Background: Endometriosis is a condition characterized by the growth of the endometrium, or the tissue that lines the uterus, outside of the uterus, and it is diagnosed through the presence of endometriotic lesions in the pelvic region. The disease is most often associated with abnormal and painful vaginal bleeding. Currently, minimal literature exists concerning the management of endometriosis in low and middle-income countries (LMICs), which may influence the lack of a cultural competent understanding of menstruation in LMICs and, therefore, a lack of evidence-based policies concerning menstruation.

Methods: Social and cultural barriers influencing endometriosis reporting and management in LMICs were examined through a systematic literature review. Online databases yielded a list of relevant studies. Then, use of MAXQDA, a qualitative data analysis software program, helped to extract and code specific text segments from each study that pertain to the research topic. In-context analysis of coded segments revealed the most common trends, which were organized into broader themes.

Results: Findings demonstrated that social and cultural ideas regarding vaginal bleeding influenced the lack of disease reporting and management of endometriosis in LMICs. Socioeconomic challenges include a lack of hygiene and sanitation measures and education regarding menstruation and vaginal bleeding. Also, many diseases associated with the abnormal vaginal bleeding are often disregarded and not prioritized in clinical settings. It also became clear that cultural taboos regarding menstruation and vaginal bleeding often create feelings of anxiety and fear in women and girls throughout communities in LMICs. However, further research is needed to examine the ways in which women in those communities treat symptoms of irregular vaginal bleeding related to endometriosis.

Conclusions: Socioeconomic, gender, and sex-related factors may influence the ways in which endometriosis is reported and treated and may affect the way the related diseases are understood. Evidence-based policies using a culturally competent understanding of abnormal vaginal bleeding in LMICs may help positively affect the reproductive health of women and girls in such areas.

Globally, suicide is the second leading cause of death, and accounts for about 800,000 deaths per year worldwide (WHO, 2013). The majority of these deaths occur in low and middle-income countries (LMIC), yet the research and documentation of suicide is heavily skewed to higher income countries where more systematic reporting of suicide occurs, along with a larger existing evidence base. Nepal is one LMIC where the speculated burden of suicide is high, with a predicted suicide rate of 7th highest in the world. Using both public-health and ethnographic approaches, the current study contributes to the discussion about suicide in Nepal. The primary goal of this research study is to understand the similarities and differences in perceived drivers for suicide for men and women in Nepal. Interviews conducted in Kathmandu and Jumla, Nepal were transcribed, and free lists which described drivers for suicide for men and women were extracted from the narratives. Thematic codes were then created to classify narrative responses into a cultural domain. The most salient codes listed by males and females for drivers for male/female suicide were analyzed and further contextualized using interview dialogue. Findings reveal social and relational drivers of suicide as the most salient for both genders, suggesting that suicide is not an individual act, but something that is caused by the broader, social environment. Additionally, perceptions of the reasons for suicide vary between gender. Perceived drivers for suicide for males are more often correlated with financial burden and the responsibilities tied to being the source of income and prosperity in a highly patriarchal society. Violence and inequality are perceived to be among the main drivers for female suicide. Findings contribute to the ethnographic research of suicide and the suicide literature in Nepal, and generate a better understanding of how reasons for suicide differ among males and females.

Investment and interest in mental health on a global scale is increasing. This interest creates a need to gain an in depth understanding about how mental illness is conceptualized and treated in different cultures. This article aims to explore the views of maternal mental health in Kenya's sub-counties. Maternal mental health has a significant impact on child development outcomes, so the topic has cross-generational importance. Ten focus group discussions with a variety of participants were conducted to understand the health care system. The participants were from four Kenya sub-counties: Rachuonyo N., Wagwe, Okiki Amayo, Nyative and they were either members of either SCHMT (Sub-county health management team), CHEW (community health extension worker), facility/staff of the county hospital, HHCDO (Homa Hills Community Development Organization), THRIVE II staff (Catholic Relief Service's early childhood development program) or mothers and fathers with children under two years of age. The qualitative data were translated and transcribed on site and then retranslated and counterchecked. A secondary data analysis using Atlas.ti was performed to identify themes and trends in factors that contribute to maternal wellbeing. Four main categories were identified as having prevalent effects on the Kenyan mothers' mental health: cultural values, broken support system, limitations of resources, and knowledge, behavior and attitudes. The participants were broken up into administrative, clinical, social, maternal and paternal categories to determine specific influence in each of these areas. Further analysis defined participants' involvement in the categories as mediating, moderating and direct effects on maternal depression. Main contributors to depression were identified as a lack of paternal support, poor cultural values, and administrative resistance. Discussion focuses on consequences for the future.

Maternal health and mental health have recently become globally recognized as critical areas of focus. The continued research into the relationship between maternal health and mental health—in particular, how they are affected by public policy and infrastructure—is vital to the improvement of general health outcomes. An investigation of literature, current health landscape and indicators, gray literature, and the current policy landscape in an exemplar country (Australia), Bangladesh and Nepal was done. Bangladesh and Nepal were chosen due to the recent amounts of change seen in each country’s maternal health status. Both Bangladesh and Nepal are severely lacking in official mental health services, facilities, and personnel. The analysis revealed flaws and disparities in each country’s current policy landscape. Despite these disparities it should be recognized that policies and programs are being implemented – just in a very piecemeal manner, and not entirely by each country’s respective government. Integration of maternal health services and mental health services is recommended to improve functionality of already existing services. The addition of minimal but necessary components to health systems is recommended.

Suicide is one of the fastest-growing and least-understood causes of death, particularly in low and middle income countries (LMIC). In low-income settings, where the technical capacity for death surveillance is limited, suicides may constitute a significant portion of early deaths, but disappear as they are filtered through reporting systems shaped by social, cultural, and political institutions. These deaths become unknown and unaddressed. This dissertation illuminates how suicide is perceived, contested, experienced, and interpreted in institutions ranging from the local (i.e., family, community) to the professional (i.e., medical, law enforcement) in Nepal, a country purported to have one of the highest suicide rates in the world. Drawing on a critical medical anthropology approach, I bridge public health and anthropological perspectives to better situate the problem of suicide within a greater social-political context. I argue that these complex, contestable deaths, become falsely homogenized, or lost. During 18 months of fieldwork in Nepal, qualitative, data tracing, and psychological autopsy methodologies were conducted. Findings are shared through three lenses: (1) health policy and world systems; (2) epidemiology and (3) socio-cultural. The first investigates how actors representing familial, legal, and medical institutions perceive, contest, and negotiate suicide documentation, ultimately failing to accurately capture a leading cause of death. Using epidemiologic perspectives, surveillance data from medical and legal agencies are analyzed and pragmatic approaches to better detect and prevent suicidal death in the Nepali context are recommended. The third lens provides perceived explanatory models for suicide. These narratives offer important insights into the material, social, and cultural factors that shape suicidal acts in Nepal. Findings are triangulated to inform policy, prevention, and intervention approaches to reduce suicidal behavior and improve health system capabilities to monitor violent deaths. These approaches go beyond typical psychological investigations of suicide by situating self-inflicted death within broader familial, social, and political contexts. Findings contribute to cultural anthropological theories related to suicide and knowledge production, while informing public health solutions. Looking from the margins towards centers of power, this dissertation explicates how varying institutional numbers can obfuscate and invalidate suffering experienced at local levels.

Background: Despite increasing recognition of the high burden of suicide deaths in low- and middle-income countries, there is wide variability in the type and quality of data collected and reported for suspected suicide deaths. Suicide data are filtered through reporting systems shaped by social, cultural, legal, and medical institutions. Lack of systematic reporting may underestimate public health needs or contribute to misallocation of resources to groups most at risk.

Methods: The goal of this study was to explore how institutional structures, cultural perspectives on suicide, and perceived criminality of self-harm influence the type and quality of suicide statistics, using Nepal as an example because of its purported high rate of suicide in the public health literature. Official documentation and reporting networks drawn by police, policy makers, and health officials were analyzed. Thirty-six stakeholders involved in various levels of the death reporting systems in Nepal participated in in-depth interviews and an innovative drawn surveillance system elicitation task.

Results: Content analysis and social network analysis revealed large variation across the participants perceived networks, where some networks were linear pathways dominated by a single institution (police or community) with few nodes involved in data transmission, while others were complex and communicative. Network analysis demonstrated that police institutions controlled the majority of suicide information collection and reporting, whereas health and community institutions were only peripherally involved. Both health workers and policy makers reported that legal codes criminalizing suicide impaired documentation, reporting, and care provision. However, legal professionals and law review revealed that attempting suicide is not a crime punishable by incarceration. Another limitation of current reporting was the lack of attention to male suicide.

Conclusions: Establishment and implementation of national suicide prevention strategies will not be possible without reliable statistics and comprehensive standardized reporting practices. The case of Nepal points to the need for collaborative reporting and accountability shared between law enforcement, administrative, and health sectors. Awareness of legal codes among health workers, in particular dispelling myths of suicide’s illegality, is crucial to improve mental health services and reporting practices.