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Decker MJ, Gutmann-Gonzalez A, Saphir M, Nguyen NT, Zhi Q, Brindis CD. Integrated Theory-Based Health and Development Interventions for Young People: A Global Scoping Review. HEALTH EDUCATION & BEHAVIOR 2024; 51:82-93. [PMID: 36314359 PMCID: PMC10785565 DOI: 10.1177/10901981221130734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
BACKGROUND Most health and developmental issues affecting young people are interrelated. However, few interventions address multiple behavioral domains simultaneously or are based on theories that encompass a holistic perspective of youth development. AIM The purpose of this scoping review was to identify and describe the range of theory-based, multibehavioral health interventions aimed at improving two or more of the following behavioral youth outcomes: (1) sexual and reproductive health; (2) education and employment; (3) violence; and (4) substance use. METHODS Interventions conducted worldwide and published in English or Spanish between January 2000 and July 2020 were identified using four databases: PubMed, PsycINFO, LILACS, and SciELO. RESULTS A total of 11,084 articles were identified, of which 477 were retrieved and assessed for eligibility. Twenty-three articles (evaluating 21 interventions) ultimately met the inclusion criteria. Most interventions were conducted in the United States and addressed two behavioral domains of interest, although seven interventions incorporated three domains, and one incorporated all four. Substance use was the most common domain (16 interventions) but only in the United States/Canada, followed by sexual and reproductive health (14 interventions). All produced significant improvement in at least one outcome or for at least one subgroup of youth. The most common theoretical foundations were positive youth development and social learning theory. CONCLUSION Integrated interventions that are theory based and evidence informed can support positive development and empower youth to make healthy decisions. Further efforts are needed to address structural and policy issues that affect young people's developmental opportunities and health outcomes.
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Affiliation(s)
| | | | - Melissa Saphir
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Qi Zhi
- University of Hawaiʻi at Mānoa, Honolulu, HI, USA
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Wood SN, Byrne ME, Thiongo M, Devoto B, Wamue-Ngare G, Decker MR, Gichangi P. Fertility and contraceptive dynamics amidst COVID-19: who is at greatest risk for unintended pregnancy among a cohort of adolescents and young adults in Nairobi, Kenya? BMJ Open 2023; 13:e068689. [PMID: 37130679 PMCID: PMC10163330 DOI: 10.1136/bmjopen-2022-068689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Among youth in Nairobi, we (1) characterised fertility and contraceptive use dynamics by gender; (2) estimated pregnancy prevalence over the pandemic; and (3) assessed factors associated with unintended pandemic pregnancy for young women. DESIGN Longitudinal analyses use cohort data collected at three timepoints prior to and during the COVID-19 pandemic: June to August 2019 (pre-pandemic), August to October 2020 (12-month follow-up) and April to May 2021 (18-month follow-up). SETTING Nairobi, Kenya. PARTICIPANTS At initial cohort recruitment, eligible youth were aged 15-24 years, unmarried and residing in Nairobi for at least 1 year. Within-timepoint analyses were restricted to participants with survey data per round; trend and prospective analyses were restricted to those with complete data at all three timepoints (n=586 young men, n=589 young women). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes comprised fertility and contraceptive use for both genders, and pregnancy for young women. Unintended pandemic pregnancy (assessed at 18-month follow-up) was defined as a current or past 6-month pregnancy with intent to delay pregnancy for more than 1 year at 2020 survey. RESULTS While fertility intentions remained stable, contraceptive dynamics varied by gender-young men both adopted and discontinued coital-dependent methods, whereas young women adopted coital-dependent or short-acting methods at 12-month follow-up (2020). Current pregnancy was highest at 2020 (4.8%), and approximately 2% at 2019 and 2021. Unintended pandemic pregnancy prevalence was 6.1%, with increased odds for young women recently married (adjusted OR (aOR)=3.79; 95% confidence interval (CI) 1.83-7.86); recent contraceptive use was protective against unintended pandemic pregnancy (aOR=0.23; 95% CI 0.11-0.47). CONCLUSIONS Current pregnancy in Nairobi was highest at the height of the COVID-19 pandemic (2020), and subsided to pre-pandemic levels by 2021 data collection; however, requires further monitoring. New marriages posed considerable risk for unintended pandemic pregnancy. Contraceptive use remains a crucial preventive strategy to averting unintended pregnancy, particularly for married young women.
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Affiliation(s)
- Shannon N Wood
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meagan E Byrne
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Thiongo
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
| | - Bianca Devoto
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Grace Wamue-Ngare
- Department of Sociology, Gender and Development Studies, Kenyatta University, Nairobi, Kenya
| | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Peter Gichangi
- International Centre for Reproductive Health Kenya, Mombasa, Kenya
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Burchett HED, Griffin S, de Melo M, Picardo JJ, Kneale D, French RS. Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14414. [PMID: 36361287 PMCID: PMC9658296 DOI: 10.3390/ijerph192114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sally Griffin
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | | | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Braverman-Bronstein A, Vidaña-Pérez D, Ortigoza AF, Baldovino-Chiquillo L, Diez-Canseco F, Maslowsky J, Sánchez BN, Barrientos-Gutiérrez T, Diez Roux AV. Adolescent birth rates and the urban social environment in 363 Latin American cities. BMJ Glob Health 2022; 7:bmjgh-2022-009737. [PMID: 36253017 PMCID: PMC9577896 DOI: 10.1136/bmjgh-2022-009737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. Methods We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15–19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). Results The median subcity ABR was 58.5 per 1000 women 15–19 (IQR 43.0–75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). Conclusions The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brisa N. Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Kons K, Biney AAE, Sznajder K. Factors Associated with Adolescent Pregnancy in Sub-Saharan Africa during the COVID-19 Pandemic: A Review of Socioeconomic Influences and Essential Interventions. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:386-396. [PMID: 38596281 PMCID: PMC10903609 DOI: 10.1080/19317611.2022.2084199] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 04/11/2024]
Abstract
Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms "sub-Saharan Africa," "Gender Norms," "Poverty," and "Adolescent Pregnancy" were used to search the literature for preexisting determinants of adolescent pregnancy in academic and grey literature. "COVID-19" was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescent girls during the Ebola outbreak, which lead to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare) factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets including, expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies.
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Affiliation(s)
- Kelly Kons
- Penn State College of Medicine, Hershey, PA, USA
| | - Adriana A E Biney
- Regional Institute for Population Studies, University of Ghana, Legon, Ghana
| | - Kristin Sznajder
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
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Stoebenau K, Madhavan S, Smith-Greenaway E, Jackson H. Economic Inequality and Divergence in Family Formation in sub-Saharan Africa. POPULATION AND DEVELOPMENT REVIEW 2021; 47:887-912. [PMID: 35498387 PMCID: PMC9053376 DOI: 10.1111/padr.12443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Economic inequality has been rising in many sub-Saharan African countries alongside rapid changes to union and family formation. In high-income countries marked by rising inequality, union and family formation practices have diverged across socioeconomic statuses, with intergenerational social and health consequences for the disadvantaged. In this study, we address whether there is also evidence of demographic divergence in low-income settings. Specifically, we model the age at first marriage and first birth by socioeconomic status groups for women born between 1960-1989 using Demographic and Health Survey data from twelve sub-Saharan African countries where economic inequality levels are relatively high or rising. We argue that economic and socio-cultural factors may both serve to increasingly delay marriage and childbearing for the elite as compared to others in the context of rising inequality. We find emerging social stratification in marriage and childbearing, and demonstrate that this demographic divergence is driven by the elites who are increasingly marrying and having children at later ages, with near stagnation in the age at first marriage and birth among the remaining majority. We urge further research at the intersection of socioeconomic and demographic inequality to inform necessary policy levers and curtail negative social and health consequences.
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Mbabazi C, Kintu A, Asiimwe JB, Ssekamatte JS, Shah I, Canning D. Proximate and distal factors associated with the stall in the decline of adolescent pregnancy in Uganda. BMC Public Health 2021; 21:1875. [PMID: 34663262 PMCID: PMC8522069 DOI: 10.1186/s12889-021-11403-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 06/28/2021] [Indexed: 01/22/2023] Open
Abstract
Background Adolescent pregnancy in Uganda declined from 31% in 2000–01 to 25% in 2006 but thereafter stalled at 25% from 2006 to 2016. This paper investigates the factors associated with the recent stall in the rate of decline of adolescent pregnancy in Uganda. Methods We used logistic regression models for 4 years (2000–01, 2006, 2011 and 2016) of data from the Uganda Demographic Health Survey to explore proximate and distal factors of adolescent pregnancy in Uganda. We carried out Blinder-Oaxaca decomposition models to explore the contributions of different factors in explaining the observed decline in adolescent pregnancy between 2001 and 2006, and the subsequent stall between 2006 and 2016. Results We found that marriage among women aged 15–19 years, and early sexual debut, were strongly associated with adolescent pregnancy. These declined substantially between 2000 and 01 and 2006, leading to a decline in adolescent pregnancy. Their decline was in turn associated with rising levels of female education and household wealth. After 2006, education levels and household wealth gains stalled, with associated stalls in the decline of marriage among women aged 15–19 years and sexual debut, and a stall in the decline of adolescent pregnancy. Conclusions The stall in the decline of adolescent pregnancies in Uganda was linked to a stall in the reduction of adolescent marriage, which in turn was associated with limited progress in female educational attainment between 2006 and 2016. We emphasize the need for a renewed focus on girl’s education and poverty reduction to reduce adolescent pregnancy in Uganda and subsequently improve health outcomes for adolescent girls. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11403-6.
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Affiliation(s)
- Catherine Mbabazi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA. .,National Population Council, Ministry of Finance, Planning and Economic Development, Statistics House, Plot 9, Colville Street, P.O. Box 2666, Kampala, Uganda.
| | - Alexander Kintu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Iqbal Shah
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David Canning
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Lee Y, Park J, Min M, Lee Y, Yu Y, Shim MK, Kim MG. Gender Equity and Vertically Transmitted Infections: A Country-Level Analysis Across 153 Countries. Health Equity 2021; 5:23-29. [PMID: 33564737 PMCID: PMC7868578 DOI: 10.1089/heq.2020.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: Gender inequality is a barrier to education toward women and accessibility to health facilities, which are important for preventing vertical transmission. This study was conducted to analyze the impact of gender equity on vertically transmitted infections (hepatitis viruses, human immunodeficiency virus [HIV], and syphilis) using country-level indicators. Methods: The relationship between the Global Gender Gap Index (GGGI), which is indicator of gender equity, and vertical transmission was analyzed. GGGI scores were collected from 153 countries in 2020. Vertical transmission included 10 outcomes for hepatitis viruses, HIV, and syphilis. Generalized linear model (GLM) was used for analyzing the relationship. Other predictors included skilled birth attendant and country income. Results: The median GGGI score was 0.706 (interquartile range, 0.664–0.736). GLM showed that the GGGI score was significantly associated with the incidence of both chronic hepatitis B and C in under 5 years (both p<0.001). For HIV, GGGI score was significantly associated with the pregnant women with unknown HIV status (p=0.001), no early infant diagnosis (p=0.027), and final transmission rate (p=0.005). There was no significant predictor for pregnant women who have not received antiretroviral therapy for prevention of mother-to-child transmission. All syphilis indicators have improved in high-income countries compared to low-income countries. GGGI score had a significant association only with no syphilis screening (p<0.001). Conclusions: A lower GGGI score was associated with higher vertical transmission of hepatitis and HIV. The improvement of gender equity might prevent vertical transmission of these viruses. Further intervention studies are warranted to verify the results.
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Affiliation(s)
- Youngmi Lee
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Junseok Park
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Myeungki Min
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Youjin Lee
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Youngun Yu
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Mi Kyoung Shim
- College of Pharmacy, CHA University, Pocheon, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea.,Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
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Espinel-Flores V, Gotsens M, Puig-Barrachina V, León-Gómez BB, Peralta A, Pérez G. Trends in teenage motherhood in Ecuador: challenges and inequalities. Int J Public Health 2020; 65:1647-1655. [PMID: 33145658 PMCID: PMC7608400 DOI: 10.1007/s00038-020-01517-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/04/2020] [Accepted: 10/20/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012. METHODS We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI. RESULTS The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador. CONCLUSIONS Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.
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Affiliation(s)
- Verónica Espinel-Flores
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain. .,Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023, Barcelona, Catalonia, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
| | | | - Brenda Biaani León-Gómez
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023, Barcelona, Catalonia, Spain
| | - Andrés Peralta
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Political and Social Sciences, Health Inequalities Research Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Centre, Barcelona, Spain
| | - Glòria Pérez
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain.,Agència de Salut Pública de Barcelona, Pl. Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
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Kane S, Miedema E, Dieleman M, Broerse J. 'You have a child who will call you "mama" ': understanding adolescent pregnancy in South Sudan. Glob Health Action 2019; 12:1553282. [PMID: 30620262 PMCID: PMC6327934 DOI: 10.1080/16549716.2018.1553282] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Pregnancy amongst adolescent girls is common in many parts of the world. The dominant discourse in public health unquestioningly paints this as a problem; it does not pay sufficient attention to girls' views. OBJECTIVES This paper presents a critical account of adolescent South Sudanese girls' reasons for and explanations of childbearing. It discusses their experiences and views on childbearing and attempts to explain their reproductive choices and actions, in context. METHODS The study draws upon 24 interviews with adolescent boys, girls and parents from Wau, South Sudan. Data was analysed using the framework analysis approach. RESULTS Three interacting themes within which adolescent girls framed their views and decisions about childbearing are identified. The local society places high value on motherhood - adolescent girls' desires to become mothers is a reproduction of this social norm. Girls linked having a child to the possibility of making one's 'own home'; in the difficult and uncertain context they lived in, for many girls, having a child (and making a home) appeared as one of the few means to be happy. In making the decision to bear a child, the girls navigated multiple dilemmas and trade-offs between an unpromising present and an uncertain future. Bearing a child and making one's 'own home' was seen as a way to exit into the world of adults, and as a strategy towards achieving security and stability. CONCLUSIONS Instead of simplistically problematizing adolescent pregnancy in South Sudan, it is important to take into account the experiences and standpoints of adolescent girls, and to recognize that in choosing to become mothers, they are in many ways exercising agency despite being severely constrained by complex, insecure and unfair social circumstances. We argue that such an approach will allow the development of more appropriate, realistic and inclusive health and social policies and programs.
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Affiliation(s)
- Sumit Kane
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,b Nossal Institute for Global Health, Melbourne School of Population and Global Health , University of Melbourne , Melbourne , Australia
| | - Esther Miedema
- c Governance and Inclusive Development Programme , University of Amsterdam , Amsterdam , The Netherlands
| | - Marjolein Dieleman
- a KIT Health , KIT Royal Tropical Institute , Amsterdam , The Netherlands.,d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
| | - Jacqueline Broerse
- d Faculty of Earth and Life Sciences, Athena Institute for Research on Innovation and Communication in Health and Life Sciences , VU University Amsterdam , Amsterdam , The Netherlands
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Benova L, Neal S, Radovich EG, Ross DA, Siddiqi M, Chandra-Mouli V. Using three indicators to understand the parity-specific contribution of adolescent childbearing to all births. BMJ Glob Health 2018; 3:e001059. [PMID: 30498589 PMCID: PMC6254748 DOI: 10.1136/bmjgh-2018-001059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 11/03/2022] Open
Abstract
Introduction A strong focus on sexual and reproductive health of female adolescents is a key to achieving sustainable development goals, due to the large size of the current cohort in low-income and middle-income countries (LMICs) and adolescents' biological and social vulnerability. Several indicators of fertility among adolescents are in wide use, but the contribution of adolescent births to all births is poorly understood. We propose and calculate a package of three indicators capturing the contribution of adolescent births to all births, stratified by parity (first and second/higher). Methods We used Demographic and Health Survey data for 30 LMICs and vital registration for two high-income countries (to calculate levels and trends across a range of countries) for three time periods: 1990-1999, 2000-2009 and 2010-2015. The three indicators were calculated overall and by age thresholds (<16, <18 and <20 years) and exact ages, for each country and time point. Patterns of changes in indicators for the three cumulative thresholds over time are described. Results In the 30 LMICs, the percentage of all live births occurring to adolescents varied across countries, with a median of 18% for adolescents <20 years. Three countries (Jordan, Indonesia and Rwanda) had levels below 10%; Bangladesh had the highest at 33%. The contribution of adolescent first-order births to all first-order births was high; a median of 49%. Even among second-order and higher-order births, the contribution of adolescent childbearing was appreciable (median of 6%). Over the period under examination, the proportion of adolescent births among all live births declined in the majority of the LMICs. Conclusion These three indicators add to our understanding of the scale of adolescent childbearing and can be used in conjunction with population estimates to assess the absolute need for age-appropriate and parity-appropriate reproductive, maternal and newborn healthcare and to monitor progress in improving young people's health.
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Affiliation(s)
- Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Emma G Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - David A Ross
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, London, UK
| | - Manahil Siddiqi
- Department of Reproductive Health and Research/Human Reproduction Program, World Health Organization, Geneva, Switzerland
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research/Human Reproduction Program, World Health Organization, Geneva, Switzerland
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