Thursday, March 19, 2015

Reproductive Health: Jessica Gipson

Jessica Gipson, Assistant Professor in the Department of Community Health Sciences in the UCLA Fielding School of Public Health, conducts research on maternal and child health, women’s empowerment, and sexual and reproductive decision-making. A current project, which focuses on a newly constructed Tibetan birth center in western China, furthers her ongoing research on reproductive health issues in lower-income settings. 

On a national level, China is on track to meet the Millennium Development Goal to reduce maternal mortality, but maternal mortality rates remain high in rural, disadvantaged, and ethnically diverse areas of western China. Gipson recently co-authored an article in Reproductive Health Matters on an intervention that was developed based on her Tibetan colleagues’ previous research on barriers to hospital births for rural women in the Qinghai Province. They found that the barriers to hospital delivery included transportation difficulties, lack of accommodation by the hospitals for accompanying families, cost of hospital delivery services, and language and cultural barriers.

Therefore, the research team developed and evaluated a three-level intervention, which took place at county, community, and individual levels. At the county level, they launched the Tibetan Natural Birth and Health Training Centre, where women who would not normally deliver in a hospital could receive accessible, culturally appropriate medical care before, during, and after delivery. At the community level, the team recruited and trained health-care workers in basic obstetrics, in order to provide care to women who deliver at home. Lastly, at the individual level, the Birth Centre provided a Maternal and Child Health Education Handbook to midwives, health workers, and village residents, who were asked to serve as peer educators in their communities. 

Gipson and her colleagues found this three-level approach to be effective, not only in terms of the number of health-care workers trained and the increased utilization of formal delivery services,  but also in terms of the perceptions of maternal health-care and delivery options among the target population of women in the region. The team indicates that although this study was not designed to measure potential reductions in maternal mortality rates, results indicate that the birth center is providing services that the community is utilizing. In fact, when the researchers conducted a survey of the women who had received services at the birth center, 98% of the women reported being “highly satisfied” or “satisfied” with their experience, and 95% of the women reported that they would refer a family member or friend to the birth center in the future. 

There are several points that the authors see as potentially applicable or of interest to other communities. First, the study highlights the barriers faced by women who are giving birth in rural and lower-income communities. It also provides a successful demonstration of a collaboration between an international nonprofit organization, a provincial university, local government agencies, and UCLA. Lastly, it is an example of a “bottom-up” approach, in which community members and local health workers are essential to improving knowledge and utilization of maternal health services in these more remote areas.  

Gipson and her co-authors recently completed another article reporting on findings from the project, “Tibetan Women’s Perspectives and Satisfaction with Delivery Care in a Rural Birth Center,” which will appear in International Journal of Obstetrics & Gynecology. This article uses quantitative and qualitative data to describe the perceptions about delivery care and the characteristics of women who have delivered at the center.  Findings from this study provide preliminary insight into alternate models of care, such as the Tibetan birth center, which may begin to address disparities in maternal care particularly in low- and middle-income countries.
Info on the Tibetan Healing Fund:

Reproductive Health: Christine Dunkel Schetter

With a primary research focus on stress processes in pregnancy, Christine Dunkel Schetter, Professor in the Department of Psychology, Chair of the Health Psychology training program, and Director of the Stress Processes and Pregnancy Lab, recently co-authored two critical papers on women’s perinatal health, one on postpartum depression and one on pregnancy anxiety. In a comprehenssive review on the biological and psychosocial predictors of postpartum depression (PPD) that will appear in the Annual Review of Clinical Psychology, she and her co-authors argue that the literature on postpartum depression generally focuses on the biological predictors of postpartum depression (such as genetic factors) or on the psychosocial predictors (such as stressors and interpersonal relationships). Therefore, the article systematically reviews both bodies of literature, with the intention of identifying ways in which they overlap and might be integrated. Coauthors are Dr. Ilona Yim at UC Irvine, two UCLA doctoral students who now have their Ph.D.s (Dr. Christine Guardino, Dr. Lynlee Tanner Stapleton now at USAID In Washington, DC), and a former UCLA postdoctoral award recipient, Dr. Jennifer Hahn Holbrook, who is now on faculty at Chapman University. 

In terms of the biological literature, they find that “the real challenge facing this field is not in the absence of biological effects, but rather the need to take a more sophisticated approach to testing theoretical premises.” For example, theory suggests that hormonal adaptations established during the course of pregnancy may be disrupted, thus challenging the mother’s body to create a new endocrine balance. However, this area has been largely understudied. In addition, the authors point to problematic issues in the timing of biological measures, as well as how the diagnosis of PPD is often established in biological studies.

In terms of the psychosocial literature, the authors find much stronger empirical support for mainly severe life events, some forms of chronic strain, relationship quality, and support from partner, as the strongest predictors of PPD risk. Based on their findings, the authors call for integrative empirical studies, which look at both biological and psychosocial predictors of pregnancy together. While they recognize the challenges in doing this type of cross-disciplinary research, they suggest that it is needed in order to understand the relationships between biological and psychosocial processes and advance our prevention and treatment efforts. 

Dunkel Schetter also recently co-authored an article with postdoctoral fellow Christine Guardino titled, “Understanding Pregnancy Anxiety: Concepts, Correlates, and Consequences” in a special journal called Zero to Three, 2014). They define pregnancy anxiety as “a negative emotional state that is tied to worries about ‘the health and well-being of one’s baby, the impending childbirth, of hospital and healthcare experiences […], birth and postpartum, and parenting or maternal role. ” Their article indicates that evidence on pregnancy anxiety as a risk factor for preterm birth and child outcomes is building rapidly and makes a good case for interventions to reduce pregnancy anxiety and improve women and children’s outcomes. 

Guardino (shown at right) and Dunkel Schetter also published a study, which was funded by a CSW seed grant, in Journal of Health Psychology on a mindfulness intervention for pregnant anxious women that showed promising effects. Current work is focused on testing alternative interventions—such as cognitive behavioral skills—for reducing anxiety about pregnancy, general anxiety, and depression in pregnancy.

Reproductive Health: Paula Tavrow

Director of UCLA’s Bixby Program in Population and Reproductive Health and Adjunct Associate Professor in the Department  of Community Health Sciences in the UCLA Fielding School of Public Health, Paula Tavrow focuses her research on adolescent reproductive health, coerced sex, and the quality of primary health care in East Africa. 

Before coming to UCLA, she served as the Deputy Research Director for the USAID-funded global Quality Assurance Project (1997–2001), a women’s health advisor and researcher at the University of Malawi’s Centre for Social Research (1993–95), a USAID health officer who helped design Tanzania’s National AIDS Control Program and National Family Planning Program (1987–90), a USAID assistant food for peace officer who assisted Ogadeni refugees in Somalia (1984-86), and a project evaluator for nutrition activities in the Bandundu region of Zaire (1984).

In an article, titled “Community Norms About Youth Condom Use in Western Kenya: Is Transition Occurring?,” published in the African Journal of Reproductive Health, Tavrow and her co-authors describe their findings from focus groups conducted in rural Kenya as part of their evaluation of the Youth for Youth (Y4Y) program. 

They find that although there has been some change in attitude, there continue to be barriers to condom use, particularly for those who view condom use as associated with deviance. They observe that “until all condom users are re-framed as responsible, non-deviant people, sexually-active youths will have difficulty accessing condoms and using them consistently.” In addition, they find differences in attitude by gender, with female students and teachers generally more opposed to condom use than male students and teachers. 

Tavrow et al. suggest that this difference in attitude by gender might be due in part to female students’ greater distrust of male motivations and actions and to their feelings of being less in control of sexual decision-making.  

They end the article with recommendations for how condom use may be encouraged in Kenya, including: eliminating sanctions for students found with condoms at school, discouraging providers from interrogating youths about their reasons for wanting condoms, and focusing the messaging health campaigns so that they portray condoms as effective and respectable, so that their use is encouraged.


Adolescent Reproductive Health in 
Sub-Saharan Africa
UCLA School of Public Health: Continuing the Conversation 
WEBINAR by Paula Tavrow (

Adolescence is generally a period of exploration, identity formation, and risk-taking. For many youths, it is also a time when they are particularly vulnerable to coerced sex, HIV/AIDS ,and unwanted pregnancies. In this recent webinar, Tavrow describes how social, cultural and economic forces in sub-Saharan Africa heighten youths’ vulnerability to reproductive health problems. Drawing on her research in western Kenya, she focuses on two areas: (1) the barriers to effective contraceptive use by rural African adolescents, and (2) the role of traditional male circumcision in rigidifying gender roles. 


Established in 2001 at the UCLA Fielding School of Public Health, the Bixby Center on Population and Reproductive Health promotes and supports students and faculty engaged in research and internships in the areas of population, reproductive health, and family planning. The principal focus of the program is on reproductive health issues in developing countries, where population growth rates remain high and reproductive health services are poor or inaccessible. However, the Bixby Center also works on reproductive health-related issues in the United States. 

Anne R. Pebley, Professor in the Departments of Community Health Sciences and Department of Sociology, is the Center’s Director and Paula Tavrow, Adjunct Assistant Professor in the Department of Community Health Sciences, is the Director of the Bixby Program on Population and Reproductive Health, a central activity of the Bixby Center. The Bixby Program sponsors lecture series, research mentorships, international internships, graduate-level courses in advocacy skills and adolescent health, occasional conferences, a listerv, and two graduate student groups. The Bixby Program also offers a Certificate in Population and Reproductive Health to graduate students in all departments in the UCLA Fielding School of Public Health who complete the requirements.