conclusions: OOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

• Changole, Josephine; Kafulafula, Ursula; Sundby, Johanne & Thorsen, Viva Combs (2018). Community perceptions of obstetric fistula in Malawi. Culture, Health and Sexuality. ISSN 1369-1058. s. 1–13. doi: 10.1080/13691058.2018.1497813. Fulltekst i vitenarkiv
• Myint, Aye Nyein Moe; Liabsuetrakul, Tippawan; Htay, Thein Thein; Wai, Myint Myint; Sundby, Johanne & Bjertness, Espen (2018). Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: A cross-sectional study. International Journal for Equity in Health. 17(63). doi: 10.1186/s12939-018-0778-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. Methods A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. Results Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. Conclusion There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.

• Abathun, Asresash Demissie; Gele, Abdi Ali & Sundby, Johanne (2017). Attitude towards the Practice of Female Genital Cutting among School Boys and Girls in Somali and Harari Regions, Eastern Ethiopia. Obstetrics and Gynecology International. ISSN 1687-9589. 2017. doi: 10.1155/2017/1567368. Fulltekst i vitenarkiv
• Miltenburg, Andrea Solnes; Eem, Lisette van der; Nyanza, Elias C; Pelt, Sandra van; Ndak, Pendo & Basinda, Namanya [Vis alle 7 forfattere av denne artikkelen] (2017). Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study. PLOS ONE. 12(12), s. 1–15. doi: 10.1371/journal.pone.0188279. Fulltekst i vitenarkiv Vis sammendrag

  Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria.

• Sundby, Johanne (2017). Maternity care system in Maputo, Mozambique: Plans and practice. Cogent Medicine. 4, s. 1–15. doi: 10.1080/2331205x.2017.1412138. Fulltekst i vitenarkiv
• Wangamati, Cynthia; Gele, Abdi Ali & Sundby, Johanne (2017). Post rape care provision to minors in Kenya: An assessment of health providers? Knowledge, attitudes, and practices. Journal of Interpersonal Violence. ISSN 0886-2605. 35(5-6), s. 1415–1441. doi: 10.1177/0886260517696863. Fulltekst i vitenarkiv
• Wangamati, Cynthia; Thorsen, Viva Combs; Gele, Abdi Ali & Sundby, Johanne (2016). Postrape care services to minors in Kenya: are the services healing or hurting survivors? International Journal of Women's Health. 8, s. 249–259. doi: 10.2147/IJWH.S108316. Fulltekst i vitenarkiv Vis sammendrag

  Abstract: Child sexual abuse is a global problem and a growing concern in Sub-Saharan Africa. It constitutes a profound violation of human rights. To address this problem, Kenya has established the Sexual Offences Act. In addition, Kenya has developed national guidelines on the management of sexual violence to grant minors access to health care. However, little is known about the experiences of sexually abused minors when they interact with the health and legal system. Accordingly, this study uses a triangulation of methods in the follow-up of two adolescent girls. Health records were reviewed, interactions between the girls and service providers were observed, in-depth interviews were conducted with the girls, and informal discussions were held with guardians and service providers. Findings indicated that the minors’ rights to quality health care and protection were being violated. Protocols on postrape care delivery were unavailable. Furthermore, the health facility was ill equipped and poorly stocked. Health providers showed little regard for informed assent, confidentiality, and privacy while offering postrape care. Similarly, in the justice system, processing was met with delays and unresponsive law enforcement. Health providers and police officers are in grave need of training in sexual and gender-based violence, its consequences, comprehensive postrape care, and sexual and reproductive health rights to ensure the protection of minors’ rights. Health administrators should ensure that facilities are equipped with skilled health providers, medical supplies, and equipment. Additionally, policies on the protection and care of sexually abused minors in Kenya require amendment.

• Ilboudo, Patrick Christian Gueswende; Greco, Giulia; Sundby, Johanne & Torsvik, Gaute (2016). Estimating the costs for the treatment of abortion complications in two public referral hospitals: A cross-sectional study in Ouagadougou, Burkina Faso. BMC Health Services Research. 16(1), s. 1–10. doi: 10.1186/s12913-016-1822-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Treatment costs of induced abortion complications can consume a substantial amount of hospital resources. This use of hospitals scarce resources to treat induced abortion complications may affect hospitals’ capacities to deliver other health care services. In spite of the importance of studying the burden of the treatment of induced abortion complications, few studies have been conducted to document the costs of treating abortion complications in Burkina Faso. Our objective was to estimate the costs of six abortion complications including incomplete abortion, hemorrhage, shock, infection/sepsis, cervix or vagina laceration, and uterus perforation treated in two public referral hospital facilities in Ouagadougou and the cost saving of providing safe abortion care services. Methods: The distribution of abortion-related complications was assessed through a review of postabortion care-registers combined with interviews with key informants in maternity wards and in hospital facilities. Two structured questionnaires were used for data collection following the perspective of the hospital. The first questionnaire collected information on the units and the unit costs of drugs and medical supplies used in the treatment of each complication. The second questionnaire gathered information on salaries and overhead expenses. All data were entered in a spreadsheet designed for studying abortion, and analyses were performed on Excel 2007. Results: Across six types of abortion complications, the mean cost per patient was USD45.86. The total cost to these two public referral hospital facilities for treating the complications of abortion was USD22,472.53 in 2010 equivalent to USD24,466.21 in 2015. Provision of safe abortion care services to women who suffered from complications of unsafe induced abortion and who received care in these public hospitals would only have cost USD2,694, giving potential savings of more than USD19,778.53 in that year. Conclusions: The treatment of the complications of abortion consumes a significant proportion (up to USD22,472.53) of the two public hospitals resources in Burkina Faso. Safe abortion care services may represent a cost beneficial alternative, as it may have saved USD19,778.53 in 2010.

• Abathun, Asresash Demissie; Sundby, Johanne & Gele, Abdi Ali (2016). Attitude toward female genital mutilation among Somali and Harari people, Eastern Ethiopia. International Journal of Women's Health. 8, s. 557–569. doi: 10.2147/IJWH.S112226. Fulltekst i vitenarkiv Vis sammendrag

  Background: Female genital mutilation (FGM) is a worldwide problem, and it is practiced by many communities in Africa and Asia as well as immigrants from those areas. This prac - tice results in short- and long-term health consequences on women’s health. Like many other developing countries, FGM is widely practiced in Ethiopia, especially among Somali and Harari ethnic groups. Despite intensive campaigns against FGM in Ethiopia, since 2011, it has been practiced in the aforementioned communities. There is no recent information as to whether these campaigns have an impact on the attitude and practice of the community regarding FGM. This qualitative research was aimed at exploring the attitudes of Somali and Harari people between 18 and 65 years toward FGM. Methods: A purposive sampling technique was used to recruit 64 (32 in each region) partici - pants. Data were collected from October to December 2015 in Somali and Harari Regions. Results: The findings showed that there was a strong support for the continuation of the practice among female discussants in Somali region, whereas male discussants from the same region and the majority of the participants from Harari region had a positive attitude toward the discontinuation of the practice. Marriageability was the major reason for practicing FGM in Somali region, whereas making girls calm, sexually inactive, and faithful for their husbands were mentioned in Harari region. Although young men in both the regions prefer to marry uncircumcised girls, the study showed that there are some differences in the attitude toward the FGM practice between the people in the two regions. Conclusion: The findings show that there is an attitudinal difference between the people in the two regions, which calls for behavioral change communication using women-centered approach and culturally appropriate strategies. As young people in both the regions had the intention to marry uncircumcised girls, there has to be a strong advocacy and multisectoral collaboration to stop FGM in both the regions.

• Ilboudo, Patrick Christian Gueswende; Greco, Giulia; Sundby, Johanne & Torsvik, Gaute (2015). Costs and consequences of abortions to women and their households: A cross-sectional study in Ouagadougou, Burkina Faso. Health Policy and Planning. ISSN 0268-1080. 30(4), s. 500–507. doi: 10.1093/heapol/czu025. Fulltekst i vitenarkiv Vis sammendrag

  Little is known about the costs and consequences of abortions to women and their households. Our aim was to study both costs and consequences of induced and spontaneous abortions and complications. We carried out a cross-sectional study between February and September 2012 in Ouagadougou, the capital city of Burkina Faso. Quantitative data of 305 women whose pregnancy ended with either an induced or a spontaneous abortion were prospectively collected on sociodemographic, asset ownership, medical and health expenditures including pre-referral costs following the patient’s perspective. Descriptive analysis and regression analysis of costs were performed. We found that women with induced abortion were often single or never married, younger, more educated and had earlier pregnancies than women with spontaneous abortion. They also tended to be more often under parents’ guardianship compared with women with spontaneous abortion. Women with induced abortion paid much more money to obtain abortion and treatment of the resulting complications compared with women with spontaneous abortion: US89 (44 252 CFA ie franc of the African Financial Community) vs US56 (27 668 CFA). The results also suggested that payments associated with induced abortion were catastrophic as they consumed 15% of the gross domestic product per capita. Additionally, 11–16% of total households appeared to have resorted to coping strategies in order to face costs. Both induced and spontaneous abortions may incur high expenses with short-term economic repercussions on households’ poverty. Actions are needed in order to reduce the financial burden of abortion costs and promote an effective use of contraceptives.

• Chi, Primus Che; Bulage, Patience; Urdal, Henrik & Sundby, Johanne (2015). Barriers in the delivery of emergency obstetric and neonatal care in post-conflict Africa: Qualitative case studies of Burundi and Northern Uganda. PLOS ONE. 10(9). doi: 10.1371/journal.pone.0139120. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Maternal and neonatal mortality and morbidity rates are particularly grim in conflict, post-conflict and other crisis settings, a situation partly blamed on non-availability and/or poor quality of emergency obstetric and neonatal care (EmONC) services. The aim of this study was to explore the barriers to effective delivery of EmONC services in post-conflict Burundi and Northern Uganda, in order to provide policy makers and other relevant stakeholders context-relevant data on improving the delivery of these lifesaving services. Methods This was a qualitative comparative case study that used 42 face-to-face semi-structured in-depth interviews and 4 focus group discussions for data collection. Participants were 32 local health providers and 37 staff of NGOs working in the area of maternal health. Data was analysed using the framework approach. Results The availability, quality and distribution of EmONC services were major challenges across the sites. The barriers in the delivery of quality EmONC services were categorised into two major themes; human resources-related challenges, and systemic and institutional failures. While some of the barriers were similar, others were unique to specific sites. The common barriers included shortage of qualified staff; lack of essential installations, supplies and medications; increasing workload, burn-out and turnover; and poor data collection and monitoring systems. Barriers unique to Northern Uganda were demoralised personnel and lack of recognition; poor referral system; inefficient drug supply system; staff absenteeism in rural areas; and poor coordination among key personnel. In Burundi, weak curriculum; poor harmonisation and coordination of training; and inefficient allocation of resources were the unique challenges. To improve the situation across the sites, efforts are ongoing to improve the training and recruitment of more staff; harmonise and strengthen the curriculum and training; increase the number of EmONC facilities; and improve staff supervision, monitoring and support. Conclusions Post-conflict health systems face different challenges in the delivery of EmONC services and as such require context-specific interventions to improve the delivery of these services.

• Chi, Primus Che; Bulage, Patience; Urdal, Henrik & Sundby, Johanne (2015). A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC Pregnancy and Childbirth. 15(18). doi: 10.1186/s12884-015-0449-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Armed conflict has been described as an important contributor to the social determinants of health and a driver of health inequity, including maternal health. These conflicts may severely reduce access to maternal health services and, as a consequence, lead to poor maternal health outcomes for a period extending beyond the conflict itself. As such, understanding how maternal health-seeking behaviour and utilisation of maternal health services can be improved in post-conflict societies is of crucial importance. This study aims to explore the determinants (barriers and facilitators) of women’s uptake of maternal, sexual and reproductive health services (MSRHS) in two post-conflict settings in sub-Saharan Africa; Burundi and Northern Uganda, and how uptake is affected by exposure to armed conflict. Methods This is a qualitative study that utilised in-depth interviews and focus group discussions (FGDs) for data collection. One hundred and fifteen participants took part in the interviews and FGDs across the two study settings. Participants were women of reproductive age, local health providers and staff of non-governmental organizations. Issues explored included the factors affecting women’s utilisation of a range of MSRHS vis-à-vis conflict exposure. The framework method, making use of both inductive and deductive approaches, was used for analyzing the data. Results A complex and inter-related set of factors affect women’s utilisation of MSRHS in post-conflict settings. Exposure to armed conflict affects women’s utilisation of these services mainly through impeding women’s health seeking behaviour and community perception of health services. The factors identified cut across the individual, socio-cultural, and political and health system spheres, and the main determinants include women’s fear of developing pregnancy-related complications, status of women empowerment and support at the household and community levels, removal of user-fees, proximity to the health facility, and attitude of health providers. Conclusions Improving women’s uptake of MSRHS in post-conflict settings requires health system strengthening initiatives that address the barriers across the individual, socio-cultural, and political and health system spheres. While addressing financial barriers to access is crucial, attention should be paid to non-financial barriers as well. The goal should be to develop an equitable and sustainable health system.

• Sørbye, Ingvil; Daltveit, Anne Kjersti; Sundby, Johanne; Stoltenberg, Camilla & Vangen, Siri (2015). Caesarean section by immigrants' length of residence in Norway: a population-based study. European Journal of Public Health. ISSN 1101-1262. 25(1), s. 78–84. doi: 10.1093/eurpub/cku135. Fulltekst i vitenarkiv
• Chi, Primus Che; Bulage, Patience; Urdal, Henrik & Sundby, Johanne (2015). Perceptions of the effects of armed conflict on maternal and reproductive health services and outcomes in Burundi and Northern Uganda: A qualitative study. BMC International Health and Human Rights. 15(7). doi: 10.1186/s12914-015-0045-z. Fulltekst i vitenarkiv Vis sammendrag

  Background Armed conflict potentially poses serious challenges to access and quality of maternal and reproductive health (MRH) services, resulting in increased maternal morbidity and mortality. The effects of armed conflict may vary from one setting to another, including the mechanisms/channels through which the conflict may lead to poor access to and quality of health services. This study aims to explore the effects of armed conflict on MRH in Burundi and Northern Uganda. Methods This is a descriptive qualitative study that used in-depth interviews (IDIs) and focus group discussions (FGDs) with women, health providers and staff of NGOs for data collection. Issues discussed include the effects of armed conflict on access and quality of MRH services and outcomes, and the mechanisms through which armed conflict leads to poor access and quality of MRH services. A total of 63 IDIs and 8 FGDs were conducted involving 115 participants. Results The main themes that emerged from the study were: armed conflict as a cause of limited access to and poor quality of MRH services; armed conflict as a cause of poor MRH outcomes; and armed conflict as a route to improved access to health care. The main mechanisms through which the conflict led to poor access and quality of MRH services varied across the sites: attacks on health facilities and looting of medical supplies in both sites; targeted killing of health personnel and favouritism in the provision of healthcare in Burundi; and abduction of health providers in Northern Uganda. The perceived effects of the conflict on MRH outcomes included: increased maternal and newborn morbidity and mortality; high prevalence of HIV/AIDS and SGBV; increased levels of prostitution, teenage pregnancy and clandestine abortion; and high fertility levels. Relocation to government recognised IDP camps was perceived to improve access to health services. Conclusions The effects of armed conflict on MRH services and outcomes are substantial. The mechanisms through which armed conflict leads to poor access and quality of MRH services vary from one setting to another. All these issues need to be considered in the design and implementation of interventions to improve MRH in these settings.

• Chi, Primus Che; Urdal, Henrik; Umeora, Odidika U.J; Sundby, Johanne; Spiegel, Paul & Devane, Declan (2015). Improving maternal, newborn and women's reproductive health in crisis settings. Cochrane Database of Systematic Reviews. doi: 10.1002/14651858.CD011829. Fulltekst i vitenarkiv
• Sundby, Johanne (2014). Women's Sexual and Reproductive Health Rights - or Gender Equality? I Sterri, Aksel Braanen (Red.), Global citizen - challenges and responsibility in an interconnected world. Brill | Sense. ISSN 9789462099289. s. 47–51. doi: 10.1007/978-94-6209-929-6_6. Fulltekst i vitenarkiv
• Gombachika, Belinda Chimphamba; Sundby, Johanne; Chirwa, Ellen & Malata, Address (2014). Parenting experiences of couples living with human immunodeficiency virus: A qualitative study from rural Southern Malawi. SAHARA-J: Journal of Social Aspects of HIV/AIDS. ISSN 1729-0376. 11(1), s. 10–19. doi: 10.1080/17290376.2014.886140. Fulltekst i vitenarkiv
• Fredriksen, Eva Haukeland; Harris, Janet; Moland, Karen Marie & Sundby, Johanne (2014). "They ask whether this is real or fake": a qualitative Norwegian study of pregnancy complaints and access to social benefits. Health Care for Women International. ISSN 0739-9332. 35(3), s. 266–284. doi: 10.1080/07399332.2013.794463. Fulltekst i vitenarkiv Vis sammendrag

  Women increasingly combine paid work and childbearing, but working full time throughout pregnancy is commonly experienced as overtaxing. We explored access to sick leave or medical care as experienced by Norwegian women suffering from pelvic girdle pain during pregnancy. Through a grounded theory approach we compared results from qualitative interviews and open Internet discussions, and found that women struggled with credibility and that their claims for sick leave or medical care were commonly disregarded. Support from peers was seen as instrumental in regaining control over their health and was a vehicle in developing critical health literacy.

• Ilboudo, Patrick Christian Gueswende; Somda, Serge MA & Sundby, Johanne (2014). Key determinants of induced abortion in women seeking postabortion care in hospital facilities in Ouagadougou, Burkina Faso. International Journal of Women's Health. 6(1), s. 565–572. doi: 10.2147/IJWH.S60709. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Despite the universal recognition of unsafe abortion as a major public health problem, very little research has been conducted to document its precipitating factors in Burkina Faso. Our aim was to investigate the key determinants of induced abortion in a sample of women who sought postabortion care. Materials and methods: A cross-sectional household survey was carried out from February to September 2012 in Ouagadougou, Burkina Faso. Data of 37 women who had had an induced abortion and 267 women who had had a spontaneous abortion were prospectively collected on sociodemographic characteristics, pregnancy and birth history, abortion experience, including previous abortion experience, and selected clinical information, including the type of abortion. A two-step regression analysis consisting of a univariate and a multivariate logistic regression was run on Stata version 11.2 in order to identify the key determinants of induced abortion. Results: The findings indicated that 12% of all abortions were certainly induced. Three key factors were significantly and positively associated with the probability of having an induced abortion: whether the woman reported that her pregnancy was unwanted (odds ratio [OR] 10.45, 95% confidence interval [CI] 3.59–30.41); whether the woman reported was living in a household headed by her parents (OR 6.83, 95% CI 2.42–19.24); and if the woman reported was divorced or widowed (OR 3.47, 95% CI 1.08–11.10). On the contrary, being married was protective against induced abortion, with women who reported being married having an 83% (OR 0.17, CI 0.03–0.89) lower chance of having an induced abortion, even when the pregnancy was unwanted. Conclusion: This study has identified three major determinants of induced abortion in Ouagadougou, Burkina Faso. Improved targeted programs on family planning counseling, methods of contraception, and availability of contraceptives should be widely promoted.

• Sundby, Johanne (2014). I solidaritet med kvinner. Forskerens samfunnsansvar for Kvinners helse i Norge og Afrika. Arr - Idéhistorisk tidsskrift. ISSN 0802-7005. 3-4, s. 43–50. Fulltekst i vitenarkiv
• Sundby, Johanne (2014). A rollercoaster of policy shifts: Global trends and reproductive Health policy in The Gambia. Global Public Health. ISSN 1744-1692. 9(7-8), s. 894–909. doi: 10.1080/17441692.2014.940991. Fulltekst i vitenarkiv
• Sørbye, Ingvil; Daltveit, Anne Kjersti; Sundby, Johanne & Vangen, Siri (2014). Preterm subtypes by immigrants' length of residence in Norway: A population-based study. BMC Pregnancy and Childbirth. 14. doi: 10.1186/1471-2393-14-239. Fulltekst i vitenarkiv Vis sammendrag

  Background: The reduction of the preterm delivery (PTD) rate is a maternal and child health target. Elevated rates have been found among several immigrant groups, but few studies have distinguished between PTD according to the mode of birth start. In addition, migrants’ birth outcomes have further been shown to be affected by the time in residence; however, the association to PTD subtypes has not previously been assessed. In this study we examined if the risk of spontaneous and non-spontaneous, or iatrogenic, PTD among immigrants in Norway varied according to the length of residence and the country of birth, and compared with the risks among the majority population. Methods: We linked population-based birth and immigration data for 40 709 singletons born to immigrant women from Iraq, Pakistan, the Philippines, Somalia, Sri Lanka and Vietnam and 868 832 singletons born to non-immigrant women from 1990–2009. Associations between the length of residence and subtypes of PTD were estimated as relative risks (RRs) with 95% confidence intervals (CIs) from multivariable models. Results: In total, 48 191 preterm births occurred. Both spontaneous and non-spontaneous PTD rates were higher among immigrants (4.8% and 2.0%) than among non-immigrants (3.6% and 1.6%). Only non-spontaneous PTD was associated with longer lengths of residence (p trend <0.001). Recent immigrants (<5 years of residence) and non-immigrants had a similar risk of non-spontaneous PTD, whereas immigrants with lengths of residence of 5–9 years, 10–14 years and ≥15 years had adjusted RRs of 1.18 [95% CI 1.03,1.35], 1.43 [95% CI 1.20,1.71] and 1.66 [95% CI 1.41,1.96]. The association was reduced after further adjustments for maternal and infant morbidity. Conversely, the risk of spontaneous PTD among immigrants was not mitigated by length of residence, but varied with country of birth according to the duration of pregnancy in term births. Conclusions: Non-spontaneous PTD increased with the length of residence whereas spontaneous PTD remained elevated regardless of the length of residence. Policies to improve birth outcomes in ethnically mixed populations should address the modifiable causes of PTD rather than aiming to reduce absolute PTD rates.

• Sørbye, Ingvil; Stoltenberg, Camilla; Sundby, Johanne; Daltveit, Anne Kjersti & Vangen, Siri (2014). Stillbirth and infant death among generations of Pakistani immigrant descent: a population-based study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 93(2), s. 168–174. doi: 10.1111/aogs.12303. Fulltekst i vitenarkiv
• Thorsen, Viva Combs; Sundby, Johanne; Meguid, T & Malata, Address (2014). Easier said than done!: Methodological challenges with conducting maternal death review research in Malawi. BMC Medical Research Methodology. 14(1). doi: 10.1186/1471-2288-14-29. Fulltekst i vitenarkiv Vis sammendrag

  Background Maternal death auditing is widely used to ascertain in-depth information on the clinical, social, cultural, and other contributing factors that result in a maternal death. As the 2015 deadline for Millennium Development Goal 5 of reducing maternal mortality by three quarters between 1990 and 2015 draws near, this information becomes even more critical for informing intensified maternal mortality reduction strategies. Studies using maternal death audit methodologies are widely available, but few discuss the challenges in their implementation. The purpose of this paper is to discuss the methodological issues that arose while conducting maternal death review research in Lilongwe, Malawi. Methods Critical reflections were based on a recently conducted maternal mortality study in Lilongwe, Malawi in which a facility-based maternal death review approach was used. The five-step maternal mortality surveillance cycle provided the framework for discussion. The steps included: 1) identification of cases, 2) data collection, 3) data analysis, 4) recommendations, and 5) evaluation. Results Challenges experienced were related to the first three steps of the surveillance cycle. They included: 1) identification of cases: conflicting maternal death numbers, and missing medical charts, 2) data collection: poor record keeping, poor quality of documentation, difficulties in identifying and locating appropriate healthcare workers for interviews, the potential introduction of bias through the use of an interpreter, and difficulties with locating family and community members and recall bias; and 3) data analysis: determining the causes of death and clinical diagnoses. Conclusion Conducting facility-based maternal death reviews for the purpose of research has several challenges. This paper illustrated that performing such an activity, particularly the data collection phase, was not as easy as conveyed in international guidelines and in published studies. However, these challenges are not insurmountable. If they are anticipated and proper steps are taken in advance, they can be avoided or their effects minimized.

• Lerberg, Priya Miriam; Sundby, Johanne; Jammeh, Abdou & Fretheim, Atle (2014). Barriers to Skilled Birth Attendance: A Survey among Mothers in Rural Gambia. African Journal of Reproductive Health. ISSN 1118-4841. 18(1), s. 35–43. Fulltekst i vitenarkiv
• Rostad, Berit; Schmidt, Lone; Sundby, Johanne & Schei, Berit (2014). Infertility experience and health differentials - a population-based comparative study on infertile and non-infertile women (the HUNT Study). Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 93(8), s. 757–764. doi: 10.1111/aogs.12404. Fulltekst i vitenarkiv
• Gele, Abdi Ali; Bø, Bente Puntervold & Sundby, Johanne (2013). Attitudes toward Female Circumcision among Men and Women in Two Districts in Somalia: Is It Time to Rethink Our Eradication Strategy in Somalia? Obstetrics and Gynecology International. ISSN 1687-9589. doi: 10.1155/2013/312734. Fulltekst i vitenarkiv Vis sammendrag

  Somalia has the highest global prevalence (98%) of female circumcision (FC), and, despite a long history of abandonment efforts, it is not clear as to whether or not these programmes have changed people’s positive attitudes toward the practice. Against this background, this paper explores the attitudes of Somalis living in Hargeisa and Galkayo districts to the practice of FC. Methods. A purposive sampling of 24 Somalis, including activists and practitioners, men and women, was conducted in Somalia. Unstructured interviews were employed to explore the participants' knowledge of FC, their attitudes toward the continuation/discontinuation of the practice, and the type they want to continue or not to continue. Result. The findings of this qualitative study indicate that there is a strong resistance towards the abandonment of the practice in Somalia. The support for the continuation of Sunna circumcision is widespread, while there is a quite large rejection of Pharaonic circumcision. Conclusion. Therefore, since the “zero tolerance policy” has failed to change people’s support for the continuation of the practice in Somalia, programmes that promote the pinch of the clitoral skin and verbal alteration of status, with the goal of leading to total abandonment of FC, should be considered for the Somali context.

• Gele, Abdi Ali; Bø, Bente Puntervold & Sundby, Johanne (2013). Have we made progress in Somalia after 30 years of interventions? Attitudes toward female circumcision among people in the Hargeisa district. BMC Research Notes. 6(122). doi: 10.1186/1756-0500-6-122. Fulltekst i vitenarkiv Vis sammendrag

  Background: Female circumcision is a major public health problem that largely contributes to the ill-health of women and their children globally. Accordingly, the international community is committed to take all possible measures to abolish the practice that is internationally considered to be absolutely intolerable. While the practice is a social tradition shared by people in 28 African countries, there is no country on earth where FC is more prevalent than in Somalia. Yet, since the early 1990s, there is no quantitative study that has investigated whether the perception towards the practice among Somali men and women in Somalia has improved or not. Thus, this cross-sectional quantitative study examines the attitudes toward the practice among people in Hargeisa, Somalia. Methods: A cross-sectional study of 215 randomly selected persons, including both men and women, was conducted in Hargeisa, Somalia from July to September of 2011. Participants were interviewed using structured questionnaires, with questions including the circumcision status of the female participants, the type of circumcision, if one has the intention to circumcise his/her daughter, whether one supports the continuation or discontinuation of the practice and men’s perceptions toward having an uncircumcised woman as a wife. Result: The findings show that 97% of the study’s participants were circumcised with no age differences. Of this, 81% were subjected to Type 3, while 16% were subjected to either Type 1 or 2 and only 3% were left uncircumcised. Approximately 85% of the respondents had intention to circumcise their daughters, with 13% were planning the most radical form. Among men, 96% preferred to marry circumcised women, whereas overall, 90% of respondents supported the continuation of the practice. The vast majority of the study’s respondents had a good knowledge of the negative health effects of female circumcision. In multivariate logistic regressions, with an adjustment for all other important variables, female circumcision (the Sunna form) is a religious requirement 16.5 (2.43-112.6) and the Sunna form is not harmful 25.1(2.35-281.1), are the two factors significantly associated with the continuation of female circumcision. Moreover, females were less likely to support the continuation of FC compared to their male counterparts (aOR 0.07; CI: 0.05-0.88). Conclusion: The study shows that the support towards the persistence of the practice is profoundly high in Somalia. People are aware of the health and human rights effect of female circumcision, and yet they support the continuation of the practice. Therefore, over 30 years of campaigns with limited progress demand an alternative approach towards the eradication of female circumcision in Somalia.

• Sundby, Johanne; Essén, Birgitta & Johansen, Ragnhild Elise B (2013). Female Genital mutilation/cutting or circumcision. Obstetrics and Gynecology International. ISSN 1687-9589. doi: 10.1155/2013/240421. Fulltekst i vitenarkiv
• Gombachika, B. Chimphamba; Chirwa, Ellen; Malata, Address; Sundby, Johanne & Fjeld, Heidi E (2013). Reproductive decisions of couples living with HIV in Malawi: What can we learn for future policy and research studies? Malawi Medical Journal. ISSN 1995-7262. 25(3), s. 65–71. Fulltekst i vitenarkiv
• Hassan, Sahar J. A.; Sundby, Johanne; Husseini, Abdullatif Said & Bjertness, Espen (2013). Translating evidence into practice in childbirth: A case from the Occupied Palestinian Territory. Women and Birth. ISSN 1871-5192. 26(2), s. E82–E89. doi: 10.1016/j.wombi.2012.12.002. Fulltekst i vitenarkiv Vis sammendrag

  English

• Rostad, Berit; Schmidt, Lone; Sundby, Johanne & Schei, Berit (2013). Has fertility declined from mid-1990s to mid-2000s? Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 92(11), s. 1284–1289. doi: 10.1111/aogs.12224. Fulltekst i vitenarkiv
• Thorsen, Viva Combs; Sundby, Johanne & Malata, Address (2012). Piecing Together the Maternal Death Puzzle through Narratives: The Three Delays Model Revisited. PLOS ONE. 7(12). doi: 10.1371/journal.pone.0052090. Fulltekst i vitenarkiv
• Kululanga, Lucy Ida; Malata, Address; Chirwa, Ellen & Sundby, Johanne (2012). Malawian fathers' views and experiences of attending the birth of their children: a qualitative study. BMC Pregnancy and Childbirth. 12. doi: 10.1186/1471-2393-12141. Fulltekst i vitenarkiv
• Chinkonde, Jacqueline Rosa & Sundby, Johanne (2012). Den farlige melken - hiv og spedbarnsernæring i en skiftende kontekst. I Bondevik, Hilde & Lie, Anne Kveim (Red.), Rødt og hvitt. Om blod og melk i fortid og nåtid. Unipub forlag. ISSN 9788274775190. s. 227–245. Fulltekst i vitenarkiv
• Kumbani, L C; Maluwa, Alfred; Choko, Augustine; Chirwa, Ellen; Malata, Address & Sundby, Johanne [Vis alle 7 forfattere av denne artikkelen] (2012). Adverse perinatal outcomes in Chiradzulu, Southern Malawi. AFRICAN Journal of Midwifery and Women’s Health. ISSN 1759-7374. 6(4), s. 190–197. doi: 10.12968/ajmw.2012.6.4.190. Fulltekst i vitenarkiv
• Sundby, Johanne (2012). Blodssøstre. I Bondevik, Hilde & Lie, Anne Kveim (Red.), Rødt og hvitt. Om blod og melk i fortid og nåtid. Unipub forlag. ISSN 9788274775190. s. 129–136. Fulltekst i vitenarkiv
• Hassan, Sahar J. A.; Sundby, Johanne; Husseini, Abdullatif Said & Bjertness, Espen (2012). The paradox of vaginal examination practice during normal childbirth: Palestinian women’s feelings, opinions, knowledge and experiences. Reproductive Health. 9(16). doi: 10.1186/1742-4755-9-16. Fulltekst i vitenarkiv Vis sammendrag

  English

• Kumbani, Lily C; Sundby, Johanne & Odland, Jon Øyvind (2012). Factors associated with perinatal deaths in women delivering in a health facility in Malawi. Journal of Research in Nursing and Midwifery. ISSN 2315-568X. 1(5), s. 69–79. Fulltekst i vitenarkiv
• Gele, Abdikadir Ali; Johansen, Ragnhild Elise B & Sundby, Johanne (2012). When female circumcision comes to the West: Attitudes toward the practice among Somali Immigrants in Oslo. BMC Public Health. 12. doi: 10.1186/1471-2458-12-697. Fulltekst i vitenarkiv Vis sammendrag

  Background Female circumcision (FC) has lifelong adverse social and health consequences for women, and its abolition will not only enhance the health of children and women, but also promote gender equality. Like many other Western countries, Norway hosts a large proportion of immigrants from FC-practicing countries, though primarily from Somalia, which is the country with the highest prevalence of FC in the world. A behavioral change by the practicing communities has the best chance to successfully and sustainably eliminate this practice. However, FC prevention programs require a behavioral surveillance that monitors the process of change, with this being the first quantitative study since the major migration of the Somali community to Norway began in 1991 to investigate whether or not Somali immigrants’ attitudes toward the practice has improved in favor of its abandonment. Methods A cross-sectional study using a respondent-driven sampling (RDS) was conducted in Oslo from April to June of 2011. A sample of 214 persons was interviewed, using structured questionnaires. Results The results show that 70% of Somalis in Oslo support the discontinuation of all forms of FC compared to 30% who support its continuation, with the latter group more likely to be people who lived in Norway ≤ 4 years. Of the 10 girls who came to Norway at the age of ≤ 7 years, only one was circumcised, though whether the circumcision occurred before or after the girl’s arrival in Norway remains unclear. The perception that FC is required by religion was the sole factor to be significantly associated with an ongoing support of FC. Conclusion The study reveals that Somalis in Oslo demonstrate a trend to abandon this practice over time. Nevertheless, the 30% of the people who still support its continuation, and who are primarily newly arrived immigrants, require a targeted intervention that is implemented in the early phase of the immigrants’ arrival.

• Gombachika, Belinda; Fjeld, Heidi E; Chirwa, Ellen; Sundby, Johanne; Malata, Address & Maluwa, Alfred (2012). A Social Ecological Approach to Exploring Barriers to Accessing Sexual and Reproductive Health Services among Couples Living with HIV in Southern Malawi. ISRN Public Health. doi: 10.5402/2012/825459. Fulltekst i vitenarkiv
• Kululanga, Lucy Ida; Sundby, Johanne; Chirwa, Ellen; Malata, Address & Maluwa, Alfred (2012). Barriers to husbands' involvement in maternal health care in a rural setting in Malawi: a qualitative study. Journal of Research in Nursing and Midwifery. ISSN 2315-568X. 1(1), s. 1–10. doi: 10.1186/1742-4755-8-36. Fulltekst i vitenarkiv
• Gombachika, Belinda; Chirwa, Ellen; Sundby, Johanne; Malata, Address; Maluwa, Alfred & Fjeld, Heidi E (2012). Marriage Partner Selection by Heterosexual Couples Living with HIV from Rural Southern Malawi. Journal of AIDS and Clinical Research. doi: 10.4172/2155-6133. Fulltekst i vitenarkiv
• Kululanga, Lucy Ida; Sundby, Johanne; Malata, Address & Chirwa, Ellen (2012). Male Involvement in Maternity Health Care in Malawi. African Journal of Reproductive Health. ISSN 1118-4841. 16(1), s. 145–157. Fulltekst i vitenarkiv
• Gele, Abdikadir Ali; Kumar, Bernadette. N; Hjelde, Karin Harsløf & Sundby, Johanne (2012). Attitudes towards female circumcision among Somali immigrants in Oslo: a qualitative study. International Journal of Women's Health. 4, s. 7–17. doi: 10.2147/IJWH.S27577. Fulltekst i vitenarkiv

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• Sundby, Johanne (2017). Hundekjøring. Blinke forlag www.blinke.no. ISBN 9788293026136. 150 s. Fulltekst i vitenarkiv

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• Miltenburg, Andrea Solnes; Bains, Sukhjeet Kaur; Strøm-Roum, Ellen Marie; Vartdal, Vegard Weyergang; Sørbye, Ingvil Krarup & Alnæs-Katjavivi, Patji [Vis alle 8 forfattere av denne artikkelen] (2023). Svangerskap, fødsel og barseltid – mer enn bare overlevelse. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(15), s. 1–3. doi: 10.4045/tidsskr.23.0500. Fulltekst i vitenarkiv
• Sundby, Johanne Sommerschild (2022). Globale paroler på kvinnedagen. 142(5). doi: 10.4045/tidsskr.22.0175. Fulltekst i vitenarkiv
• Sundby, Johanne; Miltenburg, Andrea Solnes; Lafontain, Sara Rivenes; Wangamati, Cynthia Khamala & Odland, Maria Lisa (2019). Quality of Care for women and adolescent girls - from policy to practice, or the other way around? Fulltekst i vitenarkiv
• Thomassen, Tor Oskar; Waaler, Rune & Sundby, Johanne (2018). Forskningsprosjekt hundekjøring. Motivasjon og lidenskap hos hundekjørere. Fulltekst i vitenarkiv
• Thorsen, Viva Combs; Meguid, Tarek; Sundby, Johanne & Malata, Address (2014). Components of maternal healthcare delivery system contributing to maternal deaths in Malawi: a descriptive cross-sectional study. African Journal of Reproductive Health. ISSN 1118-4841. 18(1), s. 16–26. Fulltekst i vitenarkiv
• Sundby, Johanne (2014). Kan jeg få snakke med dagens morder? Samtiden. Tidsskrift for politikk, litteratur og samfunnsspørsmål. 2, s. 86–98. Fulltekst i vitenarkiv
• Rostad, Berit; Schmidt, Lone; Sundby, Johanne & Schei, Berit (2013). Impact of infertility experience on health, psychological diatress, and life satisfaction (The HUNT Study). Fulltekst i vitenarkiv
• Hassan, Sahar J. A.; Sundby, Johanne; Husseini, Abdullatif Said & Bjertness, Espen (2013). Medicalisation of childbirth in the occupied Palestinian territory: an operational study. The Lancet. ISSN 0140-6736. 382, s. 18–18. Fulltekst i vitenarkiv
• Austveg, Berit; Storeng, Katerini Tagmatarchi & Sundby, Johanne (2013). Der abort er risikosport. Fulltekst i vitenarkiv
• Sørbye, Ingvil; Vangen, Siri; Daltveit, Anne Kjersti & Sundby, Johanne (2012). Perinatal mortality among generations of Pakistani immigrants to Norway: a linked registry based study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 91, s. 128–129. doi: 10.1111/j.1600-0412.2012.01435_2.x. Fulltekst i vitenarkiv
• Hassan, Sahar J. A.; Sundby, Johanne; Husseini, Abdullatif Said & Bjertness, Espen (2012). Palestinian women’s feelings and opinions about vaginal examinations during normal childbirth: an exploratory study. The Lancet. ISSN 0140-6736. Fulltekst i vitenarkiv Vis sammendrag

  English

• Rostad, Berit; Schei, Berit; Sundby, Johanne & Schmidt, Lone (2012). Time trend in fertility - comparison of two cohorts of postmenopausal women in Norway. Fulltekst i vitenarkiv
• Ouédraogo, Ramatou; Ouattara, Fatoumata; Storeng, Katerini Tagmatarchi; Drabo, Seydou; Sundby, Johanne & Gruénais, Marc-Eric (2012). Plural vulnerability of young women to unsafe abortion. Fulltekst i vitenarkiv
• Ouédraogo, Ramatou; Ouattara, Fatoumata; Storeng, Katerini Tagmatarchi; Drabo, Seydou; Sundby, Johanne & Gruénais, Marc-Eric (2012). “When the illegal becomes legal”. An ethnography of post-abortions care inOuagadougou (Burkina Faso). Fulltekst i vitenarkiv
• Gele, Abdi Ali; Sundby, Johanne & Bø, Bente Puntervold (2013). Female Circumcision at Home and Away: Attitudes toward the practice among Somali immigrants in Oslo, Norway, and their corresponding group in Hargeisa and Galka'ayo, Somalia. Universitetet i Oslo. ISSN 9788282646048. Fulltekst i vitenarkiv

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