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Policies and programmes to improve preconception nutrition in South Asia
No full textThe health and health behaviours of women before conception significantly influence maternal and child health outcomes. Despite growing evidence supporting preconception nutrition care, data on the implementation of related policies and programmes remains limited. This paper reviews public policies and programmes delivering preconception nutrition interventions in eight South Asian countries, targeting married pre-pregnant women aged 15–49 years and identifies the systems bottlenecks in programme implementation. Most countries, except Sri Lanka, lack universal programmes for health and nutrition screening, provision of essential micronutrients, counselling on healthy eating and treatment for at-risk women. Even in countries, where supportive policies exist, implementation of comprehensive nutrition services for pre-pregnant women faces significant bottlenecks across six health system building blocks. Addressing these barriers is critical to improving intervention effectiveness, programme implementation, and informed decision-making. Further testing of a proposed comprehensive algorithm for preconception nutrition in diverse country contexts across South Asia is necessary
We move together: A realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia
No full textIntroduction: In Zambia, where less than half of pregnant women complete the continuum of care for maternal health, community engagement initiatives like the Safe Motherhood Action Groups (SMAGs) are used to mobilise communities and support maternal and newborn health (MNH) care-seeking. However, there is a lack of documented evidence on communication in community engagement and its implementation across diverse settings. This study examines how communication in community engagement influences MNH care-seeking in Zambia’s Eastern Province. Methods: This realist evaluation used two iterative multi-method case studies to evaluate the SMAG programmes at Chibolya Urban Health Clinic and Jerusalem Rural Health Clinic. Data were collected from facility metrics, in-depth interviews, realist photovoice discussions, focus-group discussions and observations. Participants, including SMAGs (n=10), local leaders (n=2), pregnant women (n=10), community members (n=20), healthcare providers (n=4) and Ministry of Health stakeholders (n=4) were purposively sampled. Results: Seven programme theories, informed by 50 context-mechanism-outcome configurations, were refined and organised to explain how the SMAG programme in Zambia works when communities are actively involved, messaging is relevant and relatable, SMAGs are trusted, SMAGs are familiar, the programme and facility are well-coordinated, the community perceives benefits from the messaging and SMAGs are motivated. Conclusion: This realist evaluation offers research, practice and policy recommendations to enhance communication in community engagement for MNH, with potential applicability to other health domains. It emphasises trust and strong community-programme relationships as key drivers of effective and sustainable community engagement
Measuring abortion incidence, severity of complications, and health facilities’ capacity to provide abortion care in refugee settings in Uganda: Technical report
Full text linkUnsafe abortion remains an avoidable cause of maternal mortality and morbidity in East Africa. However, little is known about abortion incidence or abortion-related complications among refugee populations in Uganda, which hosts the largest number of refugees in Africa (estimated at 1.6 million refugees in 2023). To fill this critical evidence gap and support program planning and advocacy, the Baobab Research Program Consortium (RPC), in collaboration with the Guttmacher Institute, implemented the first-ever Abortion Incidence Complications Method (AICM) in refugee settings in Uganda. The main objectives of this study were to measure the incidence of abortion; determine the severity of abortion-related complications; and assess the capacity of the health system to offer post-abortion care to women living in all 13 refugee settlements in Uganda
Impact of implementing digital enabled interventions for community health workers on maternal, newborn and child health in Kisumu County
No full textThis was a quasi-experimental study that employed a mixed-methods approach, including a household survey and a community health volunteers\u27 survey, to assess the impact of the Digitally Enabled, Equipped, Supervised, and Compensated (DESC) enabled community health program on key maternal, newborn, and child health outcomes in Kisumu County, Kenya. The study was conducted among women aged 18–49 who were currently pregnant or who had a live birth in the last 18 months, caregivers of children under 2 years of age, and community health volunteers. The second component was the community health volunteers survey, which aimed to document experiences of use of digital platforms as well as their motivation and job satisfaction
Understanding sexual and reproductive health need of unmarried adolescents and youth in urban slums: Evidence from a formative study in Uttar Pradesh, India
No full textBackground: Despite the intentional focus of national programs and strategies in last decade, unmarried adolescents and youth (AY) face multiple challenges related to sexual and reproductive health (SRH) information, and access to health and counseling services. With massive urbanization and growing slum and more focus on married youth, the situation and need of unmarried AY are often overlooked. The present study explores the SRH need of AY to gain a holistic understanding of the SRH landscape in the context of slums of Uttar Pradesh, India. Methods: A formative qualitative study was conducted in the slums of two cities in Uttar Pradesh using qualitative research techniques—in-depth interviews (IDI) and focus group discussions (FGDs) with unmarried adolescents and youths aged 15–24 years. Thematic analysis was guided by principles of grounded theory and narrative inquiry, both inductive and deductive approaches. Results: The study found limited awareness of SRH issues and often inaccurate knowledge of modern contraceptives among the unmarried youth.Gendered access to SRH information emerged clearly, with boys benefitting from wider peer network, while girls relied on familial networks. Lack of social networks and support, communication gap, and limited reach of health providers have majorly contributed to misinformation and misconceptions. Information through social media and online sources served as a key source of SRH knowledge among adolescents and unmarried youth, but concerns remained about the accuracy and reliability of the information accessed. Structural constraints such as stigma, mobility restrictions, and provider bias further marginalized unmarried youth—especially girls—from accessing reliable SRH services. Conclusion: The study highlighted demand for SRH knowledge, source of knowledge, major concerns, and opportunities of AY in urban slums. A clear need for multi-faceted strategies targeting sexual health education, adolescent-responsive SRH services, and expanded digital outreach with verified content for this vulnerable populations are identified. However, targeted intervention through system level approaches for AY can be helpful for dispelling myths and providing accurate information
Schooling and intimate partner violence: Retrospective analysis of India’s \u3ci\u3eSarva Shiksha Abhiyan\u3c/i\u3e using quasi-experimental techniques
No full textBackground: Almost one-third of ever-married women in India experience physical, psychological or sexual violence by their husbands or partners. In this study, we examined the associations of universal primary education with long-term intimate partner violence (IPV) rates and attitudes condoning IPV among women in India. Methods: We used data from the National Family Health Survey 2019–2021 and compared women who were eligible for Sarva Shiksha Abhiyan (SSA)—a national programme of universal primary schooling implemented in 2001—with women who were older and not eligible for SSA. We employed a quasi-experimental method of propensity score matching and fixed effects regression analyses, accounting for a rich set of background socioeconomic and demographic characteristics as covariates. Results: Intervention group women who were originally eligible for SSA in 2001 (4 years below the primary to secondary transition age of 14 years) were 16%–31% less likely to justify IPV or experience emotional violence than control group women who were not eligible for the programme (4 years above the age cut-off). There were no statistically significant associations between SSA eligibility and the rates of physical IPV experienced by women. The results were robust to a series of sensitivity analyses and alternate model specifications. Conclusions: Our findings indicate that universal access to primary schooling may play an important role in reducing IPV and improving gender equality in India and similar low-income and middle-income countries
IPM South Africa, NPC: Pioneering HIV prevention options for women
Full text linkThe Population Council is leveraging its innovative ring technology to develop a range of next-generation prevention products that advance the science of HIV prevention. These include a three-month dapivirine-only vaginal ring as well as combination rings that leverage the potency of different ARVs.
There will be no single solution to ending the epidemic—stopping HIV will require a variety of options. Research from the family planning field has shown that when more options are available, women are able to choose what best fits their circumstance and life stage. This means that there is an urgent need to expand the number of available options for HIV prevention from which women can choose
A retrospective cohort study of valproate and infertility in men with epilepsy or bipolar disorder using international health data
No full textValproate is highly effective at treating epilepsy and bipolar disorder. It faces prescribing restrictions in men due to concerns it causes testicular dysfunction and infertility. These mostly stem from animal models – the human evidence is limited and conflicting. We report the largest ever retrospective cohort study of infertility in men with epilepsy or bipolar disorder, using real-world healthcare data from TriNetX. 91,917 of the men are exposed to valproate, and 535,803 unexposed. Cohorts are propensity score matched for a comprehensive set of baseline covariates, and survival analysis is undertaken using Cox-proportional hazards models. No significant difference is seen between valproate-exposed and unexposed men across lifetime risks of infertility, testicular hypofunction, testicular atrophy, and a composite of low sperm concentration, motility, vitality, normal forms, and semen volume (p \u3e 0.05). Our findings do not support an association between valproate and infertility in men with epilepsy or bipolar disorder in real-world settings
The intersections of climate change, gender, migration, and sexual and reproductive health in Sub-Saharan Africa: A scoping review
No full textBackground: Climate change drives socio-environmental shifts in Sub-Saharan Africa, disproportionately impacting marginalized groups. This scoping review aims to document the impacts of climate change, explore its effects on gender, migration, and sexual and reproductive health (SRH), while also mapping adaptation strategies. Methods: A systematic approach was employed to review peer-reviewed articles, gray literature, and relevant policy documents sourced from major academic databases and authoritative international organizations. The inclusion criteria focused on studies published between 2000 and 2025 that addressed climate change and its associated impacts in Sub-Saharan Africa and explored intersections with gender, migration, or SRH. Data were extracted using a standardized form and synthesized thematically to identify patterns, disparities, and interconnections in climate-related vulnerabilities across affected populations. Results: Findings from the 22 included studies revealed that climate change disproportionately affects women, girls, and adolescents in Sub-Saharan Africa. These impacts are reflected in the deepening of existing gender inequalities, significant disruptions to SRH service availability and accessibility, and heightened vulnerability during migration and displacement events. Though limited in scale and depth of implementation, studies have also documented gender-responsive adaptation strategies, such as community-led resilience initiatives, local coping mechanisms, and targeted policy interventions, highlighting emerging models of localized adaptation and response. Conclusion: Climate change presents a significant and multifaceted threat to adolescents, youth, and women, particularly in relation to SRH, gender inequality, and migration. Effectively addressing these challenges requires integrated, multidisciplinary approaches and inclusive policies that prioritize vulnerable populations
Understanding incentives preferences to improve community health worker performance using discrete choice experiments
No full textThis was a cross-sectional study among Community Health Workers aged 18 years and over, using discrete choice experiments to elicit employment preferences of government-supported community health workers in Uganda and Kenya. The objectives of the study were:
1) To identify the key hypothetical attributes, both financial and non-financial, that influence the performance of CHWs;
2) To identify levels of each of the attributes such that the levels are feasible to achieve in practice;
3) To assess the relative strength of the selected attributes, individually and in combination, to determine the preferred job preferences of CHWs