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A Behavioral Economics ppproach to reduce the injectable contraceptive discontinuation rate in Ethiopia: A stratified-pair, cluster-randomized field study.
Arlington, Virginia, JSI, Research and Training Institute, 2018. 36 p.Behavioral economics offers one way to design interventions by improving understanding of why people choose as they do and what motivates their decision-making and action. Behavioral economics has recently been used to improve reproductive health programming, suggesting that the approach could potentially be applied to mitigate the contraceptive discontinuation problem in Ethiopia. This report highlights the behavioral economics methodology used to conduct a behavioral diagnosis and design an intervention package to change health-related behaviors and decision-making around the use of injectable contraceptives in Ethiopia. Given that injectable methods are the primary method of choice among married women of reproductive age in the country and that the government sector provides 82% of contraceptive methods, JSI's Last Ten Kilometers project, in collaboration with ideas42, worked with Ethiopia's flagship Health Extension Program (HEP) to design and test behavioral approaches to mitigate the problem of discontinuation of injectable contraceptives. The JSI team implemented a stratified-pair, cluster-randomized experiment in the eight primary health center units (PHCUs), each of which serves about 25,000 people. This report highlights the four stages of behavioral health methodology used in the study, including the various interventions tested, and the results achieved by the end of the two-year activity.
[Washington, D.C.], Population Services International [PSI], 2018. 24 p.Expanding Effective Contraceptive Options (EECO) is a USAID-funded project led by WCG with PSI and other partners to support the introduction of new contraceptive and dual protection methods. This case study presents EECO’s analysis of consumer insights and market data to develop a marketing strategy for the Woman’s Condom in Malawi and Zambia.
Coaching community health volunteers in integrated community case management improves the care of sick children under-5: experience from Bondo, Kenya.
International Journal of Integrated Care. 2018 Oct 24; 18(4):1-11.Background: Shortages of healthcare workers is detrimental to the health of communities, especially children. This paper describes the process of capacity building Community Health Volunteers (CHVs) to deliver integrated preventive and curative package of care of services to manage common childhood illness in hard-to-reach communities in Bondo Subcounty, Kenya. Methods: A pre-test/post-test single-group design was used to assess changes in knowledge and skills related to integrated community case management (iCCM) among 58 Community Health Volunteers who received a six-day iCCM clinical training and an additional 3-week clinical coaching at health facilities. Thereafter, community health extension workers and health managers provided supportive supervision over a six-month period. Skills were assessed before the six-day training, during coaching, and after six months of iCCM implementation. Results: CHVs knowledge assessment scores improved from 54.5% to 72.9% after the six-day train¬ing (p < 0.001). All 58 CHVs could assess and classify fever and diarrhoea correctly after 3–6 weeks of facility-based clinical coaching; 97% could correctly identify malnutrition and 80%, suspected pneumonia. The majority correctly performed four of the six steps in malaria rapid diagnostic testing. However, only 58% could draw blood correctly and 67% dispose of waste correctly after the testing. The proportion of CHV exhibiting appropriate skills to examine for signs of illness improved from 4% at baseline to 74% after 6 months of iCCM implementation, p < 0.05. The proportion of caregivers in intervention community units who first sought treatment from a CHV increased from 2 to 31 percent (p < 0.001). Conclusions: Training and clinical coaching built CHV’s skills to manage common childhood illnesses. The CHVs demonstrated ability to follow the Kenya iCCM algorithm for decision-making on whether to treat or refer a sick child. The communities’ confidence in CHVs’ ability to deliver integrated case management resulted in modification of care-seeking behaviour.
Journal of Nepal Health Research Council. 2018 Jul-Sep; 16(40):359-361.Chlorhexidine is a broad-spectrum antiseptic, effective on gram positive and gram negative bacteria as well as some viruses, having strong skin binding effect. Randomized controlled trials conducted in South Asian countries have proven that the use of chlorhexidine (4% weight/weight) for cord care can reduce neonatal mortality and prevent severe cord infections. Between 2011 and 2017, Nepal completed nationwide scale-up of the use of chlorhexidine by integrating with ongoing maternal and neonatal health programs, under the leadership of the Child Health Division. The chlorhexidine coverage and compliance study (2017) has revealed that the country has achieved 59% coverage of the intervention to date, with lowest use among home births. The strategy should be further strengthened to ensure that every newborn in need is reached with chlorhexidine.
The effect of implementation strength of basic emergency obstetric and newborn care (BEmONC) on facility deliveries and the met need for BEmONC at the primary health care level in Ethiopia.
BMC Pregnancy and Childbirth. 2018; 18(123): p.Background: Basic emergency obstetric and newborn care (BEmONC) is a primary health care level initiative promoted in low- and middle-income countries to reduce maternal and newborn mortality. Tailored support, including BEmONC training to providers, mentoring and monitoring through supportive supervision, provision of equipment and supplies, strengthening referral linkages, and improving infection-prevention practice, was provided in a package of interventions to 134 health centers, covering 91 rural districts of Ethiopia to ensure timely BEmONC care. In recent years, there has been a growing interest in measuring program implementation strength to evaluate public health gains. To assess the effectiveness of the BEmONC initiative, this study measures its implementation strength and examines the effect of its variability across intervention health centers on the rate of facility deliveries and the met need for BEmONC. Methods: Before and after data from 134 intervention health centers were collected in April 2013 and July 2015. A BEmONC implementation strength index was constructed from seven input and five process indicators measured through observation, record review, and provider interview; while facility delivery rate and the met need for expected obstetric complications were measured from service statistics and patient records. We estimated the dose–response relationships between outcome and explanatory variables of interest using regression methods. Results: The BEmONC implementation strength index score, which ranged between zero and 10, increased statistically significantly from 4.3 at baseline to 6.7 at follow-up (p < .05). Correspondingly, the health center delivery rate significantly increased from 24% to 56% (p < .05). There was a dose–response relationship between the explanatory and outcome variables. For every unit increase in BEmONC implementation strength score there was a corresponding average of 4.5 percentage points (95% confidence interval: 2.1–6.9) increase in facility-based deliveries; while a higher score for BEmONC implementation strength of a health facility at follow-up was associated with a higher met need. Conclusion: The BEmONC initiative was effective in improving institutional deliveries and may have also improved the met need for BEmONC services. The BEmONC implementation strength index can be potentially used to monitor the implementation of BEmONC interventions.
Juba, South Sudan, Oxfam, 2019 Feb. 46 p.This research found that 71% of women and girls between 15 and 49 years old living in Nyal, South Sudan, were married before 18, and 10% were married before 15. These findings are based on a survey carried out among about 200 women and girls, and on almost 30 interviews and focus groups with local decision makers and practitioners, and boys and girls between 13 and 18 years old. Millions of people have been affected by the conflict that started in 2013 in South Sudan, and women and girls continue to suffer from rape and abduction for sexual slavery. Many people living in the most affected areas have fled to Nyal, a region still affected by increased poverty, food insecurity and sexual violence driven by the conflict. While it is difficult to identify any increase in child marriage rates due to the conflict, because there was no data available on child marriage in Nyal before the conflict, the rates are alarming. With this report, Oxfam urges government, donors, and humanitarian actors to take action to address gender inequality and support community-based action to address this pressing issue.
Tanzania economic update: the power of investing in girls: educating girls and ending child marriage in Tanzania.
[Washington, D.C.], World Bank, 2019 Jan. 79 p.This report is the 11th in a series of updates on the economy of Tanzania published by the World Bank. Unlike others in the series however, this report has a special focus on the economic implications of girls’ education and child marriage. The report builds on some of the analysis from the study looking at the economic impact of child marriage conducted by the World Bank and International Center for Research on Women. The authors find that overall child marriage and early child bearing are still prevalent, and girls’ educational attainment is on average low. Overall, ending child marriage in Tanzania could lead to: up to US$311 million in education budget savings by 2030; up to US$219 million benefit from reduced under 5 mortality by 2030; US$5 billion in welfare benefits through reduced population growth by 2030. The report concludes with policy recommendations to increase opportunities for adolescent girls, including strategies to improve access to and quality of education, to change social norms that perpetuate gender stereotypes, to empower girls, and to increase economic opportunities for girls.
Revealing the truth of marriage dispensation an analysis of child marriage practice in Tuban, Bogor, and Mamuju districts.
Jakarta, Indonesia, UNICEF, 2019. 9 p.This research helps to understand the process of marriage dispensation in Tuban, Bogor, and Mamuju, Indonesia. Through this procedure, families can ask Religious Courts to allow marriage for people who are under the legal age of marriage. The research reviewed 377 rulings issued by Religious Courts between 2013 and 2015. Most dispensation subjects were aged between 13 and 18 years and 55 % of dispensation requests were for girls. Of all requests reviewed for the study, 97.3 % were approved, thus allowing children to marry before the legal age. The report calls for policy reforms to promote child rights and protect Indonesian children from practices such as marriage dispensation.
London, United Kingdom, Girls Not Brides, 2018 Nov. 4 p.In sub-Saharan Africa and countries like Ethiopia, levels of child marriage have declined at a modest rate in recent years through concerted efforts from government and civil society. Political will has been demonstrated with national launches of the African Union Campaign to end child marriage taking place in 24 countries. However, rapidly growing populations combined with declines in child marriage prevalence in South Asia mean that unless progress is significantly accelerated, sub-Saharan Africa will become the region with the highest absolute numbers of child brides in future.
London, United Kingdom, Girls Not Brides, 2018 Nov. 8 p.In recent years, there has been growing evidence and recognition of the importance of engaging men and boys to improve gender equality and empower women and girls. The evidence base on male engagement in ending child marriage, specifically, is relatively thin, with only a handful of studies assessing whether programmes shift the attitudes and behaviours of men and boys around child marriage. Those programmes that have been rigorously studied suggest that it is indeed possible to shift boys’ attitudes toward child marriage including the appropriate age of marriage for girls. From these programmes, as well as those from other fields, we know that the positive and informed engagement of men and boys - including brothers, fathers, uncles, future husbands, future fathers-inlaw, and community and religious leaders, among others - can help to advance more gender equitable relationships, norms and behaviours. It is particularly important to ground male engagement programmes and strategies in gender-equitable approaches that specifically aim to empower women and girls. This brief provides a rationale for engaging men and boys in ending child marriage and synthesises some key lessons learned, guiding principles, recommendations and evidence gaps. It draws heavily on several of the resources listed on the last page.
[London, United Kingdom], Girls Not Brides, 2018 Oct. 55 p.Child marriage is caused by many different factors and is not determined by any particular religion. Yet religious leaders often have great influence over beliefs and behaviours in their communities. So with almost 80% of the world’s population professing a religious belief, working with religious leaders can be an important part of the comprehensive approach needed to end child marriage. Some religious leaders have taken action to address child marriage and have been powerful agents of change. Others have been obstacles to progress and civil society organisations have faced challenges in engaging with them. To support its members in overcoming these challenges, Girls Not Brides commissioned the Unit for Religion and Development Research at Stellenbosch University, South Africa, to explore why and how some religious leaders resist efforts to end end child marriage, and what organisations can do when facing religious resistance. Based on a literature review and 15 interviews with practitioners working with various religious communities across different regions, the researchers developed a typology of religious resistance, identifying six ways in which some religious leaders oppose actions to end child marriage, and seven reasons why they do so. The report then highlights three key principles that any organisation wishing to engage with religious leaders should follow, and five common strategies that have proved useful to work effectively with religious leaders across different contexts.
London, United Kingdom, Girls Not Brides, 2018 Nov. 8 p.Every year 12 million girls are married before the age of 18. Child marriage has many causes, but is primarily driven by inequitable gender norms which deprive girls and young women of their sexual and reproductive rights and limit their life choices. A key driver of adolescent pregnancy, child marriage has a hugely detrimental impact on the health and well-being of girls and young women, as well as on that of their children. Adolescent pregnancy also acts as a driver of child marriage in contexts where pre-marital sexuality is taboo. By acting to prevent child marriage, and by improving married and unmarried adolescent girls’ access to sexual and reproductive health services, we can dramatically improve health and broader development outcomes for millions of girls and children worldwide.
Surrey, United Kingdom, Plan International, 2018. 36 p.Since 2013, the conflict in South Sudan has displaced 4 million people and placed 7 million in need of humanitarian assistance. This report commissioned by Plan International explores how adolescent girls aged 10-14 and 15-19 understand and respond to the unique impact their country’s crisis has upon them. Drawing on research conducted with girls and members of their families and communities in multiple sites in South Sudan and Uganda, the report highlights child marriage as the most commonly reported form of violence affecting girls in this context. A number of key recommendations are made to donors, policy makers and practitioners to better respond to the needs of adolescent girls affected by the crisis.
Surrey, United Kingdom, Plan International, 2018. 54 p.The crisis affecting the Lake Chad Basin is one of the most severe humanitarian emergencies in the world, with more than 10.8 million in need of humanitarian assistance across North East Nigeria, Cameroon’s Far North, Western Chad and South East Niger. This report by Plan International explores how adolescent girls understand and respond to the unique impact the crisis has upon them. Drawing on research conducted with girls and members of their families and communities in multiple sites across the region, the study highlights multiple issues, including child marriage, which are often reinforced by the protracted crisis. The report includes a number of recommendations to help improve the lives of adolescent girls living in these contexts.
The responsibility to prevent and respond to sexual and gender-based violence in disasters and crises: research results of sexual and gender-based violence (SGBV) prevention and response before, during and after disasters in Indonesia, Lao PDR and the Philippines.
Kuala Lumpur, Malaysia, IFRC, 2018. 115 p.This report presents the research results from a sexual and gender based violence (SGBV) prevention and response led by the International Federation of Red Cross and Red Crescent Socities (IFRC) in the Philippines (Typhoon Haiyan in 2013), Indonesia (Pidie Jaya earthquake and Bima floods in 2016) and Lao PDR (Oudomxay floods in 2016). It explores why and how SGBV risks increase during humanitarian disasters, and looks at how humanitarian actors can better prevent and respond to those risks. All participants in the research described child marriage and intimate partner violence as the most prevalent types of SGBV in these contexts. The authors hope that this research can help strengthen domestic disaster legislation, promoting coordination between governmental and non-governmental humanitarian actors, building partnerships at the national level, and strengthen the provision of local health, legal, and psychosocial support for those who have suffered such violence.
Toward an end to child marriage: lessons from research and practice in development and humanitarian sectors.
Berkeley, California, University of California, Berkeley, School of Law, Human Rights Center, 2018 Jun. 94 p.This report by the Human Rights Center looks at efforts to address child marriage in both humanitarian and development contexts. It provides recommendations to help Save the Children strengthen their response to child marriage. These recommendations will also be relevant for many other organisations. Based on a review of existing research, of Save the Children and other organisations’ reports and programme documents, and on interviews with practitioners, this report summarises what we know about the benefits and challenges of different types of interventions in development and crisis-affected contexts. It highlight gaps in research and in practitioners’ responses, and makes suggestions on how to fill these gaps.
[New York, New York], UNICEF, . 8 p.This short brief provides an overview of the situation of child marriage in countries affected by conflict and displacement in the Middle-East and North Africa. Developed by UNICEF, UNFPA, CARE International, the Women’s Refugee Commission, Terre des Hommes and the University of Bedforshire, it also outlines five key strategies to address child marriage in the region. These strategies are the basis of a Regional Accountability Framework of Action to End Child Marriage in Arab States / MENA (RAF), led by UNICEF and UNFPA in partnership with a consortium of other UN agencies and civil society organisations.
Amman, Jordan, UNICEF, 2018. 161 p.This study by UNICEF explores the prevalence and causes of child marriage in six countries in the Middle-East and North Africa (MENA): Egypt, Jordan, Lebanon, Morocco, Sudan and Yemen. While child marriage in MENA has declined over the last decades, some rates remain alarming especially where populations are affected by conflict and displacement. Like in other regions, girls in MENA are more affected by child marriage than boys. Restricted mobility due to insecurity means that many girls living in poor communities in rural areas don’t engage much in social networks and have limited access to education, health services, justice, and economic opportunities, which all strengthen risks of child marriage. Girls who are already married also lack appropriate services to support them in their life. Based on these findings, the study highlights eight ways to strengthen promising practices in addressing child marriage in the region: Interventions addressing child marriage in MENA must be context specific and include a gender analysis; They should be informed by the knowledge and experience of local women’s organisations; They should follow a theory of change, allow all key actors to participate in the design, and be piloted; Funding should run over several years and allow rigorous evaluation of the impact of child marriage; Programmes addressing child marriage should focus on addressing child marriage and its structural causes; They should be scaled up to reach the most rural and remote communities; They should recognise that different level might be affected: the individual, the community etc.; National legal frameworks should remove exceptions to the minimum age of marriage. The study also provides many specific recommendations for the UNICEF-UNFPA Global Programme on child marriage.
Selangor Darul Ehsan, Malaysia, Sisters in Islam [SIS], 2018. 60 p.Describing Malaysia as an upper-middle income country with high female youth literacy rates, ARROW and Sisters in Islam highlight that poverty and a lack of education are not significant drivers of child marriage in the country. Instead, they look at the root causes of child marriage and explore how religious conservatism and patriarchy continue to drive gender inequality and sustain child marriage. They advocate for greater awareness and empowerment of children, parents, community leaders and the society at large on issues related to gender, patriarchal beliefs and sexual and reproductive health and rights.
[Baltimore, Maryland, Jhpiego, 2018 Nov. 2 p.The global family planning community is working to ensure that more women around the world have access to contraceptive options and family planning services and information. As part of this global effort, a group of organizations collaborated to make contraceptive implants—a previously less accessible family planning option—more available to women in the world’s poorest countries. Since the launch of the Implant Access Program (IAP) in 2013, tremendous progress has been made toward expanding contraceptive access and options and strengthening global family planning systems overall.
Islamabad, Pakistan, National Institute of Population Studies, 2019 Jan. 573 p.The 2017-18 Pakistan Demographic and Health Survey (PDHS) was implemented by the National Institute of Population Studies (NIPS) under the aegis of the Ministry of National Health Services, Regulations and Coordination. This PDHS is the fourth to be conducted in Pakistan and follows surveys in 1990-91, 2006-07, and 2012-13. Data collection took place from 22 November 2017 to 30 April 2018. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Support for the survey was also provided by the Department for International Development (DFID) of the United Nations Population Fund (UNFPA). According to the Population Census of 2017, the total population of Pakistan is 207 million with a growth rate of 2.4% (Government of Pakistan 2017). The size of the population and the growth rate present serious challenges to governmental efforts to prevent food insecurity, water scarcity, rapid urbanisation, inadequate housing, and loss of economic opportunities. Such challenges necessitate regular assessment of their demographic impact through collection of reliable data in surveys such as the PDHS. The primary objective of the 2017-18 PDHS is to provide up-to-date estimates of basic demographic and health indicators. The PDHS provides a comprehensive overview of population, maternal, and child health issues in Pakistan. Specifically, the 2017-18 PDHS collected information on: Key demographic indicators, particularly fertility and under-5 mortality rates, at the national level, for urban and rural areas, and within the country’s eight regions; Direct and indirect factors that determine levels and trends of fertility and child mortality; Contraceptive knowledge and practice; Maternal health and care including antenatal, perinatal, and postnatal care; Child feeding practices, including breastfeeding, and anthropometric measures to assess the nutritional status of children under age 5 and women age 15-49; Key aspects of family health, including vaccination coverage and prevalence of diseases among infants and children under age 5; Knowledge and attitudes of women and men about sexually transmitted infections (STIs), including HIV/AIDS, and potential exposure to risk; Women's empowerment and its relationship to reproductive health and family planning; Disability level; Extent of gender-based violence; Migration patterns. The information collected through the 2017-18 PDHS is intended to assist policymakers and program managers at the federal and provincial government levels, in the private sector, and at international organisations in evaluating and designing programs and strategies for improving the health of the country’s population. The data also provides information on indicators relevant to the Sustainable Development Goals.
Kenilworth, New Jersey, Merck, MSD for Mothers, 2019 Jan. 19 p.The health of women and children is a linchpin for building healthy and stable societies around the world. By now we know that quality health infrastructure which adequately supports mothers delivers powerful benefits for women, children, families, communities, and countries. But today, health systems, particularly those in many low- and middle-income countries, are not sufficiently equipped to achieve the ambitious global agenda and SDG targets for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH). Funding is one part of the problem. While international RMNCAH funding accounts for approximately half of total development assistance for global health, an estimated annual funding deficit of more than $30 billion remains and pressure on foreign aid budgets in donor countries could exacerbate this gap. Achieving good health and well-being for all will require an unprecedented expansion and diversification of financing for RMNCAH. In an effort to begin to benchmark donor investments through private sector funding approaches, Devex and MSD for Mothers researched and interviewed seven of the leading bilateral donors to RMNCAH. We also surveyed more than 500 development professionals working in RMNCAH and conducted in-depth interviews with global health organizations and experts to learn more about how to better integrate the private sector in RMNCAH in the future. We hope that this report will encourage international donors and other funders to better understand the impact of the private sector in RMNCAH and begin to more rigorously track and report investments in the future.
Investing in contraception and maternal and newborn health in the Ouagadougou Partnership countries.
New York, New York, Guttmacher Institute, 2018 Dec. 2 p.The Ouagadougou Partnership was formed in 2011 by the governments of Benin, Burkina Faso, Côte d’Ivoire, Guinea, Mali, Mauritania, Niger, Senegal and Togo to address the need for modern contraceptives in Francophone West Africa. The nine countries seek to increase the number of women electing to use modern contraceptives by 2.2 million between 2015 and 2020. The Guttmacher Institute, an FP2020 Commitment Maker, has compiled a fact sheet that provides an overview of: The dire need for services in each country; Costs of contraceptive services and maternal and newborn care; Benefits of investing in both types of care; and Recommendations for meeting the challenge.
Geneva, Switzerland, WHO, 2018. 88 p.This document provides an overview of sexual and reproductive health and rights issues that may be important for the human rights, health and well-being of adolescents (aged 10–19 years) and the relevant World Health Organization (WHO) guidelines on how to address them in an easily accessible, user-friendly format. The document serves as a gateway to the rich body of WHO guidelines, and as a handy resource to inform advocacy, policy and programme/project design and research. It aims to support the implementation of the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016–2030, and is aligned with the WHO Global Accelerated Action for the Health of Adolescents (AA-HA!) as well as the WHO Operational Framework on Sexual Health and Its Linkages to Reproductive Health.
Risk of adverse pregnancy outcomes associated with short and long birth intervals in Bangladesh: evidence from six Bangladesh Demographic and Health Surveys, 1996-2014.
BMJ Open. 2019 Feb 22; 9(2):e024392.OBJECTIVE: To examine the effect of short (<36 months) and long (>/=60 months) birth intervals on adverse pregnancy outcomes in Bangladesh. DESIGN, SETTING AND PARTICIPANTS: We analysed data from six Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004, 2007, 2011 and 2014). We included all singleton non-first live births, most recently born to mothers within 5 years preceding each survey (n=21 382). We defined birth interval according to previous research which suggests that a birth interval between 36 and 59 months is the most ideal interval. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted ORs (aOR) respectively to assess the odds of first-day neonatal death, early neonatal death and small birth size for both short (<36 months) and long (>/=60 months) spacing between births. MAIN OUTCOME MEASURES: First-day neonatal death, early neonatal death and small birth size. RESULTS: In the multivariable analysis, compared with births spaced 36-59 months, infants with a birth interval of <36 months had increased odds of first-day neonatal death (aOR: 2.11, 95% CI: 1.17 to 3.78) and early neonatal death (aOR: 1.58, 95% CI: 1.13 to 2.22). Compared with births spaced 36-59 months, infants with a birth interval of >/=60 months had increased odds of first-day neonatal death (aOR: 2.02, 95% CI: 1.10 to 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02 to 1.34). When there was a history of any previous pregnancy loss, there was an increase in the odds of first-day and early neonatal death for both short and long birth intervals, although it was not significant. CONCLUSIONS: Birth intervals shorter than 36 months and longer than 59 months are associated with increased odds of adverse pregnancy outcomes. Care-providers, programme managers and policymakers could focus on promoting an optimal birth interval between 36 and 59 months in postpartum family planning. (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.