Rural-urban variation in hypertension among women in Ghana: insights from a national survey

Abstract Background Hypertension is one of the leading causes of cardiovascular morbidities in Ghana and represents a major public health concern. There is dearth of information on the rural-urban disparity in hypertension among women in Ghana. Therefore, this study aimed at examining the rural-urban variation in hypertension among women in Ghana. Methods We extracted data from the women’s file of the 2014 Ghana Demographic and Health Survey. The sample included 9333 women aged 15–49 with complete data on hypertension. The analysis was done using Pearson Chi-square and binary logistic regression at 95% confidence interval. The results of the binary logistic regression were presented as Odds Ratios (ORs) and Adjusted Odds Ratios (AORs). Statistical significance was set at p < 0.05. Results Hypertension prevalence among urban and rural residents were 9.5% and 5.1% respectively. Rural women had lower odds of hypertension [OR = 0.59; 95% CI = 0.52, 0.67] compared to urban women, however, this was insignificant in the adjusted model [aOR = 0.84; 95% CI = 0.70, 1.00]. The propensity to be hypertensive was lower for women aged 15–19 [aOR = 0.07; 95% CI = 0.05, 0.11]. The poorest were less likely to be hypertensive [aOR = 0.63; 95% CI = 0.45, 0.89]. Single women were also less probable to have hypertension [aOR = 0.66; 95% CI = 0.46, 0.97]. Conclusions Women from urban and rural areas shed similar chance to be hypertensive in Ghana. Therefore, the health sector needs to target women from both areas of residence (rural/urban) when designing their programmes that are intended to modify women’s lifestyle in order to reduce their risks of hypertension. Other categories of women that need to be prioritised to avert hypertension are those who are heading towards the end of their reproductive age, richest women and the divorced.

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Intimate Partner Violence and its Association With Contraceptive Use Among Women in Pakistan

Pakistan Journal of Psychological Research ◽

10.33824/pjpr.2019.34.1.9 ◽

2019 ◽

Vol 34 (Spring 2019) ◽

pp. 157-173

Author(s):

Kashif Siddique ◽

Rubeena Zakar ◽

Ra’ana Malik ◽

Naveeda Farhat ◽

Farah Deeba

Keyword(s):

Intimate Partner Violence ◽

Logistic Regression ◽

Partner Violence ◽

Contraceptive Use ◽

Binary Logistic Regression ◽

Intimate Partner ◽

Married Women ◽

Reproductive Age ◽

Outcome Variable ◽

Odds Ratios

The aim of this study is to find the association between Intimate Partner Violence (IPV) and contraceptive use among married women in Pakistan. The analysis was conducted by using cross sectional secondary data from every married women of reproductive age 15-49 years who responded to domestic violence module (N = 3687) of the 2012-13 Pakistan Demographic and Health Survey. The association between contraceptive use (outcome variable) and IPV was measured by calculating unadjusted odds ratios and adjusted odds ratios with 95% confidence intervals using simple binary logistic regression and multivariable binary logistic regression. The result showed that out of 3687 women, majority of women 2126 (57.7%) were using contraceptive in their marital relationship. Among total, 1154 (31.3%) women experienced emotional IPV, 1045 (28.3%) women experienced physical IPV and 1402 (38%) women experienced both physical and emotional IPV together respectively. All types of IPV was significantly associated with contraceptive use and women who reported emotional IPV (AOR 1.44; 95% CI 1.23, 1.67), physical IPV (AOR 1.41; 95% CI 1.20, 1.65) and both emotional and physical IPV together (AOR 1.49; 95% CI 1.24, 1.72) were more likely to use contraceptives respectively. The study revealed that women who were living in violent relationship were more likely to use contraceptive in Pakistan. Still there is a need for women reproductive health services and government should take initiatives to promote family planning services, awareness and access to contraceptive method options for women to reduce unintended or mistimed pregnancies that occurred in violent relationships.

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The Co-Occurrence of Overweight and Micronutrient Deficiencies or Anemia among Women of Reproductive Age in Malawi

Journal of Nutrition ◽

10.1093/jn/nxaa076 ◽

2020 ◽

Vol 150 (6) ◽

pp. 1554-1565 ◽

Cited By ~ 1

Author(s):

Elizabeth C Rhodes ◽

Parminder S Suchdev ◽

K M Venkat Narayan ◽

Solveig Cunningham ◽

Mary Beth Weber ◽

...

Keyword(s):

Rural Women ◽

Rural Areas ◽

Prevalence Ratio ◽

Micronutrient Deficiency ◽

Reproductive Age ◽

Micronutrient Deficiencies ◽

Urban Residence ◽

Chi Square ◽

Double Burden ◽

Individual Level

ABSTRACT Background In low-resource settings, urbanization may contribute to the individual-level double burden of malnutrition (DBM), whereby under- and overnutrition co-occur within the same individuals. Objective We described DBM prevalence among Malawian women by urban-rural residence, examined whether urban residence was associated with DBM, and assessed whether DBM prevalence was greater than the prevalence expected by chance given population levels of under- and overnutrition, which would suggest DBM is a distinct phenomenon associated with specific factors. Methods We analyzed nationally representative data of 723 nonpregnant women aged 15–49 y from the 2015–2016 Malawi Micronutrient Survey. DBM was defined as co-occurring overweight or obesity (OWOB) and ≥1 micronutrient deficiency or anemia. We used Poisson regression models to examine the association between urban residence and DBM and its components. The Rao-Scott modified chi-square test compared the observed and expected DBM prevalence. Results Nationally, 10.8% (95% CI: 7.0, 14.5) of women had co-occurring OWOB and any micronutrient deficiency and 3.4% (95% CI: 1.3, 5.5) had co-occurring OWOB and anemia. The prevalence of co-occurring OWOB and any micronutrient deficiency was 2 times higher among urban women than rural women [urban 32.6 (24.1, 41.2) compared with rural 8.6 (5.2, 11.9), adjusted prevalence ratio: 2.0 (1.1, 3.5)]. Co-occurring OWOB and anemia prevalence did not significantly differ by residence [urban 6.9 (0.6, 13.2) compared with rural 3.0 (0.8, 5.3)]. There were no statistically significant differences in observed and expected prevalence estimates of DBM. Conclusions This analysis shows that co-occurring OWOB and any micronutrient deficiency was higher among women in urban Malawi compared with rural areas. However, our finding that co-occurring OWOB and any micronutrient deficiency or anemia may be due to chance suggests that there may not be common causes driving DBM in Malawian women. Thus, there may not be a need to design and target interventions specifically for women with DBM.

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Sociodemographic Risk Factors of Being Underweight Among Ever-Married Bangladeshi Women of Reproductive Age: A Multilevel Analysis

Asia Pacific Journal of Public Health ◽

10.1177/1010539520979924 ◽

2020 ◽

pp. 101053952097992

Author(s):

Abdur Rahman ◽

Nusrat Jahan Sathi

Keyword(s):

Risk Factors ◽

Rural Women ◽

Rural Areas ◽

Media Coverage ◽

Significant Risk ◽

Binary Logistic Regression ◽

Reproductive Age ◽

Healthy Weight ◽

Factors Associated ◽

Sociodemographic Risk

The study’s primary goal is to identify a few sociodemographic risk factors associated with women’s underweight status. We have applied multilevel binary logistic regression using the Bangladesh Demographic and Health Survey 2014 data, considering hierarchical effect. The model implies that age <30 years (odds ratio [OR]: 2.19; 95% CI: 1.82-2.63), no education (OR: 1.44; 95% CI: 1.28-1.61), oral contraceptive nonuser (OR: 1.26; 95% CI: 1.14-1.39), and not watching TV (OR: 1.56; 95% CI: 1.41-1.73) are significant risk factors associated with women’s underweight status. Remarkably, women from rural areas and belonging to a community with poverty rates of 50% and higher are 46% and 52% more likely to be underweight, respectively. Policy makers and organizations should create a supportive environment for rural women by controlling education, media coverage, and poverty to enrich their knowledge about healthy weight to reduce community inequality and maintain a healthy life.

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Prevalence and determinants of contraceptives use among rural young women (15-24 years) in Ghana

10.21203/rs.3.rs-25494/v1 ◽

2020 ◽

Author(s):

Mohammed Gazali Salifu ◽

Kamaldeen Mohammed ◽

Mac-Cauley Harrison ◽

Aaron Atimpe ◽

Rogers Wuniwumda Abukari ◽

...

Keyword(s):

Young Women ◽

Rural Women ◽

Rural Areas ◽

Educational Level ◽

Contraceptive Use ◽

Reproductive Age ◽

Categorical Variables ◽

Chi Square ◽

History Of ◽

Living Children

Abstract Background: Contraceptives use has significant effect on controlling fertility, preventing STIs, reducing unwanted pregnancies and induced abortions. The use of contraceptives among reproductive age women (15-49 years) has been largely reported. However, what is unclear is whether the reported prevalence of, and factors that influence the usage of contraceptives is comparable in the context of young adults (aged 15-24 years) in rural areas. The purpose of this study was therefore to report the prevalence and factors that influence contraceptives use among young women (15-24 years) in rural Ghana.Methods: Data (n = 3797) collected using a questionnaire through a mutli-stage probability sampling method in the 2017 Ghana Maternal Health Survey (GMHS) was analyzed by descriptive and inferential statistical methods. The chi-square test was used to identify significant associations between categorical variables at a significant level of p < 0.05. Univariate and multivariate logistic regression analyses was conducted to explore how well each independent variable predicted contraceptive use. Results: Out of the 3,797 women, only 21.49% (95% CI: 19.56, 23.55) used contraceptives. Number of living children, health insurance, knowledge of fertility period, history of abortion, ever given birth, educational level, age of participants and current union were found to influence contraceptives use. Strong significant predictors (at 95% CI, p<0.05) of contraceptives use were history of abortion, age of participants, educational level, number of living children, and knowledge of fertility period. Conclusion: Low usage of contraceptives has been identified among rural women and so there is the need for policymakers to intensify education and facilitate widespread access to modern contraceptives in rural areas and promote their effective use.

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The Association between Ethnicity and Level of Education with Exclusive Breastfeeding Practice in the Context of the Place of Residence in Nigeria

10.21203/rs.3.rs-40855/v1 ◽

2020 ◽

Author(s):

Nkemdilim P Anazonwu ◽

Chukwuedozie K Ajaero ◽

Peter O Mbah

Keyword(s):

Exclusive Breastfeeding ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Binary Logistic Regression ◽

Outcome Variable ◽

Place Of Residence ◽

Chi Square ◽

Level Of Education ◽

Urban And Rural Areas

Abstract BackgroundWhile researches have been done separately on ethnicity and level of education as factors of exclusive breastfeeding (EBF) practice, there is dearth of studies on the peculiarities of EBF practice in the context place of residence as regards to the combined influence of ethnicity and level of education. To examine the association of ethnicity and level of education with exclusive breastfeeding (EBF) practice in urban and rural areas of Nigeria.MethodsData was from the Nigeria Demographic and Health Survey (NDHS) of 2018. The sample comprised of 16,982 urban and 24,834 rural women aged 15-49 years in all the 36 States and the Federal Capital Territory (FCT) of Nigeria. The outcome variable was exclusive breast-feeding (EBF) practice while the major predictor variables were ethnicity and level of education. Analyses of data were by descriptive statistics, Pearson Chi square and binary logistic regression at 0.05 level of significance. ResultsHigher education levels were significantly associated with decreased engagement in EBF practice in urban and rural areas while ethnic differences were significantly associated with EBF practice in the rural areas. Being aged 25-34 years (OR=2.316; p=0.000) was significantly associated with increased odds of EBF practice in urban areas. Moreover, region of residence was significantly associated with EBF practice in the rural areas. Finally, in both rural and urban areas, households with more than two children were significantly associated with increased odds of EBF.ConclusionsMore sensitization campaigns on the need to incorporate EBF practice into formal employment work ethics where women with higher levels of education mostly work are needed in urban areas. In addition, ethnic practices, which promote EBF practices, should be encouraged in antenatal and postnatal clinics.

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Factors associated with the intention to undergo Pap smear testing in the rural areas of Indonesia: a health belief model

Reproductive Health ◽

10.1186/s12978-021-01188-7 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Sumarmi Sumarmi ◽

Yu-Yun Hsu ◽

Ya-Min Cheng ◽

Shu-Hsin Lee

Keyword(s):

Cervical Cancer ◽

Health Beliefs ◽

Rural Women ◽

Rural Areas ◽

Pap Smear ◽

Statistical Significance ◽

Health Belief ◽

Pap Smear Test ◽

Smear Test ◽

Smear Testing

Abstract Purposes This study aimed to understand the influence of health beliefs, demographic factors, and health characteristics on the intention to undergo Pap smear testing among women in rural areas of Indonesia. Methods A descriptive cross-sectional study was conducted and 687 married women participated in the study. A convenience sampling was applied to recruit the participants from community health centres in a rural region in Indonesia. Self-reported data using the Health Beliefs Model Scale for Cervical Cancer and Pap Smear Test was collected to assess the health beliefs. Independent t-tests, simple logistic regressions, and a hierarchical logistic regression with 3 steps were run. Statistical significance for analysis was set at p < 0.05. Results The mean age of the participants was 42 years (SD = 8.4). Among the participants, 81% of the women had never undergone a Pap smear test, and 61% (n = 422) of the women reported a high intention of receiving a Pap smear test. Income and education Health beliefs regarding Pap smear testing were different between women who had low and high intentions to undergo Pap smear testing. Health beliefs, such as perceived benefits, severity, barriers to Pap smear testing, and health motivation for a Pap smear test were associated with the intention to undergo Pap smear testing among rural Indonesian women. Overall, the hierarchical multiple regression with 3 steps containing demographic, health characteristics, and health belief variables accounted for 31% variance of the intention to undergo Pap smear test among the Indonesian rural women. Conclusions Low screening rates of cervical cancer and high intentions to do the screening exist among rural Indonesian women. Health beliefs significantly affect the rural women’s intention of Pap smear testing in Indonesia.

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Overweight and obesity among women of reproductive age in Mali: what are the determinants?

International Health ◽

10.1093/inthealth/ihaa094 ◽

2020 ◽

Author(s):

Abdul-Aziz Seidu ◽

Bright Opoku Ahinkorah ◽

Ebenezer Agbaglo ◽

Albert Apotele Nyaaba

Keyword(s):

Statistical Significance ◽

Binary Logistic Regression ◽

Overweight And Obesity ◽

Reproductive Age ◽

Negative Effects ◽

Wealth Status ◽

Middle Income ◽

Middle Income Countries ◽

Region Of Residence ◽

Public Health Promotion

Abstract Background Existing evidence suggests that there has been a surge of overweight and obesity in low- and middle-income countries around the world. In this study we investigated the prevalence and factors associated with overweight and obesity among women in Mali. Methods We conducted the study among 5198 women using the 2018 Mali Demographic and Health Survey data. We used binary logistic regression for the analysis and pegged statistical significance at p<0.05. Results The prevalence of overweight and obesity was 26.9%. The likelihood of overweight and obesity was high among women 40–44 y of age (adjusted odds ratio [AOR] 5.94 [confidence interval {CI} 4.10 to 8.60]), those who were widowed/divorced/separated (AOR 1.59 [CI 1.04 to 2.43]), those with secondary education (AOR 1.41 [CI 1.13 to 1.75]), richest women (AOR 3.61 [CI 2.63 to 4.95]), those who watched television at least once a week (AOR 1.28 [CI 1.07 to 1.52]) and those who lived in the Kidal region (AOR 10.71 [CI 7.05 to 16.25]). Conversely, the likelihood of overweight and obesity was low among women who belonged to other religions compared with Muslims (AOR 0.63 [CI 0.43 to 0.92]). Conclusions This study found a predominance of overweight and obesity among women in Mali. The study showed that age, marital status, education, religion, region of residence, wealth status and frequency of watching television are associated with overweight and obesity among women in Mali. It is therefore critical for public health promotion programs in Mali to sensitize people to the negative effects associated with overweight and obesity. This implies that policies aimed at controlling overweight and obesity in Mali must take these factors into consideration.

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Role of Ambulatory Blood Pressure Monitoring in Predicting Adverse Maternofetal Events in Pregnancy

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1708576 ◽

2021 ◽

Author(s):

Satish Kumar Rao Vavilala ◽

Indrani Garre ◽

Sumalatha Beeram

Keyword(s):

Blood Pressure ◽

Logistic Regression ◽

Standard Deviation ◽

Ambulatory Blood Pressure ◽

Blood Pressure Monitoring ◽

Statistical Significance ◽

Binary Logistic Regression ◽

Pressure Monitoring ◽

In Pregnancy

Abstract Aims To correlate the relationship between the ambulatory blood pressure parameters and the occurrence of the antenatal and postnatal adverse maternofetal events in pregnancy. Methods Observational study designed for 50 pregnant patients who had an appointment to the obstetrics with abnormal blood pressure (BP) measurements and for whom ambulatory blood pressure monitoring (ABPM) was studied between January 2019 and June 2019. Data about age, personal history, obstetrics, family, body mass index (BMI), weight gain in pregnancy, values of blood pressure in the appointment, values recorded in ABPM, delivery and newborn, pregnancy and postpartum events, and follow-up of woman and child. Data were analyzed using descriptive and inferential statistics with Minitab 17.0 for Windows. Results Patients demographic data, clinical history, and laboratory results, including the ABPM parameters, were compiled. Antenatal complications occurred in 22 patients (44%), and postpartum complications were found in 41 patients (82%) whose ABPM values were deranged. Antenatal complications were studied using the binary logistic regression analysis for calculating the role each factor played in the development of hypertension. In the sample studied, mean age was 24.980 with a standard deviation of 4.876 (p = 0.003; minimum age of 19 years and maximum age of 38 years), mean weight of patient was 63.71 with a standard deviation of 63.71 (p = 0.001), mean gravida was 1.780 with a standard deviation of 0.910 (p = 0.034), mean gestation weeks at presentation was 33.000 weeks with a standard deviation of 4.086 (p = 0.041), mean birth weight was 2.226 with a standard deviation of 0.797 (p = 0.000), mean maximum diastole was 109.22 with a standard deviation of 16.53 (p = 0.002), mean day maximum systole was 187.2 with a standard deviation of 203.5 (p = 0.009), mean day minimum diastole was 63.50 with a standard deviation of 12.99 (p = 0.013), all of which had statistical significance. It is found that the nighttime diastolic blood pressure (DBP) and daytime maximum systolic blood pressure (SBP) were the best predictors of adverse events. Among antenatal complications (ANC), the most common complication is intrauterine growth restriction (IUGR), noted in (n = 19, 86.36%) preterm delivery (n = 17, 77.27%) among the 17 babies who were delivered preterm; 12 (70.5%) needed neonatal intensive care unit (NICU) care of which 4 (25%) babies died because of prematurity; intrauterine death (IUD) was noted in 7 (31.81%) patients and eclampsia was seen in 5 (22.72%). Nondippers proðle had a worse survival rate at follow-up until delivery compared with those with a dipper proðle. Postnatal complications were seen in 41 patients; among them, 13 patients (31.7%) had abnormal fundus examination, 15 patients (36.58%) required usage of antihypertensive beyond first postpartum, 9 patients (21.95%) required blood transfusion for severe bleeding in the form of postpartum hemorrhage. Binary logistic regression for systolic dippers versus nondippers shows statistical significance in age (p = 0.023), weight (p = 0.038), and para (p = 0.045) (Table 3). Binary logistic regression for diastolic dippers versus nondippers shows statistical significance in age (p = 0.039), weight (p = 0.020), birth weight (p = 0.010), maximum heart rate (p = 0.043), and ANC (p = 0.007) Adverse events occurred most commonly in nondippers. Systole nondippers is noted in (n = 41, 82%). Dippers is noted in (n = 9, 18%), Diastole nondippers is noted in (n = 39, 78%) Dippers is noted in (n = 11, 22%). Conclusion ABPM recorded blood pressure is very precise. ABPM is the advised method for both diagnostic and therapeutic monitoring of hypertensive pregnancy diseases, mainly in situations like whitecoat hypertension, masked hypertension, nocturnal hypertension, and nondipping profile. In patients with high-risk pregnancy, elderly primigravida, and precious pregnancy, who have a high-risk of developing pregnancy-induced hypertension (PIH) and related complications, early use of ABPM predicts adverse maternofetal events, which when intervened at an earlier date can prevent antenatal and postnatal complications.

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Comparative assessment of overweight/obesity among rural and urban reproductive-age women in Ethiopia: Evidence from a cross-sectional 2016 national survey

Nutrition and Health ◽

10.1177/0260106020982346 ◽

2021 ◽

pp. 026010602098234

Author(s):

Gizachew Worku Dagnew ◽

Melash Belachew Asresie

Keyword(s):

Family Size ◽

Health Problem ◽

Rural Women ◽

Alcohol Intake ◽

Statistical Significance ◽

Public Health Problem ◽

Reproductive Age ◽

P Value ◽

Cross Sectional ◽

Reproductive Age Women

Background: Overweight/obesity has become a global health problem for both developed and developing regions. Nowadays, overweight/obesity among childrearing-age women has become rapidly increasing in both urban and rural areas. Aim: This study aimed to assess the variation of overweight/obesity among urban and rural reproductive-age women in Ethiopia. Methods: For this study, the 2016 Ethiopia Demographic and Health Survey data were used. The survey was a community-based cross-sectional study, which used a two-stage stratified cluster sampling technique to select the participants. A total of 13,451 reproductive-age women were included in the analysis. Both descriptive and analytical analysis was performed. A p-value of less than 0.05 was used as the measure of statistical significance. Results: The prevalence of overweight/obesity among urban reproductive-age women was statistically higher ( p = 21.5%; 95% confidence interval (CI): 18.2–25.1) than the rural women ( p = 3.5%; 95% CI: 2.9%–4.2%). Women who attend secondary or above education, women in the age groups 25–34 and ≥ 35 years, and high wealth index (rich) had higher odds of overweight/obesity in both urban and rural women. Moreover, women who were married, who had a large family size, and who have a history of alcohol intake had higher odds of overweight/obesity among urban women. Conclusions: Overweight/obesity among reproductive-age women is a public health problem in Ethiopia, especially for women who are living in urban settings. Therefore, it is important to establish targeted overweight reduction programs with particular emphasis on urban, older aged, educated, and married women. Additionally, encouraging the limitation of the number of family size and alcohol intake can reduce women’s overweight/obesity.

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Inequality in institutional delivery of the recent birth among married women in Nepal: a trend analysis

10.21203/rs.3.rs-27816/v2 ◽

2020 ◽

Author(s):

Ramesh Adhikari ◽

Aakriti Wagle

Keyword(s):

Developing Countries ◽

Maternal Mortality ◽

Rural Women ◽

Institutional Delivery ◽

Maternal Mortality Ratio ◽

Binary Logistic Regression ◽

Bivariate Analysis ◽

Demographic And Health Surveys ◽

Chi Square ◽

Safe Delivery

Abstract Background The huge discrepancy in health statistics between developed and developing countries occur in the area of maternal mortality, with developing countries contributing most of the figures. Nepal has higher maternal mortality ratio than its South Asian neighbors. This study assesses the trend of institutional delivery of recent birth and compared the inequalities with associated factors that affect institutional delivery in Nepal.Methods The data for this study was obtained from three sequential Nepal Demographic and Health Surveys [NDHS] of 2006, 2011, and 2016. The information was collected from mothers having a child within last five years preceding the survey years. The total number of such mothers was 4066, 4148, and 3998 respectively in the survey of 2006, 2011, and 2016.The association between institutional delivery and the explanatory variables was assessed via bivariate analysis (chi-square test) and multivariate analysis (binary logistic regression).Results The utilization of health service during delivery stepped up from 21% in 2006 to 62% in 2016.Although the proportion of delivery in health facility increased among poorest over the period of 10 years, the disparity between richest and poorest still persisted from 2006 to 2016 and the association was highly significant in all the surveys. Although, government of Nepal has launched the maternity incentive scheme through safe delivery incentive program in 2005, poor women are still deprived from utilizing the service. Poorest and poorer women were 78 percent (aOR=0.22, 95% CI 0.17-0.27) and 71 Percent (aOR=0.23, 95%CI 0.23-0.35) respectively less likely to have institutional delivery than the richest women after controlling the other socio-demographic and culture factors. Furthermore, this study found that education, place of residence, women’s autonomy, religion, number of ANC visits, exposure to newspaper and TV were significant predicators for place of delivery. Conclusion Although there has been three-fold increment in utilization of health services during delivery over the period of 10 years, the discrepancy between rich and poor, educated and uneducated and urban and rural area is highly evident. Overall, our study highlights the necessity of interventions to promote institutional delivery with greater focus on poor, uneducated, and rural women.

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