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Doherty M. Why Study Guaranteed Income in Oncology? Lessons Learned From Launching the Guaranteed Income and Financial Treatment Trial. J Am Coll Radiol 2024:S1546-1440(24)00532-5. [PMID: 38908741 DOI: 10.1016/j.jacr.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/03/2024] [Accepted: 06/11/2024] [Indexed: 06/24/2024]
Abstract
By targeting income and financial stress as key social determinants of health, unconditional cash transfers (UCTs) may improve cancer health outcomes and reduce cancer health disparities. Described in policy circles as guaranteed or basic income, UCTs have been shown to improve a range of health outcomes in low-income populations but have not yet been examined as a targeted intervention for people with cancer. This article describes some of the lessons learned from launching the Guaranteed Income and Financial Treatment trial, a two-arm randomized controlled trial of UCTs in oncology, along with a rationale for studying UCTs in people with cancer who have low incomes, and presents an introductory primer on UCT research for oncology clinicians and researchers and future directions for research.
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Affiliation(s)
- Meredith Doherty
- Assistant Professor, School of Social Policy and Practice; Senior Fellow, Leonard Davis Institute of Health Economics; Full Member, Abramson Cancer Center, Perelman School of Medicine; and Innovation Faculty, Penn Center for Cancer Care Innovation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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2
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Bosman S, Misra S, Flax-Nel LM, van Heerden A, Humphries H, Essack Z. A 5-Year Review of the Impact of Lottery Incentives on HIV-Related Services. Curr HIV/AIDS Rep 2024; 21:131-139. [PMID: 38573583 PMCID: PMC11130023 DOI: 10.1007/s11904-024-00694-0] [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] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE OF REVIEW Lottery incentives are an innovative approach to encouraging HIV prevention, treatment initiation, and adherence behaviours. This paper reviews the latest research on lottery incentives' impact on HIV-related services, and their effectiveness for motivating behaviours to improve HIV service engagement and HIV health outcomes. RECENT FINDINGS Our review of ten articles, related to lottery incentives, published between 2018 and 2023 (inclusive) shows that lottery incentives have promise for promoting HIV-related target behaviours. The review highlights that lottery incentives may be better for affecting simpler behaviours, rather than more complex ones, such as voluntary medical male circumcision. This review recommends tailoring lottery incentives, ensuring contextual-relevance, to improve the impact on HIV-related services. Lottery incentives offer tools for improving uptake of HIV-related services. The success of lottery incentives appears to be mediated by context, the value and nature of the incentives, and the complexity of the target behaviour.
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Affiliation(s)
- Shannon Bosman
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa.
| | - Shriya Misra
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa
| | - Lili Marie Flax-Nel
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa
| | - Alastair van Heerden
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa
- SAMRC/WITS Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Hilton Humphries
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa
- School of Applied Human Sciences, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Zaynab Essack
- Centre for Community Based Research, Human Sciences Research Council, Old Bus Depot, 1 Caluza Street, Sweetwaters, KwaZulu Natal, South Africa
- School of Law, University of KwaZulu Natal, Pietermaritzburg, South Africa
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Costanzo MA, Magnuson KA, Gennetian LA, Halpern-Meekin S, Noble KG, Yoshikawa H. Contraception use and satisfaction among mothers with low income: Evidence from the Baby's First Years study. Contraception 2024; 129:110297. [PMID: 37806470 PMCID: PMC10843149 DOI: 10.1016/j.contraception.2023.110297] [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] [Received: 02/15/2023] [Revised: 09/19/2023] [Accepted: 10/01/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Low income can lead to limited choice of and access to contraception. We examine whether an unconditional cash transfer (UCT) impacts contraceptive use, including increased satisfaction with and reduced barriers to preferred methods, for individuals with low income. STUDY DESIGN Baby's First Years is a randomized control study of a monthly UCT to families with low incomes. The study enrolled 1000 mothers at the time of childbirth across four US sites in 2018-2019; 400 were randomized to receive a UCT of $333/mo and 600 were randomized to receive $20/mo for the first years of their child's life. We use intent-to-treat analyses to estimate the impact of the cash transfer on contraception use, satisfaction with contraception method, and barriers to using methods of choice. RESULTS Over 65% of mothers reported using some type of contraception, and three-quarters reported using the method of their choice. We find no impact of the UCT on mothers' choice of, satisfaction with, or barriers to contraception. However, the cash transfer was associated with trends toward using multiple methods and greater use of short-term hormonal methods. CONCLUSIONS We find high levels of satisfaction with current contraceptive use among mothers of young children with low income. Receipt of monthly UCTs did not impact contraception methods, perceived barriers to use, or satisfaction. Yet, 25% were not using the method of their choice, despite the provision of cash, indicating that this cash amount alone may not be sufficient to impact contraceptive use or increase satisfaction. IMPLICATIONS Satisfaction with contraception use among low-income populations may be higher than previously documented. Nevertheless, provision of modest financial resources alone may not sufficiently address access, availability, and satisfaction for individuals with low-incomes of childbearing age. This suggests the importance of exploring how other nonfinancial factors influence reproductive autonomy, including contraceptive use.
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Affiliation(s)
- Molly A Costanzo
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, United States.
| | - Katherine A Magnuson
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, United States; Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States
| | - Lisa A Gennetian
- Sanford School of Public Policy, Duke University, Durham, NC, United States
| | - Sarah Halpern-Meekin
- School of Human Ecology, University of Wisconsin-Madison, Madison, WI, United States; LaFollette School of Public Affairs, University of Wisconsin-Madison, Madison, WI, United States
| | - Kimberly G Noble
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States; Department of Human Development, Teachers College, Columbia University, New York, NY, United States
| | - Hirokazu Yoshikawa
- Department of Applied Psychology at the Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, United States
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Kneale D, Kjaersgaard A, de Melo M, Joaquim Picardo J, Griffin S, French RS, Burchett HED. Can cash transfer interventions increase contraceptive use and reduce adolescent birth and pregnancy in low and middle income countries? A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001631. [PMID: 37943721 PMCID: PMC10635429 DOI: 10.1371/journal.pgph.0001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/22/2023] [Indexed: 11/12/2023]
Abstract
Becoming pregnant and giving birth under the age of 20 is associated with a range of adverse social, socioeconomic and health outcomes for adolescent girls and their children in Low and middle income countries. Cash transfers are an example of a structural intervention that can change the local social and economic environment, and have been linked with positive health and social outcomes across several domains. As part of a wider review of structural adolescent contraception interventions, we conducted a systematic review on the impact of cash transfers on adolescent contraception and fertility. Fifteen studies were included in the review with eleven studies providing evidence for meta-analyses on contraception use, pregnancy and childbearing. The evidence suggests that cash transfer interventions are generally ineffective in raising levels of contraceptive use. However, cash transfer interventions did reduce levels of early pregnancy (OR 0.90, 95% CI 0.81 to 1.00). There was suggestive evidence that conditional, but not unconditional, cash transfers reduce levels of early childbearing. Given that much of the evidence is drawn from interventions providing cash transfers conditional on school attendance, supporting school attendance may enable adolescent girls and young women to make life choices that do not involve early pregnancy.
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Affiliation(s)
- Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Abel Kjaersgaard
- EPPI-Centre, UCL Social Research Institute, University College London, London, United Kingdom
| | - Malica de Melo
- International Centre for Reproductive Health Mozambique (ICRH-M), Maputo, Mozambique
| | | | - Sally Griffin
- International Centre for Reproductive Health Mozambique (ICRH-M), Maputo, Mozambique
| | - Rebecca S. French
- Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen E. D. Burchett
- Department of Public Health, Environments and Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Moreira LR, Blumenberg C, Caicedo Velasquez BE, Ewerling F, Balandrán A, Vidaletti LP, Varela AR, Hellwig F, Ponce de Leon RG, Barros AJ, Silveira MF, Wehrmeister FC. The role of gender inequality and health expenditure on the coverage of demand for family planning satisfied by modern contraceptives: a multilevel analysis of cross-sectional studies in 14 LAC countries. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100435. [PMID: 36950033 PMCID: PMC10025422 DOI: 10.1016/j.lana.2023.100435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023]
Abstract
Background Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. Methods Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. Findings DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman's education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. Interpretation Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population's reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. Funding Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO).
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Affiliation(s)
- Laísa Rodrigues Moreira
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Corresponding author. Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil.
| | - Cauane Blumenberg
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Beatriz Elena Caicedo Velasquez
- Facultad Nacional de Salud Pública, Universidad de Antioquia, Medellín, Colombia
- Grupo de Investigación Epidemiología y Bioestadística, Universidad CES, Medellín, Colombia
| | - Fernanda Ewerling
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Alejandra Balandrán
- Inter-american Conference on Social Security, Direction of Health Systems Evaluation & Research, San Ramón s/n, San Jerónimo Lídice, 10200, Mexico City, Mexico
| | - Luis Paulo Vidaletti
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | | | - Franciele Hellwig
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology/Women's Health and Reproductive Health of the Pan American Health Organization (CLAP/WR-PAHO/ WHO), Montevideo, Uruguay
| | - Aluisio J.D. Barros
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Mariangela Freitas Silveira
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
| | - Fernando C. Wehrmeister
- Federal University of Pelotas, International Center for Equity in Health, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Federal University of Pelotas, Post-Graduation Program in Epidemiology, 1160 Marechal Deodoro St., 3rd floor, Pelotas, RS, 96020220, Brazil
- Institute for Global Public Health (IGPH), Rady Faculty of Health Sciences, Community Health Sciences, R070 Med Rehab Bldg, 771 McDermot Avenue, University of Manitoba (Bannatyne Campus), Winnipeg, Manitoba, R3E 0T6, Canada
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D'Souza P, Phagdol T, D'Souza SRB, D S A, Nayak BS, Velayudhan B, Bailey JV, Stephenson J, Oliver S. Interventions to support contraceptive choice and use: a global systematic map of systematic reviews. EUR J CONTRACEP REPR 2023; 28:83-91. [PMID: 36802955 DOI: 10.1080/13625187.2022.2162337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND To review the highest level of available evidence, a systematic map identified systematic reviews that evaluated the effectiveness of interventions to improve contraception choice and increase contraception use. METHODS Systematic reviews published since 2000 were identified from searches of nine databases. Data were extracted using a coding tool developed for this systematic map. Methodological quality of included reviews was assessed using AMSTAR 2 criteria. FINDINGS AND CONCLUSION Fifty systematic reviews reported evaluations of interventions for contraception choice and use addressing three domains (individual, couples, community); Meta-analyses in 11 of the reviews mostly addressed interventions for individuals. We identified 26 reviews covering High Income Countries, 12 reviews covering Low Middle-Income Countries and the rest a mix of both. Most reviews (15) focussed on psychosocial interventions, followed by incentives (6) and m-health interventions (6). The strongest evidence from meta-analyses is for the effectiveness of motivational interviewing, contraceptive counselling, psychosocial interventions, school-based education, and interventions promoting contraceptive access, demand-generation interventions (community and facility based, financial mechanisms and mass media), and mobile phone message interventions. Even in resource constrained settings, community-based interventions can increase contraceptive use. There are gaps in the evidence on interventions for contraception choice and use, and limitations in study designs and lack of representativeness. Most approaches focus on individual women rather than couples or wider socio-cultural influences on contraception and fertility. This review identifies interventions which work to increase contraception choice and use, and these could be implemented in school, healthcare or community settings.
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Affiliation(s)
- Preethy D'Souza
- UCL Social Research Institute, University College London, London, UK
| | - Tenzin Phagdol
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sonia R B D'Souza
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anupama D S
- Department of Obstetrics and Gynaecological Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Pediatric Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Binil Velayudhan
- Department of Mental Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Julia V Bailey
- Research Department of Primary Care and Population Health, University College London, Royal Free Hospital, London, UK
| | | | - Sandy Oliver
- UCL Social Research Institute, University College London, London, UK.,Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa
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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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Tiendrebeogo CO, Joseph V, Bicaba F, Bila A, Bicaba A, Druetz T. Does abolishing user fees for family planning increase contraception use? An impact evaluation of the national policy in Burkina Faso. J Glob Health 2022; 12:04086. [PMID: 36227754 PMCID: PMC9559360 DOI: 10.7189/jogh.12.04086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Unmet needs for contraception constitute a major public health problem in sub-Saharan Africa. Several mechanisms have been tested to reduce the financial barrier and facilitate access to family planning services, with inconclusive results. Based on the positive impacts following the introduction of free health care for pregnant women, Burkina Faso decided to extend its national policy and abolished direct payment for family planning services. This study aims to evaluate the impact of this policy on contraceptive use and unmet needs for contraception among women of reproductive age (WRA) in Burkina Faso. Methods This study uses two different study designs to examine the impact of a user fee removal policy on contraceptive use across a panel of 1400 households randomly selected across eight health districts. Data were collected using a standardized socio-demographic questionnaire at three different time points during the pilot and scale-up phases of the fee abolition program. The questionnaire was administered six months after the launch of the pilot fee abolition program in four health districts. For the remaining four health districts, the survey was conducted one year prior to and six months after the implementation of the program in those areas. All WRA in the households were eligible to participate. A cross-sectional study design was used to determine the association between knowledge of the fee abolition policy among WRA and actual use of contraceptives by WRA six months after the policy’s implementation and across all eight districts. Additionally, a pre-post study with a non-randomized, reflexive control group was designed using repeated surveys in four health districts. Hierarchical logistic mixed effects models were adjusted for a set of time-variant individual variables; the impact was assessed by a difference-in-differences approach that compared pre-post changes in contraception use in women who knew about the new policy and those who did not. Results Of the 1471 WRA surveyed six months after the removal of user fees for family planning services, 56% were aware of the policy’s existence. Knowledge of the fee abolition policy was associated with a 46% increase probability of contraceptive use among WRA six months after the policy’s implementation. Among the subset of the participants who were surveyed twice (n = 507), 65% knew about the fee removal policy six months after its introduction and constitute the intervention group. Pre-post changes in contraceptive use differed significantly between the intervention (n = 327) and control groups (n = 180). Removing user fees for family planning led to an 86% (95% confidence interval (CI) = 0.49, 1.31) increase in the likelihood of using contraception. In the study area, the policy reduced the prevalence of unmet needs for contraception by 13 percentage points. Conclusions Removing user fees for family planning services is a promising strategy to increase access to, and reduce unmet needs for, contraception. A broader dissemination of the policy’s existence will likely increase its impact on the overall population.
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Affiliation(s)
- Cheick Oumar Tiendrebeogo
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Vena Joseph
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso.,Sciences de la Vie et de la Santé, University Aix-Marseille, Marseille, France
| | - Alice Bila
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherches en Santé Publique, Ouagadougou, Burkina Faso
| | - Thomas Druetz
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada.,Centre de recherche en santé publique, Montreal, Quebec, Canada.,Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Perera C, Bakrania S, Ipince A, Nesbitt‐Ahmed Z, Obasola O, Richardson D, Van de Scheur J, Yu R. Impact of social protection on gender equality in low- and middle-income countries: A systematic review of reviews. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1240. [PMID: 36913187 PMCID: PMC9133545 DOI: 10.1002/cl2.1240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background More than half of the global population is not effectively covered by any type of social protection benefit and women's coverage lags behind. Most girls and boys living in low-resource settings have no effective social protection coverage. Interest in these essential programmes in low and middle-income settings is rising and in the context of the COVID-19 pandemic the value of social protection for all has been undoubtedly confirmed. However, evidence on whether the impact of different social protection programmes (social assistance, social insurance and social care services and labour market programmes) differs by gender has not been consistently analysed. Evidence is needed on the structural and contextual factors that determine differential impacts. Questions remain as to whether programme outcomes vary according to intervention implementation and design. Objectives This systematic review aims to collect, appraise, and synthesise the evidence from available systematic reviews on the differential gender impacts of social protection programmes in low and middle-income countries. It answers the following questions: 1.What is known from systematic reviews on the gender-differentiated impacts of social protection programmes in low and middle-income countries?2.What is known from systematic reviews about the factors that determine these gender-differentiated impacts?3.What is known from existing systematic reviews about design and implementation features of social protection programmes and their association with gender outcomes? Search Methods We searched for published and grey literature from 19 bibliographic databases and libraries. The search techniques used were subject searching, reference list checking, citation searching and expert consultations. All searches were conducted between 10 February and 1 March 2021 to retrieve systematic reviews published within the last 10 years with no language restrictions. Selection Criteria We included systematic reviews that synthesised evidence from qualitative, quantitative or mixed-methods studies and analysed the outcomes of social protection programmes on women, men, girls, and boys with no age restrictions. The reviews included investigated one or more types of social protection programmes in low and middle-income countries. We included systematic reviews that investigated the effects of social protection interventions on any outcomes within any of the following six core outcome areas of gender equality: economic security and empowerment, health, education, mental health and psychosocial wellbeing, safety and protection and voice and agency. Data Collection and Analysis A total of 6265 records were identified. After removing duplicates, 5250 records were screened independently and simultaneously by two reviewers based on title and abstract and 298 full texts were assessed for eligibility. Another 48 records, identified through the initial scoping exercise, consultations with experts and citation searching, were also screened. The review includes 70 high to moderate quality systematic reviews, representing a total of 3289 studies from 121 countries. We extracted data on the following areas of interest: population, intervention, methodology, quality appraisal, and findings for each research question. We also extracted the pooled effect sizes of gender equality outcomes of meta-analyses. The methodological quality of the included systematic reviews was assessed, and framework synthesis was used as the synthesis method. To estimate the degree of overlap, we created citation matrices and calculated the corrected covered area. Main Results Most reviews examined more than one type of social protection programme. The majority investigated social assistance programmes (77%, N = 54), 40% (N = 28) examined labour market programmes, 11% (N = 8) focused on social insurance interventions and 9% (N = 6) analysed social care interventions. Health was the most researched (e.g., maternal health; 70%, N = 49) outcome area, followed by economic security and empowerment (e.g., savings; 39%, N = 27) and education (e.g., school enrolment and attendance; 24%, N = 17). Five key findings were consistent across intervention and outcomes areas: (1) Although pre-existing gender differences should be considered, social protection programmes tend to report higher impacts on women and girls in comparison to men and boys; (2) Women are more likely to save, invest and share the benefits of social protection but lack of family support is a key barrier to their participation and retention in programmes; (3) Social protection programmes with explicit objectives tend to demonstrate higher effects in comparison to social protection programmes without broad objectives; (4) While no reviews point to negative impacts of social protection programmes on women or men, adverse and unintended outcomes have been attributed to design and implementation features. However, there are no one-size-fits-all approaches to design and implementation of social protection programmes and these features need to be gender-responsive and adapted; and (5) Direct investment in individuals and families' needs to be accompanied by efforts to strengthen health, education, and child protection systems. Social assistance programmes may increase labour participation, savings, investments, the utilisation of health care services and contraception use among women, school enrolment among boys and girls and school attendance among girls. They reduce unintended pregnancies among young women, risky sexual behaviour, and symptoms of sexually transmitted infections among women. Social insurance programmes increase the utilisation of sexual, reproductive, and maternal health services, and knowledge of reproductive health; improve changes in attitudes towards family planning; increase rates of inclusive and early initiation of breastfeeding and decrease poor physical wellbeing among mothers. Labour market programmes increase labour participation among women receiving benefits, savings, ownership of assets, and earning capacity among young women. They improve knowledge and attitudes towards sexually transmitted infections, increase self-reported condom use among boys and girls, increase child nutrition and overall household dietary intake, improve subjective wellbeing among women. Evidence on the impact of social care programmes on gender equality outcomes is needed. Authors' Conclusions Although effectiveness gaps remain, current programmatic interests are not matched by a rigorous evidence base demonstrating how to appropriately design and implement social protection interventions. Advancing current knowledge of gender-responsive social protection entails moving beyond effectiveness studies to test packages or combinations of design and implementation features that determine the impact of these interventions on gender equality. Systematic reviews investigating the impact of social care programmes, old age pensions and parental leave on gender equality outcomes in low and middle-income settings are needed. Voice and agency and mental health and psychosocial wellbeing remain under-researched gender equality outcome areas.
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Affiliation(s)
| | | | | | | | | | | | | | - Ruichuan Yu
- UNICEF Office of Research—InnocentiFlorenceItaly
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Bari MDA, Khan GD, He B, Yoshida Y. The impact of unconditional cash and food assistance on contraceptive expenditure of rural households in Coastal Bangladesh: Evidence from fuzzy RDD. PLoS One 2022; 17:e0262031. [PMID: 35061751 PMCID: PMC8782502 DOI: 10.1371/journal.pone.0262031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
This study investigates the impact of unconditional cash and food (UCF) assistance on the monthly contraceptive expenditure of rural households in coastal Bangladesh using a fuzzy regression discontinuity design (RDD). Eligibility for UCF assistance was based on the running variable of land ownership in acres. We used eligibility as an instrumental variable to estimate the local average treatment effect of UCF assistance on contraceptive expenditures. The results show that UCF assistance results in increases in monthly contraceptive expenditures.
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Affiliation(s)
- MD. Abdul Bari
- Graduate School for International Development and Cooperation, Hiroshima University, Kagamiyama, Higashi-Hiroshima, Japan
| | - Ghulam Dastgir Khan
- Graduate School for International Development and Cooperation, Hiroshima University, Kagamiyama, Higashi-Hiroshima, Japan
- * E-mail:
| | - Bing He
- School of Business, Jiangsu Ocean University, Haizhou District, Lianyungang, Jiangsu, China
| | - Yuichiro Yoshida
- Graduate School of Humanities and Social Sciences, Hiroshima University, Kagamiyama, Higashi-Hiroshima, Japan
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11
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A Rapid Review of Interventions to Prevent First Pregnancy among Adolescents and Its Applicability to Latin America. J Pediatr Adolesc Gynecol 2021; 34:491-503. [PMID: 33561565 DOI: 10.1016/j.jpag.2021.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. RESULTS Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. CONCLUSION This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA.
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1156. [PMID: 37131925 PMCID: PMC8356350 DOI: 10.1002/cl2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The preconception period is an ideal time to introduce interventions relating to nutrition and other lifestyle factors to ensure good pregnancy preparedness, and to promote health of mothers and babies. In adolescents, malnutrition and early pregnancy are the common challenges, particularly among those who live in low- and middle-income countries (LMIC) where 99% of all maternal and newborn deaths occur. These girls receive little or no attention until their first pregnancy and often the interventions after pregnancy are too late to revert any detrimental health risks that may have occurred due to malnutrition and early pregnancy. Objectives To synthesise the evidence of the effectiveness of preconception care interventions relating to delayed age at first pregnancy, optimising inter-pregnancy intervals, periconception folic acid, and periconception iron-folic acid supplementation on maternal, pregnancy, birth and child outcomes. Search Methods Numerous electronic databases (e.g., CINAHL, ERIC) and databases of selected development agencies or research firms were systematically searched for all available years up to July 2019. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished studies. Selection Criteria Primary studies, including large-scale programme evaluations that assessed the effectiveness of interventions using randomised controlled trials (RCTs) or quasi-experimental designs (natural experiments, controlled before-after studies, regression discontinuity designs, interrupted time series [ITS]), that targeted women of reproductive age (i.e., 10-49 years) during the pre- and periconceptional period in LMICs were included. Interventions were compared against no intervention, standard of care or placebo. Data Collection and Analysis Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data and assessed risk of bias. We used random-effects model to conduct meta-analyses, given the diverse contexts, participants, and interventions, and separate meta-analyses for the same outcome was performed with different study designs (ITS, RCTs and controlled before after studies). For each comparison, the findings were descriptively summarised in text which included detailing the contextual factors (e.g., setting) to assess their impact on the implementation and effectiveness of each intervention. Main Results We included a total of 43 studies; two of these were included in both delaying pregnancy and optimising interpregnancy intervals resulting in 26 studies for delaying the age at first pregnancy (14 RCTs, 12 quasi-experimental), four for optimising interpregnancy intervals (one RCT, three quasi-experimental), five on periconceptional folic acid supplementation (two RCTs, three quasi-experimental), and 10 on periconceptional iron-folic acid supplementation (nine RCTs, one quasi-experimental). Geographically, studies were predominantly conducted across Africa and Asia, with few studies from North and Central America and took place in a combination of settings including community, schools and clinical. The education on sexual health and contraception interventions to delay the age at first pregnancy may make little or no difference on risk of unintended pregnancy (risk ratio [RR], 0.42; 95% confidence internal [CI], 0.07-3.26; two studies, =490; random-effect; χ 2 p .009; I 2 = 85%; low certainty of evidence using GRADE assessment), however, it significantly improved the use of condom (ever) (RR, 1.54; 95% CI, 1.08-2.20; six studies, n = 1604; random-effect, heterogeneity: χ 2 p .004; I 2 = 71%). Education on sexual health and and provision of contraceptive along with involvement of male partneron optimising interpregnancy intervals probably makes little or no difference on the risk of unintended pregnancies when compared to education on sexual health only (RR, 0.32; 95% CI, 0.01-7.45; one study, n = 45; moderate certainty of evidence using GRADE assessments). However, education on sexual health and contraception intervention alone or with provision of contraceptive showed a significant improvement in the uptake of contraceptive method. We are uncertain whether periconceptional folic acid supplementation reduces the incidence of neural tube defects (NTDs) (RR, 0.53; 95% CI, 0.41-0.77; two studies, n = 248,056; random-effect; heterogeneity: χ 2 p .36; I 2 = 0%; very low certainty of evidence using GRADE assessment). We are uncertain whether preconception iron-folic acid supplementation reduces anaemia (RR, 0.66; 95% CI, 0.53-0.81; six studies; n = 3430, random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessment) even when supplemented weekly (RR, 0.70; 95% CI, 0.55-0.88; six studies; n = 2661; random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessments),and in school set-ups (RR, 0.66; 95% CI, 0.51-0.86; four studies; n = 3005; random-effect; heterogeneity: χ 2 p < .0001; I 2 = 87%; very low certainty of evidence using GRADE assessment). Data on adverse effects were reported on in five studies for iron-folic acid, with the main complaint relating to gastrointestinal side effects. The quality of evidence across the interventions of interest was variable (ranging from very low to moderate) which may be attributed to the different study designs included in this review. Concerning risk of bias, the most common concerns were related to blinding of participants and personnel (performance bias) and whether there were similar baseline characteristic across intervention and comparison groups. Authors' Conclusions There is evidence that education on sexual health and contraception interventions can improve contraceptive use and knowledge related to sexual health, this review also provides further support for the use of folic acid in pregnancy to reduce NTDs, and notes that weekly regimes of IFA are most effective in reducing anaemia. However the certainty of the evidence was very low and therefore more robust trials and research is required, including ensuring consistency for reporting unplanned pregnancies, and further studies to determine which intervention settings (school, community, clinic) are most effective. Although this review demonstrates promising findings, more robust evidence from RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Sophie G. E. Kedzior
- Faculty of Health and Medical Sciences, Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | | | - Yamna Jadoon
- Department of PaediatricsAga Khan University HospitalKarachiPakistan
| | - Jai K. Das
- Division of Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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13
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Ravindran TKS, Govender V. Sexual and reproductive health services in universal health coverage: a review of recent evidence from low- and middle-income countries. Sex Reprod Health Matters 2020; 28:1779632. [PMID: 32530387 PMCID: PMC7887992 DOI: 10.1080/26410397.2020.1779632] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
If universal health coverage (UHC) cannot be achieved without the sexual and reproductive health (SRH) needs of the population being met, what then is the current situation vis-à-vis universal coverage of SRH services, and the extent to which SRH services have been prioritised in national UHC plans and processes? This was the central question that guided this critical review of more than 200 publications between 2010 and 2019. The findings are the following. The Essential Package of Healthcare Services (EPHS) across many countries excludes several critical SRH services (e.g. safe abortion services, reproductive cancers) that are already poorly available. Inadequate international and domestic public funding of SRH services contributes to a sustained burden of out-of-pocket expenditure (OOPE) and inequities in access to SRH services. Policy and legal barriers, restrictive gender norms and gender-based inequalities challenge the delivery and access to quality SRH services. The evidence is mixed as to whether an expanded role and scope of the private sector improves availability and access to services of underserved populations. As momentum gathers towards SRH and UHC, the following actions are necessary and urgent. Advocacy for greater priority for SRH in government EPHS and health budgets aligned with SRH and UHC goals is needed. Implementation of stable and sustained financing mechanisms that would reduce the proportion of SRH-financing from OOPE is a priority. Evidence, moving from descriptive towards explanatory studies which provide insights into the "hows" and "whys" of processes and pathways are essential for guiding policy and programme actions.
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Affiliation(s)
- T. K. Sundari Ravindran
- Principal Visiting Fellow, United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Veloshnee Govender
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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14
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Velasco MC, Chrysanthopoulou SA, Galárraga O. Cash Transfers and Contraceptive Use: A Regression Discontinuity Analysis. Stud Fam Plann 2020; 51:309-321. [PMID: 33283276 PMCID: PMC8011311 DOI: 10.1111/sifp.12142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Conditional cash transfers (CCTs) have become important components of social protection policies in Latin America. By establishing coresponsibilities tied to health and education, CCTs may reduce poverty and encourage human capital investment. While CCT programs can have unintended effects on sexual and reproductive health outcomes, such effects have been mixed and poorly documented in South America. This study examines the impact of Ecuador's CCT program, Bono de Desarrollo Humano, on contraceptive behavior among women of childbearing age who are sexually active and do not wish to become pregnant. We analyze nationally representative data in a regression-discontinuity quasi-experimental design. Using an instrumental variable approach and a set of robustness checks, our study finds no significant effects of the CCT program on contraceptive use. Our results offer important considerations for the ongoing policy debate in South America regarding the effects of cash transfer programs on beneficiaries.
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Affiliation(s)
- Maria Carolina Velasco
- Maria Carolina Velasco, Stavroula A. Chrysanthopoulou, Department of Biostatistics, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Stavroula A Chrysanthopoulou
- Maria Carolina Velasco, Stavroula A. Chrysanthopoulou, Department of Biostatistics, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Omar Galárraga
- Omar Galárraga, Department of Health Services Policy and Practice, Brown University School of Public Health, Providence, RI, 02903, USA
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15
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Keats EC, Jain RP, Bhutta ZA. Indirect health sector actions and supportive strategies to prevent malnutrition. Curr Opin Clin Nutr Metab Care 2020; 23:190-195. [PMID: 32167985 DOI: 10.1097/mco.0000000000000653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Malnutrition is a pervasive problem that causes negative acute, long-term, and intergenerational consequences. As we have begun to move from efficacy to effectiveness trials of nutrition interventions, and further still to more holistic case study approaches to understanding how and why nutrition outcomes change over time, it has become clear that more emphasis on the 'nutrition-sensitive' interventions is required. RECENT FINDINGS In this article, we propose recategorizing the nutrition-specific and sensitive terminology into a new framework that includes direct and indirect health sector actions and supportive strategies that exist outside the health sector; an adjustment that will improve sector-specific planning and accountability. We outline indirect health sector nutrition interventions, with a focus on family planning and the evidence to support its positive link with nutrition outcomes. In addition, we discuss supportive strategies for nutrition, with emphasis on agriculture and food security, water, sanitation, and hygiene, and poverty alleviation and highlight some of the recent evidence that has contributed to these fields. SUMMARY Indirect health sector nutrition interventions and supportive strategies for nutrition will be critical, alongside direct health sector nutrition interventions, to reach global targets. Investments should be made both inside and outside the health sector.
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Affiliation(s)
- Emily C Keats
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Reena P Jain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
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Lassi ZS, Kedzior SG, Das JK, Bhutta ZA. PROTOCOL: Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low‐ and middle‐income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1007. [PMCID: PMC6988117 DOI: 10.1002/cl2.1007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Zohra S. Lassi
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Sophie G.E. Kedzior
- Robinson Research Institute, Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Jai K. Das
- Department of PediatricsAga Khan UniversityKarachiSindhPakistan
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17
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Lissner CL, Ali M. Systematic Reviews of Mechanisms for Financing Family Planning: Findings, Implications, and Future Agenda. Stud Fam Plann 2018; 47:295-308. [PMID: 27925673 DOI: 10.1111/sifp.12008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The article describes an international collaboration that systematically reviewed the evidence on financing mechanisms for family planning/contraception, assessed the strength of and summarized the evidence, identified research gaps, and proposed a new research agenda to address the gaps. The review found that the evidence base is weak owing to the paucity of studies, diversity in findings, and variations in intervention, study design, and outcome measures. Of more than 17,000 papers reviewed only 38 met the eligibility criteria. A number of general recommendations on the directions and areas of future research can be drawn. There is a strong need for more robust study designs on the effectiveness of financial incentives in family planning.
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Affiliation(s)
- Craig L Lissner
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization (WHO), Geneva
| | - Moazzam Ali
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization (WHO), Geneva
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