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[Un]met need and [un]wanted family planning: A cross-sectional study among women in Argentina, Ghana, and India examining characteristics, reasons, and alignment with fertility desires
No full textUnwanted family planning often refers to fertility desires as a proxy for contraceptive desire and lacks alignment with the tenets of person-centered care. We construct a person-centered measure of unwanted family planning by asking women whether they wanted to use a method, examine its alignment with the fertility-derived measure, and describe the characteristics of women with unwanted family planning and reasons women state for not wanting to use a method. We conducted a cross-sectional study of women aged 15–49 in Argentina, Ghana, and India. Data were collected on stated desire to use contraception and basic sociodemographic characteristics. Fertility desire was collected using the standard Demographic and Health Survey questionnaire. In total, 4794 women were included in our study. Among women using a method, 2.5 percent (n = 53) of women had unwanted family planning, with 4.2 percent in Ghana, 2.2 percent in Argentina, and 2.0 percent in India. Most unwanted family planning (85.2 percent, n = 23) occurred among women who did not want a child within the next nine months. Sexual infrequency was the most common reason behind a lack of desire to use a method. Our results highlight the substantial differences found between classifying women\u27s contraceptive needs from a person-centered versus a fertility-derived approach
Women’s self-help group participation and discussion of reproductive coercion: Associations with past experiences of violence among family planning clients in Kenya
No full textReproductive coercion (RC) and intimate partner violence (IPV) are prevalent in Kenya and undermine women’s reproductive agency; community-based women’s groups may offer an opportunity to address these issues. We quantitatively examined women’s participation in women-only self-help groups, described discussions of RC within these groups, and assessed differences based on prior experiences of RC and IPV among a clinic-based sample of Kenyan women seeking family planning services to inform future programming. Data were collected from 659 women of reproductive age seeking family planning services at six private clinics in Nairobi as part of the baseline for an intervention to address RC and IPV within family planning counseling. We used descriptive statistics, bivariate hypothesis testing, and adjusted mixed-effect logistic regression models to examine the relationship between self-help group participation and lifetime experience of RC and IPV. Using the same methods, we analyzed group discussions about RC in relation to lifetime experiences of abuse among women who had recently participated in groups. Additionally, we explored associations between RC discussions and the type of self-help group (e.g., economic, charitable) using bivariate tests. Over half of women reported prior participation in women-only self-help groups, with most participating in economic groups (63%). More than one in two women reported prior IPV and one in three reported prior RC. Self-help group participation was not significantly associated with prior experiences of RC or IPV. However, women who had ever experienced RC were more likely to report discussions about RC within groups (AOR 1.82 95% CI 1.06-3.14). Discussions of RC were less common in economic groups. Women-only self-help group participation is common and acceptable among Kenyan women, including those experiencing violence. However, economic groups—though widespread—discuss RC less often, indicating a key opportunity to integrate RC/IPV programming into these settings to strengthen community-based support
Tensions, funding, and sustainability: Young feminist organizing’s relations with donors and key stakeholders
No full textAlthough young feminist women are an important part of the feminist movement in Mexico, there is very little information written from their perspective about their relationship with larger organizations, foundations, and national and international donor organizations, and with key actors at the institutional level, as shown by the results of the Rapid Evidence Assessment on the panorama and impact of young feminist organizing in Mexico.
This brief highlights the complexity of the relationships between young feminist organizations (YFOs) and collectives in Mexico and foundations and donor organizations as well as government institutions, while recognizing good practices. We analyze and synthesize the reflections that the young participants in the project shared with us through focus groups and interviews, as well as including their own testimonies. In this way, we seek to show the perspective they themselves have on their relationship with other civil society organizations (CSOs), government and private institutions, donors, international organizations, and foundations
Evidence and Learning Forum: Improving the Measurement of Social and Gender Norms Change in the Practice of FGM
No full textThe November 2024 Evidence and Learning Forum: Improving Measurement of Social and Gender Norm Change in the Practice of FGM brought together over 80 participants representing program officers, socio-behavioral experts and scientists from 10 countries in East, West and North Africa. Hosted by the FGM Data Hub in partnership with UNICEF, UNFPA, and WHO, the two-day forum was geared toward sharing and examining tools and approaches, successful strategies, and challenges in measuring shifts in social and gender norms surrounding FGM.
The meeting objectives were to: 1) Review and assess the progress made in developing and using valid measures for evaluating changes in social and gender norms and practices within FGM interventions, and 2) Identify areas and action points to strengthen tools, measurement, and scale up the use of these tools.
To this end, experts in social behavioral research and program implementation exchanged experiences of evaluating the effectiveness of their programs in measuring norm changes using various tools. This report documents the meeting proceedings, including detailed discussions and key takeaways
Reproductive health equity: Demystifying unmet need for family planning among young women in Uttar Pradesh
No full textBackground: The unmet need for contraception among adolescent women in India is a significant public health concern, contributing to unintended pregnancies and abortions. This paper seeks to examine the regional variations and factors driving rural–urban disparities in unmet family planning needs in Uttar Pradesh (UP), India’s most populous state, where the total unmet need among adolescents is as high as 19%. Methods: The study is based on 11,018 adolescent women from the recent round of India’s DHS, NFHS-5 (2019–21). To fulfil the study’s objective, Multilevel logit model and Oaxaca Blinder Decomposition was applied. Results: The Multilevel logit model results show statistically significant variations at community and district level, implying a strong presence of unobserved factors affecting the unmet demand. Oaxaca decomposition results show that difference in rural and urban adolescent unmet need is explained by factors like wealth, religion and intra-state regions. Conclusion: The results call for the need to implement culturally appropriate reproductive and sexual health literacy programs to increase uniform access to modern contraception and to raise women’s autonomy in the state of Uttar Pradesh
Acceptability of a dapivirine levonorgestrel vaginal ring in two Phase 1 trials (MTN-030/IPM 041 and MTN-044/IPM 053/CCN019): Implications for multipurpose prevention technology development
No full textEnd-user feedback early in product development is important for optimizing multipurpose prevention technologies for HIV and pregnancy prevention. We evaluated the acceptability of the 90-day dapivirine levonorgestrel ring (DPV-LNG ring) used for 14 days compared to a dapivirine-only ring (DVR-200mg) in MTN-030/IPM 041 (n = 23), and when used for 90 days cyclically or continuously in MTN-044/IPM 053/CCN019 (n = 25). We enrolled healthy, non-pregnant, HIV-negative women aged 18–45 in Pittsburgh, PA and Birmingham, AL (MTN-030 only). Self-reports of vaginal bleeding and adherence (ring removals, expulsions) were collected via daily short message service. Acceptability data were recorded in face-to-face interviews at study exit. We assessed differences in acceptability by product characteristics and adherence; and associations between baseline characteristics/demographics, number of bleeding days, adherence, and overall acceptability. Most (21/23) women in the 14-day MTN-030 study and about half (13/25) in the 90-day MTN-044 study liked their assigned rings. In MTN-030 there were no significant associations between any variables and overall acceptability of either ring. In MTN-044, women who disliked the DPV-LNG ring had a significantly higher incidence of unanticipated vaginal bleeding, and reporting that vaginal bleeding changes were unacceptable than those who liked it. Although we found no overall association between adherence and acceptability, significantly more women who disliked (versus liked) the DPV-LNG ring reported expulsions during toileting. The DPV-LNG ring could meet the needs of women seeking simultaneous protection from HIV and unintended pregnancy. Addressing issues related to vaginal bleeding and expulsions early in product development will likely enhance acceptability of the DPV-LNG ring
How climate change is shaping young people’s health: A participatory, youth co-led study from Bangladesh, Guatemala and Nigeria
No full textIntroduction: Climate change is shaping adolescent and young people’s (AYP) transitions to adulthood with significant and often compounding effects on their physical and mental health. The climate crisis is an intergenerational inequity, with the current generation of young people exposed to more climate events over their lifetime than any previous one. Despite this injustice, research and policy to date lacks AYP’s perspectives and active engagement. Methods: Participatory, youth co-led qualitative focus group discussions were held in Bangladesh, Guatemala and Nigeria in mid-2023. A total of 196 AYP ages 12–25 years participated. Open-ended questions elicited responses regarding AYP knowledge, experiences and perceptions of climate change. Using NVivo software, translated transcripts were coded to explore and synthesise key thematic areas. Results: Respondents discussed varied climate exposures and associated health risks, for example, how flooding events were impeding access to sexual and reproductive health commodities. Acute climate events like flooding and cyclones increased perceived risk of early marriage and gender-based violence in Bangladesh and Guatemala. In Nigeria, respondents discussed health effects of extreme heat, and how droughts were shifting women into more traditionally male roles in agriculture and income-generating activities, increasing the perceived risk of household tensions and gender-based violence. Commonly reported themes included perceived climate impacts on sexual and reproductive health including early marriage or gender-based violence. Another common theme was anxiety about climate change, its effects on economic and food insecurity in communities and feeling hopeless, lacking agency and not feeling supported by local institutions, all linked with worse mental health. Conclusion: Our results summarise how AYP perceive climate change is affecting their physical and mental health, finding similarities and differences across these three settings. Our results can inform the development of policies and programmes that directly address AYP needs in a way that is inclusive and responsive
Ampliando el ecosistema de Abriendo Oportunidades®: Equipando a jóvenes mentoras con habilidades y recursos para ampliar la programación centrada en las niñas en Belice
No full textBasándose en el éxito del programa Abriendo Oportunidades® (AO®) en Guatemala, en 2014 Population Council Guatemala (PC-Guatemala) y el Consejo de Mujeres Mayas de Toledo (TMWC o Toledo Mayan Women’s Council) establecieron el programa de adolescentes de Toledo (TAG o Toledo Adolescent Girls), una iniciativa de espacios seguros que dotó a niñas indígenas y a mentoras de habilidades para la vida. El proyecto demostró que países vecinos están interesados en expandir el modelo AO®, y que el Council puede apoyar con éxito la adaptación programática para responder a las necesidades de otras comunidades indígenas en Mesoamérica. Esto se logró introduciendo grupos segmentados por edad, priorizando fondos de transporte para mentoras y supervisoras, y continuando la adecuación al contexto local. Este informe es parte de la Serie: El legado de Abriendo Oportunidades®, que celebra y destaca 20 años de implementación programática con impacto