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Ojong SA, Temmerman M, Khosla R, Bustreo F. Women's health and rights in the twenty-first century. Nat Med 2024; 30:1547-1555. [PMID: 38886622 DOI: 10.1038/s41591-024-03036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 04/30/2024] [Indexed: 06/20/2024]
Abstract
In the twenty-first century, the complex relationship between women's health and rights has been influenced by a range of interconnected challenges, including gender inequity, reproductive health disparities, maternal mortality and morbidity, and women's inability to access life-saving, high-quality healthcare services including family planning. Going forward, the world needs to find ways to implement the unfinished agenda of the International Conference on Population and Development (ICPD) 1994 and the Sustainable Development Goals (SDGs), thus prioritizing health and rights for women and girls as essential not only to their survival but also to their progress, agency and empowerment. It is also important to consider the interconnection between women's health and rights and climate change, with its disproportionate impact on the well-being of girls and women, and to address the impact and opportunities afforded by digital technologies. By embracing a holistic approach, societies might be able to advance the cause of women's health and rights in a more inclusive and sustainable manner.
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Affiliation(s)
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, East Africa, Aga Khan University, Nairobi, Kenya.
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland.
| | - Rajat Khosla
- International Institute on Global Health, United Nations University, Kuala Lumpur, Malaysia
| | - Flavia Bustreo
- Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland
- Fondation Botnar Board, Basel, Switzerland
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Henderson H, Soares Xavier HA, da Silva M, da Silva AM, Mendonca SA, de Araújo RM, Vaughan C, Bohren MA. 'If we take the engine out, how will the car go?': beliefs, understanding and access to vasectomy services in Timor-Leste. CULTURE, HEALTH & SEXUALITY 2024:1-17. [PMID: 38634414 DOI: 10.1080/13691058.2024.2341847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
Vasectomy is a safe, highly effective and affordable method of permanent contraception, and one of the few currently available contraceptive methods for men. Despite this, vasectomy uptake remains overall low, making up just 2% of the global contraceptive method mix. To better understand access to vasectomy in a country with negligible uptake, we conducted participatory and operational research in the Democratic Republic of Timor-Leste (Timor-Leste). We held 14 participatory group discussions with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse), and individual in-depth interviews with 24 healthcare providers (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. Community awareness and understanding about vasectomy were limited, with concerns expressed about physical and social side effects. Healthcare providers had limited experience and knowledge about vasectomy, and about male sexual and reproductive health more generally. However, our findings also indicate a small but existing demand for vasectomy services that could be grown and better met through health systems strengthening initiatives. Insights from our research have informed programmatic decision-making in Timor-Leste and can be further used to inform national health policy and practice.
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Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
- MSI Asia Pacific, Melbourne, VIC, Australia
| | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | | | | | - Cathy Vaughan
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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Strong J. "Even when you write with a pencil there is an eraser to clean it": Examining men's conceptualisations of and involvement in emergency contraceptive use in Accra, Ghana. Soc Sci Med 2024; 344:116635. [PMID: 38324975 DOI: 10.1016/j.socscimed.2024.116635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 12/01/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
Emergency contraceptive pills are an essential and unique post-coital method to avoid a pregnancy, with evidence showing the significant role men can have in procurement and decisions to use. Global Health recommendations specify that emergency contraceptive pills be used sparingly and under specific conditions. This increasingly misaligns with the myriad conceptualisations and rationales among the public for why they choose to use emergency contraceptive pills. There has been a paucity of research aiming to understanding men's involvement and how they shape women's access, choice, and autonomy. This study interrogates how emergency contraceptive pills are conceptualised by men in James Town, Ghana, and how this intersects with their motivations to be involved in its use. Mixed method data from a survey (n = 270) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The analysis examines men's framings of emergency contraceptive pills and how these shape their involvement in its use. Men's knowledge of post-coital contraceptives was high, while knowledge of the specific term 'emergency contraception' was lower. While some men understood the pills in ways that aligned to Global Health framings, many more men saw emergency contraceptive pills as another means of pregnancy prevention in line with other contraceptives. This included its conceptualisation as a contraceptive that facilitates pleasurable (condomless) and spontaneous sex. Gendered perceptions of women who use emergency contraceptive pills were bound in sexual stigma, and men indicated that emergency contraceptive pills were a directly observable form of contraception that they could pressure their partner into using. Understanding plural conceptualisations away from 'emergency' are necessary to create policies and programmes that account for men's involvement. This includes understanding how emergency contraceptive pills are located within people's sexual and reproductive lives and gendered power dynamics, to reflect the public's own rationales for and experiences using post-coital contraceptives.
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Affiliation(s)
- Joe Strong
- Department of Social Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Kolak M, Agardh A, Rubertsson C, Hansson SR, Ekstrand Ragnar M. Immigrant men 's perceptions and experiences of accompanying their partner for contraceptive counselling provided by midwives in Sweden- a qualitative study. PLoS One 2024; 19:e0295796. [PMID: 38165872 PMCID: PMC10760736 DOI: 10.1371/journal.pone.0295796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Male involvement in maternal health care has proven to be beneficial for improving maternal and child health and is often crucial in areas of family planning and contraceptive use. However, compared to male involvement in maternal health care, male involvement in contraceptive counselling is complex and controversial and thus faces certain challenges. Immigrant men in Sweden are often accompanying their partner for contraceptive counselling. Little is known about their presence and role. AIM To explore how immigrant men from the Middle East and Afghanistan perceive and experience accompanying their partner for contraceptive counselling provided by midwives in Sweden. METHODS Inductive qualitative content analysis guided the interpretation of data based on 21 individual in-depth interviews. FINDINGS Balancing conflicting values and norms about sexual and reproductive health and rights including family planning was challenging and confusing when living in Sweden. Contraceptive counselling was perceived as a joint visit, and men were often acting as decision makers. The midwife's role as a contraceptive counsellor was perceived as trusted, but knowledge was lacking about the Swedish midwifery model and the Swedish healthcare system. Providers' ways of communicating sensitive information were crucial. Without marriage contraceptive counselling was unthinkable. CONCLUSION Highlighting male engagement and including men's sexual and reproductive health at policy levels are necessary for improving women's sexual and reproductive health and rights. Additional and new ways of contraceptive counselling and midwifery services, such as outreach work and joint visits, are needed in order to reach both men and women.
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Affiliation(s)
- Mia Kolak
- Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Obstetrics and Gynecology, Skane University Hospital, Malmö, Lund, Sweden
| | - Anette Agardh
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Christine Rubertsson
- Department of Obstetrics and Gynecology, Skane University Hospital, Malmö, Lund, Sweden
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Stefan R. Hansson
- Department of Obstetrics and Gynecology, Skane University Hospital, Malmö, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Malmö, Sweden
| | - Maria Ekstrand Ragnar
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Henderson H, Soares Xavier HA, Mendonca SA, da Silva AM, da Silva M, de Araújo RM, Bohren MA, Vaughan C. 'It depends on who is asking and why they will use it': Access to male condoms in Timor-Leste. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002409. [PMID: 37773929 PMCID: PMC10540955 DOI: 10.1371/journal.pgph.0002409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023]
Abstract
The uptake of male condoms remains markedly low in The Democratic Republic of Timor-Leste (Timor-Leste), an island nation in South-East Asia. To understand why, we conducted participatory and operational research about beliefs, understanding and access to male condoms from both a community and healthcare provider perspective. We held 14 participatory group discussions (PGDs) with 175 community participants (84 men, 91 women; aged 18-72) across seven municipalities (Ainaro, Baucau, Bobonaro, Dili, Lautem, Manufahi, and Oecusse) in 2019. We held individual in-depth interviews (IDIs) with 24 healthcare providers working in the same community catchment areas as the PGDs. Two counsellors, four doctors, fifteen midwives, and three nurses participated (16 women, 8 men; aged 25-56 years). Data were analysed using reflexive thematic analysis. PGD and IDI participant awareness, understanding and beliefs about male condoms were diverse. Male condoms were often discussed as something negative and taboo, and as something that is highly regulated and discouraged within society and the health system. However, many PGD and IDI participants also challenged this narrative by providing a more rights-based perspective about universal access to sexual and reproductive health information and services, including male condoms. Insights from our research have been used to inform programmatic decision-making in Timor-Leste, including health promotion and service delivery initiatives. Our findings can be further used to inform national health policy, healthcare provider training, and advocacy and communication work.
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Affiliation(s)
- Helen Henderson
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
- MSI Asia Pacific, Melbourne, Victoria, Australia
| | | | | | | | - Mariano da Silva
- Marie Stopes Timor-Leste, Rua Belarmino Lobo, Bidau Lecidere, Dili, Timor-Leste
| | | | - Meghan A. Bohren
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Cathy Vaughan
- Gender and Women’s Health Unit, Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
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Alemayehu M, Medhanyie AA, Reed E, Kahsay ZH, Kalayu M, Mulugeta A. Effects of continuum of care for maternal health service utilisation on intention to use family planning among pastoralist women of Ethiopia: a robust regression analysis and propensity score matching modelling. BMJ Open 2023; 13:e072179. [PMID: 37438064 PMCID: PMC10347460 DOI: 10.1136/bmjopen-2023-072179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES This study examines the effect of continuum care for maternal health service utilisation on intention to use family planning among the pastoralist community in Ethiopia. DESIGN A community-based cross-sectional study. SETTING Data were collected from three districts of the pastoralist community of the Afar region. PARTICIPANTS Randomly selected 891 married pastoralist women. PRIMARY OUTCOME Intention to use family planning. RESULTS Intention to use family planning would increase (β=0.122, 95% CI: 0.036, 0.287) or by 12.2%, if all married pastoralist women received continuum of care for maternal health service utilisation compared with their counterparts. Results from the robust regression analysis indicate that intention to use family planning was higher among women who had a discussion about family planning with their husband (β=0.31, SE=0.035, p<0.001), women who possessed an electronic devices (β=0.096, SE=0.029, p<0.001) and women who had an unmet need for family planning (β=0.056, SE=0.026, p<0.000). However, intention to use family planning was lower for women who were in a polygamous marriage (β=-0.168, SE=0.065, p<0.01). There was a significant linear increase in the score of intention to use family planning for attitude towards family planning (β=0.009, SE=0.001, p<0.000), subjective norm (β=0.003, SE=0.001, p<0.003) and perceived control over family planning (β=0.002, SE=0.008, p<0.024) given other explanatory variables in the model. CONCLUSION Continuum of care for maternal health service utilisation increases pastoralist women's intention to use family planning. Maximising any opportunity to counsel women who come to health facilities about family planning would be vital to increase their intention to use family planning. TRIAL REGISTRATION NUMBER NCT03450564.
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Affiliation(s)
- Mussie Alemayehu
- Department of Public Health, College of Health Sciences, Mekelle, Ethiopia
| | | | - Elizabeth Reed
- Department of Public Health, San Diego State University, San Diego, California, USA
| | | | - Mebrhatu Kalayu
- Department of Public Health, College of Health Sciences, Mekelle, Ethiopia
| | - Afework Mulugeta
- Department of Public Health, College of Health Sciences, Mekelle, Ethiopia
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Efendi F, Sebayang SK, Astutik E, Reisenhofer S, McKenna L. Women's empowerment and contraceptive use: Recent evidence from ASEAN countries. PLoS One 2023; 18:e0287442. [PMID: 37368912 PMCID: PMC10298759 DOI: 10.1371/journal.pone.0287442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND A fundamental element of gender equity are women's rights to reproductive choice. Women's empowerment is often linked to enabling decisions around contraceptive use and reduced fertility worldwide, although limited evidence is currently available around contraceptive use and decision making in ASEAN countries. OBJECTIVE To examine the association between women's empowerment and contraceptive use in five selected ASEAN member states. METHODS Data from the latest Demographic and Health Survey of Cambodia, Indonesia, Myanmar, The Philippines, and Timor-Leste were used. The main outcome was contraceptive use among married women (15-49 years) from these five countries. We considered four indicators of empowerment: labor force participation; disagreement with reasons for wife beating; decision-making power over household issues; and knowledge level. RESULTS Labor force participation was found to be significantly associated with contraceptive use in all nations. Disagreement with justification of wife beating was not significantly related to contraceptive use in any country. Decision-making power (higher) was only associated with contraceptive use in Cambodia, while higher knowledge levels were associated with contraceptive use in Cambodia, and Myanmar. CONCLUSION This study suggests women's labor force participation is an important determinant of contraceptive use. Policies designed to open the labor market and empower women through education should be implemented to enable women's participation. Gender inequality may also be tackled by engaging women in decision-making processes at national, community and family levels.
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Affiliation(s)
- Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Susy Katikana Sebayang
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Erni Astutik
- Department of Epidemiology, Biostatistics, Population Studies and Health Promotion, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Sonia Reisenhofer
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Bornstein M, Norris A, Shaba G, Huber-Krum S, Gipson JD. "I know my body and I just can't get pregnant that easily" - Women's use and non-use of the injection to manage fertility. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100071. [PMID: 37021076 PMCID: PMC10069985 DOI: 10.1016/j.ssmqr.2022.100071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Approximately one-third of contraceptive users in Malawi use the Depo-Provera injection, a method that must be re-injected every three-months to prevent pregnancy and may reduce fecundity for a time after discontinuation. Little is known about how women use the injection to achieve their desired family size. In 2018, we conducted 20 in-depth interviews with women who were part of a cohort study in rural Malawi. Interviews focused on contraceptive decision-making. Data were indexed (summarized) and coded using narrative, process, and thematic codes. Women described the importance of knowing about their "natural" fertility by having children prior to ever using contraception because women considered contraception to have a potential negative effect on fertility. Women then applied what they learned about their fertility (i.e., how easy/difficult it was to become pregnant) to manage their fertility over their reproductive life-course. As part of fertility management, women frequently described using the injection less frequently than clinically recommended, using signs from their body (e.g., menstruation) to determine when to reinject. Managing fertility through subclinical injection use was viewed as a way to optimize women's' chances of preventing unintended pregnancy while maintaining their ability to become pregnant when they wanted to. Women wanted to play an active role in managing their fertility and were not passive consumers of contraception. It is therefore critical that family planning programs provide contraceptive counseling to women that engages their desire to manage their fertility, acknowledges their concerns about fertility, and helps them choose a method that best fits their needs.
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Affiliation(s)
- Marta Bornstein
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
| | - Alison Norris
- The Ohio State University College of Public Health, Division of Epidemiology, 250 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43201, USA
| | | | - Sarah Huber-Krum
- Harvard T.H. Chan School of Public Health, Cambridge, MA, 02115, USA
| | - Jessica D. Gipson
- University of California Los Angeles Fielding School of Public Health, Department of Community Health Sciences, 650 Charles E. Young Drive S, Los Angeles, CA, 90015, USA
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Robinson M, Aventin Á, Hanratty J, Ruane-McAteer E, Tomlinson M, Clarke M, Okonofua F, Lohan M. Nothing so practical as theory: a rapid review of the use of behaviour change theory in family planning interventions involving men and boys. Reprod Health 2021; 18:126. [PMID: 34120630 PMCID: PMC8201745 DOI: 10.1186/s12978-021-01173-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/06/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND There is growing recognition of the need for interventions that effectively involve men and boys to promote family planning behaviours. Evidence suggests that the most effective behavioural interventions in this field are founded on theoretical principles of behaviour change and gender equality. However, there are few evidence syntheses on how theoretical approaches are applied in this context that might guide best practice in intervention development. This review addresses this gap by examining the application and reporting of theories of behaviour change used by family planning interventions involving men and boys. METHODS We adopted a systematic rapid review approach, scoping findings of a previously reported evidence and gap map of intervention reviews (covering 2007-2018) and supplementing this with searches of academic databases and grey literature for reviews and additional studies published between 2007 and 2020. Studies were eligible for inclusion if their title, abstract or keywords referred to a psychosocial or behavioural intervention targeting family planning behaviours, involved males in delivery, and detailed their use of an intervention theory of change. RESULTS From 941 non-duplicate records identified, 63 were eligible for inclusion. Most records referenced interventions taking place in low- and middle-income countries (65%). There was a range of intervention theories of change reported, typically targeting individual-level behaviours and sometimes comprising several behaviour change theories and strategies. The most commonly identified theories were Social Cognitive Theory, Social Learning Theory, the Theory of Planned Behaviour, and the Information-Motivation-Behaviour Skills (IMB) Model. A minority of records explicitly detailed gender-informed elements within their theory of change. CONCLUSION Our findings highlight the range of prevailing theories of change used for family planning interventions involving men and boys, and the considerable variability in their reporting. Programmers and policy makers would be best served by unified reporting and testing of intervention theories of change. There remains a need for consistent reporting of these to better understand how complex interventions that seek to involve men and boys in family planning may lead to behaviour change.
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Affiliation(s)
- Martin Robinson
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Áine Aventin
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Jennifer Hanratty
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | | | - Mark Tomlinson
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Mike Clarke
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Friday Okonofua
- Women's Health Action Research Centre, Benin City, Edo State, Nigeria
| | - Maria Lohan
- School of Nursing and Midwifery and Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK
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Dasgupta ANZ, Makoka D, Dudha Z, Stephenson N, Crampin AC. Fish hooks and gumboots: the language of pregnancy prevention in northern Malawi. Bull World Health Organ 2020; 99:67-68. [PMID: 33658736 DOI: 10.2471/blt.20.250456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/27/2020] [Accepted: 06/29/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Aisha Nandini Zoe Dasgupta
- United Nations, Department of Economic and Social Affairs, Population Division, 2 UN Plaza, New York, NY, 10017, United States of America
| | - Dorothy Makoka
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Zein Dudha
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Naia Stephenson
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Karonga Prevention Study, Lilongwe, Malawi
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11
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Bagade T, Chojenta C, Harris ML, Nepal S, Loxton D. Does gender equality and availability of contraception influence maternal and child mortality? A systematic review. BMJ SEXUAL & REPRODUCTIVE HEALTH 2020; 46:244-253. [PMID: 31754064 DOI: 10.1136/bmjsrh-2018-200184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Current global maternal and child health policies rarely value gender equality or women's rights and are restricted to policies addressing clinical interventions and family planning. Gender equality influences the knowledge, autonomy and utilisation of contraception and healthcare, thereby affecting maternal and child health. This systematic review aims to analyse the concurrent effect of gender equality and contraception on maternal and under-5 child mortality. METHODS A systematic review was conducted to investigate the current evidence. Studies were eligible if three themes-namely, indicators of gender equality (such as female education, labour force participation, gender-based violence), contraception, and maternal or child mortality-were present together in a single article analysing the same sample at the same time. RESULTS Even though extensive literature on this topic exists, only three studies managed to fit the selection criteria. Findings of two studies indicated an association between intimate partner violence (IPV) and infant mortality, and also reported that women's contraceptive use increased the risk of IPV. The third study found that the mother's secondary education attainment significantly reduced child mortality, while the mother's working status increased the odds of child mortality. The researchers of all included studies specified that contraceptive use significantly reduced the risk of child mortality. CONCLUSION Improvement in gender equality and contraception concurrently affect the reduction in child mortality. These findings provide strong support to address the research gaps and to include a gender equality approach towards maternal and child health policies.
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Affiliation(s)
- Tanmay Bagade
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Melissa L Harris
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Smriti Nepal
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Deborah Loxton
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
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Narasimhan M, Yeh PT, Haberlen S, Warren CE, Kennedy CE. Integration of HIV testing services into family planning services: a systematic review. Reprod Health 2019; 16:61. [PMID: 31138307 PMCID: PMC6538541 DOI: 10.1186/s12978-019-0714-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Despite significant interest in integrating sexual and reproductive health (SRH) services into HIV services, less attention has been paid to linkages in the other direction. Where women and girls are at risk of HIV, offering HIV testing services (HTS) during their visits to family planning (FP) services offers important opportunities to address both HIV and unwanted pregnancy needs simultaneously. METHODS We conducted a systematic review of studies comparing FP services with integrated HTS to those without integrated HTS or with a lower level of integration (e.g., referral versus on-site services), on the following outcomes: uptake/counseling/offer of HTS, new cases of HIV identified, linkage to HIV care and treatment, dual method use, client satisfaction and service quality, and provider knowledge and attitudes about integrating HTS. We searched three online databases and included studies published in a peer-reviewed journal prior to the search date of June 20, 2017. RESULTS Of 530 citations identified, six studies ultimately met the inclusion criteria. Three studies were conducted in Kenya, and one each in Uganda, Swaziland, and the USA. Most were in FP clinics. Three were from the Integra Initiative. Overall rigor was moderate, with one cluster-randomized trial. HTS uptake was generally higher with integrated sites versus comparison or pre-integration sites, including in adjusted analyses, though outcomes varied slightly across studies. One study found that women at integrated sites were more likely to have high satisfaction with services, but experienced longer waiting times. One study found a small increase in HIV seropositivity among female patients testing after full integration, compared to a dedicated HIV tester. No studies comparatively measured linkage to HIV care and treatment, dual method use, or provider knowledge/attitudes. CONCLUSIONS Global progress and success for reaching SRH and HIV targets depends on progress in sub-Saharan Africa, where women bear a high burden of both unintended pregnancy and sexually transmitted infections, including HIV. While the evidence base is limited, it suggests that integration of HTS into FP services is feasible and has potential for positive joint outcomes. The success and scale-up of this approach will depend on population needs and health system factors.
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Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research and UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme, World Health Organization, Geneva, Switzerland
| | - Ping Teresa Yeh
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Sabina Haberlen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | - Caitlin E. Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Blakney AK, Jiang Y, Woodrow KA. Application of electrospun fibers for female reproductive health. Drug Deliv Transl Res 2018; 7:796-804. [PMID: 28497376 DOI: 10.1007/s13346-017-0386-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Here, we present the current challenges in women's reproductive health and the current state-of-the-art treatment and prevention options for STI prevention, contraception, and treatment of infections. We discuss how the versatile platform of electrospun fibers can be applied to each challenge, and postulate at how these technologies could be improved. The void of approved electrospun fiber-based products yields the potential to apply this useful technology to a number of medical applications, many of which are relevant to women's reproductive health. Given the ability to tune drug delivery characteristics and three-dimensional geometry, there are many opportunities to pursue new product designs and routes of administration for electrospun fibers. For each application, we provide an overview of the versatility of electrospun fibers as a novel dosage form and summarize their advantages in clinical applications. We also provide a perspective on why electrospun fibers are well-suited for a variety of applications within women's reproductive health and identify areas that could greatly benefit from innovations with electrospun fiber-based approaches.
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Affiliation(s)
- Anna K Blakney
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Yonghou Jiang
- Department of Bioengineering, University of Washington, Seattle, WA, USA
| | - Kim A Woodrow
- Department of Bioengineering, University of Washington, Seattle, WA, USA.
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14
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Snowden JM, Rodriguez MI, Jackson SD, Marcus JL. Preexposure Prophylaxis and Patient Centeredness: A Call for Holistically Protecting and Promoting the Health of Gay Men. Am J Mens Health 2016; 10:353-8. [PMID: 27387042 PMCID: PMC4968031 DOI: 10.1177/1557988316658288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Preexposure prophylaxis has transformed HIV prevention, becoming widespread in communities of gay and bisexual men in the developed world in a short time. There is a broad concern that preexposure prophylaxis will discourage condom use among gay men (i.e., "risk compensation"). This commentary argues for broadening the focus on gay men's health beyond sexual health to address the holistic health and well-being of gay men. Gay men may benefit from being offered candid, nonjudgmental health promotion/HIV prevention messages not requiring condom use for anal sex. Lessons can be drawn from the family planning movement, which has undergone a similar shift in focus. The principle of patient centeredness supports such a shift in gay men's health toward the goal of providing men with the knowledge to evaluate various prevention approaches according to the specifics of their life circumstances and health needs. Bringing more nuance to discussions of sexual risk and sexual pleasure could facilitate more universally healthy attitudes regarding sex among gay men, in turn enabling healthier decisions more compatible with men's own values and preferences.
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15
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Paul M, Näsström SB, Klingberg-Allvin M, Kiggundu C, Larsson EC. Healthcare providers balancing norms and practice: challenges and opportunities in providing contraceptive counselling to young people in Uganda - a qualitative study. Glob Health Action 2016; 9:30283. [PMID: 27174861 PMCID: PMC4865766 DOI: 10.3402/gha.v9.30283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 03/18/2016] [Accepted: 03/18/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. OBJECTIVE This study aims to explore healthcare providers' (HCPs) perceptions and practices regarding contraceptive counselling to young people. DESIGN We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. RESULTS The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. CONCLUSIONS Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical guidelines should be implemented alongside in-service training including value clarification and attitude transformation to equip providers to be able to better cater to young people seeking sexual and reproductive health advice.
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Affiliation(s)
- Mandira Paul
- Department of Women's and Children's Health/IMCH, Uppsala University, Uppsala, Sweden
| | - Sara B Näsström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Marie Klingberg-Allvin
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Charles Kiggundu
- Department of Obstetrics and Gynaecology, Mulago Hospital, Kampala, Uganda
| | - Elin C Larsson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden;
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16
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Ochako R, Mbondo M, Aloo S, Kaimenyi S, Thompson R, Temmerman M, Kays M. Barriers to modern contraceptive methods uptake among young women in Kenya: a qualitative study. BMC Public Health 2015; 15:118. [PMID: 25884675 PMCID: PMC4336491 DOI: 10.1186/s12889-015-1483-1] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/27/2015] [Indexed: 12/03/2022] Open
Abstract
Background Young women in Kenya experience a higher risk of mistimed and unwanted pregnancy compared to older women. However, contraceptive use among youth remains low. Known barriers to uptake include side effects, access to commodities and partner approval. Methods To inform a youth focussed behaviour change communication campaign, Population Services Kenya developed a qualitative study to better understand these barriers among young women. The study was carried out in Nyanza, Coast, and Central regions. Within these regions, urban or peri-urban districts were purposively selected based on having contraceptive prevalence rate close to the regional average and having a population with low socioeconomic profiles. In depth interviews were conducted with a sample of sexually active women aged 15–24, both users and non-users, that were drawn from randomly selected households. Results All the respondents in the study were familiar with modern methods of contraception and most could describe their general mechanisms of action. Condoms were not considered as contraception by many users. Contraception was also associated with promiscuity and straying. Fear of side effects and adverse reactions were a major barrier to use. The biggest fear was that a particular method would cause infertility. Many fears were based on myths and misconceptions. Young women learn about both true side effects and myths from their social networks. Conclusion Findings from this research confirm that awareness and knowledge of contraception do not necessarily translate to use. The main barriers to modern contraceptive uptake among young women are myths and misconceptions. The findings stress the influence of social network approval on the use of family planning, beyond the individual’s beliefs. In such settings, family planning programming should engage with the wider community through mass and peer campaign strategies. As an outcome from this study, Population Services Kenya developed a mass media campaign to address key myths and misconceptions among youth.
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Affiliation(s)
- Rhoune Ochako
- Population Services Kenya (PS Kenya), P.O. Box 22591, 00400, Nairobi, Kenya.
| | - Mwende Mbondo
- Population Services Kenya (PS Kenya), P.O. Box 22591, 00400, Nairobi, Kenya.
| | - Stephen Aloo
- Population Services Kenya (PS Kenya), P.O. Box 22591, 00400, Nairobi, Kenya.
| | - Susan Kaimenyi
- Population Services Kenya (PS Kenya), P.O. Box 22591, 00400, Nairobi, Kenya.
| | - Rachel Thompson
- Population Services International, P.O. Box 14355, 00800, Nairobi, Kenya.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
| | - Megan Kays
- Population Services International, P.O. Box 14355, 00800, Nairobi, Kenya.
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Affiliation(s)
- Jenny Trinitapoli
- Department of Sociology & Population Research Institute, Penn State University, PA, USA.
| | - Janneke Verheijen
- Amsterdam Institute for Social Science Research, University of Amsterdam, The Netherlands
| | - Susan Watkins
- California Center for Population Research, University of California, Los Angeles, CA, USA
| | - Sara Yeatman
- Department of Health and Behavioral Sciences, University of Colorado Denver, CO, USA
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