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Method-specific beliefs associated with the choice of future contraception among women in refugee settlements in Uganda
No full textBackground: Factors underlying reproductive decisions, including contraceptive method choice, are poorly understood, especially in humanitarian settings where sexual and reproductive health (SRH) needs may be highest due to heightened risk of sexual violence and disruptions of health services. Aim: We examined the association between method-specific beliefs and future method choice among women in refugee settlements in Uganda. Method: Data were from a baseline of a one-year prospective study involving a cohort of 2,498 women aged 15–45 years living in Kiryadongo and Kyangwali refugee settlements. Analysis used cross-tabulation with chi-square test and conditional logistic regression analysis to examine associations between method-specific beliefs and intention to use injectables, implants, or pills among contraceptive non-users. Result: Among contraceptive non-users (n=1486), 32% intended to use a method within the next 12 months or later. Injectable was the most preferred future method (39%), followed by implants (25%) and pills (17%). Concerns about interference with menstruation, unpleasant side effects, and safety for long-term use were common across all three methods (range 58%-90%). The likelihood that a woman intended to use injectable, implant, or pill in future was positively associated with perceived ease to access (AOR=1.95;95%CI:1.03-3.66]), ease of use (AOR=4.17:95%CI:2.22-7.86), safety for long use (AOR=4.51;95%CI:1.61-12.64), and satisfaction with past use (AOR=2.87:95%CI:1.51-5.46). Conclusion: Intention to use contraception in future among non-users in refugee settlements is low, coupled with widespread negative beliefs of available methods. There is need to improve counseling to counter negative beliefs and to expand access to a range of modern contraceptive methods
Wages withheld, deferred or deflected: The case of child domestic workers in Addis Ababa, Ethiopia
No full textBackground: Most studies of child domestic workers highlight extreme hardship, abuse and exploitation. Few studies have examined the dynamics of wages/payments among young domestic workers. Objective: The objective is to explore the dynamics of payment between child domestic workers and employers, specifically, factors associated with direct or withheld payments, or payment sent to family members. Participants and setting: This study of child domestic workers took place in selected locations of Addis Ababa, where large numbers were known to be present. Methods: The is a large-scale, mixed-method study, including a quantitative survey of domestic workers, a sub-sample who were interviewed in-depth, and a validation study among former domestic workers. Results: Sixty-seven percent of child domestic workers were paid directly for their services. The remainder had their salary withheld by the employer (28 percent) or sent to the family members (5 percent). Being younger (AOR 2.4, p \u3c 0.001 among age 12–14; AOR 2.5, p \u3c 0.006 among age 15–17) was associated with increased odds of one\u27s employer withholding salary, while having an employment contract was associated with decreased odds of withheld pay (AOR 0.6, p \u3c 0.002). Those who were placed in work by family members were over five times more likely (AOR 5.1, p \u3c 0.001) to have payment sent to families. Conclusions: Our research underscores the importance of enforcement of child labor laws and laws related to ‘young workers.’ Among those of legal working age, our results underscore the need for formal employment contracts, increased legal protection and improved working conditions for domestic workers. Acknowledgements: The U.S. Department of State, Office for Trafficking in Persons and the Freedom Fund provided technical and financial support to this study
Developing and validating measures of unintended pregnancy and reasons for contraceptive non-use
No full textThis was a prospective cohort study involving follow-up with women to monitor their reproductive outcomes and adoption and continuation of contraceptive use over 18 months in Homa Bay County, Kenya
Assessing the role of law in reducing the practice of FGM/C in Kenya
No full textThis study aimed to understand how better to use criminal law to promote the abandonment of female genital mutilation/cutting (FGM/C) among men and women aged 18 years and above in Narok/Kisii and Isiolo counties in Kenya
Lessons learned from engaging healthcare providers in research on implementation of HIV preexposure prophylaxis
No full textBackground: Health care providers are critical for successful implementation of HIV preexposure prophylaxis (PrEP), but barriers to PrEP provision persist. Researchers must engage with providers to understand how to optimize PrEP delivery across settings. Yet researcher–provider collaborations can be challenging. To offer guidance on engaging providers in PrEP implementation research, we synthesized the experiences of researchers working with different types of providers on studies related to PrEP implementation that were funded as part of the US Ending the HIV Epidemic (EHE) initiative. Setting: Geographic areas designated as high priority by the EHE initiative. Methods: We defined providers broadly, including physicians, pharmacists, health educators, and peer navigators. Using thematic analysis from collaborative case reports by EHE study teams, we synthesized strategies, challenges, and successes related to provider engagement, with categorization into three stages of research: study development, recruitment, and data collection. Results: Among 17 research teams invited, 9 contributed. Findings suggested that extensive resources (eg, time, professional networks, financial, and nonfinancial incentives) are required to engage clinical and nonclinical providers across all stages of PrEP implementation research, with the most intensive strategies required for recruiting clinical providers who are not yet providing PrEP. However, when effective strategies are deployed, this investment of resources can yield rich insights into PrEP implementation. Conclusions: The lessons learned by the investigators in our study can be applied to future EHE-funded projects, other HIV-prevention studies, and studies in other areas of health research to improve engagement of providers during all stages of the research process
Childhood exposure to intimate partner violence against women and its association with violence against children in refugee settlements in Uganda
No full textBackground: The association between witnessing intimate partner violence against women (IPVAW) and experiencing violence against children (VAC) has received limited attention in humanitarian settings. We examined the prevalence of witnessing IPVAW in childhood and its association with experiencing caregiver-perpetrated physical and emotional VAC and sexual VAC by any perpetrator in Uganda refugee settlements. Methods: Data were from the first-ever Ugandan Humanitarian Violence against Children and Youth Survey (HVACS), conducted from March to April 2022, involving 1,338 females and 927 males aged 13–24 years. Indicators of VAC included ever experiencing sexual (by any perpetrator), physical, or emotional (by a caregiver) violence among 13-17-year-olds and experiencing such violence prior to age 18 among 18-24-year-olds. The analysis entailed cross-tabulation with a chi-square (χ²) test and a multivariate logistic regression model. Results: The prevalence of witnessing IPVAW in childhood was significantly higher among males (31.2%) compared to females (16.5%). Witnessing IPVAW in childhood was associated with increased odds of experiencing physical VAC by a caregiver for both females (AOR = 2.53; 95% CI = 1.41–4.52) and males (AOR = 3.37; 95% CI = 1.72–6.59). It also significantly increased the odds of experiencing sexual VAC for females (AOR = 3.62; 95% CI = 1.65–7.92) and males (AOR = 5.52; 95% CI = 3.42–8.91). Additionally, witnessing IPVAW increased the odds of experiencing emotional VAC by a caregiver for both females (AOR = 2.61; 95% CI = 1.36–5.03) and males (AOR = 2.78; 95% CI = 1.53–5.07), compared to their peers who did not witness IPVAW. Conclusion: Witnessing IPVAW in childhood is common in refugee settlements in Uganda and is strongly associated with experiencing VAC perpetrated by a caregiver. Violence prevention and response programs should pay attention to IPVAW as a risk factor for VAC, emphasizing integrated approaches that target both forms of violence within households
Reproductive health education in Ghana: Perspectives of School Health Education Programme (SHEP) Coordinators
Full text linkSchools in Ghana have integrated reproductive health education (RHE) topics into their curricula and School Health Education Programme (SHEP) Coordinators recognize the importance of RHE. However, for RHE to reach its full potential, it needs to be established as a stand-alone subject. This study highlights the challenges and opportunities in delivering in-school RHE, underscoring the interplay between policy frameworks, implementation strategies, and locally accepted approaches
Governmental influence on childbearing: What\u27s really at stake?—Slide deck
Full text linkOn the sidelines of CSW 69, the Population Council held a thought-provoking discussion on pronatalist policies and their implications for the lives of women and girls.
A growing number of countries seek to increase childbearing to achieve economic and cultural objectives. Speakers explored social, health, economic, and legal impacts of these policies in diverse settings including in China, across North America, and in Indigenous communities.
Speakers and Commentators:
Dr. Rana Hajjeh, President of the Population Council provided introductory remarks and perspective on the Council\u27s work on this issue.
Ms. Yiping Cai, PhD candidate at University of California Irvine, and member of the DAWN Executive Committee spoke on the transition of China’s population policy and how its challenges offer an opportunity to reconfigure social policies centered on justice and equality.
Dr. Joan Kaufman, Senior Director for Academic Programs for the Schwarzman Scholars Program and Lecturer on Global Health at Harvard Medical School, amplified observations with reference to China.
Ms. Judith Bruce, Senior Advisor, Population Council (Moderator)
Professor Shelley Clark, James McGill Professor of Sociology at McGill University, highlighted the impact of pronatalist policies for urban and rural women in the United States, drawing on her own research.
Dr. Kelly Hallman, Founder and Executive Director of the Indigenous Justice Circle, and an enrolled member of the Cherokee nation, centered her remarks on implications of both antinatalist and pronatalist policies for Indigenous girls and women.
Dr. Vladimira Kantorova, Chief of the Fertility and Population Ageing Section of the Population Division, Department of Economic and Social Affairs, United Nations whose research has focused on fertility, reproductive health and family dynamics addressed the demographic foundations—especially in Europe—and the effectiveness (and fairness) of population policies
Linking research to action to address unintended pregnancy in refugee settings in Ethiopia
Full text linkHumanitarian crises expose women and girls to the risk of unintended pregnancy due to disruptions in access to and provision of sexual and reproductive health (SRH) services. Evidence available to support and shape improved family planning programming in refugee settings is sparse, and little is known about how to effectively deliver such programming to the most vulnerable, including women and girls. The Baobab Research Programme Consortium (RPC) is exploring how access to SRHR services can be expanded using existing, low-cost approaches, and how such approaches be communicated and scaled up in refugee settings. We propose harnessing existing food distribution and refugee verification platforms as a strategic avenue for reaching women with family planning information and counseling, coupled with strengthened referral procedures between these platforms and health facilities for actual family planning provision and uptake
Big data and AI in sexual and reproductive health: A comment
No full textBig data and artificial intelligence (AI) have the potential to transform sexual and reproductive health (SRH), offering new avenues to enhance access, efficiency, and personalization in healthcare. AI-driven tools can provide opportunities to improve service delivery and optimize resource allocation. Through data-driven insights, healthcare providers can better understand population trends, predict health risks, and tailor interventions for diverse communities, ultimately advancing gender equality and empowerment. However, the integration of AI into SRH also presents significant challenges. Ethical concerns such as informed consent, data privacy, and transparency are critical to ensuring that AI applications do not violate individual autonomy and rights. The digital divide—disparities in technology access between different regions and populations—further risks exacerbating inequalities in SRH services and the provision of care. Moreover, there is a need for robust governance frameworks and global data protection laws to regulate the use of AI in SRH, and in healthcare more broadly. Programs and policies must focus on bridging these gaps, emphasizing equity and ethical considerations while leveraging AI\u27s potential to enhance SRH services and support the vision of SRH and rights for all