Browsing by Author "Shankar, Mridula"

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    Menstrual regulation: Examining the incidence, methods, and sources of care of this understudied health practice in three settings using cross-sectional population-based surveys
    (BMC, 2023) Bell, Suzanne O.; Shankar, Mridula; Omoluabi, Elizabeth
    Menstrual regulation is a practice that may exist within the ambiguity surrounding one’s pregnancy status and has been the subject of limited research. The aim of this study is to measure the annual rate of menstrual regulation in Nigeria, Cote d’Ivoire, and Rajasthan, India, overall and by background characteristics and to describe the methods and sources women use to bring back their period. Data come from population-based surveys of women aged 15–49 in each setting. In addition to questions on women’s background characteristics, reproductive history, and contraceptive experiences, interviewers asked women whether they had ever done something to bring back their period at a time when they were worried they were pregnant, and if so, when it occurred and what methods and source they used. A total of 11,106 reproductiveaged women completed the survey in Nigeria, 2,738 in Cote d’Ivoire, and 5,832 in Rajasthan. We calculated one-year incidence of menstrual regulation overall and by women’s background characteristics separately for each context using adjusted Wald tests to assess signifcant. We then examined the distribution of menstrual regulation methods and sources using univariate analyses.
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    Quality of care offered by health care retail markets for medication abortion self-management: Findings from states in Nigeria and India
    (Public Library of Science, 2025) Omoluabi, Elizabeth; Shankar, Mridula; OlaOlorun, Funmilola Morinoye
    Dispensing of misoprostol and mifepristone by pharmacies and chemist shops for self-management of medication abortion (MA) fills a crucial gap in settings where abortion care by trained health professionals is not readily available. This promising service delivery pathway, endorsed by the World Health Organization (WHO), is hindered by concerns of poor-quality care. Simulated clients collected data on MA pill dispensing practices from 92 pharmacies and chemist shops in three Nigerian states and 127 pharmacies in an Indian state that we have anonymized. Guided by the WHO’s abortion guideline, we measured process-related quality indicators such as medication use instructions, warning signs, and respectful treatment among other aspects. We aggregated indicators under three domains: technical competence, information given to clients, and client experience. Overall, 51% of facilities in the Nigerian states and 32% in the Indian state offered MA pills. Most dispensing facilities offered the misoprostol-only regimen in Nigeria (68%) and the combination regimen in the Indian state (83%). Among facilities offering MA pills, 26% in Nigeria and 78% in the Indian state provided correct instructions on route of pill administration. Accurate information on the appropriate interval between pill type in the combination regimen was low in Nigeria (27%) and the Indian state (14%). Excessive bleeding as a warning sign was discussed more frequently in the Indian (56%) versus Nigerian states (32%); other abnormal bleeding patterns were rarely mentioned. Aggregate technical competency scores were low at 18% in Nigeria and 34% in the Indian state, with highest scores for client experience at 90% and 91% respectively. Findings suggest that people using MA pills purchased from the retail market are not given accurate and adequate information for most effective self-use. If MA self-management remains outside regulatory boundaries, technical quality will remain sub-standard, imposing unnecessary costs to people, their health, and health systems.
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    Social network-based measurement of abortion incidence: promising findings from population-based surveys in Nigeria, Cote d’Ivoire, and Rajasthan, India
    (Springer Nature, 2020) Bell, Suzanne O.; Shankar, Mridula; Omoluabi, Elizabeth
    Background: Monitoring abortion rates is highly relevant for demographic and public health considerations, yet its reliable estimation is fraught with uncertainty due to lack of complete national health facility service statistics and bias in self-reported survey data. In this study, we aim to test the confidante methodology for estimating abortion incidence rates in Nigeria, Cote d’Ivoire, and Rajasthan, India, and develop methods to adjust for violations of assumptions. Methods: In population-based surveys in each setting, female respondents of reproductive age reported separately on their two closest confidantes’ experience with abortion, in addition to reporting about their own experiences. We used descriptive analyses and design-based F tests to test for violations of method assumptions. Using post hoc analytical techniques, we corrected for biases in the confidante sample to improve the validity and precision of the abortion incidence estimates produced from these data.