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Maternal and Child Health Publications

If you can not access any of the full publications, please contact Nicola Hawley.

1. Barriers to adequate prenatal care utilization in American Samoa.

Hawley, N.L., Brown, C., Nu’usolia, O., Ah-Ching, J., Muasau-Howard, B. & McGarvey, S.T. (2014) Maternal and Child Health 18 (10): 2284-2292.

In the study, we used data from the prenatal clinic records of 692 women in American Samoa to describe the utilization of prenatal care and to identify socio-demographic predictors of inadequate prenatal care utilization. The study found that, between 2001 and 2008, 85.4% of women received inadequate prenatal care and that the introduction of a prenatal care incentive scheme led to earlier initiation of prenatal care and to improved adequacy of received services. These findings recommend improvements in accessibility and prenatal care incentive programs in order to increase prenatal care utilization in the population.

2. The contribution of feeding mode to obesogenic growth trajectories in American Samoan infants.

Hawley, N.L., Johnson, W.O., Nu’usolia, O. & McGarvey, S.T. (2014). Pediatric Obesity 9 (1): e1-e13.

This study aimed to examine the prevalence of excess weight and obesity and to determine the contribution of feeding mode to obesogenic growth trajectories in American Samoan infants. Using the data of 715 Samoan infants aged 0–15 months, we found 23.3% of boys and 16.7% of girls to be obese at 15 months. Formula-fed infants were also seen to gain weight and length faster than breastfed infants. These findings show that obesity in American Samoa is not confined to adults and recommend obesity prevention efforts targeted at early life and the promotion of breastfeeding as interventions.

3. Gestational weight gain among Samoan women and its impact on delivery and infant outcomes.

Hawley, N.L., Johnson, W.O., Hart, C.N., Triche, E.W., Muasau-Howard, B., & McGarvey, S.T. (2015). BMC Pregnancy and Childbirth 15: 10-17.

This paper described gestational weight gain (GWG) among American Samoan women and examines the association between GWG and four adverse pregnancy and infant outcomes: cesarean delivery, small- and large-for-gestational age (SGA/LGA), and infant overweight/obesity. The findings show 86% of women studied were overweight or obese in early pregnancy and greater GWG in the 2nd trimester and early pregnancy weight were independently associated with increased odds of a c-section. This paper recommend that physicians in American Samoa encourage women into prenatal care early and begin education about appropriate GWG and the potential risks of excess weight gain for both the mother and baby.

4. Hospital practices and concerns about infant satiety are barriers to exclusive breastfeeding in American Samoa.

Hawley, N.L., Holmdahl, I., Strait, E.A., Freeman, J.R., Muasau-Howard, B.T., Solaita, A. & McGarvey S.T. (2015) Pacific Journal of Reproductive Health 1 (1): 14-24.

This study aimed to understand the influences on infant feeding in American Samoa and to identify potential barriers to exclusive breastfeeding. We followed 44 Samoan women, their partners, and their infants from late pregnancy until 8 weeks postpartum, and found that barriers to breastfeeding included lack of skin-to-skin contact after delivery, delays in the initiation of breastfeeding, pain during breastfeeding, and a lack of education about infant satiety cues. The study concludes structural, rather than individual, level barriers to breastfeeding were identified by participants, and recommends that existing evidence-based interventions to promote exclusive breastfeeding could be adapted for use in this setting.

5. Mothers’ attitudes and beliefs about infant feeding highlight barriers to exclusive breastfeeding in American Samoa.

Hawley, N.L., Rosen, R.K., Strait, E.A., Ruffuci, G., Holmdahl, I., Freeman, J.R., Muasau-Howard, B.T., & McGarvey, S.T. (2015) Women and Birth 28 (3): e80-86.

This study examined American Samoan mothers' feeding experiences, attitudes, and beliefs about infant feeding and to identify potential barriers to exclusive breastfeeding. Through 18 semi-structured interviews with American Samoan mothers several weeks postpartum, we found that intention to breastfeed did not predict practice. The identified barriers to exclusive breastfeeding included: the convenience of formula, perceptions among mothers that they were not producing enough breast milk, and pain while breastfeeding. The study highlights barriers to exclusive breastfeeding can be immediately addressed by providers of breastfeeding support services.

6. An evaluation of gestational diabetes mellitus screening practices in American Samoa.

Freeman, J., Thompson, K., Muasau-Howard, B., McGarvey, S.T. & Hawley, N.L. (2015) Pacific Journal of Reproductive Health 1 (2): 68-73

The study evaluated the adequacy of gestational diabetes screening among pregnant women in American Samoa through the review of 622 clinical records to determine: whether or not the patient was screened, the week of gestation in which the screening occurred, and the type of screening the patient received. According to the findings, only 16.2% of women received adequate gestational diabetes screening. This study highlights the critical need for improved screening in this high risk population and urges that the causes of inadequate screening be identified and that interventions be targeted at both patients and clinicians.

7. Predictors of prenatal care satisfaction among pregnant women in American Samoa.

Adeyinka S., Jukic A.M., McGarvey, S.T., Faiai, M., Muasau-Howard, B.T. & Hawley, N.L. (2017). BMC Pregnancy and Childbirth 17 (1): 381.

This study aimed to identify the predictors of prenatal care satisfaction in American Samoa through analysis of data collected from 165 pregnant women receiving prenatal care at the Lyndon B Johnson Tropical Medical Center, Pago Pago. We identified three domains of satisfaction: satisfaction with clinic services, clinic accessibility, and physician interactions. These findings indicate the three domains of satisfaction all contribute to prenatal care satisfaction, and suggest prenatal care clinics should focus on making it easier for women to reach clinics, improving waiting times, and increasing time with providers.

8. Conceptions of pregnancy health and motivations for healthful behavior change among women in American Samoa.

Kocher, E., Sternberg-Lamb, J., McGarvey, S.T., Faiai, M., Muasau-Howard, B.T. & Hawley, N.L. (2017) Women and Birth 31: e32-e41.

This study aimed to understand American Samoan women's conceptions of health during pregnancy, their motivations for pregnancy behavior change, and the role of their family in both enabling and preventing these changes. Using eighteen postpartum women’s semi-structured interviews, we found participants expressed a Westernized conception of health during pregnancy that focused on eating a balanced diet and exercising regularly and described external motivations for adopting healthy behaviors, most notably the perceived benefit to their baby. These findings show pregnancy is an opportune moment for health behavior intervention and suggest future efforts should capitalize on external motivations for behavior change and encourage the development of internal motivators.

9. Knowledge of Gestational Diabetes Mellitus among pregnant women in American Samoa.

Hawley, N., Tripathi, R., Muasau-Howard, B., Howells, M., Faiai, M., & Van der Ryn, M. (2019). Pacific Journal Reproductive Health, 1(8), 410-422. doi:10.18313/pjrh.2019.902

The aim of this study was to examine the knowledge of Gestational Diabetes Mellitus, or GDM, among pregnant women in America. Using an 86-item survey completed by women attending a prenatal care clinic during a cross-sectional study, we tabulated and normalized scores for five domains including: general knowledge, risk factors, maternal complications, infant complications, and testing and treatment. We found the mean total knowledge scores were low—25.8 out of 100—and mean scores were highest for the testing and treatment domain and lowest for the knowledge of risk factors domain. The findings show a lack of GDM knowledge reported by pregnant woman in American Samoa and suggest a critical need to develop effective and wide-reaching health communications interventions to address knowledge deficits and potentially improve utilisation of GDM screening.

10. "It’s free, it’s available, and it’s healthy”: a cross-sectional, qualitative study of fathers’ preferences for breastfeeding in American Samoa and their desire for father-specific, practical breastfeeding education.

Hawley, N., Freeman, J., Wetle, T., Strait, E., Holmdahl, I., Muasau-Howard, B., Suisala, M., To'oto'o-Solaita, A., Rosen, R., & McGarvey, S. (2019). Pacific Journal Reproductive Health, 1(8), 447-461.doi:10.18313/pjrh.2019.905

This study aimed to understand American Samoan fathers’ current roles in infant feeding and to determine whether there is a need/desire for additional infant feeding education specifically targeted to fathers in this setting. Using longitudinal semi-structured interviews (before and after the infant’s birth), we spoke with 15 fathers about their roles in infant care and feeding, knowledge and beliefs about breast- and formula feeding, preferences for infant feeding, and interest in further infant feeding education. Fathers reported a high level of involvement in infant care and ‘partnership’ with their child’s mother, and requested further infant feeding education and ways in which they could support their partners to begin and continue breastfeeding. These findings suggest providing targeted infant feeding education for fathers could be an important health promotion strategy.

11. Fathers’ roles in infant feeding in American Samoa: a qualitative study.

Hawley, N.L., Freeman, J.R., Wetle, T., Holmdahl, I., Strait, E.A., Suisala, M.J.E., Muasau-Howard, B. & McGarvey, S.T. (2019). Pacific Journal of Reproductive Health 1 (8): 447-461.

In this study, the researchers sought to understand American Samoan fathers’ current roles in infant feeding. There is existing research on the relationship between mothers’ knowledge, attitudes, and beliefs and infant feeding practices, but little is known about the fathers’ role in this setting. Using a qualitative approach, the researchers conducted longitudinal semi-structured interviews with fifteen fathers prior to and six-weeks after their infant’s birth. The questions focused on fathers’ roles in infant care and feeding, knowledge about breast- and formula- feeding, and interest in further infant feeding education. After conducting a thematic analysis, the researchers found that fathers reported a high level of involvement in infant care, and had strong preferences for breastfeeding, but were also cognizant of the associated challenges for their partners. According to the study, given the benefits of sustained exclusive breastfeeding, giving fathers targeted infant feeding education could help promote health strategy.

12. Scaling up breastfeeding policy and programs in Samoa: application of the Becoming Breastfeeding Friendly Initiative.

Soti-Ulberg, C., Hromi-Fiedler, A., Hawley, N.L., Naseri, T., Manuele-Magele, A., Ah Ching, J. & Perez-Escamilla, R. International Breastfeeding Journal (in press).

The purpose of this study was to implement the Becoming Breastfeeding Friendly (BBF) initiative in Samoa. A 20 member committee of breastfeeding experts collected and utilized national level data to score the degree of friendliness of Samoa’s breastfeeding environment, identify gaps, and propose policy recommendations to address those gaps. The overall BBF Index score for Samoa indicated a moderate breastfeeding friendly environment for scaling up policies and programs that protect, promote, and support breastfeeding. The six prioritized recommendations were: to develop and implement a National Breastfeeding Policy and Strategic Action Plan; to strengthen the monitoring and evaluation of all breastfeeding activities; to ratify the International Labour Organization’s Maternity Protection Convention 2000; to identify high-level advocates to champion and serve as role models for breastfeeding; to create a national budget line for breastfeeding activities; and to hire a national breastfeeding coordinator and trainer. The researchers conclude that implementation of BBF in Samoa yielded important policy recommendations that will address current gaps in national level breastfeeding support, and that this consultation process can be successfully applied to other countries within the Western Pacific region.