6867 research outputs found
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“Then I will say that we have to marry each other”: A qualitative view of premarital pregnancy as a driver of child marriage in Malawi
No full textChild marriage is common in Malawi, with 42.1% of women ages 20-24 marrying before age 18. Although global research on child marriage has increased in recent years, the reasons are context-specific and there is limited evidence on specific drivers of child marriage in Malawi. We explored pathways to child marriage in Mangochi and Nkhata Bay, drawing on focus groups (n=20) and in-depth interviews (n=39) with adolescent girls and parents of adolescent girls. We find that pregnancy often determines marriage timing and partner selection among adolescents, due in part to norms of adolescent dating or courtship and premarital sexual activity. Once pregnancy occurs, marriage is nearly inevitable even if the girl is under age 18. These findings have important implications for programs to delay marriage; programs must address weak motivations to prevent pregnancy and work to create alternative livelihood opportunities to foster economic self-sufficiency
“When you live in good health with your husband, then your children are in good health ….” A qualitative exploration of how households make healthcare decisions in Maradi and Zinder Regions, Niger
No full textBackground: Gender dynamics influence household-level decision-making about health behaviors and subsequent outcomes. Health and development programs in Niger are addressing gender norms through social and behavior change (SBC) approaches, yet not enough is known about how health care decisions are made and if gender-sensitive programs influence the decision-making process. Methods: We qualitatively explored how households make decisions about family planning, child health, and nutrition in the Maradi and Zinder regions, Niger, within the context of a multi-sectoral integrated SBC program. We conducted 40 in-depth interviews with married women (n = 20) and men (n = 20) between 18 and 61 years of age. Results: Male heads of household were central in health decisions, yet women were also involved and expressed the ability to discuss health issues with their husbands. Participants described three health decision-making pathways: (1st pathway) wife informs husband of health issue and husband solely decides on the solution; (2nd pathway) wife informs husband of health issue, proposes the solution, husband decides; and (3rd pathway) wife identifies the health issue and both spouses discuss and jointly identify a solution. Additionally, the role of spouses, family members, and others varied depending on the health topic: family planning was generally discussed between spouses, whereas couples sought advice from others to address common childhood illnesses. Many participants expressed feelings of shame when asked about child malnutrition. Participants said that they discussed health more frequently with their spouses’ following participation in health activities, and some men who participated in husbands’ schools (a group-based social and behavior change approach) reported that this activity influenced their approach to and involvement with household responsibilities. However, it is unclear if program activities influenced health care decision-making or women’s autonomy. Conclusions: Women are involved to varying degrees in health decision-making. Program activities that focus on improving communication among spouses should be sustained to enhance women role in health decision-making. Male engagement strategies that emphasize spousal communication, provide health information, discuss household labor may enhance couple communication in Niger. Adapting the outreach strategies and messages by healthcare topic, such as couples counseling for family planning versus community-based nutrition messaging, are warranted
Integrated health care delivery for adolescents living with and at risk of HIV infection: A review of models and actions for implementation
No full textIntegrated service delivery, providing coordinated services in a convenient manner, is important in HIV prevention and treatment for adolescents as they have interconnected health care needs related to HIV care, sexual and reproductive health and disease prevention. This review aimed to (1) identify key components of adolescent-responsive integrated service delivery in low and middle-income countries, (2) describe projects that have implemented integrated models of HIV care for adolescents, and (3) develop action steps to support the implementation of sustainable integrated models. We developed an implementation science-informed conceptual framework for integrated delivery of HIV care to adolescents and applied the framework to summarize key data elements in ten studies or programs across seven countries. Key pillars of the framework included (1) the socioecological perspective, (2) community and health care system linkages, and (3) components of adolescent-focused care. The conceptual framework and action steps outlined can catalyze design, implementation, and optimization of HIV care for adolescents
The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria
No full textBackground: CPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria. Methods: In a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance. Results: Majority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01-8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14-3.99, p-value = 0.02). Conclusion: Community Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria
To protect access to medication abortion in the US, make the misoprostol-only regimen a reality
No full textUrban disparities in sexual and reproductive health and rights (SRHR) in the Global South: A scoping review of the evidence
No full textThe world is rapidly urbanizing, with the Global South estimated to contain three-quarters of the world’s urban inhabitants by 2050. There are no standardized definitions of urban settings, and urban populations are significantly heterogeneous with regard to their demographic makeup, economic status, access to services, and health outcomes. Sexual and reproductive health and rights (SRHR) are a critical component of developing healthy and productive urban populations. We hypothesize that SRHR needs, services, and preferences are heterogenous within urban areas, and highly inequitable, and that current data available are not sufficient to fully understand how to address these inequities. A scoping review of the literature will be conducted to explore current research findings (2010 to the present) to understand health and economic disparities within urban settings in the Global South, the role of social and gender equity, and evidence around proposed and tested interventions to date. The potential impact of the COVID-19 pandemic in urban areas will also be considered, including disruption of service delivery and shifts in outcomes such as gender-based violence, sexual debut, early marriage, and fertility preferences. Findings from this review will elucidate research gaps and next steps for stakeholders such as researchers, programmers, policymakers and donors that aim to foster inclusive urbanization in part by improving access to and uptake of SRHR services for all, as well as addressing linkages to gender equity and education. The objective of this review is to summarize the evidence regarding the SRHR needs and experiences of urban dwellers in the Global South, identify any successful interventions or programs that have been tested, and outline gaps in the literature and opportunities moving forward
If we ask, will they tell? (and then, what?): Screening for sexual violence against children in Kenya
No full textThis study assesses the feasibility of using a screening tool to proactively identify child survivors of sexual violence in Kenyan primary school and health facility settings, and to refer such survivors to care. A mixed-methods design was employed, involving quantitative screening tool data, as well as service data from 497 girls and boys in two primary schools (in standards six to eight) and one hospital site (11–17-year-olds) and qualitative data (in the form of field notes) generated during the screening process. Results point to the feasibility of this screening intervention, as evidenced by the proportion of children in the school and health facility sites combined: 97 per cent were willing to be screened for sexual violence, 45 per cent disclosed lifetime sexual violence and 75 per cent received care subsequent to disclosing lifetime experiences of sexual violence. Further, the qualitative results ‘give voice’ to child survivors and their parents, demonstrating the acceptability of, and demand for, the intervention among these populations. Findings from this study suggest that screening for sexual violence against children is feasible in both school and health facility settings. Such screening also holds potential for expanding child survivors\u27 access to care
Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia
No full textObjectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15–24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability