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‘We are the bridge’: An implementation research study of SEWA Shakti Kendras to improve community engagement in publicly funded health insurance in Gujarat, India
No full textIntroduction: India’s efforts towards universal health coverage include a national health insurance scheme that aims to protect the most vulnerable from catastrophic health expenditure. However, emerging evidence on publicly funded health insurance, as well as experience from community-based schemes, indicates that women face specific barriers to access and utilisation. Community engagement interventions have been shown to improve equitable utilisation of public health services, but there is limited research specific to health insurance. We examined how existing community-based resource centres implemented by a women’s organisation could improve women’s access to, and utilisation of, health insurance. Methods: We conducted an implementation research study in Gujarat, India to examine how SEWA Shakti Kendras, established by the Self-Employed Women’s Association, worked to improve community engagement in health insurance. SEWA organises women in the informal sector and provides social protection through health, insurance and childcare services. We examined administrative data, programme reports and conducted 30 in-depth qualitative interviews with users and staff. Data were analysed thematically to examine intervention content, context, and implementation processes and to identify enablers and barriers to improving women’s access to health insurance through SEWA’s community engagement approach. Results: The centres worked through multiple channels—doorstep services, centre-based support and health system navigation—to strengthen women’s capability to access health insurance. Each centre’s approach varied by contextual factors, such as women’s digital literacy levels and rural–urban settings. Effective community engagement required local leadership, strong government partnerships and the flexibility to address a range of public services, with implementation by trusted local health workers. Conclusion: SEWA Shakti Kendras demonstrate how a local, flexible and community-based model can serve as a bridge to improve utilisation of health insurance, by engaging women and their households through multiple channels. Scaling up this approach will require investing in partnerships with community-based organisations as part of strategies towards universal health coverage
Women\u27s groups and COVID-19: An evidence review on savings groups in Africa
No full textThe coronavirus disease 2019 (COVID-19) pandemic and some of the associated policy responses have resulted in significant gendered impacts that may reverse recent progress in gender equality, including in sub-Saharan Africa. This paper presents emerging evidence from studies in diverse contexts in sub-Saharan Africa -with a deep dive into Nigeria and Uganda-on how COVID-19 has affected women\u27s groups, especially savings groups, and how these groups have helped mitigate the gendered effects of the pandemic\u27s and the associated policy responses\u27 consequences up until April 2021. The synthesis presents evidence that savings groups found ways to continue operating, provided leadership opportunities for women during the pandemic, and mitigated some of the negative economic consequences of COVID-19 on individual savings group members. Savings, credit, and group support from other members all likely contributed to the ability of groups to positively affect the resilience of women\u27s group member during COVID-19. Households with a female member in a savings group in Nigeria and Uganda have coped with the crisis better than those not in savings groups. While savings groups have shown the potential for resilience during the pandemic, they often faced financial challenges because of decreased savings, which sometimes resulted in the depletion of group assets. Savings groups also contributed to community responses and provided women a platform for leadership. These findings are consistent with a recent evidence synthesis on how past covariate shocks affected women\u27s groups and their members. We conclude the paper by presenting various policy recommendations to enable savings groups to achieve improvements in women\u27s empowerment and economic outcomes, and research recommendations to address some of the current evidence gaps on how COVID-19 is affecting women\u27s groups and their members
Has urbanization slowed down in Pakistan?
No full textPakistan is the seventh largest contributor to world urban growth and exhibits high levels of urbanization. The recent 2017 Population Census results show a slowing of urban growth. We question whether this apparent slowdown reflects lowering of the rate of natural increase and migration, or is the result of a disconnect between the administrative definition of urban and actual reality. Alternative estimates presented here suggest that the 2017 Census may have underestimated urbanization by as much as 22.2 per cent, that is, the actual level of urbanization may be 44.5 per cent compared to 36.4 per cent reported in the census. We decompose the urban growth to assess the relative impact of natural increase, reclassification and migration and we utilize alternative methods of classification of urban areas to assess urbanization levels for Pakistan and its provinces. Continuing high levels of urban fertility and natural increase are the major contributors to urban growth. Internal migration is the next biggest contributor, however directions of movements may be changing. These findings have implications for the forthcoming 2022 census to improve the enumeration of urban areas and for urban planning to take advantage of the beneficial effects of building connectivity between small, medium, and large cities
How can behavioral determinant data inform family planning SBC programs and policies?
No full textIn this blog published by Knowledge SUCCESS, Breakthrough RESEARCH\u27s Leanne Dougherty and Phil Anglewicz of Performance Monitoring for Action (PMA) share the importance of collecting behavioral determinant data to inform family planning (FP) social and behavior change (SBC) programs and policies. Behavioral determinants are the factors that influence or shape a health behavior. In the context of FP, some relevant behavioral determinants include intentions (for example, motivation to use an FP method) and attitudes (satisfaction with the method). In addition to its importance, the authors share their expertise on how, and at-scale, to collect the data, and the challenges they have encountered while trying to gather this data
Video: Population Council 70th Anniversary
No full textFor 70 years, the Population Council has transformed global thinking on critical health and development issues through our social science, public health, and biomedical research.
As the world confronts multiple social, economic, political, and environmental crises, there is increasing need for high-quality and clearly communicated evidence to inform smart policies and sound investments.
At the Population Council, we are redoubling our efforts to make the greatest contributions through new ideas, rigorous evidence, and innovative solutions.
In November 2022, the Council launched its new Strategic Plan, which focuses on four global goals that reflect the urgent problems the world faces. Through these, we will contribute to the United Nations’ 2030 Sustainable Development Goals (SDGs), which seek to end poverty, protect the planet, and ensure that all people enjoy peace and prosperity
Sexual debut and risk behaviors among orphaned and vulnerable children in Zambia: Which protective deficits shape HIV risk?
No full textOrphaned and vulnerable children (OVC) are not only affected by, but also rendered at-risk of, HIV due to overlapping deficits in protective assets, from school to household financial security. Drawing from a protective deficit framework, this study examines correlates of sexual risk—including multiple sexual partnerships, unprotected sex, and age at sexual debut—among OVC aged 13–17 years in Zambia. In May-October 2016, a two-stage stratified random sampling design was used to recruit OVC and their adult caregivers (N = 2,034) in four provinces. OVC-caregiver dyads completed a structured interview addressing household characteristics, protective assets (i.e. finances, schooling, and nutrition), and general health and wellbeing. Associations of factors derived from the multi-component protective deficits framework were examined using multivariable ordered logistic regression, comparing sexually inexperienced OVC to those with a sexual debut and reporting ≥ 1 sexual behavior(s). A sub-analysis of older (ages 15–17) OVC identified correlates of early (before age 15) and later (at or after age 15) sexual debut using multinomial logistic regression. Among 735 OVC aged 13–17, 14% reported a sexual debut, among whom 14% and 22% reported 2+ past-year partners and non-condom last sex, respectively. Older age (Adjusted Odds Ratio [aOR] = 2.08, 95% Confidence Interval [CI] 1.32–3.27), male sex (aOR = 1.90, CI 1.22–2.96), not having a birth certificate (aOR = 2.05, CI 1.03–4.09), out-of-school status (aOR = 2.63, CI 1.66–4.16), and non-household labor (aOR = 1.84, CI 1.01–3.38) were significantly associated with higher sexual risk. Male sex was the only factor significantly associated with early sexual debut in multivariable analysis. Sexual risk-reduction strategies require age- and sex-specific differentiation and should be prioritized for OVC in financially distressed households
SBC Cost Data Repository
No full textThe SBC Cost Data Repository was funded by the U. S. Agency for International Development and developed by Breakthrough RESEARCH. The repository is a centralized database that contains social and behavior change (SBC) cost data from 197 studies in the peer review and grey literature, with data from 1973–2021. The repository was originally developed by Avenir Health as part of the Business Case for Investing in Social and Behavior Change for Family Planning.
SBC donors, implementers, and researchers can use this database to assist with planning and budgeting. The unit costs in this database can also be found in the Global Health Cost Consortium\u27s Unit Study Cost Repository at: https://ghcosting.org/pages/data/ucsr/app/. See the Guide tab for further information on how to use the cost repository
Extramarital fertility in low- and middle-income countries
No full textBackground: In most societies, childbearing is largely confined to women in formal marital unions, but in a subset of contemporary low-fertility Western societies, extramarital fertility has become common. However, extramarital fertility is often ignored in fertility research in contemporary low and middle-income countries (LMICs). Objective: To document recent levels, trends, and differentials in extramarital fertility (both premarital and postmarital) in LMICs. Methods: We employ Schoumaker’s (2013) Stata program tfr2 to calculate two fertility measures from Demographic and Health Surveys in 63 countries: (1) the standard total fertility rate (TFR), which is based on all births in the three years before the survey date, and (2) the marital total fertility rate (MTFR), which is based on all births within marital unions in the three years before the survey date. The percentage of fertility that is extramarital (PEM) is estimated as 100 x (TFR–MTFR)/TFR. Results: The unweighted average PEM for the most recent surveys in the 63 DHS countries equals 11.3%, with 7.9% premarital and 3.4% postmarital. By far the highest percentage premarital is found in southern Africa (43%) and the lowest in Asia/North Africa (0.9%). Postmarital fertility is most common in sub-Saharan Africa and Latin America. Conclusions: Childbearing outside of marriage is an important feature of contemporary reproductive regimes in sub-Saharan Africa and Latin America. By contrast, less than 2% of births are extramarital in most Asian and North African societies
Longitudinal examination of young married women\u27s fertility and family planning intentions and how they relate to subsequent family planning use in Bihar and Uttar Pradesh India
No full textObjectives: This study examines which fertility and family planning (FP) intentions are related to subsequent FP use in a sample of young, married women in India. Design: We use 3-year longitudinal data from married women ages 15-19 in 2015-2016 (wave 1) who are not using contraception to examine factors associated with any use of FP in 2018-2019 (wave 2). Setting: Data were collected in the states of Bihar and Uttar Pradesh, India. Participants: A representative sample of 4893 young married women ages 15-19 was surveyed in 2015-2016 and 4000 of them were found and interviewed 3 years later. This analysis focused on the 3614 young women who were not using FP at wave 1. Primary outcomes: This study examines FP use at wave 2 as the main outcome variable. Results: Multivariate analyses demonstrated that young women who wanted to delay childbearing three or more years or who did not want any(more) children at wave 1 were more likely to use contraception at wave 2. Additionally, intention to use FP in the next 12 months at wave 1 was significantly associated with FP use at wave 2 whereas unmet need at wave 1 was not significantly related to subsequent use. A combined measure of fertility desires and intention to use FP demonstrated the importance of both measures on subsequent use. Having any children and being pregnant at wave 1 were both related to FP use at wave 2. Conclusions: It is important to reach young, married women prior to a first pregnancy with nuanced messages addressing their fertility and FP intentions. Programmes targeting women at antenatal and postpartum visits are important for young women to help support them to use FP to address their desires to delay or limit future childbearing for the health and well-being of themselves and their children