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The Afford Health Marketing Initiative In Uganda: Mid-Term Evaluation, Oleksandr Rohozynsky, Christie Billingsley, Annette Bongiovanni Jan 2009

The Afford Health Marketing Initiative In Uganda: Mid-Term Evaluation, Oleksandr Rohozynsky, Christie Billingsley, Annette Bongiovanni

HIV and AIDS

AFFORD is a five-year (2005–10) social marketing initiative financed by the United States Agency for International Development (USAID)/Uganda. It supports the Uganda Ministry of Health’s strategic plan to promote positive health-care-seeking behavior and reduce the shortage of health products and services related to family planning and reproductive health; child health; malaria prevention and treatment; and HIV prevention, care, and treatment. AFFORD seeks to achieve the sustainable marketing of products and services that prevent transmission of HIV, malaria, and diarrheal diseases; to help couples plan their families; and to help people living with HIV enjoy improved quality of life. Target groups …

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Final Evaluation Of The Project For Expanding The Role Of Networks Of People Living With Hiv/Aids, Young-Mi Kim, John Lukwago, Stella Neema Jan 2009

Final Evaluation Of The Project For Expanding The Role Of Networks Of People Living With Hiv/Aids, Young-Mi Kim, John Lukwago, Stella Neema

HIV and AIDS

In July 2006, the International HIV/AIDS Alliance launched a three-year project on Expanding the Role of Networks of People Living with HIV/AIDS in Uganda. The project, which is funded by the United States Agency for International Development (USAID)/Uganda, sought to increase the involvement of people living with HIV/AIDS (PHA) in the HIV/AIDS response and to improve access to and utilization of prevention, treatment, care, and support services for PHA households. USAID/Uganda commissioned an evaluation of the project’s design, strategies, and performance in order to improve its implementation and learn from its successes and challenges. The study was a cross-sectional descriptive …

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Formative Evaluation: Presidential Initiative On Aids Strategy For Communication To Youth, Netsayi N. Mudege, Chi-Chi Undie Jan 2009

Formative Evaluation: Presidential Initiative On Aids Strategy For Communication To Youth, Netsayi N. Mudege, Chi-Chi Undie

HIV and AIDS

HIV prevention programming is increasingly taking place in school settings, which provide an expansive population of young people and offer immense potential for impact on the lives of this target group. The Presidential Initiative on AIDS Strategy for Communication to Youth (PIASCY) is a school-based program that has sought to address the HIV/AIDS epidemic in Uganda in a holistic manner since 2002, targeting young people, school personnel, parents, and the wider community. A formative evaluation was conducted by the African Population and Health Research Center in February 2009 to provide an understanding of: the extent to which PIASCY is achieving …

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The Overlooked Epidemic: Addressing Hiv Prevention And Treatment Among Men Who Have Sex With Men In Sub-Saharan Africa, National Aids Control Council Of Kenya, Population Council Jan 2009

The Overlooked Epidemic: Addressing Hiv Prevention And Treatment Among Men Who Have Sex With Men In Sub-Saharan Africa, National Aids Control Council Of Kenya, Population Council

HIV and AIDS

Globally, less than 1 out of 20 men who have sex with men (MSM) has access to HIV prevention and care. UNAIDS has estimated that at least 5 to 10 percent of all HIV infections globally occur through male-to-male sexual activity. In spite of the high risk of HIV infection and evidence of extensive sexual networks, national HIV programs in Africa have been slow to address MSM in prevention and treatment efforts. To address these issues, the Population Council and the National AIDS Control Council of Kenya convened a meeting on May 14–15, 2008. The goals of the meeting were …

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Technical Assistance To The Uganda Aids Commission For Operationallisation Of The Performance Monitoring And Management Plan, Frederick Makumbi, Roy Mayega, David Kisitu, Juliet Sekandi, Denis A. Bwesigye, Robert Miller, Sam Kalibala Jan 2009

Technical Assistance To The Uganda Aids Commission For Operationallisation Of The Performance Monitoring And Management Plan, Frederick Makumbi, Roy Mayega, David Kisitu, Juliet Sekandi, Denis A. Bwesigye, Robert Miller, Sam Kalibala

HIV and AIDS

The Uganda AIDS Commission (UAC) has committed to rolling out and making operational a new National Performance Monitoring and Management Plan (PMMP) to monitor and evaluate the national response to the HIV/AIDS epidemic. The PMMP has at its core the collection and processing of 58 national indicators, 47 district output indicators, and 22 outcome indicators covering prevention, care, treatment, and social support. The rollout is challenging because at least seven organizations must collaborate at the national level, and appropriate staff at the district level need to be in place and trained in new procedures of data collection. In addition, these …

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Family Centred Approach For Hiv Services: Pilot Study In South Africa, Meredith Sheehy, Nomtandazo Patricia Mini, Tonicah Maphanga, Scott E. Kellerman Jan 2009

Family Centred Approach For Hiv Services: Pilot Study In South Africa, Meredith Sheehy, Nomtandazo Patricia Mini, Tonicah Maphanga, Scott E. Kellerman

HIV and AIDS

In 2003, UNICEF estimated that nearly 250,000 children were infected with HIV in South Africa. While scale-up of prevention of mother-to-child transmission (PMTCT) programs has improved testing and care for perinatally infected infants, uptake of these services remains low in much of sub-Saharan Africa and few HIV infected children are diagnosed and receive services through PMTCT programs. With support from USAID/PEPFAR, the Horizons Program adapted a family-centered model for children and families in need of broader-reaching HIV diagnostic services in South Africa. The Family Centered Approach (FCA) pilot intervention was designed to expand access to HIV testing for family members …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Cambodia 2005, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Cambodia 2005, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Cambodia 2005” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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Ensuring Education For All In Bihar: Highlighting The Obstacles, International Institute For Population Sciences (Iips), Population Council Jan 2009

Ensuring Education For All In Bihar: Highlighting The Obstacles, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

The extent to which India will be able to successfully harness its demographic dividend depends significantly on the situation of its youth, notably on the levels of education and market-oriented skills they attain. While many states have made progress on the education front, many other states, including Bihar, have lagged behind. Looking at the current educational situation of youth in Bihar, this policy brief argues that significant investments in terms of appropriate policies and programs are required to enable the state to: achieve the Millennium Development Goals of universal primary education and elimination of gender disparity in primary and secondary …

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Adolescent Girls In Urban Ethiopia: Vulnerability And Opportunity, Abebaw Ferede, Annabel Erulkar Jan 2009

Adolescent Girls In Urban Ethiopia: Vulnerability And Opportunity, Abebaw Ferede, Annabel Erulkar

Poverty, Gender, and Youth

In 2008, the Population Council undertook a survey of out-of-school, adolescent girls (aged 10 to 19) in slum areas of urban Ethiopia—a population that is highly vulnerable to HIV infection. The survey serves as a baseline for HIV prevention programs designed and implemented jointly by the Ministry of Youth and Sports, Regional Bureaus of Youth and Sports, and the Population Council. This study provided valuable direction for programmers interested in supporting adolescent girls, particularly early adolescent (10 to 14 years old) and out-of-school girls who are highly vulnerable and in need of dedicated attention. Special efforts are needed to support …

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Hospice Africa Uganda: End-Of-Project Evaluation Of Palliative Care Services, Annette Bongiovanni, Mary Alexis Greenan Jan 2009

Hospice Africa Uganda: End-Of-Project Evaluation Of Palliative Care Services, Annette Bongiovanni, Mary Alexis Greenan

HIV and AIDS

Hospice Africa Uganda (HAU) is a nongovernmental organization that provides palliative care services to people living with HIV/AIDS (PHA) and cancer. Based in Kampala, HAU aims to scale-up palliative care within and beyond the nation’s borders. From 2005–08, HAU sought to achieve the following objectives: 1) Increase coverage and scope of palliative care services available to PHA and their families; 2) Train health workers and other HIV/AIDS care providers to integrate pain management, symptom control, and end-of-life care into their existing HIV/AIDS support programs; 3) Build the capacity of families, communities, and community-based organizations in palliative care provision; 4) Integrate …

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Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend Jan 2009

Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend

Reproductive Health

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from …

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Kwazulu-Natal Department Of Health Policy And Guidelines For Integrated Ante And Postnatal Care At District Hospital Community Health Centre And Clinic Level, Population Council Jan 2009

Kwazulu-Natal Department Of Health Policy And Guidelines For Integrated Ante And Postnatal Care At District Hospital Community Health Centre And Clinic Level, Population Council

Reproductive Health

A 2006 baseline survey conducted by CARE Kenya indicated that sexual and gender-based violence (SGBV) is widespread throughout Kenya’s North Eastern Province. Other findings revealed that high levels of stigma and gender imbalances are associated with sexual violence and female genital mutilation (FGM) and that a coordinated approach to responding to the service needs of survivors is missing. As noted in this report, there is limited awareness of the legal mechanisms available to survivors. The Population Council’s study in Wajir District ascertained the need for and possible components of an integrated and comprehensive services model that could meet the needs …

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Integration Of Services: Making Integrated Services A Reality, Frontiers In Reproductive Health Jan 2009

Integration Of Services: Making Integrated Services A Reality, Frontiers In Reproductive Health

Reproductive Health

Programs seeking to provide a more comprehensive RH service may establish or strengthen referrals between related yet separately provided services that enable a client to receive the range of needed services. There are two main rationales for integrating services. First, many clients have needs for several services; and second, there is an expectation that providing integrated or linked services can be more efficient programmatically. Little empirical evidence exists to support these underlying rationales, or to guide policies and programs in organizing services effectively and efficiently. Lessons from FRONTIERS have demonstrated not only the demand for multiple services, but also the …

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A Religious Oriented Approach To Addressing Female Genital Mutilation/Cutting Among The Somali Community Of Wajir, Kenya, Maryam Sheikh Abdi, Ian Askew Jan 2009

A Religious Oriented Approach To Addressing Female Genital Mutilation/Cutting Among The Somali Community Of Wajir, Kenya, Maryam Sheikh Abdi, Ian Askew

Reproductive Health

The Somali ethnic community, in Kenya as well in Somalia, Djibouti, and Ethiopia, has practiced genital cutting for centuries and the practice appears to have remained largely unchanged. The community practices the severest form of FGM/C, type III or infibulation. The Population Council’s FRONTIERS program, with support from USAID/Kenya, carried out two studies to better understand the practice of FGM/C among the Somalis in North Eastern Province so as to inform the design and implementation of interventions that would encourage abandonment of the practice. Both studies collected data through in-depth interviews and focus group discussions with community and religious leaders, …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Lesotho 2004, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Lesotho 2004, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Lesotho 2004” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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Youth In India: Situation And Needs 2006-2007, Rajasthan, International Institute For Population Sciences (Iips), Population Council Jan 2009

Youth In India: Situation And Needs 2006-2007, Rajasthan, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This report is the result of a sub-national study undertaken by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi, as part of a project to collect information on key transitions experienced by youth in India. This report from the Youth in India: Situation and Needs study describes the transition to adulthood experienced by young men and women in Rajasthan. In brief, the Youth Study has documented, for the first time, the multifaceted situation of youth in Rajasthan, emphasizing their heterogeneity, not only in terms of their situation but also with regard to their stated needs …

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The Making Of The Kenya Sexual Offenses Act, 2006: Behind The Scenes, Washington Onyango-Ouma, Njoki Ndung'u, Nancy Baraza, Harriet Birungi Jan 2009

The Making Of The Kenya Sexual Offenses Act, 2006: Behind The Scenes, Washington Onyango-Ouma, Njoki Ndung'u, Nancy Baraza, Harriet Birungi

Reproductive Health

Kenya’s enactment of the Sexual Offenses Bill in 2006 was a milestone in dealing with sexual offenses and gender-based violence. The bill is Kenya’s first legal recognition of the many sex crimes that occur in the country. Among other things, the law criminalizes deliberate transmission of HIV/AIDS and provides rape victims with free medical care and counseling in public institutions. Convicted rapists will now face a minimum sentence of ten years, while a maximum penalty will be life imprisonment. A retrospective study was conducted to document the process leading to the enactment of the law. The objective was to document …

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Youth In India: Situation And Needs 2006-2007, Bihar, International Institute For Population Sciences (Iips), Population Council Jan 2009

Youth In India: Situation And Needs 2006-2007, Bihar, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This report is the result of a sub-national study undertaken by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi, as part of a project to collect information on key transitions experienced by youth in India. The report focuses on findings from the survey conducted in Bihar. The four leading problems facing youth expressed by both young men and women were unemployment, poverty, lack of amenities, and lack of educational opportunities. The study alerts us to the many challenges confronting youth and their ability to make a successful transition to adulthood, and emphasizes the heterogeneity of …

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Youth In India: Situation And Needs 2006-2007, Tamil Nadu, International Institute For Population Sciences (Iips), Population Council Jan 2009

Youth In India: Situation And Needs 2006-2007, Tamil Nadu, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

This report is the result of a sub-national study undertaken by the International Institute for Population Sciences, Mumbai and the Population Council, New Delhi, as part of a project to collect information on key transitions experienced by youth in India. The report focuses on findings from the survey conducted in Tamil Nadu. The Youth Study findings highlight the need for further study in terms of formative research that explores in greater depth the factors impeding successful transitions to adulthood, in the areas, for example, of secondary school completion, economic activity, sexual relations, and marriage and parenthood. The study alerts us …

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Demographic Data For Development In Sub-Saharan Africa, Wendy Baldwin, Judith A. Diers Jan 2009

Demographic Data For Development In Sub-Saharan Africa, Wendy Baldwin, Judith A. Diers

Poverty, Gender, and Youth

More demographic data are being collected throughout the developing world than ever before, but the effective use of that data to further development goals is often lacking. This working paper summarizes case studies on the demand for data in four sub-Saharan African countries, namely Ethiopia, Ghana, Senegal, and Uganda. The project’s objective was to create a detailed portrait of access and demand at the country level, and to determine whether policymakers are getting the data they need to develop sound policies. Common findings across the four countries include an increased external demand from international initiatives that has not necessarily translated …

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Educational Inequalities In The Midst Of Persistent Poverty: Diversity Across Africa In Educational Outcomes, Cynthia B. Lloyd, Paul C. Hewett Jan 2009

Educational Inequalities In The Midst Of Persistent Poverty: Diversity Across Africa In Educational Outcomes, Cynthia B. Lloyd, Paul C. Hewett

Poverty, Gender, and Youth

This working paper explores inequalities in education across sub-Saharan Africa, focusing mostly on primary school completion rates, with attention also given to literacy as a more proximate indicator of human capital acquisition. Using data from the Demographic and Health Surveys and UNICEF’s Multiple Indicator Cluster Surveys, we explore cross-country variations in primary school completion rates, gender and wealth gaps in education, and literacy rates in relation to one another and in relation to cross-country variations in national income per capita. While these data paint a picture of overall educational progress, particularly for girls, this general picture is juxtaposed against an …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—India 2005/06, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—India 2005/06, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: India 2005/06” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Pakistan 2006/07, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Pakistan 2006/07, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Pakistan 2006/07” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Vietnam 2002, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Vietnam 2002, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Vietnam 2002” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Ukraine 2007, Population Council Jan 2009

The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Ukraine 2007, Population Council

Poverty, Gender, and Youth

“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Ukraine 2007” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …

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Directory Of Programs For Rural Girls In Ethiopia, Elshaday Kifle, Mekuria Yilma, Emil Parker Jan 2009

Directory Of Programs For Rural Girls In Ethiopia, Elshaday Kifle, Mekuria Yilma, Emil Parker

Poverty, Gender, and Youth

Rural girls in Ethiopia face significant challenges on a host of issues including health, education, civic participation, and access to services. Beyond traditional female roles of wife and mother, the livelihood options open to girls and women are narrow. The goal of the Ethiopia “Brain Trust” project is to expand and improve programs for rural girls in Ethiopia. Under the Trust, a team of program practitioners convenes to explore best practices in reaching and supporting rural girls. Currently, 18 organizations are represented in the Trust. In addition, the Trust seeks to improve networking and information sharing among program practitioners working …

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Broadening Girls' Horizons: Effects Of Life Skills Education Programme In Rural Uttar Pradesh, Rajib Acharya, Shveta Kalyanwala, Shireen J. Jejeebhoy, Vinita Nathani Jan 2009

Broadening Girls' Horizons: Effects Of Life Skills Education Programme In Rural Uttar Pradesh, Rajib Acharya, Shveta Kalyanwala, Shireen J. Jejeebhoy, Vinita Nathani

Poverty, Gender, and Youth

This report is the result of a collaborative project undertaken by Prerana, a Delhi-based NGO, and the Population Council to implement a life-skills education program for unmarried adolescent girls in rural Uttar Pradesh and to evaluate its effectiveness. The intervention program aimed to empower unmarried adolescent girls aged 13–17 years and address their vulnerabilities by: building their agency, fostering egalitarian gender role attitudes, building awareness about sexual and reproductive health matters, developing vocational skills and future work aspirations, and influencing perceptions about marriage and the ability to negotiate marriage-related decisions (delaying marriage and first pregnancy).

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Needs Assessment Of Marginalised, Socially Excluded Immigrant Populations In Johannesburg, South Africa, Population Council Jan 2009

Needs Assessment Of Marginalised, Socially Excluded Immigrant Populations In Johannesburg, South Africa, Population Council

Poverty, Gender, and Youth

The birth of democracy in South Africa and the subsequent economic boom have made the country a prospective haven for many Africans willing or forced to leave their countries. Johannesburg has maintained its reputation as a city where everything is possible and accessible. Berea, Hillbrow, and Yeoville have become destinations for both internal and international (cross-border) migrants as a consequence of their proximity to the city center. However, migrant populations face obstacles that limit access to basic services such as health care, housing, transportation, employment, credit, and security. Asylum-seekers, refugees, and the undocumented are particularly vulnerable and at risk of …

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Transition To Marriage And Parenthood Among Youth In Jharkhand, International Institute For Population Sciences (Iips), Population Council Jan 2009

Transition To Marriage And Parenthood Among Youth In Jharkhand, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

Delaying the transition to marriage and parenthood among young people has been a policy and program priority for a number of years in India. For example, several national-level policies formulated since 2000 have advocated special program attention to delay age at marriage and age at first birth. Despite these commitments, substantial proportions of girls continue to marry in adolescence. As recently as in 2005–06, more than two-fifths of women aged 20–24 were married by 18 years nationally. Likewise, over one-fifth of women aged 20–24 had given birth before age 18 and two-fifths before age 20. While the magnitude of early …

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Romance And Sex Before Marriage Among Young Women And Men In Jharkhand, International Institute For Population Sciences (Iips), Population Council Jan 2009

Romance And Sex Before Marriage Among Young Women And Men In Jharkhand, International Institute For Population Sciences (Iips), Population Council

Poverty, Gender, and Youth

Premarital partnerships among youth, including those that do not involve sexual relations, are widely discouraged in India. There is a widespread perception that youth do not find opportunities to mix and form romantic relationships and that premarital sex is negligible. These kinds of perceptions are often cited to argue against the provision of sex or family life education and sexual and reproductive health services to unmarried young people. While several small and unrepresentative studies have noted that sizable proportions of young people, particularly young men, are sexually active before marriage, the lack of rigorous and representative evidence on the levels …

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