Social and Behavioral Sciences Commons^™

Expanding The Evidence Base On Comprehensive Care For Survivors Of Sexual Violence In Sub-Saharan Africa, Population Council

Reproductive Health

The Expanding the Evidence Base on Comprehensive Care for Survivors of Sexual Violence in sub-Saharan Africa program was a four-year agreement between the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka (the S-N Team), and the Population Council. From 2009 to 2013, the program sought to mitigate the impact and incidence of sexual and gender-based violence (SGBV) in sub-Saharan Africa by strengthening the capacities of medical, legal, and justice sectors to care for survivors of such violence. This approach was intended to serve the S-N Team’s larger development objectives of preventing HIV transmission in sub-Saharan Africa …

Social Accountability: What Are The Lessons For Improving Family Planning And Reproductive Health Programs?, Victoria Boydell, Jill Keesbury

Reproductive Health

The concept of accountability is increasingly important in the family planning (FP) and reproductive health (RH) field. While much recent discussion has focused on developing global or national-level mechanisms for accountability, less emphasis has been placed on understanding the relevance of “social accountability” approaches for ensuring access to, and quality of, FP/RH services. Social accountability refers to the efforts of citizens and civil society to scrutinize and hold duty bearers (politicians, government officials, and service providers) to account for providing promised services, actions most often at the subnational or community level. In the FP/RH field, this concept builds on a …

Strengthening The Evidence Base On Social Accountability For Improving Family Planning And Reproductive Health Programs, Victoria Boydell, Jill Keesbury, Kelsey Wright

Reproductive Health

The concept of accountability is important in the family planning (FP) and reproductive health (RH) sector, building on a rich history of community involvement and civil society participation. There are three categories of FP/RH accountability initiatives: tracking donor and government financial commitments, tracking national-level program implementation, and tracking service-delivery outcomes. The third category, often referred to as “social accountability,” includes the efforts of citizens and civil society to scrutinize and hold duty bearers to account for providing promised services, most often at the subnational or community levels. Social accountability is premised on the assumption that increased and targeted citizen and …

Increasing Access To Family Planning In Ghana Through Policy Change: Task-Sharing To Enable Auxiliary Nurses To Provide Contraceptive Implant Services, Population Council

Reproductive Health

Ghana has made significant progress toward reducing the maternal mortality ratio but the rate is still unacceptably high. Up to 26 percent of married Ghanaian women have unmet need for family planning and one in four currently married women is using a modern contraceptive method. Satisfying unmet need for family planning could cut the number of maternal deaths by almost a third. One factor contributing to low usage of modern methods is shortage of trained staff, particularly those skilled in providing long-acting reversible and permanent methods. Until recently, implant services were provided primarily by Ghana Health Service (GHS) trained midwives, …

Training Manual On Basic Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan

Reproductive Health

Social and behavior change communication (SBCC) interventions are key for addressing social and cultural barriers and achieving goals laid out for health programs. Often these interventions are not evidence based and monitoring and evaluation (M&E) is limited. Lack of trained and skilled human resources for M&E has been a limitation in general. A serious effort is needed to build the capacity of M&E personnel to monitor and evaluate performance of SBCC interventions in terms of reach and effectiveness among intended audiences. The Improving Healthy Behaviors Program of FHI360 aims to provide technical assistance to strengthen capacities to monitor and evaluate …

Promoting Respectful Maternity Care: A Training Guide For Community-Based Workshops—Community Facilitator's Guide, Charity Ndwiga, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Alice Maranga, Christine Ochieng, Mary Wanjala, Beatrice Chelang'at, Anne Njeru, Annie Gituto, George Odhiambo, Faith Mbehero, Lucia Maina, Jeremiah Maina

Reproductive Health

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. The Community Facilitator’s Guide, designed to be used by facilitators to promote respectful maternity care at the community level, can be adapted to educate a variety of stakeholders in community settings (i.e., Community Health Extension …

Population And Health Dynamics In Nairobi's Informal Settlements: Report Of The Nairobi Cross-Sectional Slums Survey (Ncss 2012), African Population And Health Research Center (Aphrc)

Reproductive Health

This report documents the living conditions and health risks of slum-dwellers across Nairobi’s informal settlements a decade after the Nairobi Cross-sectional Slums Survey (NCSS) of 2000. It aims to not only highlight the needs of slum-dwellers but also inform policymakers on the changes that have occurred in the living conditions of Nairobi’s urban poor since 2000, considering development interventions by the Government of Kenya and its development partners. The NCSS 2012 results highlight marked improvements in environmental, health, and educational indicators among slum dwellers. However, these improvements were not uniform, with subgroups of younger women and women without formal education …

Prevalence Of Unintended Pregnancy And Needs For Family Planning Among Married Adolescent Girls Living In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Sabiha Chowdhuri, Bidhan Krishna Sarker, Noushin Islam, Anisuddin Ahmed

Reproductive Health

This STEP UP research report examined the prevalence and basic underlying factors of unintended pregnancy among married adolescent girls in five urban slums in Dhaka, Bangladesh. The specific objectives of the study were to: 1) document the prevalence of unintended pregnancy among married adolescent girls aged 15–19 years living in urban slums of Dhaka; 2) identify the factors associated with or which contribute to unintended pregnancy among urban married adolescent girls; 3) estimate the proportion of married adolescent girls who have an unmet need for family planning (FP) services; and 4) explore the barriers to access and effective use of …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape: A Review Of Policies, Programmes And Country Experiences In Sub-Saharan Africa, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

This study examined how pregnancy prevention and management services (specifically, the provision of emergency contraception, pregnancy testing and counseling, and termination or referral for termination of pregnancy services) feature within post-rape care services in sub-Saharan Africa. The study drew on a range of sources via a desk review, as well as on information provided through key informant interviews. The existence of numerous national guidelines in the region demonstrates countries’ desire to respond to this public health and legal challenge. However, if left in their current state, the gaps and inconsistencies observed across most national guidelines contribute to a violation of …

Building Evidence On Effective Programs To Delay Marriage And Support Married Girls In Africa, Population Council

Poverty, Gender, and Youth

In the early 2000s, the Population Council collaborated on the first rigorously evaluated program in Africa to delay the age of marriage and support girls married as children. Berhane Hewan (Light for Eve) targeted married and unmarried girls aged 10–19 in rural areas of Amhara. The program’s four components—community conversations to raise awareness and address cultural and social norms, provision of school supplies to remain in school, conditional asset transfer to address economic incentives to marry girls, and girls’ mentoring groups—were based on formative research and consultations with local leadership. Building on the Berhane Hewan pilot, the Council and partners …

Building The Assets To Thrive: Addressing The Hiv-Related Vulnerabilities Of Adolescent Girls In Ethiopia—Policy Brief, Population Council

Poverty, Gender, and Youth

In Eastern and Southern Africa, HIV is the leading cause of death among girls aged 15–19. Despite decades of investment and substantial progress against HIV, adolescent girls remain at disproportionate risk of infection. Few programs have sought to take a “whole girl” approach to addressing the multiple vulnerabilities to HIV infection experienced by the most marginalized adolescent girls in the poorest communities in Africa. “Building the Assets to Thrive: Addressing the HIV-related Vulnerabilities of Adolescent Girls in Ethiopia” is a comprehensive review of three programs implemented and evaluated by the Population Council and the Ethiopian government beginning in 2007: Biruh …

Accessing Adolescent Friendly Health Clinics In India: The Perspectives Of Adolescents And Youth, K.G. Santhya, Ravi Prakash, Shireen J. Jejeebhoy, Santosh Kumar Singh

Poverty, Gender, and Youth

The recently launched Rashtriya Kishor Swasthya Karyakram (RKSK) health program seeks to enable all adolescents and youth to realize their full potential by making informed and responsible decisions concerning their health and well-being and by accessing the services and support needed to implement their decisions. To realize this vision, the RKSK framework acknowledges that the strengthening of Adolescent Friendly Health Clinics (AFHCs) and the provision of correct knowledge and information through counseling services are two of its seven critical components. As the government makes efforts to roll out the RKSK program at scale across the country, reviewing the experiences of …

Adolescents In Rajasthan 2012: Changing Situation And Needs, Shireen J. Jejeebhoy, Rajib Acharya

Poverty, Gender, and Youth

Several national policies and programs formulated since 2000 have underscored India’s commitment to addressing the multiple needs of youth. The Rashtriya Kishor Swasthya Karyakram (RKSK) program launched in 2014 helped provide the framework for services for young people’s health in general, and their sexual and reproductive health, mental health, and prevention and care of noncommunicable diseases, in particular. The earlier Youth in India: Situation and Needs 2006–2007 study was the first-ever subnationally representative study conducted to identify key transitions experienced by married and unmarried youth in India. Data have now become available from a repeated survey conducted in 2012 in …

Trafficking Of Minor Girls For Commercial Sexual Exploitation In India: A Synthesis Of Available Evidence, K.G. Santhya, Shireen J. Jejeebhoy, Sharmistha Basu

Poverty, Gender, and Youth

Understanding factors that place minor girls at risk of being trafficked for commercial sexual exploitation (CSE) and the consequences of trafficking for their health and life-course trajectories is limited by the scattered evidence available on these issues. The role of various stakeholders in trafficking, namely, families, traffickers, and brothel owners, and the role of law enforcement agencies in preventing it are also poorly understood. Further, adequate data consolidating the responses of government and nongovernmental organizations to issues related to CSE of minor girls are lacking. There is a need, therefore, to consolidate this scattered body of evidence and to identify …

Pmtct Cascade Analysis In Côte D'Ivoire: Results From A National Representative Sample, Stephen S. Gloyd, Julia Robinson, Serge A. Dali, S. Adam Granato, Rebecca Bartlein, Seydou Kouyate, David Aka, Doroux A. Billy, Irma Ahoba, Ahoua Kone

HIV and AIDS

Without treatment, an HIV-positive pregnant woman has a 30–35 percent chance of transmitting the infection to her child. Early detection and appropriate treatment during pregnancy, childbirth, and breastfeeding can reduce those odds to less than 5 percent. Consequently, WHO and countries around the world have instituted prevention of mother-to-child transmission of HIV (PMTCT) programs, consisting of the “PMTCT cascade”: testing for HIV at the first antenatal visit; CD4 test of HIV-positive patients; antiretroviral (ARV) prophylaxis to mother throughout pregnancy and breastfeeding; ARV prophylaxis to child at delivery and throughout breastfeeding; HIV testing of child and initiation of antiretroviral therapy (ART) …

Cultural Factors Associated With Utilization Of Antenatal Care Services In Rural India, Anjali Om

Undergraduate Research Posters

Despite vast economic growth in developing countries in the past few years, infant mortality continues to plague underdeveloped regions, particularly rural regions of India. Many of these deaths are caused by a lack of education and motivation in regard to utilization of antenatal and neonatal care services to prevent and treat consequences of unhygienic umbilical cord care.

For years, high incidences of neonatal tetanus have plagued rural areas of India as a result of cultural practices that encourage topical applications of cow dung to cut umbilical stumps either directly or by using ghee heated with cow dung to warm umbilical …

Formative Research To Develop An Intervention For Addressing Mental Health/Psychosocial Issues And Hiv Vulnerability Of Marginalized Adolescents In Addis Ababa, Ethiopia, Nrupa Jani, Katie D. Schenk

HIV and AIDS

Children and adolescents who migrate from rural regions to Addis Ababa, Ethiopia often flee their households to escape from abusive families, forced marriages, poverty, lack of economic opportunity and education, and other social problems. They are often met with equally harsh, if not worse, challenges when they arrive in Addis Ababa, including treacherous living situations, abusive working conditions with meager compensation, limited opportunities for education and socialization, and absence of family support. This study conducted a qualitative needs assessment to determine type and extent of mental health and psychological needs among adolescent migrants living in Addis Ababa in order to …

Documentation Of Hiv Prevention Research And Programmatic Learnings From India—Selected Peer-Reviewed Journal Articles And Key Highlights: 2013-2014 (Volume 2), Population Council

HIV and AIDS

Over the past decade (2001–11), there has been a steady decline in adult HIV prevalence in India as a result of evidence-based, intensive, and scaled HIV-prevention programs. Findings from the implementation of programs have been widely documented and have been published both as reports and peer-reviewed journal articles. In “Documentation of HIV Prevention Research and Programmatic Learnings from India,” Volume 2, we bring together recent articles published in peer-reviewed journals on the lessons learned from the HIV-prevention program in India. The document is divided into four thematic sections, and research highlights are presented at the start of each section. This …

Hiv/Aids Vulnerabilities, Discrimination, And Service Accessibility Among Nigeria's Youth, Population Council

HIV and AIDS

This report documents the findings of a study implemented between August 2011 and July 2012 that sought to provide a comprehensive, evidence-based picture of the HIV-related issues facing Nigerian youth and the prevailing legal, policy, and programmatic responses. The study was designed to establish a basis for a sharper focus on youth within the national response to HIV. Researchers conducted an analytical review of the relevant literature on factors associated with HIV risk-taking and health-seeking behaviors among young people aged 15–24 in Nigeria. In addition, qualitative and quantitative analyses enabled an evaluation of the factors associated with young people’s sexual …

Policy And Programme Considerations For Arv-Based Prevention For Women: Insights From Key Opinion Leaders In Zimbabwe About Tenofovir Gel, Samukeliso Dube, Barbara Friedland, Saiqa Mullick, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

Zimbabwe has seen a tremendous shift in the HIV landscape in the last decade, particularly regarding prevalence. Yet many people, especially women, are still at high risk and efforts to identify and implement additional HIV-prevention options remain critical. After nearly 20 years of microbicides research, 1 percent tenofovir gel is the first vaginal microbicide to show promise. Since 2011, Zimbabwe has been scaling up use of tenofovir-based regimens as first-line therapy for adults infected with HIV. A randomized, placebo-controlled, double-blind trial demonstrated that women assigned to use 1 percent tenofovir gel had a 39 percent lower risk of HIV infection …

The Global Health Security Agenda In An Age Of Biosecurity, Lawrence O. Gostin, Alexandra Phelan

Georgetown Law Faculty Publications and Other Works

Historically, the Oval Office has been a leader in global health assistance. From the President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI) under the Bush Administration, to the Global Health Initiative launched by President Obama in 2009. However, unlike PEPFAR and PMI, the Global Health Initiative met an untimely end with the launch of a bold new global health measure by the Obama Administration: the Global Health Security Agenda (GHS Agenda). The GHS Agenda aims to “accelerate progress toward a world safe and secure from infectious disease threats” through a US-led diplomatic collaboration with 30 …

Governing For Health As The World Grows Older: Healthy Lifespans In Aging Societies, Lawrence O. Gostin, Anna Garsia

Georgetown Law Faculty Publications and Other Works

So much of global health governance focuses intensely on a brief moment in the human lifespan—from a safe birth to infant and child survival. Yet, with all the attention to this early window of life (infancy to age five), the opposite end of the life spectrum is comparatively neglected. The Millennium Development Goals (MDGs) do not mention a healthy lifespan or a healthy old age. This inadequate attention to the older years of the life appears to be a glaring omission given the universal challenges posed by aging societies. Aging is a demographic fact in almost all countries, but it …

Sexual Rights For Marginalized Populations, Louis Graham, Mark Padilla

Louis F Graham

Governance And Transparency At Pepfar, Matthew Kavanagh, Brook Baker

Matthew M. Kavanagh

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.

The Politics Of Transition & The Economics Of Hiv: Aids & Pepfar In South Africa, Matthew M. Kavanagh

Matthew M. Kavanagh

AIDS poses a unique and unprecedented challenge to South Africa. The country has the largest HIV epidemic in the world—with 6.4 million people living with HIV—and one of the largest TB epidemics in the world as well. The country’s recent AIDS response has generated enormous optimism, both in South Africa and internationally. The biggest change, in many ways, has been political—dramatic shifts in ideology and motivation at the highest levels of government have moved the country from denialism and inaction to a bold national mobilization to bring anti-retroviral treatment to scale. Meanwhile, the approach of the U.S. government has evolved …

Governance And Transparency At Pepfar, Matthew M. Kavanagh, Brook K. Baker

Brook K. Baker

The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013, and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa. PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations.