6867 research outputs found
Sort by
Syrian refugee women’s access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon
No full textBackground: Political, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women’s interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women. Methods: We carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data. Results: The crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women’s demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity. Conclusions: We suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills
Improving measures of access to legal abortion: A validation study triangulating multiple data sources to assess a global indicator
No full textBackground: Global mechanisms have been established to monitor and facilitate state accountability regarding the legal status of abortion. However, there is little evidence describing whether these mechanisms capture accurate data. Moreover, it is uncertain whether the legal status of abortion is a valid proxy measure for access to safe abortion, pursuant to the global goals of reducing preventable maternal mortality and advancing reproductive rights. Therefore, this study sought to assess the accuracy of reported monitoring data, and to determine whether evidence supports the consistent application of domestic law by health care professionals such that legality of abortion functions as a valid indicator of access. Methods and findings: We conducted a validation study using three countries as illustrative case examples: Argentina, Ghana, and India. We compared data reported by two global monitoring mechanisms (Countdown to 2030 and the Global Abortion Policies Database) against domestic source documents collected through in-depth policy review. We then surveyed health care professionals authorized to perform abortions about their knowledge of abortion law in their countries and their personal attitudes and practices regarding provision of legal abortion. We compared professionals\u27 responses to the domestic legal frameworks described in the source documents to establish whether professionals consistently applied the law as written. This analysis revealed weaknesses in the criterion validity and construct validity of the legal status of abortion indicator. We detected discrepancies between data reported by the global monitoring and accountability mechanisms and the domestic policy reviews, even though all referenced the same source documents. Further, provider surveys unearthed important context-specific barriers to legal abortion not captured by the indicator, including conscientious objection and imposition of restrictions at the provider\u27s discretion. Conclusions: Taken together, these findings denote weaknesses in the indicator legal status of abortion as a proxy for access to safe abortion, as well as inaccuracies in data reported to global monitoring mechanisms. This information provides important groundwork for strengthening indicators for monitoring access to abortion and for renewed advocacy to assure abortion rights worldwide
Utilizing implementation research to influence parents’ experiences of care for their hospitalized newborns and young children in Kenya
No full textBackground: The World Health Organization’s standards for paediatric services reinforce the importance of improving experience of care for young children and their caregivers within the health system. There is limited information on how to adequately partner with families in caring for hospitalized young children in low resource settings. We co-created and embedded a pilot structural and provider behaviour change (PBC) intervention approach to improve facility-based experiences of care for parents of sick newborns and young children in hospital settings in Kenya. The intervention encompassed coaching parents on respectful and nurturing care elements, emotional support for parents, involvement of fathers in shared decision-making during hospitalization, and feedback meetings with providers. Methods: The intervention was implemented in five hospitals across Kenya providing newborn and paediatric services. We used a mixed methods approach and periodic monitoring during the intervention implementation to measure parent experiences. We conducted short parent exit interviews (n=531) at midline, a follow up survey (n=382), and qualitative in-depth interviews with parents (n=17) at endline. Results: Seventy-eight percent of parents experienced high quality communication with providers including dialogue, providers using understandable language, and showing attentiveness. Similar levels of parents (78%) described providers showing respect towards families, and the hospitalized child. There was varied information provided on nurturing care elements such as optimizing nutrition, positioning, and handling, safeguarding sleep, protecting skin, and minimizing stress. However, parents (82%) reported feeling empowered, in caring for one’s newborn and young children and fathers described being allowed to visit their children freely (83%) and receiving information about their child’s care while in hospital (63%). Although parents reported elevated levels of stress measured by a 23-item scale that ranged 1-128 points (mean score=83.5, SD=18.1)., they also described receiving emotional support from providers that included encouragement and reassurance. Discussion: It is acceptable and feasible to implement a low-cost intervention to improve respectful and nurturing care for newborns and young children in Kenya. Using implementation research to work closely with facility providers and managers in everyday healthcare settings was key in establishing how to involve parents in care and institutionalizing parent feedback forms to improve experiences of care
Data Brief—Success Stories of Girls-led Climate Action, Their Impact on Their Communities, and Global Advocacy Movements
Get PDF
Evaluation of Breakthrough ACTION-Nigeria’s social and behavior change public sector capacity strengthening approach
Get PDFCost-effectiveness analysis comparing integrated and malaria-only social and behavior change programming in Nigeria: Midline analysis
Get PDFThe United States Agency for International Development (USAID)/Nigeria is working closely with the Nigerian government to improve the practice of priority health behaviors through the Breakthrough ACTION project. Breakthrough RESEARCH is leading an evaluation of Breakthrough ACTION’s program comparing the integrated social and behavior change (SBC) program (malaria, family planning, maternal and child health, and nutrition) in Kebbi and Sokoto states and vertical SBC program (malaria-only) in Zamfara state. While the first initial cost report covered the time frame from program initiation in April 2018 through December 2019, this midline report covers January 2020 through December 2021. This report examines four important areas: 1) program expenditures and cumulative expenditures during this time period; 2) COVID-19 related expenditures; 3) unit costs for SBC interventions; and 4) program impact in integrated Kebbi state from the baseline to midline behavioral sentinel surveillance (BSS) survey
Lessons from a behavior change intervention to improve provider-parent partnerships and care for hospitalized newborns and young children in Kenya
No full textEnhancing respectful, responsive, integrative, and nurturing care for hospitalized newborns and young children (aged 0–24 months) is globally recognized but under-researched in low- and middle-income countries. Responsive, family-centered interventions target providers and parents and emphasize partnership in caring roles. From February 2020 to August 2021, we engaged in a participatory co-creation process with parents, providers, and newborn and child health stakeholders in Kenya to develop a comprehensive provider behavior change intervention and implemented it across 5 hospitals in Nairobi and Bungoma counties in Kenya. The multifaceted intervention included a 7-module orientation, feedback meetings, job aids, and psychosocial support—leveraging in-person and remote modalities—for providers working in newborn and pediatric units. We used a mixed-methods evaluation drawing on a pre-post provider survey, pre-post qualitative interviews with providers and parents, and a follow-up parental survey. There were significant post-intervention improvements in provider knowledge on safeguarding sleep, positioning and handling, and protecting skin. However, there were also significant reductions in providers’ knowledge in identifying a child’s pain, parental stress, and environmental stress. Among parents who received coaching from providers, there were higher levels of interpersonal communication between parent and provider, parental empowerment, and improved ability to provide integrated, responsive care to their child. Despite the challenges of implementing a provider-focused intervention to improve care for hospitalized newborns and young children during the global COVID-19 pandemic, we have demonstrated that it is feasible to implement a hybrid virtual and in-person process to influence several outcomes, including provider knowledge and practice, improved provider partnerships with parents, and parents’ capacity to engage in the care of their newborn or young child
Embedding implementation research to cross the quality of care chasm during the covid-19 pandemic and beyond
No full textMichael Peters and colleagues argue that concerted efforts to embed implementation research can improve health services, even in the most challenging operating environments