Free Communication (Oral) Presentations

Free Communication (Oral) Presentations

International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313 Free Communication (Oral) Presentations FCS01. Medical Education FCS...

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International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313

Free Communication (Oral) Presentations FCS01. Medical Education FCS01.1 TEACHING THE LAPAROSCOPIC APPROACH TO COLPO-SUSPENSION FOR GENUINE STRESS INCONTINENCE J. Mamo, A. Micallef Fava, I. Knyazev, D. Chetcuti. Mater Dei University Hospital, Msida, Malta Objectives: Training in the laparoscopic approach to Burch Colposuspension under the guidance of a mentor at the Minimally Invasive Gynaecology Unit. Method: Women presenting at the Gynaecological Clinic complaining of stress incontinence are assessed and management strategies were analysed, including urodynamic investigations. The results of conservative and medical therapies are explained to the patient as are the operative management options. The laparoscopic aspect for the gold standard operation is explained.Under the guidance of a mentor, doctors and specialists are trained to perform the laparoscopic approach to Burch Colposuspension. They are first trained on the virtual trainer in laparoscopic technique and observe several operations prior to being allowed to perform part and later all the operation under the guidance of the mentor. Results: Four trainees who are well versed in doing the laparotomy approach to Burch Colposuspension are given guidance and mentorship in the laparoscopic approach to the management of genuine stress incontinence. Twenty two patients have undergone the Burch colposuspension via the laparoscopic route compared with twenty open Colposuspensions. There was no significant increase in the duration of the laparoscopic operation compared with the open approach to the operation. No complications were encountered. The hospital stay was shorter then the laparotomy patients. Conclusions: It is important that the trainees have prior experience both in laparoscopic techniques and in the performance of the open approach to the Burch Colposuspension. The guidance of a mentor when learning the laparoscopic approach to Burch Colposuspension is considered essential at our Minimally Invasive Gynaecology Unit. FCS01.2 ENSURING COMPETENCY IN FAMILY PLANNING (FP) PROVISION USING THE HUMANISTIC APPROACH; FROM TRAINING TO PRACTICE H. Mukaddas 1 , E. Otolorin 2 . 1 National Obstetric Fistula Center Ningi, Bauchi State, Nigeria; 2 Jhpiego Corporation Nigeria, Abuja, Nigeria Objectives: To demonstrate use of a humanistic approach in competency based family planning training. Method: The intervention focused on 90 educators and preceptors engaged in the 10 different Health related institutions of Bauchi and Sokoto state, Nigeria who were assessed on Infection prevention in FP, Balanced Counseling Strategy and provision of long acting reversible contraception (LARC) before and after the in-service train-

ing intervention. Knowledge assessments were done on infection prevention and specific LARC methods. Skill assessments were conducted using Objective Structured Clinical Examinations (OSCE). During post training supervision after 3 months, participants’ coaching and demonstration skills were assessed during training of students in their respective schools. Results: The pre-intervention indicated paucity in the FP knowledge and skills of tutors that trained these human resources for health especially in the area of provision of long term methods of family planning. Average scores for the pretest were 48.4%. At post-test, all the 90 educators and preceptors scored more than 85% (post-training average mean score was 89%) in knowledge assessment and demonstrated satisfactorily the conduct of IUD and Jadelle insertion and removal. At 3 months post-training supervision, all the Educators and Preceptors satisfactorily demonstrated same skill and can couch students in the provision of IUD and Jadelle FP service. Conclusions: Educators/Preceptors can impact safe and better FP knowledge and skills using anatomic training models, thus competency based training of tutors can translate to better training of preservice students and increase in competent human resources for health that will address the health needs of the community. FCS01.3 PRACTICE OF GYNECOLOGY TRACK MEDICAL EDUCATION PROBLEM BASED LEARNING IN UNDERGRADUATE OBSTETRICS EDUCATION H. Kirubamani. Saveetha Medical College, Saveetha University, Thanadalam, Tamil Nadu/India, India Objectives: The assess effectiveness of Problem-Based learning in undergraduate obstetrics education. Method: At Saveetha Medical college 100 Medical students meet in small groups led by a facilitator and discuss carefully designed obstetric clinical cases and few station for obstetric drills were kept. The instructor in a PBL class facilitates the learning process by monitoring the progress of the learners and asking questions to move students forward in the problem solving process. At the end of the class they were able to gain necessary knowledge to solve the case. Results: Effectiveness was assessed by feed back questioner. 78% students had previous knowledge about PBL, 82% were able to understand theory well & made understanding of theory easy. 76% students felt it promotes self learning.68% were able to identify what they need to know & 83% were able to know what they already know because of group discussion. Problem analysis made them thing laterally in 81%, hand on drill improved there skill in 91.2%. understanding of clinical scenario was excellent after PBL. Rating of PBL methodology by students was excellent in 94%. Conclusions: PBL was found to be a more effective instructional approach for teaching obstetrics clinical cases than traditional lecture discussion. PBL is more stimulating, useful and not boring, session for students.

0020-7292/$ – see front matter © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Free Communication (Oral) Presentations / International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313



L.R. Fiorelli, B.P. Blanco, N.P. Garcia, R.R.C. de Sa, T.R.H. dos Santos, J.M. Haddad, S.T.N. Arazawa, J.M. Soares Jr, E.V. da Motta, E.C. Baracat. Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

J. Nabukeera. Jhpiego, Kampala, Uganda

Objectives: To develop low-cost models that simulates pelvic anatomical structures and genital prolapse, in order to increase medical student learning on the Pelvic Organ Prolapse Quantification (POP-Q) system. Method: Four monitor-students who previously attended the course, oriented by the course coordinators were assigned to develop new anatomy teaching models. The monitors created a low cost anatomic model using socks, elastic bands, cellophane, Velcro, cardboard cylinders, and ink pen. These materials were shaped to simulate the vagina, pelvic fascia and the main pelvic ligaments. A second model was designed to simulate different cases of genital prolapse in order to teach POP–Q classification. After classes that used these models, the students filled a questionnaire. Results: This study showed increased interest from monitorstudents in the design and production of didactic models. The models were effective to increase pelvic anatomy and pelvic organ prolapse learning for third-year medical students. All students approved as complementar activity after expositive class and before the contact with real patient. Conclusions: Anatomical model is a useful and effective method for teaching gynecological propaedeutic, as well as to enhance the understanding of genital prolapse. They can be developed in an academic environment using low-cost materials. FCS01.5 INFORMATION AND COMMUNICATION TECHNOLOGY TO IMPROVE GYNECOLOGICAL PROPAEDEUTIC TEACHING IN MEDICAL SCHOOL L.R. Fiorelli, L. Couceiro, A.F.F. Pan, B.C.A. Rodrigues, F.S. Terzi, T.R. Figueredo, T.R. Lourenço, M. Tacla, J.M. Haddad, S.T.N. Arazawa, C.L. Wen, J.M. Soares Jr, E.V. da Motta, E.C. Baracat. Disciplina de Ginecologia do Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil Objectives: Create virtual environment with learning objects for medical students to improve gynecological propaedeutic teaching in Faculdade de Medicina da Universidade de São Paulo. Method: Monitor-students, course coordinators and telemedicine professor identified demands for audiovisual resources to improve gynecological propaedeutic teaching, with priority for Primary Care. Results: Graphics, flowcharts, woman virtual videos based on dynamic 3D graphics computing, videos of history and fundamental examination techniques were developed. Moreover, a debate in roundtable format with teachers and monitors were recorded. All materials prepared and used in class were available in Moodle platform with restricted access by password and Tablets in the University of Sao Paulo Library. An example of material is available on Moreover, the work group established more link between professors and monitors and allowed the adequacy of educational materials. Conclusions: Audiovisual resources and interactivity improve gynecological propaedeutic teaching in Medical School. Their availability in virtual environment increases the accessibility of materials by students and promotes learning.


Objectives: The project aims to provide evidence for operationalization of the LDHF training methodology in technical areas outside of HMS/HBB within MNCH in the Ugandan context. Method: Jhpiego is supporting three local NGOs to implement the LDHF training approach in 3 different technical areas: 1) paediatric HIV, 2) integrating family planning and HIV care, and 3) post abortion care. The first step was capacity building of the local NGOs and MoH units to design, develop and adopt materials into LDHF format. With the assistance of curriculum development specialists and instructional designers, the stakeholders were engaged and trained to standardise and harmonise training resources. Following material refinement, the NGOs and MOH are currently piloting the adapted training materials. Results: Three curriculum documents for paediatric HIV, integrating family planning into HIV care and post abortion care, as well as corresponding assessment tools, trainer and trainee guides have been developed for roll out during project implementation. Many lessons have been learned regarding the challenges and process of adapting curriculum to the LDHF format and the roll out of the training in the respective technical areas. Conclusions: To date, it has been noted that it is vital to revise curriculum of training materials and adapt into the LDHF format before implementation given that most of the materials are developed according to the traditional methods of training. In many cases this will result in the need to engage external curriculum development experts as technical expertise does not always translate into curriculum development expertise. Additionally, for the technical areas that lack a significant practical skills component, the LDHF approach must be applied in innovative ways such as sms alerts and elearning to achieve the high frequency component. FCS01.7 IMPROVING SURGICAL SKILLS OF OBGYN RESIDENTS THROUGH PARTNERSHIP WITH RURAL HOSPITALS: EXPERIENCE FROM SOUTHEAST NIGERIA O. Umeora 1 , A. Onyebuchi 1 , N. Emma-Echiegu 2 , J. Eze 1 , P. Ezeonu 1 . 1 Federal Teaching Hospital, Abakaliki, Nigeria; 2 Ebonyi State University, Abakaliki, Nigeria Objectives: To evaluate the impact of rural clinical rotations in Southeast Nigeria on the training of Obstetrics & Gynaecology resident doctors. Method: This was a mixed method cross sectional study using information from self-administered questionnaires, three focus group discussions and an in depth interview involving residents in Obstetrics & Gynaecology of the Federal Teaching Hospital Abakaliki. OBGYN residents rotate through rural mission hospitals for two to three months. Consultants supervise their activities during the posting. A total of 47 residents have undergone such postings. The Health Research Ethics Committee granted ethical approval and data was analyzed using Epi info (CDC, Atlanta USA). Results: Thirty four of 38 (89.5%) questionnaires were analyzed. There was a 900% and 460% rise in the rate of Emergency and elective Caesarean sections respectively performed by junior residents. There were similar increases with regard to gynaecological procedures. Senior residents had a 100% and 80% rise in performance of total abdominal hysterectomy and myomectomy respectively. Seventy-five percent of the residents believed their surgical skills improved while for 87.5% of the senior residents, their administrative skills improved greatly. Residents’ self confidence was boosted and they took quicker


Free Communication (Oral) Presentations / International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313

decisions. They however wanted an improvement in their welfare at the rural posts. Conclusions: Clinical rotations through high volume rural hospitals offer an opportunity for further training in surgical skills, clinical knowledge and administrative skills of resident doctors in obstetrics and gynaecology. A scale up of this programme nationwide is advocated. FCS01.8 A RANDOMIZED CONTROLLED TRIAL OF LOW VERSUS HIGH FIDELITY SIMULATION TRAINING ON COMFORT, COMPETENCE, AND SKILLS WITH INTRAUTERINE DEVICE INSERTION J. Perez-Peralta 1,2 , M.J. Haviland 1 , S. Nippita 1,2 , S. Voit 3 , M.R. Hacker 1,2 , M. Paul 1,2 . 1 Beth Israel Deaconess Medical Center, Department of Obstetrics and Gynecology, Boston, MA, USA; 2 Harvard Medical School, Department of Obstetrics, Gynecology, and Reproductive Biology, Boston, MA, USA; 3 Affiliates Risk Management Services (ARMS), New York, NY, USA Objectives: Intrauterine contraception (IUC) is highly effective, but must be inserted by trained providers. There is limited published research on optimal methods for training providers on IUC insertion. This study aims to compare novice learners’ comfort, competence, and skills with intrauterine device (IUD) insertion after practice with a high-fidelity simulator compared to a traditional low-fidelity. Method: We enrolled interns and nurse practitioner students who had inserted <5 IUDs. Participants were randomized to practice on the ARMSPelvicSim™ high fidelity simulator or a low-fidelity coaster-like model. All participants viewed didactic slides and an insertion tutorial before practicing. Participants answered questionnaires immediately before and after practice, and after three months. They were asked to evaluate self-perceived comfort and competence, as well as the value of the three training components (lectures, videos, and models.) Participants were video recorded inserting three IUD types (levonorgestrel 52mg, levonorgestrel 13.5mg, and copper T380A) into a model. Skills were evaluated using a standardized checklist. Results: Sixty participants enrolled, 29 were randomized to PelvicSim™, 30 to coaster; 59 (98.3%) completed the initial visit, 48 (80.0%) completed 3 months follow-up. The majority (66.1%) were nurse practitioner students. Median age was 27 years. Immediately postpractice, both groups reported similarly increased competence and comfort with the IUD insertion steps and with inserting the three IUD types (p>0.1 for all). Three months after, both groups reported similarly decreased comfort and competence with same activities (p>0.05 for all). PelvicSim™ participants (92%) valued their model compared to coaster participants (56.7%) (p=0.007). Skills analysis is ongoing and will be presented at the conference. Conclusions: Although the high fidelity group perceived greater value of its assigned model (PelvicSim™) compared to the low fidelity group, the type of model used to practice IUD insertion did not affect self-reported competency and comfort among trainees inexperienced with IUD insertion. The effect on insertions skills will be determined by the time of the conference.

FCS02. Medical Education FCS02.1 ATTITUDE OF PATIENTS TO MEDICAL STUDENTS’ PARTICIPATION IN THE GYNAECOLOGY CLINIC: AN AFRICAN PERSPECTIVE H. Ezegwui, A. Adiuku-Brown, I. Ezegwui, B. Ozumba. Department of Obstetrics GynaecologyCollege of Medicine Universityof Nigeria EnuguCampus, Enugu, Nigeria Objectives: This study was undertaken to determine the attitude of

patients to the participation of medical students in their evaluation in the gynaecology clinic from an African perspective. Method: This was a descriptive cross sectional survey. Selfadministered questionnaires were given to consecutive patients attending the gynaecology clinic of the University of Nigeria Teaching Hospital Enugu. Results: 195 Patients were studied. Most (n=147, 75.4%) were willing to allow medical students participate in their consultation. Some (n=78, 66.1%) preferred they participate in the history taking only. Seven (3.5%) refused any form of participation. About three-quarters (75.4%) were comfortable giving their history in the presence of female medical students; whereas only 35.6% reported same for examination in the presence of male medical students. Age and marital status were identified as influencing the acceptance of medical students of either sex. Older women that are married and had children were more agreeable to medical students’ participation. Conclusions: Majority of the women were willing to allow medical students participate in their assessment in the gynaecology clinic, but there is a preference for female students. It may be preferable to target older and married women for involvement in education of medical students. FCS02.2 HUMAN RESOURCES FOR HEALTH (HRH) PROGRAM IN RWANDA: BUILDING CAPACITY FOR GYNECOLOGY ONCOLOGY TRAINING IN OBSTETRICS AND GYNECOLOGY RESIDENCY R. Ghebre 1,2 , U. Magriples 3 , P. Bagambe 4 , R. Petersen 2 , D. Ellis 1 , M. Small 1,5 , W. Hill 1,5 , T. Randall 6,7 , S. Rulisa 4,8 . 1 1Human Resources for Health Program Rwanda, Kigali, Rwanda; 2 Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA; 3 Department of Obstetrics, Gynecology & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA; 4 Department of Obstetrics and Gynecology, Faculty of Medicine, University of Rwanda, Kigali, Rwanda; 5 Department of Obstetrics and Gynecology, Duke University School of, Durham, North Carolina, USA; 6 Department of Obstetrics and Gynecology, Harvard Medical School, Boston, Massachusetts, USA; 7 Global Oncology Initiative, Harvard Cancer Center, Boston, Massachusetts, USA; 8 Department of Clinical Research, University Teaching Hospital of Kigali, University of Rwanda, Kigali, Rwanda Objectives: The 1994 genocide in Rwanda had devastating effects on healthcare and education. In response to this crisis, the government set specific healthcare goals to be met by 2020. In 2012, the HRH program was developed through the Rwandan Ministry of Health in partnership with the Clinton Health Access Initiative and US and Rwandan academic institutions. This seven-year program aims to improve healthcare outcomes through medical education and management models. Presently, there is no in-country gynecology oncologist. It is imperative to incorporate a gynecologic oncology curriculum into medical school and residency education in order to advance women’s health in Rwanda. Method: We evaluated the growth of the existing residency program and developed a gynecology oncology curriculum for Obstetrics and Gynecology residents to be incorporated into the four-year formal Obstetrics and Gynecology residency at the University of Rwanda, College of Medicine and Health Sciences. This curriculum was implemented through lectures, skills labs, and clinical work at two of the six sites where residents train through the University of Rwanda, the University Teaching Hospital of Kigali (CHUK) and the University Teaching Hospital of Butare (CHUB). Additional needs for the curriculum were assessed through focus group discussion with residents and staff at each site. Results: The residency program expanded from 17 residents in 2012 to 47 residents in 2015. Residency education takes place at two teaching hospitals and four district hospitals. The curriculum is ex-

Free Communication (Oral) Presentations / International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313

ecuted through morning report at all sites, weekly scheduled didactics, bedside teaching on daily rounds, direct operating room supervision, and research mentorship. In 2014–2015, nine US faculty were recruited including one full time US board certified gynecology oncologist. A Gynecology Oncology curriculum was incorporated into the formal training program with a focus on: cervical cancer, breast cancer, gestational trophoblastic disease and complex pelvic surgery techniques. Conclusions: Despite significant advances in maternal and fetal health outcomes in Rwanda there is still room for improvement, specifically in gynecologic oncology. The HRH model of consortium of US academic institutions and University of Rwanda partnership to implement gynecology oncology residency training is a unique model of post graduate education. The partnering of US faculty and University of Rwanda faculty to implement the curriculum is one model of sustainable medical education in low resource setting. There is still need for further investigation regarding the efficacy of the entire curriculum which would require competency based testing. FCS02.3 DEVELOPMENT OF AN INTERN EDUCATION CURRICULUM IN OBSTETRICS AND GYNAECOLOGY AT QUEEN ELIZABETH CENTRAL HOSPITAL IN MALAWI A. Kachikis 1 , R. Tildesley 2 , P. Bonongwe 4 , F. Taulo 1 , A. Msusa 1 , R. Mataya 1,3 . 1 University of Malawi College of Medicine, Blantyre, Malawi; 2 Wirral University Hospital Trust, Liverpool, UK; 3 Loma Linda University, Loma Linda, USA; 4 Malawi Ministry of Health, Blantyre, Malawi Objectives: Before becoming qualified physicians, newly graduated medical officers in Malawi are required to complete an 18-month internship. Six months are spent in the obstetrics and gynaecology departments at either Kamuzu Central Hospital in Lilongwe or Queen Elizabeth Central Hospital in Blantyre. Following their internship, the majority of medical officers are assigned to work at the district health offices or district hospitals with minimal or no supervision of specialist physicians. The objective of the intern education curriculum is therefore to solidify key concepts in obstetrics and gynaecology and to create a standardized competency-based training curriculum. Method: Key educational topics and essential practical skills have been identified and developed into twelve educational sessions. Each session is designed to have a discussion on one of the key topics followed by practical skills training. The education sessions take place on a weekly basis. Following the twelve weeks, the sessions are then re-cycled, giving opportunity for each intern to attend the majority of the sessions. Results: The teaching sessions began in November of 2014. The number of intern participants has ranged from 5–12 interns per week. The educational sessions cover topics ranging from obstetrics to benign gynaecology, gynaecologic oncology and family planning. The practical skills sessions involve basic surgical skills, caesarean sections, operative deliveries, obstetric emergencies, ultrasonography, cardiotocography, WHO contraceptive eligibility criteria and cervical cancer screening. To date, over 30 interns have participated in the educational sessions. Conclusions: Participant feedback has been positive, although some interns report difficulty balancing clinical responsibilities with the education sessions. Some interns have even expressed the desire for more hands-on training. The next step of the education program is to develop competency forms for practical skills such as caesarean sections and basic ultrasonography that must be signed-off by consultants or upper-level registrars. Another step is to conduct research regarding the impact of the program. Increased attention must be given to providing continuing education and practical skills training to medical officer interns in order to help improve mother and child health in rural Malawi.


FCS02.4 ASSESSING THE IMPACT ON SAFETY CULTURE OF INTRODUCING A MULTI-PROFESSIONAL TEAM TRAINING DAY TO A GYNAECOLOGY UNIT S. Channing 1 , N. Ryan 1 , K. Collins 2 , S. Barnes 3 , J. Mears 2 , T. Draycott 2 , D. Siassakos 2 . 1 St. Michael’s Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK; 2 Southmead Hospital, North Bristol NHS Trust, Bristol, UK; 3 University of Bristol, Bristol, UK Objectives: Team training is embedded into the obstetrics department at North Bristol NHS Trust and there is evidence that it improves care and outcomes. A recent study has also shown that implementing team training on general surgical wards within the same hospital, using the same model of on-site multi-professional drills for all staff, can improve safety culture beyond maternity. The objective of this study was to determine whether the introduction of a multiprofessional team training day, based on the local obstetric model, would also improve safety culture in our gynaecology unit. Method: This interrupted time-series study evaluated the impact of introducing multi-professional training for all doctors, nurses and HCAs working regularly on the gynaecology unit. Two sessions ran with all staff encouraged to register to attend. Safety culture was measured using an adapted version of the validated (Sexton) “Safety Attitudes Questionnaire”. 42 (82%) of eligible staff completed the questionnaire before the introduction of training and 30 (67%) completed it 14 months later. Results: The baseline scores before implementation of training were lower than those seen in several other studies looking at safety culture, including those of our adjoining maternity unit. It was much more difficult to establish training on the gynaecology ward, despite it being adjoined to a unit with strong track record of training and international reputation for impact on outcomes. After training, there was large improvement in scores for safety climate (62.41 pre-training to 66.51 post-training) and job satisfaction (57.71 pretraining to 63.41 post-training). Conclusions: Low baseline safety climate scores in our gynaecology unit coincided with difficulty in establishing training. We encountered several challenges, including the cancellation of days due to staff being unable to be released to attend. It Is possible that those wards that need training the most, because of poor safety culture, are also the ones where training is most difficult to establish. Now that we know that multi-professional training works, we need to understand how to address the barriers to getting it started. FCS02.5 SIMULATED ROBOT ASSISTED MYOMECTOMY USING A 3-D PRINTED MODEL M. Towner 1 , J. Stone 1 , J. Carrillo 1 , W. Vitek 1 , G. Frishman 2 , A. Ghazi 1 , B. Bhagavath 1 . 1 University of Rochester Medical Center, Rochester, NY, USA; 2 Alpert Medical School at Brown University, Providence, RI, USA Objectives: To design an inexpensive, novel, high fidelity simulated inanimate model for physical learning experience (S.I.M.P.L.E.) that offers a platform for training advanced MIS skills in Gynecology. Method: Using a proprietary method, anatomically correct models of the human uterus and relevant structures were created using poly-vinyl alcohol (PVA) hydrogels. These are achieved through graded polymerization of the hydrogel by inducing crosslinks during freeze/thaw (FT) cycles, thereby stiffening the structure to the desired consistency. An expert in the field performed a simulated robot assisted myomectomy and completed a structured questionnaire. Three additional experts assessed the recorded procedure. Results: The model was determined to have high face validity (average score of 4.17/5), calculated by ratings of realism. Usefulness of


Free Communication (Oral) Presentations / International Journal of Gynecology and Obstetrics 131, Suppl. 5 (2015) E72–E313

the model as a training tool, demonstrated content validity with an average score of 4.56/5. Conclusions: Our realistic, inexpensive, high fidelity model offers an optimistic platform for procedural Gynecology simulation. If combined with the current basic task training, it could offer comprehensive training prior to operative exposure. FCS02.6 MEDICAL STUDENTS ARE AFRAID TO INCLUDE ABORTION IN THEIR FUTURE PRACTICES: IN-DEPTH INTERVIEWS IN MAHARASTRA, INDIA S. Sjostrom 1,2 , B. Essén 2 , K. Gemzell-Danielsson 1 , M. Klingberg-Allvin 1,3 . 1 Department of Women’s and Children’s Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Stockholm, Sweden; 2 Department of Women’s and Children’s Health/IMCH, Uppsala University, Uppsala, Sweden; 3 School of Health and Social Sciences, Dalarna University, Falun, Sweden Objectives: To explore the attitudes and perceptions toward abortion care services, medical abortion and task shifting in abortion care, among medical students in Maharastra, India. Method: We used a qualitative emergent design conducting in-depth interviews with twenty-three medical students in Maharastra applying a topic guide. Data was organized using thematic analysis with an inductive approach. Results: Participants described a fear to provide abortion in their future practice. They lacked understanding of the law and confused the legal regulation of abortion with the law governing sex selection, concluding that abortion is illegal in Maharastra. Medical students’ attitudes were supported by their experiences and perceptions from the clinical setting as well as traditions and norms in society. Medical abortion using mifepristone and misoprostol was believed to be unsafe and prohibited in Maharastra. Students perceived that nursemidwives were knowledgeable in Sexual and Reproductive Health and many found that they could be trained to perform abortions in the future. Conclusions: To increase chances that Medical students in Maharastra will perform abortion care services in their future practice it is important to strengthen their confidence and knowledge through improved medical education including value clarification and clinical training. FCS02.7 MODIFIED OPEN PRIMARY TROCAR ENTRY IN GYNECOLOGICAL LAPAROSCOPY – A BETTER OPTION S. Sud. Sud Surgical & Laparoscopy Hospital, Nagpur, Maharashtra, India Objectives: To compare ease of technique and complications of modified open laparoscopy primary trocar entry with closed veress needle entry. Method: A retrospective comparative study of ease of technique and intraoperative and postoperative complications in all gynecological patients including previous laparotomy undergoing diagnostic and therapeutic laparoscopy via modified open primary trocar entry and closed veress needle entry over a period of 7 year period from Jan 1, 2008 to Dec 31, 2014 at a private hospital, Nagpur,India.2420 women underwent laparoscopy using modified open primary trocar entry (n=1570) and closed veress needle entry (n=850). Statistical analysis done by using percentages & chi square test. P values <0.05 were considered as significant. Results: Recorded intraoperative and postoperative complications in modified open primary trocar entry include failure to enter (0.25%), omental injury (0.31%), subcutaneous emphysema (0.12%), surgical site infection (0.25%) and non-cosmetic healing (0.25%). Closed veress needle entry include vascular injury (0.35%), visceral injuries (0.23%),

failure to enter (0.5%), omental injury (1%), subcutaneous emphysema (0.7%), surgical site infection (0.58%)and non-cosmetic healing (0.23%).Closed veress needle entry shows statistically significant higher rate of vascular injury, failure to entry, subcutaneous emphysema, surgical site infection and omental injury (p<0.05). Ease of technique found in modified open primary trocar entry. Conclusions: Primary trocar puncture is one of the most common causes of injury in laparoscopy. The most prominent entry in gynecological laparoscopic surgery remains a closed technique. This technique has unfortunately been demonstrated in multiple series to have the potentials for visceral and vascular injuries due to its blind insertion of veress needles and trocars. In this study, modified open primary trocar entry technique is found to be an easy, safe and effective method of obtaining access to the abdominal cavity with fewer complications in comparison to closed veress needle entry.

FCS03. Sexual and Reproductive Rights FCS03.1 PREVALENCE AND PATTERN OF RAPE AS ATTENDED, IN ENUGU STATE UNIVERSITY TEACHING HOSPITAL, SOUTH EAST NIGERIA S.R. Ohayi 2 , E.C. Ezugwu 1 , C.O. Chigbu 1 , S.U. Arinze-Onyia 2 , C.A. Iyoke 1 . 1 Department of Obstetrics & Gynaecology, University of Nigeria Teaching Hospital, Ittuku-Ozalla, Enugu State, Nigeria; 2 Enugu state University Teaching Hospital, Enugu, Enugu State, Nigeria Objectives: To determine the prevalence and pattern of rape as attended, in Enugu State University Teaching Hospital, South east Nigeria. Method: A prospective descriptive study of female victims of rape that presented at the emergency gynecological and/or forensic unit of Enugu State University Teaching hospital (ESUTH) over 18 months period between 1st February, 2012 and 31st July, 2013. All female rape victims who reported at the hospital were counseled and informed consent was obtained from each participants. Data were collected using a pretested interviewer- administered questionnaire. Analysis was done using Epi info version 17. P value less than 0.05 was considered statistically significant. Ethical approval for the study was obtained from the hospital Ethics committee. Results: There were 121 reported rape victims and 1374 gynaecological emergencies giving a prevalence rate of 8.81% of all gynaecological emergencies. The mean age of the rape victim was 13.05±8.13 years. Majority (n=90, 74.4%) of the victims were below the age of 18 years. Although majority of the rape cases in both group were penetrative (74.4%), non-penetrative sex was ten times higher among young victims less than 18 years. None of the victims reported use of condom by the perpetrators.Majority (n=74, 61.2%) of the victims reported late at the hospital. Four (3.3%) of the victims became pregnant. Conclusions: A significant number of women that presented at the Gynecology emergency/forensic unit of ESUTH were victims of rape. As we condemn such abuse of sexual and the reproductive right of women, victims should be encouraged to report early at the hospital for prompt intervention to prevent unwanted pregnancy and possibly sexually transmitted disease. FCS03.2 ENHANCING THE VALUE OF WOMEN RIGHTS THROUGH IMPLEMENTATION OF COMMUNITY BASED INTERVENTIONS IN TWO GOVERNORATES OF UPPER EGYPT A. Metwally, R. Saleh, A. Tawfik, L. El Etreby, S. Salama, S. Hemeda, T. Taha. National Research Center, Dokki- Giza, Egypt Objectives: To evaluate the influence of the use of educational and promotional material along three years on enhancing the awareness

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of the women about their reproductive rights during pregnancy and postpartum period for requesting adequate care either in pregnancy, labor, or puerperium. Method: An interventional study was conducted among 1150 married women in the reproductive age in El Fayoum and Benisuef governorates of Egypt. The study passed through three stages; preinterventional assessment of women awareness, educational interventions targeting the health providers and women in their communities, and post-intervention evaluation of the change in the women’s awareness by their rights for prenatal, natal and postnatal care. Results: The studied indicators related to receiving care either in pregnancy, labor, or puerperium have changed dramatically as a result of the project interventions. The percentages of women who new their right to have pregnancy card increased and those who possessed a pregnancy card were doubled. Some indicators showed improvement more than 75%, out of which; percent of surveyed women who know that it’s their right to follow up their pregnancy and to deliver with a specialized doctor, a trained nurse or at an equipped health facility, and those who know their right to have safe delivery at home. Conclusions: More work is needed in in order to reach the required achievement for maternal mortality reduction through ensuring accessible and high quality care before provided by the governmental health facilities together with increasing the awareness of women regarding their rights in receiving such care. FCS03.3 PERCEPTIONS OF MARRIED IRANIAN WOMEN REGARDING SEXUAL RIGHTS R. Janghorban 1,2 , R. Latifnejad Roudsari 2 , A. Taghipour 5 , M. Abbasi 3 , I. Lottes 4 . 1 Department of Midwifery, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran; 2 Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran; 3 Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; 4 Department of Sociology and Anthropology, University of Maryland, Baltimore County, Baltimore, USA; 5 Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran Objectives: There has been a recent shift in the field of sexual health, representing a move away from biomedical concerns to sexual rights frameworks. However, few studies on sexuality are based on a rights framework. The unspoken nature of sexuality in Iranian culture has led to a lack of national studies on the topic. The objective of this study was to explore the perceptions of married Iranian women on sexual rights in their sexual relationships. Method: In this grounded theory study, 37 participants (25 married women, 5 husbands, and 7 midwives) were selected. Data were collected through in-depth interviews and analyzed through open, axial, and selective coding using MAXQDA software version 2007. Results: The analysis revealed the core category of women’s sexual relationships: “sexual interaction in the shadow of silence”. The interrelated categories subsumed under the core category included adopting a strategy of silence, trying to negotiate sex, seeking help, and sexual adjustment. Conclusions: The silence originating from women’s interactions with their families and society, from girlhood to womanhood, was identified as the core concept in Iranian women’s experiences of sexual rights. A focus on husbands’ roles seems salient because they can direct or alter some learned feminine roles, especially silence regarding sexual matters, which then affects the realization of women’s sexual rights.


FCS03.4 SMART INVESTMENT: YOUNG PEER EDUCATORS SERVING AS A BRIDGE TO LINK DEMAND AND SUPPLY OF SEXUAL AND REPRODUCTIVE HEALTH SERVICES IN SOUTHERN REGION, ETHIOPIA M. Soressa. Pathfinder International, Hawassa, Southern Nations Nationalities and Peoples Region (SNNPR), Ethiopia Objectives: There are over 29 million young people (aged 10–24) in Ethiopia. These young people face high rates of early marriage, unintended pregnancy, sexually transmitted infections, HIV infection, and maternal mortality and morbidity. Peer education programs focused on building the capacity of young people to educate their peers about healthy sexual and reproductive behaviors can have a positive impact on young people. Method: From 2008 to 2013, Pathfinder International supported a peer education program that aimed to reach large concentrations of youth in Ethiopia through the Integrated Family Health Program. The program recruited 2,550 in-school and out-of-school volunteer peer educators and trained them in basic peer education and counseling skills. Peer educators were then tasked with promoting positive adolescent and youth sexual and reproductive health messages, and facilitating referrals for health services. Results: From July 2008 to June 2013, peer educators reached more than 1.6 million youth with sexual and reproductive health messages, and mobilized and enabled more than 665,000 youth to obtain a range of sexual and reproductive health services (e.g., ANC, PNC, FP, PAC, PMTCT, STI treatment) in health facilities through direct visits and referrals. Peer educators also supported 1,280 young women to access post-abortion care services in nearby health facilities. Conclusions: Peer education programs with a strong adolescent sexual and reproductive health component present a powerful modality for engaging young people in health-seeking behaviors. In turn, healthier young people are more likely to continue their education, secure more stable sources of income, have healthier children, and become active, engaged citizens. FCS03.5 DISRESPECT AND ABUSE DURING FACILITY-BASED CHILDBIRTH: A CASE OF FOUR RURAL HEALTH FACILITIES IN TWO REGIONS OF ETHIOPIA M. Muleta 1 , K.P. McDonald 2 , H. Ratcliffe 2 , W. Betemariam 1 . 1 The Last 10 Kilometers Project, Addis Ababa, Ethiopia; 2 Maternal Health Taskforce, Boston/MA, USA Objectives: Disrespect and abuse during facility-based childbirth results from a complex interplay of socio-cultural and health systemrelated factors and is an invisible barrier to achieving good maternal health outcomes. Emerging evidences have described a variety of disrespectful and abusive experiences that women face during childbirth. These include categories of disrespect & abuse highlighted in a 2010 landscape review by Bowser and Hill: physical abuse, nonconsented care, non-confidential care, non-dignified care, discrimination, detention, and abandonment of care. This study was aimed at assessing the prevalence and driving factors of disrespect & abuse and how disrespect and abuse manifest itself within health system. Method: The study was conducted in four health centres located in two regions of Ethiopia and employed a non-random allocation, selfcomparison (before and after intervention) design. Two hundreds and four women who gave birth in these facilities were interviewed to explore their experience during labour and delivery, with special attention paid to instances of disrespect and abuse. Bi-variate analyses were carried out to examine the relationship between experience of disrespect and abuse and selected demographic and facility factors. Statistical significance was considered at P-value less than 0.05. Results: Overall, 21% of women reported any experience of disre-


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spect or abuse. The most commonly reported categories of disrespect and abuse were non-consented care (17.7%), lack of privacy (15.2%), & non-confidential care (13.7%).Women who were Christians; from urban; who have delivery related complications; had not previously delivered at the same health facility; and who gave birth during weekday were respectively 6.25, 2.5, 7.98, 3.2 and 1.5 times more likely to report experiencing disrespect & abuse (p<0.001; p=0.009; P<0.001; p=0.013 and P<0.005 respectively). More maternity beds & BEmONC trained staffs had a less likely and significant association with reports of disrespect and abuse. Conclusions: The study results show that disrespectful and abusive behaviours are prevalent issues at the study health facilities and intervention is warranted. The drivers and enablers of these behaviours are varied, and include both structural and interpersonal factors. With the global health community rallying around universal health coverage to be included in the post-2015 development agenda, these individual and structural factors must be considered to ensure that mothers receive not just access to health services, but attain the highest level of respectful and dignified care. FCS03.6 CONSCIENTIOUS OBJECTION TO THE PROVISION OF REPRODUCTIVE HEALTHCARE: GLOBAL DOCTORS FOR CHOICE EXAMINES PREVALENCE, HEALTH CONSEQUENCES, AND POLICY RESPONSES W. Chavkin 1,2 . 1 Columbia University, NY, NY, USA; 2 Global Doctors for Choice, NY, NY, USA Objectives: 1) To examine the global prevalence of conscientious objection by physicians to providing legal reproductive health care (abortion, assisted reproductive technologies, contraception, post abortion care, treatment in cases of maternal health risk and inevitable pregnancy loss, and prenatal diagnosis). 2) To review policy and regulatory efforts to balance individual conscience, patient autonomy in reproductive decision-making, safeguards for health, and professional medical integrity. Method: Systematic literature searches of the medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. The search was complicated by the lack of consensus about criteria for objector status and the lack of a standardized definition of the practice. Many of the quantitative, qualitative, and ethnographic studies reviewed have non-representative or small samples, low response rates, and other methodological limitations that limit their generalizability and fitness for a systematic review. Nevertheless, they were included because available data were so sparse. Results: The sturdiest estimates of prevalence come from the few places that require objectors to register and range from 14% in Hong Kong to 70% in Italy. Some studies describe physicians whose objections are not absolute but reflect opinions about patient characteristics, reasons for seeking abortion, experience of stigmatization, or opportunism. Lower rates of objection were associated with higher levels of training and experience. Several studies report consequences of institutional-level refusal of care, such as delays, or quality of care at odds with best practices, particularly involving treatment of ectopic pregnancy, maternal medical complications, and post abortion care. Conclusions: Empirical evidence is essential in order to design policies that honor individual integrity while safeguarding patients’ access to legal care. Further research could clarify the role of provider desire to avoid stigma or burdensome administrative processes; to earn more money by providing services in private practice rather than in public facilities; and lack of access to clinical training, necessary supplies or equipment. With dual commitments toward their own conscience and their obligations to patients’ health and rights, physicians and professional medical societies can lead attempts to

respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women’s lives. FCS03.7 EXPERIENCE OF SEXUAL VIOLENCE AND RISK BEHAVIOURS AMONG FEMALE UNIVERSITY STUDENTS IN BENIN CITY, NIGERIA K. Agholor 1,2 , F. Okonofua 2,3 , R. Ogu 2,4 , M. Ezeanochie 2,3 , T. Owolabi 2 . 1 Central Hospital, Warri, Delta State, Nigeria; 2 Women’s Health and Action Research Centre (WHARC), Benin City, Edo State, Nigeria; 3 University of Benin, Benin City, Edo State, Nigeria; 4 University of Port Harcourt, Port Harcourt, Rivers State, Nigeria Objectives: Despite evidence that education may act as a protective factor against sexual violence, many young women in educational institutions continue to experience sexual violence in Nigeria. The present study was therefore conducted in order to increase our understanding of sexual violence experience and associated risk behaviours of current Nigerian female university students. Method: We conducted a cross-sectional survey that enrolled a total of 637 randomly selected female undergraduate students of the University of Benin, Edo State, living in two types of student accommodations from May to June 2013. The instrument used was a 20 item semi-structured self-administered questionnaire that covered four domains: Sex free survival and age at first sex; Experience of sexual violence; Risk behaviours and unintended pregnancy. Bivariable and multivariable logistic regression models were used to assess the relationship between sexual violence and current risk behaviours and unintended pregnancy. Results: Roughly 40% of the students reported previous experience of sexual violence. Forced sex, coerced sex and sexual deception were associated with early sexual initiation (adjusted hazard ratio (AHR) = 1.9; 95% CI [1.4, 2.7]; AHR=2.0; 95% CI [1.4, 2.7]; and AHR=2.4; 95% CI [1.7, 3.4] respectively) and alcohol drinking (adjusted odds ratio (AOR) = 3.4; 95% CI [1.7, 6.6]; AOR=4.2; 95% CI [2.3, 7.8]; and AOR=2.6; 95% CI [1.2, 5.2] respectively). Coerced sex and sexual deception were associated with unintended pregnancy (AOR=1.8 [1.2, 3.2] and AOR=2.2; 95% CI [1.1, 4.4] respectively). Conclusions: A non-negligible proportion of female university students in Nigeria reported that they had experienced sexual violence in the past. As early sexual initiation, alcohol consumption and cigarette smoking were risk behaviours associated with sexual violence, the inclusion of early adolescent girls in female empowerment programmes targeted at educating them about their sexual and reproductive health rights will be useful in the prevention of sexual violence. Additionally, alcohol prevention programmes may also be warranted in university student residences. FCS03.8 CLIENT-PROVIDER COMMUNICATION ABOUT CHILDBEARING AND USE OF SAFER CONCEPTION METHODS AMONG HIV-POSITIVE CLIENTS IN UGANDA J. Beyeza-Kashesya 1 , R. Wanyenze 2 , S. Finocchario-Kessler 3 , M. Atakilt Woldetsadik 7 , D. Mindry 4 , S. Khanakwa 5 , K. Goggin 6 , G.J. Wagner 7 . 1 Mulago Hospital, Department of Obstetrics and Gynaecology, Kampala, Uganda; 2 Department of Disease Control and Environmental Health, Makerere School of Public Health, College of Health Sciences, Makerere Uninversity, Kampala, Uganda; 3 University of Kansas Medical Center, Department of Family Medicine, Kansas City, USA; 4 University of California, Los Angeles Center for Culture and Health, Los Angeles, USA; 5 The AIDS Support Organization, Kampala, Uganda; 6 Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics; Schools of Medicine and Pharmacy, University of Missouri, Kansas City, USA; 7 RAND Corporation, Santa Monica, USA Objectives: Many HIV sero-discordant and concordant positive couples living in sub-Saharan Africa desire to have children. Limited in-

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formation exists on their support for sexual and reproductive health matters including the use of safer conception methods (SCM). Our study explored the client-provider communication about childbearing and safer conception. Method: A sample of 400 HIV clients in committed relationships and with intentions to conceive a child within next two years was surveyed at The AIDS Support Organization (TASO) sites in Kampala and Jinja, Uganda. Knowledge, attitudes and practices related to childbearing and use of safer conception methods were assessed, as well as communication with providers about childbearing, which is the focus of this analysis. Results: 75% of sample are female; 61% are on antiretroviral therapy; and 61% have HIV-negative or unknown status partners. 92% wanted a child within the next 12 months. 98.0% desired to discuss childbearing intentions with their HIV-provider, however, only 56% had discussions. 28% reported their provider initiated childbearing discussions (HIV transmission-risk to partner (30%), to child (30%), and about PMTCT (27%)). Only 8% discussed safer conception methods. Females were more likely to discuss childbearing with their HIV provider (Adjusted OR 1.79 (1.04, 3.08)). However, clients with greater internalized childbearing-stigma were less likely to discuss (Adjusted OR 0.68 (95% CI 0.48, 0.98)). Conclusions: Most discussions about childbearing are initiated by HIV-positive clients rather than their providers, and only 8% include discussion of safer conception methods. Clients’ internalized childbearing stigma is a key barrier to clients communicating with providers about their childbearing intentions. There is need for programs to mitigate childbearing stigma among HIV clients and their providers to enable discussion of SCM for HIV-positive people. FCS03.9 YOUNG PEOPLE, CONTRACEPTION AND ABORTION: FIGO BRINGS TOGETHER OBSTETRICIANS AND GYNECOLOGISTS WITH REPRODUCTIVE HEALTH AND ADVOCACY GROUPS TO MOVE THE AGENDA FORWARD REGARDING SERVICE QUALITY, ACCESS, AND PARTNERSHIP WORKING IN THREE SOUTH ASIAN COUNTRIES – BANGLADESH, INDIA AND PAKISTAN J. Morris 1 , H. Rushwan 1 , S. Zaidi 2 . 1 FIGO, London, UK; 2 Ziauddin Medical University, Karachi, Pakistan Objectives: Building on FIGO’s experience delivering regional workshops on unsafe abortion and regional discussion groups between obstetricians and young people, this workshop aimed to bring together obstetricians/gynecologists with members of reproductive health and advocacy groups to generate practical and innovative strategies for improving adolescent sexual and reproductive health. By bringing representatives from these two groups together to share experiences and ideas, it was anticipated that they would be able to work together as part of a more joined-up approach to improving sexual and reproductive healthcare for young people, while also strengthening the capacity of obstetricians/gynecologists to be advocates in this area. Method: A two day interactive workshop was held in March 2015. Participants included FIGO delegates, young obstetricians/gynecologists from member associations, medical students, and delegates from youth advocacy and reproductive health organizations. The workshop had three aims: 1) increase knowledge, specifically regarding medical eligibility and quality of care considerations, 2) create awareness of and mutual understanding between the different groups represented with a view to future collaboration, 3) improve advocacy skills needed for the following: ensure young people are viewed as a priority group with specific needs, and increase young people’s access to quality information, education, and safe contraceptive and abortion services. Results: The workshop was highly participatory and produced tangible results. These included a joint statement from the participants


calling for action on increasing young people’s access to safe abortion and contraception services, along with the development of three SMART (specific, measurable, achievable, realistic and timely) action plans. These plans outlined collaborative activities to be conducted in the respective countries within the next 6 months. Enthusiastic young obstetricians/gynecologists advocated for the inclusion of these action plans into their country’s plan in the subsequent annual FIGO “Prevention of Unsafe Abortion” Workshop. Delegates’ feedback from the workshop was positive, indicating goals of increased knowledge, understanding and empathy as well as improved advocacy skills were achieved. Conclusions: Obstetricians/gynecologists and activists can and should work together to identify ways to increase young people’s access to high quality and safe contraceptive and abortion services and information. From bringing together these two groups, activists are able to identify ways of including practitioners in their advocacy work and obstetricians/gynecologists are able to provide better sexual and reproductive care for young people as well as identify how they can advocate for increased attention on young people, and provision of improved and accessible services. By working together, obstetricians/gynecologists and activists can bring better coordination between information and health services to this priority group.

FCS04. Sexual and Reproductive Rights FCS04.1 “WE DO NOT KNOW WHAT IS HAPPENING INSIDE A WOMAN’S BODY”: A QUALITATIVE INVESTIGATION OF AFRICAN REFUGEE WOMEN’S POST-RESETTLEMENT REPRODUCTIVE HEALTH CONCEPTUALIZATIONS P. Royer 1 , B. Jackson 2 , L. Olson 1 , E. Grainger 1 , D. Turok 1 . 1 University of Utah, Salt Lake City, UT, USA; 2 Unaffiliated, Salt Lake City, UT, USA Objectives: To explore post-resettlement perceptions of reproductive health among African refugee women in the United States. Method: Six focus groups (FG) were conducted with resettled Somali (n=41) and Congolese (n=26) refugee women in a large western United States city between May and August 2014. Participants were recruited via community leaders and refugee service organizations. FG were conducted in the women’s native language using a semi-structured interview guide of open-ended questions designed to elicit understanding of reproductive health perceptions and understanding. FG Audio recordings were translated and transcribed verbatim by externally located certified translators then checked for accuracy. Two researchers utilized modified grounded theory to analyze transcripts and develop themes using Atlas.ti software. Results: Median participant age was 36 years, time since resettlement was greater for Somali women than Congolese women (median: 54 v. 20 months) and Somali women had greater gravidity than Congolese women (mean: G6 v. G4) though household sizes were comparable (Mean=5). Major themes were analogous across groups and included (1) multidimensional concepts regarding health with an emphasis on the ongoing effects of pre-displacement trauma on current health (2) limited health understanding including poor knowledge regarding anatomy and physiology and (3) barriers to healthcare access including confidentiality concerns, poorly regarded interpreter services and negative interactions with post-resettlement healthcare providers and systems. Conclusions: Post-resettlement reproductive health conceptualizations, beyond obstetrical concerns, are not well-understood. This study provides description of non-obstetric women’s health challenges among resettled African refugee women. Education of refugee health providers regarding these challenges could lead to improvements in resettled refugee reproductive health. Healthcare systems could improve resettled refugee care by providing in person confi-


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dential interpreters and working to decrease barriers to effective care for this population. FCS04.2 VIOLENCE VICTIMISATION ASSOCIATED WITH SEXUAL ILL HEALTH AND SEXUAL RISK BEHAVIOURS IN SWEDISH YOUTH H. Blom 1,4 , U. Högberg 2 , N. Olofsson 3 , I. Danielsson 1,3 . 1 Dept. of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden; 2 Dept. of Women’s and Childrens’s Health, Uppsala University, Uppsala, Sweden; 3 Dept. of Public Health and Research, Sundsvall Hospital, Sundsvall, Sweden; 4 Dept. of Obstetrics and Gynecology, Sundsvall Hospital, Sundsvall, Sweden Objectives: The WHO’s definition on sexual health includes both absence of disease, and also sexual reproductive rights including pleasurable and safe sexual experiences free of coercion, discrimination and violence. Multiple violence victimisation in youth and associations to adverse mental health outcomes is recently more recognised. The aim was to assess associations and gender differences regarding multiple violence victimisation and sexual ill health and sexual risk behaviours in youth. Method: A cross-sectional population-based study in all upper secondary schools in a town in Sweden, with a study response rate of 80%. Only the sexually experienced youth, 1192 women and 1021 men, participated in this study. The questionnaire included validated questions on emotional, physical and sexual violence (NorAQ), sociodemographics, health risk behaviours and sexual ill health and sexual risk behaviours such as treatment for Chlamydia infection, selfreported experience of pregnancy, early age at sexual debut, non-use of contraceptives and several sex partners. Proportions, unadjusted and adjusted odds ratios (OR/aOR) with 95% Confidence Interval (CI) were calculated. Results: The young women had experienced multiple victimisation, i.e. victimisation with two or more different types of violence, more often than the men, 28% respectively 24%. The associations between multiple victimisation and sexual ill health/sexual risk behaviours were overall consistent for both genders, with raised aORs for experience of/involvement in pregnancy, 2.4 (1.5–3.7) for women and 2.1 (1.3–3.4) for men, and early age for first intercourse, 2.2 (1.6–3.19 for women and 1.9 (1.2–3.0) for men. No significantly raised aOR was found for non-use of contraceptives latest intercourse in both men and women. Conclusions: Multiple-violence victimisation is strongly associated with several sexual ill- health variables and sexual risk behaviours in both genders. This should be taken into consideration when counselling and addressing sexual reproductive health in youth. FCS04.3 MOBILIZING RELIGIOUS LEADERS AND FAITH-BASED ORGANIZATIONS IN AFRICA TO SCALE UP FAMILY PLANNING AND REPRODUCTIVE HEALTH (FP/RH) BEST PRACTICES AMONG AFRICAN CHRISTIAN HEALTH ASSOCIATIONS PLATFORM (ACHAP) MEMBERS S. Bitar. Evidence to Action Project, Washington, DC, USA Objectives: The Evidence to Action (E2A) Project builds evidence on new approaches to scale up FP/RH best practices. With technical assistance from E2A and ACHAP as a platform for dissemination and advocacy, E2A is testing an approach that engages religious leaders in FP programs to increase contraceptive use among those served by three faith-based service-delivery organizations in Africa. The approach aims to facilitate the adoption and scale-up of FP/RH services by building the capacity of teams of religious leaders, communityand facility-based providers, and ACHAP member organizations to enhance quality, reach, and supply of FP/RH services and improve reproductive health outcomes.

Method: E2A grants support faith-based organizations in Ethiopia, Kenya, and Uganda to engage religious leaders to encourage support for FP, work with community outreach workers to increase demand for and use of FP services among the populations served, improve the community-based provision of short-acting FP methods and referrals to nearby health facilities for long-acting methods, and enhance the quality of facility-based services. E2A’s technical assistance to the grantee organizations includes training religious leaders on FP/RH messages to share with their communities, and strengthening FP/RH counseling and services, referrals, monitoring and supervision systems, and quality of data at community and facility levels. Results: In Ethiopia, through community-based health education, which has reached approximately 55,000 people, and FP counseling, there were 3,989 new FP acceptors from October-December 2014. Intrauterine device insertion began during that period at all health centers supported by the grant, and vasectomy is being offered in one remote area. In Uganda, there were 2,815 new FP acceptors at facilities supported by the grant from January-December 2014, and 3,284 awareness-raising events, which reached 43,459 people with FP messages. In Kenya, quality-improvement trainings were conducted for health workers, religious leaders, community health volunteers, and other stakeholders, who form a robust quality-improvement team. Conclusions: With the grants, the three organizations have enhanced and scaled services through efforts that are deeply rooted in the communities they serve. According to the World Health Organization, faith-based organizations, such as the grantees, provide 40% of healthcare in Africa. With modest financial assistance to these organizations, intensive capacity-building of facility- and communitybased FP/RH service providers, a focus on the use of data for decisionmaking, and engagement of religious leaders in support of FP/RH, there is vast potential to improve health outcomes across the continent. Networks such as ACHAP can simultaneously be leveraged to hasten the spread of best practices. FCS04.4 STATUS OF WOMEN’S SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS:A COMPREHENSIVE RIGHTS-BASED MEASURE K. Ocheltree, G. Sarfaty. PAI, Washington, DC, USA Objectives: This report is the fifth in a series that assess the status of nations’ SRHR. While our previous indices frame the issues in terms of sexual and reproductive risk, this iteration deliberately shifts its focus on how to achieve healthy sexual and reproductive health and realize rights. The aim is to provide an assessment that incorporates a multidimensional approach to reproductive health and adds a new perspective to how comprehensive SRHR is defined and measured. The Index and its accompanying report provide a measure of where women 62 low- and lower-middle-income countries stand in attaining SRHR. Method: Based on the 1994 POA of the ICPD, we define SRHR according to the following four dimensions: 1. Preventing unintended pregnancy; 2. Increasing access to safe abortion and post-abortion care; 3. Helping women safely through pregnancy, childbirth and the postpartum period; and 4. Preventing and treating sexually transmitted infections, including HIV/AIDS. A fifth dimension, termed the Enabling Environment, captures factors beyond the health system that support SRHR. To calculate an Index score for each country, 11 indicators representing the dimensions of SRHR were combined into a single measure. The Index is scored on a 0 to 100 scale. Results: Index scores for the 62 countries included in our study range from 25.5 to 86.5. Though scores vary greatly within that range, the fact that no country received a score of 100 means that there are opportunities to advance the sexual and reproductive health and rights of women in all 62 countries.

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The average Index score is 54. Given that the strongest possible state of SRHR in a country according to the Index would be a score of 100, the average indicates that the needs and rights of women in these countries are being only partially fulfilled. Conclusions: Though gaps in meeting the needs and fulfilling the rights of women may be larger in some countries than others, even those countries with higher scores have room to grow. Our analysis indicates that improving the sexual and reproductive health and rights of women in these countries depends on three overarching actions: 1. Strengthen political will and financial commitments; 2. Craft and implement positive policies; and 3. Provide quality information and services. FCS04.5 REDUCING DISRESPECT AND ABUSE DURING FACILITY BASED CHILDBIRTH: PROMISING RESULTS FROM KENYA T. Abuya 1 , C. Warren 2 , C. Ndwiga 1 , A. Maranga 4 , F. Mbehero 3 , A. Njeru 5 , B. Bellows 1 . 1 Population Council, Nairobi, Kenya; 2 Population Council, Washington DC, USA; 3 NNAK, Nairobi, Kenya; 4 FIDA, Nairobi, Kenya; 5 DRH, MOH, Nairobi, Kenya Objectives: Many women continue to deliver at home due to cost, distance, cultural and geographic barriers. However an often overlooked barrier to seeking care is the perceived poor quality of care and fear of experiencing disrespectful and abusive treatment within health facilities. In order to reduce the occurrence of disresepctand abuse during facility deliveries, an implementa