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Building the A3 Policy Checklist
Get PDFThe Adolescent Atlas for Action (A3) is a suite of tools that summarizes the lives and needs of adolescents around the world to promote evidence-based decision-making. Through accessible and easy-to-grasp data just one click away, the A3 bridges the gap between decisionmakers and evidence to inform policies and programs. The A3 Policy Checklist, created by the Population Council’s GIRL Center, features a curated list of national policies relevant to the lives of adolescents under 9 thematic domains, and whether countries have enacted each policy. The checklist presents a snapshot of commitments made to achieving adolescent wellbeing through adolescent-focused policies. As of July 2022, the policy checklist includes 56 policies, which were tracked for 113 low- and middle- income countries (LMICs). This list of policies is not exhaustive, and additional policies will be added to the checklist every year. This brief elaborates on the methodology for curating the A3 Policy Checklist
Nigerian stakeholders\u27 perceptions of a pilot tier accreditation system for Patent and Proprietary Medicine Vendors to expand access to family planning services
No full textBackground: Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are often the first point of care for many Nigerians, and when sufficiently trained, they contribute to the expansion of family planning services. Nigeria\u27s task shifting policy and existing regulatory and licensing bodies provide the enabling environment for PPMVs to be stratified and trained. This study explored the perceptions of stakeholders toward the pilot three-tier accreditation system instituted by the Pharmacists Council of Nigeria with support from the IntegratE project. Methods: Two rounds of qualitative phone interviews were conducted among stakeholders in Kaduna and Lagos states in 2020 and 2021. In addition, there were two rounds of phone interviews with CPs and PPMVs (program recipients) from Lagos and Kaduna states. All participants were purposively selected, based on their involvement in the IntegratE project activities. Interviews were recorded, transcribed, and coded using Atlas.ti software. Thematic analysis was conducted. Results: Fifteen stakeholders and 28 program recipients and 12 stakeholders and 30 program recipients were interviewed during the first and second rounds of data collection respectively. The data are presented around three main themes: 1) the pilot three-tier accreditation system; 2) enabling environment; and 3) implementation challenges. The accreditation system that allows for the stratification and training of PPMVs to provide family planning services was perceived in a positive light by majority of participants. The integrated supportive supervision team that included representation from the licensing and regulatory body was seen as a strength. However, it was noted that the licensing process needs to be more effective. Implementation challenges that need to be addressed prior to scale up include bottlenecks in licensing procedures and the deep-rooted mistrust between CPs and PPMVs. Conclusion: Scale up of the three-tier accreditation system has the potential to expand access to family planning services in Nigeria. In other resource-poor settings where human resources for health are in short supply and where drug shops are ubiquitous, identifying drug shop owners, training them to offer a range of family planning services, and providing the enabling environment for them to function may help to improve access to family planning services
Oral PrEP consultations among adolescent girls and young women in Kisumu County, Kenya: Insights from the DREAMS program
No full textAlthough Kenya nationally scaled up oral pre-exposure prophylaxis (PrEP) in May 2017, adolescent girls’ (AG, aged 15–19 years) and young women’s (YW, aged 20–24 years) PrEP use remains suboptimal. Thus, we analyzed PrEP consultations—interactions with a healthcare provider about PrEP—among Kenyan AGYW. In April-June 2018, AGYW enrolled in DREAMS in Kisumu County, Kenya self-reported their HIV-related knowledge, behaviors, and service use. Among HIV negative, sexually active AG (n = 154) and YW (n = 289), we examined associations between PrEP eligibility and PrEP consultations using prevalence ratios (PR, adjusted: aPR). Most AG (90.26%) and YW (94.12%) were PrEP-eligible due to inconsistent/no condom use, violence survivorship, or recent sexually transmitted infection symptoms. Between PrEP-eligible AG and YW, more YW were ever-orphaned (58.09%), ever-married (54.41%), ever-pregnant (80.88%), and out of school (78.31%); more PrEP-eligible YW reported PrEP consultations (41.18% vs. 24.46%, aPR = 1.51 [1.01–2.27]). AG who used PEP (post-exposure prophylaxis) reported more consultations (aPR = 5.63 [3.53–8.97]). Among YW, transactional sex engagers reported more consultations (58.62% vs. 39.09%, PR = 1.50 [1.06–2.12]), but only PEP use (aPR = 2.81 [2.30–3.43]) and multiple partnerships (aPR = 1.39 [1.06–1.82]) were independently associated with consultations. Consultations were lowest among those with 1 eligibility criterion (AG = 11.11%/YW = 27.18%). Comparatively, consultations were higher among AG and YW with 2 (aPR = 3.71 [1.64–8.39], PR = 1.60 [1.07–2.38], respectively) or ≥ 3 (aPR = 2.51 [1.09–5.78], PR = 2.05 [1.42–2.97], respectively) eligibility criteria. Though most AGYW were PrEP-eligible, PrEP consultations were rare and differed by age and vulnerability. In high-incidence settings, PrEP consultations should be conducted with all AGYW. PrEP provision guidelines must be re-assessed to accelerate AGYW’s PrEP access
Comparing cohabiting unions and formal marriages among adolescent girls in Zambia: The role of premarital fertility and parental support
No full textPurpose: In developing countries, approximately one in three girls marry before the age of 18; however, early marriage is not a homogenous experience. Cohabitation can be either a precursor or an alternative to marriage, yet studies and programs often conflate marriage types. The purpose of this study is to understand the underlying factors and stability of cohabiting and formal child marriage unions among adolescent girls. Methods: This mixed-methods study draws on four rounds of quantitative data collected annually between 2013 and 2016 as part of a longitudinal study among girls 10–19 years old in Zambia. In-depth interviews were conducted in 2017 with 32 girls, divided by formal unions and informal unions, randomly selected from the quantitative sample. Multivariate logistic models were estimated to test key associations and Cox regression models used to estimate the hazard of separation/divorce by a certain age. Results: Qualitative findings highlighted that informal unions did not typically have approval of the couples’ parents and frequently ended in separation. As compared to formal unions, having both families’ approval was associated with 69% lower odds of cohabiting (odds ratio = 0.31, p \u3c .001), while forced entry into union due to pregnancy was associated with 61% greater odds of cohabiting (OR = 1.61, p \u3c .05). Being in a cohabiting union was associated with a 43% greater hazard of union dissolution (hazard ratio = 1.43, p \u3c .05). Discussion: There are key differences between formal marriages and cohabitation among adolescent girls and young women that should be considered when addressing early marriage in research and programs
ZIKV-related ideations and modern contraceptive use: Cross-sectional evidence from the Dominican Republic, El Salvador, Honduras, and Guatemala
No full textZika virus (ZIKV) can be sexually transmitted and can lead to severe neonatal and child health issues. The current study examines whether ZIKV-related ideational factors, including awareness of ZIKV and associated birth defects, are related to modern contraceptive use among women and men with sexual partners in four Latin American and Caribbean (LAC) countries. Data used are from cross-sectional household surveys conducted in 2018 in the Dominican Republic, El Salvador, Guatemala, and Honduras with representative samples of men and women aged 18–49 (N = 1,100). The association between self-reported use of modern contraception and measures of Zika knowledge, risk perceptions and social norms, and contraceptive self-efficacy was examined via sex disaggregated multivariate logistic regression models. Both men (OR 3.70, 95% CI 1.36–10.06, P \u3c 0.05) and women (OR 3.71, 95% CI 2.30–5.99, P \u3c 0.0001), who reported discussing family planning with their partner in the last year were more likely to use modern contraception compared with those who did not. Contrary to our hypothesis, knowledge that ZIKV can affect a fetus was negatively associated with modern contraceptive use for women (OR 0.49, 95% CI 0.29–0.85, P \u3c 0.05). Given the cross-sectional nature of the survey, women not using contraception may be more likely to remember that ZIKV can affect a fetus. In the event of a related outbreak, future health promotion and communication efforts in LAC should focus on known determinants of modern contraceptive use, such as knowledge and partner communication, and knowledge of the health effects of ZIKV if pregnant, to influence family planning decision-making behavior
How to use a theory of change to monitor and evaluate social and behavior change programs
Get PDFBreakthrough RESEARCH has developed a guide on how to use a theory of change to monitor and evaluate social and behavior change (SBC) programs. This guide will help managers support research, monitoring, and evaluation staff and ensure they have the programmatic data required to track results, and it will ensure the program is guided by robust theory-driven evidence with results tracked over time and at the program’s end. This guide is one of a series of Compass SBC how-to guides that provide step-by-step instructions on how to perform core SBC tasks. From formative research through monitoring and evaluation, these guides cover each step of the SBC process, offer useful hints, and include important resources and references
The perceived effects of COVID-19 pandemic on female genital mutilation/cutting and child or forced marriages in Kenya, Uganda, Ethiopia and Senegal
No full textBackground: The effects of COVID-19 on harmful traditional practices such Female Genital Mutilation/Cutting (FGM/C) and Child or Forced Marriages (CFM) have not been well documented. We examined respondents’ perceptions on how the COVID-19 pandemic has affected FGM/C and CFM in Kenya, Uganda, Senegal, and Ethiopia. Methods: A cross-sectional study design with a mixed methods approach was used. Data collection on participants’ perceptions on the effects of COVID-19 on FGM/C and CFM took place between October-December 2020. Household surveys targeting women and men aged 15–49 years in Kenya (n = 312), Uganda (n = 278), Ethiopia (n = 251), and Senegal (n = 208) were conducted. Thirty-eight key informant interviews with programme implementers and policymakers were carried out in Kenya (n = 17), Uganda (n = 9), Ethiopia (n = 8), and Senegal (n = 4). Results: In Kenya, the COVID-19 pandemic has contributed to the increase in both FGM/C and CFM cases. Minimal increase of FGM/C cases was reported in Uganda and a significant increase in CFM cases. In Ethiopia, the COVID-19 pandemic had a limited perceived effect on changes in FGM/C and CFM. In Senegal, there were minimal perceived effects of COVID-19 on the number of FGM/C and CFM cases. The pandemic negatively affected implementation of interventions by the justice and legal system, the health system, and civil societies. Conclusions: The pandemic has had varied perceived effects on FGM/C and CFM across the four countries. Generally, the pandemic has negatively affected implementation of interventions by the various sectors that are responsible for preventing and responding to FGM/C and CFM. This calls for innovative approaches in intervening in the various communities to ensure that women and girls at risk of FGM/C and CFM or in need of services are reached during the pandemic. Evidence on how effective alternative approaches such as the use of call centres, radio talk shows and the use of local champions as part of risk communication in preventing and responding to FGM/C and CFM amid COVID-19 is urgently required
Effects of men’s lifetime adverse events experience on violence, HIV risk, and wellbeing: Insights from three countries
No full textObjective: To assess men\u27s experiences of adverse events in both child and adulthood and their effects on violence, HIV risk, and well being in three sub-Saharan countries. Design: We conducted cross-sectional surveys from 2017 to 2018 with men (all 18+) recruited via the PLACE methodology at community hotspots and HIV service sites in Eswatini (n = 1091), South Africa (n = 932), and Malawi (n = 611). Methods: Prevalence of men\u27s adverse events in childhood (e.g. beaten at home often) and adulthood (e.g. robbed at gunpoint) was described. We examined associations between cumulative effects of these events on health outcomes, via log binomial regression. Results: About 70% of men in each country experienced adverse events in childhood, while adult experience varied from 47 to 64%. There was a dose–response effect of cumulative exposure. Among men with 0, 1–2, and 3+ traumas, for example, 22, 35, and 52% reported depression/anxiety in Malawi, and 8, 17, and 27% perpetrated intimate partner violence (IPV) in South Africa. In multivariate analyses, experiencing at least one event in both childhood and adulthood (vs. neither) was significantly associated with various health outcomes (e.g. multiple sexual partnerships: adjusted risk ratio or aRR = 2.40 in Malawi; IPV perpetration: aRR = 3.59 in South Africa; depression/anxiety: aRR = 1.37 in Eswatini). Conclusion: Men who experienced adverse events in childhood or adulthood faced increased HIV risk/negative health outcomes. More events were associated with worse outcomes. Interventions for men addressing trauma in both childhood and adulthood are essential for their (and their partners’) health and well being
Progress in male contraception: A brief summary of the Third International Congress on Male Contraception, May 2022
No full textDataset—How do changes in motivation to prevent pregnancy influence contraceptive continuation? Results from a longitudinal study with women who receive family planning services from community pharmacists and patent and proprietary medicine vendors in Nigeria
No full textThe IntegratE project is a proof-of-concept that Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) have the capacity to provide a wider range of family planning (FP) and primary health care (PHC) services than they are currently authorized by law to provide. The project seeks to improve the quality of FP and PHC services provided by CPs and PPMVs and support the creation of an enabling environment that will sustain these services. The dataset includes data from a larger evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service (counseling, referral or FP method) from these sources and again nine months later. We then used logistic regression models to assess whether changes in motivation to avoid pregnancy between receiving a FP service to 9 months later is associated with continued use of FP. We found that many women (89%) continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated (reported it was very important to avoid pregnancy at both interviews) were more likely to continue using contraception compared to women who became more motivated between the two interviews. Women who became less motivated were 65% less likely to continue using contraception compared to who became more motivated. Our results suggest that FP providers, including private sector pharmacists and drug shop owners, should continuously check in with women about their motivations around pregnancy to support continuation contraceptive use among those who wish to avoid pregnancy