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Articles 1 - 30 of 52
Full-Text Articles in Public Health
Unintended Pregnancy By The Numbers: A Look At Kenya, Carol Mukiira, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara
Unintended Pregnancy By The Numbers: A Look At Kenya, Carol Mukiira, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara
Reproductive Health
This fact sheet summarizes data collated during the development of the STEP UP Country Profile Report on Unintended Pregnancies for Kenya, which presents a range of key evidence aimed at informing readers about the trends, magnitude, determinants, and consequences of unintended pregnancy in Kenya. The data shown in this fact sheet are drawn mainly from the 1993, 1998, 2003 and 2008/09 Kenya Demographic and Health Surveys (KDHS) as well as other secondary sources.
Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew
Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew
Reproductive Health
This research report presents a country profile of Kenya, and looks at differential access to and quality of family planning (FP) and abortion/post-abortion services to assess their current situation, as well the various financing and delivery mechanisms for these crucial services. Since 2000, Kenya has passed several new sexual and reproductive health (SRH) and population-related policies, including a new population and development policy that addresses rapid population growth. Results of this country profile highlight the need for further research on: 1) innovative ways through which SRH information can be brought to schools; 2) FP/SRH indicators in people living with disabilities; …
Postpartum Family Planning In Burkina Faso, Marina Daniele
Postpartum Family Planning In Burkina Faso, Marina Daniele
Reproductive Health
This is a formative study aiming to identify the main barriers to the provision and uptake of quality postpartum family planning (PPFP) services at the supply, access, demand, and policy levels in Burkina Faso. This study reveals that there are substantial shortfalls in the availability of quality PPFP at all these levels. Most of the difficulties observed in the provision of PPFP services are due to the failure to translate largely sound policies and guidelines into practice. This study contributes to identifying priority areas and makes recommendations for improvement in order to respond to unmet need for family planning in …
Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc
Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc
Reproductive Health
Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report …
Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal
Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal
Reproductive Health
Social and behavior change communication (SBCC) interventions are now incorporated within state project implementation plans and increasing resources are being allocated for SBCC activities. A close monitoring of SBCC activities and an evaluation in terms of reach and effectiveness among intended audiences is thus necessary. This calls for a serious effort to build the capacity of monitoring and evaluation (M&E) personnel to monitor and evaluate performance of SBCC activities. FHI 360’s Improving Healthy Behaviors Program, funded by USAID, aims to provide technical assistance to strengthen the capacities of public program managers at the national, state, and district level to monitor …
Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council
Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council
Reproductive Health
This brief focuses on the policy options available to the Balochistan government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Balochistan—about 35 percent of the deaths in this age group are pregnancy-related. Approximately 3,000 women die each year in Balochistan due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The maternal …
Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council
Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council
Reproductive Health
This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family …
Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq
Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq
Reproductive Health
This report presents an argument for prioritizing family planning to achieve the maternal, child, and development goals of four major provinces in Pakistan, using the latest available provincial data, especially the Pakistan Demographic and Health Survey 2012-13. The analysis is based on provincial projections generated by the Population Council. Opportunities for enhancing family planning are identified, and the number of maternal, infant, and child lives that could be saved in each province through an accelerated family planning program is estimated. The analysis establishes that none of the provinces are on track to meet Millennium Development Goals 4 or 5. The …
Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab
Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab
Reproductive Health
The gender profile of the HIV/AIDS epidemic has changed since it emerged 30 years ago when infections were concentrated in key populations of men such as injecting drug users and men who have sex with men. In 2012, women accounted for nearly 50 percent of the estimated 35.3 million people living with HIV/AIDS globally. In the Middle East and North Africa, 44 percent of infected adults are women. The past 30 years have also witnessed remarkable improvements in access to high-quality information and medical services, including services for prevention of mother-to-child transmission of the virus. With care and treatment for …
Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council
Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council
Reproductive Health
This brief focuses on the policy options available to the Khyber Pakhtunkhwa (KP) government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in KP—about 27 percent of the deaths in this age group are pregnancy-related. Approximately 1,700 women die each year in KP due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. …
Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Babacar Mane, Eva Burke, Nafissatou Diop, Kate Reiss, Thoai Ngo, Katharine Footman, Maaike Van Min
Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Babacar Mane, Eva Burke, Nafissatou Diop, Kate Reiss, Thoai Ngo, Katharine Footman, Maaike Van Min
Reproductive Health
In developing countries, postpartum hemorrhage and complications related to unsafe abortions are direct causes of maternal death. In Senegal, actions have been undertaken by the government to reduce this burden and significant advances have been made in these areas in recent years. However, progress is still necessary to achieve the Millennium Development Goals for the reduction of the maternal mortality rate to the target numbers by 2015. The objective of the study was to understand the knowledge about, availability of, and practices in the provision of misoprostol at pharmacies in Dakar, Senegal, to ensure correct delivery of the product. Pharmacists …
Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian
Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian
Reproductive Health
A review of literature and analysis of large surveys were carried out with funding from the STEP UP consortium led by Population Council to build a coherent body of robust research-based evidence on the situation in India in the context of unmet need for family planning (FP) and safe abortion services. The study found that there is insufficient training of different cadres of health staff in the public health system on abortion provision, post-abortion care, FP counseling of young couples, emergency contraception, and IUD insertion/removal. Despite service delivery guidelines in India expecting providers to provide FP counseling during antenatal visits, …
Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Community-Based Workshops, Population Council
Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Community-Based Workshops, Population Council
Reproductive Health
The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Community-Based Workshops” is to orient community-health workers on the RMC concept. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal health in relation to RMC. Discuss rights-based approaches related to RMC. Discuss selected strategies that reduce disrespect and abuse (D&A). Discuss the role of the community in promoting RMC. Demonstrate knowledge and use of the Alternative Dispute Resolution mechanism. Develop action plans to support the implementation of RMC interventions at the community level. Summary: D&A deters facility-based childbirth and Skilled …
Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Mexico, Karla Berdichevsky, Claudia Diaz, Katharine Mccarthy, Ann K. Blanc
Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Mexico, Karla Berdichevsky, Claudia Diaz, Katharine Mccarthy, Ann K. Blanc
Reproductive Health
Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. …
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
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 …
Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Facility-Based Workshops, Population Council
Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Facility-Based Workshops, Population Council
Reproductive Health
The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Facility-Based Workshops” is to orient service providers on the RMC concept along with a set of evidence-based interventions to promote RMC. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to RMC and the RMC Resource Package. Demonstrate knowledge and use of Values Clarification and Attitude Transformation (VCAT) theory and practice. Discuss selected evidence-based strategies that reduce disrespect and abuse. Discuss participants’ …
Summarizing Bodies Of Evidence On The Implementation And Effectiveness Of Fp/Rh Interventions, Ian Askew
Summarizing Bodies Of Evidence On The Implementation And Effectiveness Of Fp/Rh Interventions, Ian Askew
Reproductive Health
No abstract provided.
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
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 …
Social Accountability: What Are The Lessons For Improving Family Planning And Reproductive Health Programs?, Victoria Boydell, Jill Keesbury
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 …
Research Gaps In Scale Up Of Family Planning And Reproductive Health Programming, The Evidence Project, E2a, Hpp, Measure Evaluation
Research Gaps In Scale Up Of Family Planning And Reproductive Health Programming, The Evidence Project, E2a, Hpp, Measure Evaluation
Reproductive Health
The Evidence Project, in collaboration with the Evidence to Action Project, the Health Policy Project, and MEASURE Evaluation convened a meeting to discuss research gaps related to scale-up. The meeting was held at the request of USAID’s Office of Population and Reproductive Health (OPRH) to help guide their research strategy. The meeting had four objectives: discuss scale-up experiences and the role of research and monitoring for strengthening program performance at scale; identify research gaps related to scale-up; prioritize the scale-up research gaps for OPRH; identify next steps for addressing these priority research gaps. This meeting generated a rich discussion about …
Education Sector Response To Early And Unintended Pregnancy (Eup): A Review Of Country Experiences In East And Southern Africa, Harriet Birungi, Chi-Chi Undie, Francis Onyango
Education Sector Response To Early And Unintended Pregnancy (Eup): A Review Of Country Experiences In East And Southern Africa, Harriet Birungi, Chi-Chi Undie, Francis Onyango
Reproductive Health
No abstract provided.
Increasing Choice Of And Access To Family Planning Services Via Outreach In Rajasthan, India, Kumudha Aruldas, M.E. Khan, Jaleel Ahmad, Anvita Dixit
Increasing Choice Of And Access To Family Planning Services Via Outreach In Rajasthan, India, Kumudha Aruldas, M.E. Khan, Jaleel Ahmad, Anvita Dixit
Reproductive Health
This report documents a service evaluation of Marie Stopes (MS) India’s mobile outreach program in the state of Rajasthan, which was conducted by the Population Council between March and October 2012. This study was made possible through the United States Agency for International Development (USAID)-funded Support for International Family Planning Organizations–Marie Stopes International project. It provides important findings on the safety and effectiveness of MS India’s outreach program in expanding choice and access to long-acting reversible contraception methods and voluntary surgical permanent methods of contraception, as well as recommendations for MS India and other family planning programs to consider in …
Reaching The Unreached Through Community Mobilization In An Innovative And Sustainable Way, Arupendra Mozumdar, M.E. Khan, Subrato Mondal
Reaching The Unreached Through Community Mobilization In An Innovative And Sustainable Way, Arupendra Mozumdar, M.E. Khan, Subrato Mondal
Reproductive Health
This study shows the potential of Self Help Groups (SHGs) to deliver health messages that increase women’s knowledge. The intervention for this operations research (OR) study included a day-long training for Swasth Sakhis in the experimental area. A total of 11 trainings were organized, all conducted by Population Council staff. Before the intervention, at baseline, 803 women from eligible households were interviewed for the quantitative assessment. At endline, 470 women were followed up. Additionally, 16 in-depth interviews with women, Swasth Sakhis, and Rajiv Gandhi Mahila Vikas Pariyojana staff were conducted in the experimental area to understand how the intervention was …
Operationalizing A Proposed National Protocol For The Prevention And Management Of Severe Pre-Eclampsia And Eclampsia Using A Loading Dose Of Magnesium Sulphate At Community Health Facilities In Bangladesh, Population Council
Reproductive Health
About 20 percent of maternal deaths in Bangladesh are caused by pre-eclampsia and eclampsia. Most of these deaths, which occur during care within local communities due to lack of maternal health information, poor antenatal care attendance, and delays in seeking care, can be easily prevented with low-cost maternal health commodities. A quasi-experimental pre- and post-test study, with no control group, was implemented to assess the abilities of community facility service providers to screen and detect eclampsia patients, administer a loading dose of magnesium sulphate to diagnosed patients, and refer them to an appropriate facility for condition management. These interventions were …
Reduce Contraception Discontinuation In Bangladesh By Improving Counseling On Side Effects, Fauzia Akhter Huda, Sabiha Chowdhuri
Reduce Contraception Discontinuation In Bangladesh By Improving Counseling On Side Effects, Fauzia Akhter Huda, Sabiha Chowdhuri
Reproductive Health
High rates of contraceptive discontinuation and method failure could cause Bangladesh to lose the progress made in increasing contraceptive use over the past 20 years. This policy brief concludes that if women are adequately counseled and supported to sustain their use of more effective contraceptive methods, they will need less medical attention, have fewer unintended pregnancies, and reduce the workload for medical clinics. Furthermore, if providers are adequately trained and supported in counseling and managing side effects and in helping women to switch methods when they do have a problem, the Family Planning Clinical Contraception Services Delivery Program would meet …
Kenya Country Profile: A Status Check On Unintended Pregnancy In Kenya, Joyce Mumah, Jessica Brinton, Caroline W. Kabiru, Carol Mukiira, Chimaraoke O. Izugbara
Kenya Country Profile: A Status Check On Unintended Pregnancy In Kenya, Joyce Mumah, Jessica Brinton, Caroline W. Kabiru, Carol Mukiira, Chimaraoke O. Izugbara
Reproductive Health
Kenya’s mothers are dying at an alarming rate: a woman giving birth in Kenya has a 1 in 38 chance of dying due to inadequate reproductive health services. In response, in 2014 Kenya’s First Lady Margaret Kenyatta launched the Beyond Zero campaign to create awareness and raise funds to tackle maternal mortality and morbidity and improve child health. This brief offers six policy and programmatic recommendations to address significant sexual and reproductive health challenges highlighted throughout the report. These recommendations take into account the policy context in Kenya, which is evolving at a rapid rate in part because of the …
Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed
Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed
Reproductive Health
The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …
Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff
Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff
Reproductive Health
Dans le cadre du programme de recherche « Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) », le Population Council a élaboré un Rapport du Profil Pays pour comprendre les grossesses non désirées au Sénégal. Ils ont mené une revue de la littérature, analysé des données d'enquêtes disponibles, et a mené des entretiens pour discuter plus en détail de certains aspects avec quelques parties prenantes clés. Le Profil Pays a été discuté lors d’un atelier de deux jours à Dakar regroupant les principaux acteurs du gouvernement aux niveaux central et régional, des organisations non-gouvernementales, et des acteurs de la …
Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara
Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara
Reproductive Health
Although Kenya has made significant progress in ensuring its citizens’ right to reproductive health, many Kenyans still lack access to or fail to use contraceptives, in part because of the lack of quality family planning (FP) services. Through the STEP UP research program, the African Population and Health Research Center developed a comprehensive country profile report that outlines the status, causes, and consequences of unintended pregnancy in Kenya. One of the most prominent findings was how important public health facilities are to reducing unmet need for FP. In order to solidify gains achieved and make further progress, concerted commitment from …
International Seminar On Promoting Postpartum And Post-Abortion Family Planning: Challenges And Opportunities, Iussp Scientific Panel On Reproductive Health
International Seminar On Promoting Postpartum And Post-Abortion Family Planning: Challenges And Opportunities, Iussp Scientific Panel On Reproductive Health
Reproductive Health
The IUSSP Scientific Panel on Reproductive Health, in collaboration with the Population Council, India, and the Department of Reproductive Health and Research, World Health Organization held a seminar on “Promoting postpartum and post-abortion family planning: Challenges and opportunities” in Cochin, India, November 2014. The seminar brought together 24 scientists, policymakers, and program managers to present and discuss a range of issues relating to postpartum and post-abortion family planning. This report summarizes the papers presented at the seminar which sought to answer several key questions pertaining to postpartum and post-abortion contraception. Several conclusions drawn from the evidence are presented and research …