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2018

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Articles 1951 - 1980 of 2413

Full-Text Articles in Public Health

Adolescent Girls Initiative–Kenya: Midline Results Report, Karen Austrian, Erica Soler-Hampejsek, Joyce Mumah, Beth Kangwana, Yohannes Dibaba Wado, Benta Abuya, Valsa Shah, John A. Maluccio Jan 2018

Adolescent Girls Initiative–Kenya: Midline Results Report, Karen Austrian, Erica Soler-Hampejsek, Joyce Mumah, Beth Kangwana, Yohannes Dibaba Wado, Benta Abuya, Valsa Shah, John A. Maluccio

Poverty, Gender, and Youth

Many adolescent girls in Kenya face considerable risks and vulnerabilities that affect their education status, health, and general well-being. In addition to low educational attainment and health risks, other factors that impact education and health outcomes include household poverty, lack of economic independence, limited income-earning opportunities, illiteracy, violence, and social isolation. Younger adolescent girls who live in environments laden with these vulnerabilities are at risk of experiencing negative outcomes such as school dropout, early sexual initiation, unintended pregnancy, early marriage, and sexual and gender-based violence. The Adolescent Girls Initiative–Kenya (AGI-K) delivered multisectoral interventions to over 6,000 girls aged 11–15 in …

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Stories Of Strength: Chicago Latin@S' Navigation Of Health, Well-Being, And Chronic Disease, Lilian L. Milanés Jan 2018

Stories Of Strength: Chicago Latin@S' Navigation Of Health, Well-Being, And Chronic Disease, Lilian L. Milanés

Theses and Dissertations--Anthropology

Health inequalities take many forms related to race, gender, socioeconomic status, ethnic, language and many other axes throughout communities around the world. Type two diabetes, high blood pressure, and high cholesterol are examples of conditions (among many others) that disproportionately affect Latino@s in the U.S.. The research of this dissertation is based on fieldwork conducted throughout several predominantly Latin@ neighborhoods in Chicago, IL. This dissertation examines how Latin@s in Chicago navigate health and well-being, and how they engage in agentive strategies in the face of chronic disease. I recorded individual life histories and semi-structured interviews, focus groups, and participant observation …

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Elevated Blood Lead Levels, Cancer Incidence, And All-Cause Mortality In Adults, Sherri L. Davidson Jan 2018

Elevated Blood Lead Levels, Cancer Incidence, And All-Cause Mortality In Adults, Sherri L. Davidson

All ETDs from UAB

Epidemiologic studies have indicated an association between lead exposure and cancer. Although lead exposure has declined in recent decades, from removal of lead in gasoline and paint, lead exposure remains a health concern from environmental and occupational sources including aging water systems. In a retrospective cohort study, Adult Blood Lead Epidemiology and Surveillance (ABLES) records in Alabama were linked to cancer incidence data in the Alabama Statewide Cancer Registry and mortality data from the Alabama Center for Health Statistics, using a probabilistic linkage program. Blood lead level (BLL) measurements were used to categorize exposure levels. Odds ratios approximated relative risks. …

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Social Factors, Public Policies, And Infant Mortality, Lauren Wallace Jan 2018

Social Factors, Public Policies, And Infant Mortality, Lauren Wallace

All ETDs from UAB

Despite consistent and substantial investments, the United States’ infant mortality rate (IMR) has not decreased significantly in the 21st century and disparities between racial and ethnic groups have increased. This study investigates the impact of social and health factors, and public policies on IMR at the state level. The research aims were to: 1) evaluate which state-level social factors and public policies were associated with state IMRs using principal component (PC) analysis; and 2) evaluate whether states cluster on their PC scores and IMRs using cluster analysis. The data used were six composite index scores based on social factor and …

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Immunophenotype In The Molecular Epidemiology Of Breast Cancer, Michael Behring Jan 2018

Immunophenotype In The Molecular Epidemiology Of Breast Cancer, Michael Behring

All ETDs from UAB

This research analyzes the underlying genomic features of breast tumors during immune response, with the overall goal of discovering markers of how tumor immunity and the known features of disease pathology relate. We aimed to 1) identify and validate somatic copy number variation and RNA expression associated with nodal metastasis; 2) construct an array-based measure of tumor infiltrating immune cells and determine its prominent clinical and transcriptional features; and 3) examine the relationship between somatic mutations within p53 and tumor immune cell infiltration status. In two sets of data, gene-level copy number variation (CNV) and RNA expression from the primary …

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Simulation Of Correlated Variables, Mixture Distributions, And Repeated Measures And Comparison Of Pharmacogenetic Prediction With Machine Learning Methods, Allison Cynthia Fialkowski Jan 2018

Simulation Of Correlated Variables, Mixture Distributions, And Repeated Measures And Comparison Of Pharmacogenetic Prediction With Machine Learning Methods, Allison Cynthia Fialkowski

All ETDs from UAB

Pharmacogenetics aims to improve individualized medicine by combining genetic information with clinical data when assigning drug treatments. Different diseases are often associated with different factors, each with its own distributional characteristics. For rare or complex diseases, these characteristics may not be well understood and standard analysis methods may not be appropriate. In psychiatric disorders, for example, multiple drug treatments need to be compared across small sample sizes with heterogeneous patient populations, making implementation of standard methods difficult. Simulating data that mirrors clinical data is important because it allows investigators to determine which method is best suited for data from their …

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Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight, Tatiana Martínez-Jaikel Jan 2018

Intervention For Women In Costa Rica Who Are Discouraged And Have Food Insecurity And Excess Body Weight, Tatiana Martínez-Jaikel

Theses and Dissertations

ntroduction: The coexistence of food insecurity and excess body weight has been wellrecognized by researchers, and it has been documented in women, but not men. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these programs might contribute to excess body weight, particularly in adult women. Our previous in-depth qualitative research in Costa Rica showed that discouragement was the primary link in the coexistence of food insecurity and excess body weight among Costa Rican women, and that the family and existing gender …

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Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren Jan 2018

Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and …

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How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba Jan 2018

How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba

Reproductive Health

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this …

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Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance Jan 2018

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

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Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte Jan 2018

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

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Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte Jan 2018

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

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Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows Jan 2018

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

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Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli Jan 2018

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.

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Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance Jan 2018

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

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Assessing The Feasibility And Acceptability Of Community Health Extension Workers To Treat Hypertension Associated With Pregnancy: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku Jan 2018

Assessing The Feasibility And Acceptability Of Community Health Extension Workers To Treat Hypertension Associated With Pregnancy: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

This brief reports on a study that tested the feasibility of tasking community health extension workers (CHEWs) with detecting and managing hypertension, and prescribing an oral antihypertensive drug at primary health care (PHC) facilities in Nigeria as part of a package of care for women with pre-eclampsia and eclampsia (PE/E). This evaluation measured improvements in knowledge retention and increases in early detection, prevention, and management of PE/E. Findings indicate that trained CHEWs working at intervention PHCs can correctly identify, differentiate, and manage normal, mild, moderate, and severe hypertension. These findings are important contributions to implementing Nigeria’s national task-shifting policy at …

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Baseline Evaluation Of Project Mesha In Bihar: Factsheet Results 2017-2018, Population Council Jan 2018

Baseline Evaluation Of Project Mesha In Bihar: Factsheet Results 2017-2018, Population Council

Reproductive Health

This fact sheet presents baseline results for an evaluation survey among women who were the primary decisionmakers in the rearing of goats in Bihar, India. The study underpins the Aga Khan Foundation’s implementation of “Project Mesha,” a community-based program to develop the potential of goat farming among women goat rearers in four blocks of Muzaffarpur district. The aim of the project is to increase the income and empowerment of women goat rearers through the implementation of Project Mesha in JEEViKA-run self-help groups. The fact sheet includes data on demographic and household profiles; goat ownership, rearing, income, and productive resources; access …

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Cesarean Section Deliveries In Egypt: Trends, Practices, Perceptions, And Cost, Nahla G. Abdel-Tawab, Doaa Oraby, Nevine Hassanein, Shatha El-Nakib Jan 2018

Cesarean Section Deliveries In Egypt: Trends, Practices, Perceptions, And Cost, Nahla G. Abdel-Tawab, Doaa Oraby, Nevine Hassanein, Shatha El-Nakib

Reproductive Health

In Egypt, the past decade has witnessed a sharp increase in the prevalence of cesarean section (CS) with the most recent Egypt Demographic and Health Survey documenting a CS rate of 52 percent, suggesting that cesarean delivery might be overused or used for inappropriate indications. This study aimed to explore trends, practices, and costs associated with CS deliveries to women, their families, and the health system, as well as factors that may contribute to increased use of CS in Egypt. Participating physicians and key informants unanimously agreed that the CS mode of delivery was over-used in Egypt. Perceived reasons underlying …

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Changes In Fgm/C In Somaliland: Medical Narrative Driving Shift In Types Of Cutting, Richard A. Powell, Mohamed Yussuf Jan 2018

Changes In Fgm/C In Somaliland: Medical Narrative Driving Shift In Types Of Cutting, Richard A. Powell, Mohamed Yussuf

Reproductive Health

In Somalia, female genital mutilation/cutting (FGM/C) prevalence is nearly universal at 98 percent. This qualitative study sought to explore: 1) views and experiences of married and unmarried men and women on FGM/C and potential changes in its practice; 2) individual, family, and societal factors contributing to any changes, or continuation of FGM/C; 3) the knowledge, views, and experiences of healthcare workers who offer FGM/C services and their role as change agents rather than providers; and 4) how healthcare systems’ capacities can be strengthened for management and prevention. The study finds that normative changes appear to be occurring in Somaliland society …

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Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson Jan 2018

Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson

Reproductive Health

Both the family planning sector and the environmental sector will be interested in this synopsis of findings from a study of the first four years of the Tuungane integrated population, health, and environment (PHE) project in Tanzania. The objectives of the Tuungane Project are to achieve healthier families, healthier forests, and healthier fisheries, using an integrated, cross-sectoral approach. Analyses of the 2011 baseline and 2016 midline quantitative data, and additional qualitative data from 2016, measured the project’s progress and shed light on the contribution of the project interventions to building resilience, and on the links between family planning and other …

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Collaborative Work With Somaliland Stakeholders To Increase Evidence Based Decision Making In Fgm/C, Chantalle Okondo Jan 2018

Collaborative Work With Somaliland Stakeholders To Increase Evidence Based Decision Making In Fgm/C, Chantalle Okondo

Reproductive Health

The Population Council collaborated with partners Orchid Project and Somaliland Family Health Association to pilot a new approach to disseminating research findings in order to increase the impact of evidence-based decisionmaking in program, policy, and investments in female genital mutilation/cutting (FGM/C). This brief reports on a recent workshop that utilized an open space approach to encourage review of recent key evidence on FGM/C in Somaliland; explore UNICEF’s six elements of abandonment and their relevance to the Somaliland context; link research with decisionmaking; and develop action plans. Participants identified six key themes for further reflection: behavioral/social change, medicalization, policy, child rights, …

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Dynamics Of Injectable Contraceptive Use In India, The Evidence Project Jan 2018

Dynamics Of Injectable Contraceptive Use In India, The Evidence Project

Reproductive Health

This brief describes a research study by the Population Council, with support from USAID/India, whose purpose is to provide evidence that can be used to strengthen the family planning program and meet the needs of reversible contraceptive users who want to prevent pregnancy in India. Understanding the experiences of the small but growing population of women choosing the injectable is important as the Government of India continues to roll out injectable contraceptive methods in the public sector. The report’s key recommendations include: disseminating messaging about potential side effects of the injectable, institutionalizing quality of care in pre-service trainings for all …

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Dynamics Of Interval Iud Use In India, The Evidence Project Jan 2018

Dynamics Of Interval Iud Use In India, The Evidence Project

Reproductive Health

The IUD is an important long-acting, reversible contraceptive method, and an alternative to permanent female sterilization that does not carry the risk of regret. In India, as the government aims to expand the basket of reversible method choice available to women, understanding the experiences of those who use the interval IUD is paramount. This brief describes a study by the Population Council, with support from USAID/India, which found that overall there is room to improve the quality of services clients receive. The report recommends disseminating messaging about potential side effects of the IUD, training frontline health workers on four domains …

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Dynamics Of Oral Contraceptive Pill Use In India, The Evidence Project Jan 2018

Dynamics Of Oral Contraceptive Pill Use In India, The Evidence Project

Reproductive Health

The purpose of this brief is to provide evidence that can be used to strengthen the family planning program in India, particularly for community-based and facility-based distribution of oral contraceptive pills (OCPs), use of which remains low despite their availability. Understanding women’s interactions with frontline health workers while obtaining the method and during follow-up counseling can help the Government of India improve its National Family Planning Program. Based on its findings, the report recommends that all providers, especially frontline health workers, receive training focusing on four domains of quality of care: 1) respectful care, 2) counseling to enable appropriate method …

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Dynamics Of Postpartum Iud Use In India, The Evidence Project Jan 2018

Dynamics Of Postpartum Iud Use In India, The Evidence Project

Reproductive Health

Evidence suggests that in India, compared to married women in general, postpartum married women have a much higher need for family planning that remains unmet. India’s postpartum IUD (PPIUD) program aims to help postpartum women space pregnancies and prevent mistimed or unwanted births. The majority of PPIUD users in this study were young, educated, and had one child. Most were involved in making the final decision about which family planning method to use after discussions with the provider, and most had spoken with a frontline health worker at least once about family planning methods in the three months preceding birth …

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Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren Jan 2018

Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren

Reproductive Health

Pre-eclampsia and eclampsia (PE/E)—life-threatening high blood pressure and excess protein in the urine after 20 weeks gestation—is a leading cause of pregnancy-related deaths. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. The Population Council implemented a two-phase intervention involving training, mentoring, and supervising providers at secondary facilities on detection and management of PE/E patients (Phase 1), and training primary health care (PHC) providers to administer a modified loading dose of magnesium sulphate and refer women to secondary health facilities for monitoring (Phase 2). This brief describes the Population Council’s …

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Engaging Community Women's Groups For Improved Uptake Of Antenatal Care Services In Cross River State, Nigeria: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku Jan 2018

Engaging Community Women's Groups For Improved Uptake Of Antenatal Care Services In Cross River State, Nigeria: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

The Ending Eclampsia project seeks to understand the potential of underutilized and promising interventions that increase access to services, particularly improving community referral systems. This brief reports on a study in Nigeria’s Cross River state that aimed to test the feasibility of women’s group leaders delivering health information for pre-eclampsia and eclampsia (PE/E), referral, and other antenatal care (ANC) services to their peers, to increasing access to quality maternal and newborn health services. Women’s group findings suggest that community engagement is a critical model for information sharing and is an adaptable, acceptable model for increasing PE/E prevention and danger-sign recognition …

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Expanding The Evidence Base And Networks For Sexual Violence Response In East And Southern Africa—Completion Report For The Period May 2014–February 2018, Population Council Jan 2018

Expanding The Evidence Base And Networks For Sexual Violence Response In East And Southern Africa—Completion Report For The Period May 2014–February 2018, Population Council

Reproductive Health

This is the final report of the Expanding the Evidence Base and Networks for Sexual Violence Response program, which, over the years, has enabled regional partners to collectively test and document experiences in tackling violence against children and sexual and gender-based violence (SGBV) in humanitarian contexts. To foster SGBV prevention and ensure that responses to SGBV are effective, the program has targeted a range of stakeholders, including influential regional bodies; the health, education, and justice sectors; and children and refugees—as survivors as well as members of communities where prevention is being promoted. The program has helped to change the way …

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Exploring The Nigerian Health System's Response To Female Genital Mutilation/Cutting, Otibho Obianwu Jan 2018

Exploring The Nigerian Health System's Response To Female Genital Mutilation/Cutting, Otibho Obianwu

Reproductive Health

Although Nigeria has shown a steady long-term decline in female genital mutilation/cutting (FGM/C) prevalence, the practice remains widespread. This study brief outlines the Population Council’s Evidence to End FGM/C research program, which, in collaboration with the Federal Ministry of Health, will conduct a diagnostic assessment in order to: 1) examine how the healthcare sector supports the prevention of FGM/C; 2) determine the role of the healthcare sector in the management of FGM/C-related complications and the quality of care offered to clients; and 3) identify possible solutions for strengthening the healthcare system’s capacity to manage and prevent FGM/C. Findings are intended …

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Fgm/C Decision-Making Process And The Role Of Gender Power Relations In Sudan, Ahmed Gamal Eldin, Suad Babiker, Majdi Sabahelzain, Muna Eltayeb Jan 2018

Fgm/C Decision-Making Process And The Role Of Gender Power Relations In Sudan, Ahmed Gamal Eldin, Suad Babiker, Majdi Sabahelzain, Muna Eltayeb

Reproductive Health

This study by the Population Council, Nairobi and partners aimed to contribute to a better understanding of female genital mutilation/cutting (FGM/C) in Sudan and the way different families perceive the practice and make FGM/C-related decisions. The ultimate goal was to inform interventions aimed at accelerating the pace of positive behavioral and social norm change and eventually promote the abandonment of all forms of FGM/C in Sudan. The findings indicate that although parents often make the final decision to cut or not cut their daughters, they do not act in isolation but are influenced by dominant social norms and by other …

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