International Public Health Commons^™

A Diagnostic Assessment Of The Health System's Response To Female Genital Mutilation/Cutting Management And Prevention In Kenya: A Case Study Of West Pokot County, Samuel Kimani

Reproductive Health

Female genital mutilation/cutting (FGM/C), a pervasive cultural practice in some contexts, is associated with negative impacts on women’s and girls’ health and rights. The health sector is well positioned to respond to the prevention of FGM/C and the management of its complications because of its primary role in disease prevention, health promotion, and curative services. In Kenya, the health sector’s role is anchored in national and county legal and policy instruments and guidelines that are adopted or customized from global or regional frameworks as well as skills support tools approved by the World Health Organization. This brief highlights findings from …

Improving The Documentation Of Female Genital Mutilation Or Cutting (Fgm/C) Abandonment Interventions And Their Evaluations, Caroline W. Kabiru

Reproductive Health

Female genital mutilation/cutting (FGM/C) is internationally recognized as a violation of human rights. Consequently, there have been extensive efforts to promote the abandonment of the practice. There is limited evidence on the impact of many of the efforts, in part because many interventions are implemented by small organizations with inadequate resources to document and evaluate their activities. The complex nature of FGM/C interventions, as with other interventions aimed at addressing violence against women and girls, also makes it difficult to adequately document what is done, how, when, and with what results. Nonetheless, it is important that implementing organizations make every …

Introduction Of Dmpa-Sc Self-Injection In Ghana: A Feasibility And Acceptability Study Using Sayana® Press, Dela Nai, Patrick Aboagye, Kamil Fuseini, Elizabeth Tobey, Aparna Jain, Nora Maresh, Rebecca Fertziger

Reproductive Health

This research report describes results from an implementation science study that explored the feasibility and acceptability of administering depot medroxyprogesterone acetate-subcutaneous (DMPA-SC) among health-care providers and family planning (FP) clients in Ghana. DMPA-SC is an injectable contraceptive method that can be self-administered. The study, conducted by the Population Council through the USAID-funded Evidence Project in collaboration with the Ghana Health Service, was implemented in rural, peri-urban, and urban areas of the Ashanti and Volta regions. A total of 150 health-care providers were trained to administer DMPA-SC and to train clients on self-injection. Clients assessed as being competent self-injected under the …

Reflections From Five Years Of Research On Fgm/C, Lori S. Ashford, Reshma Naik, Charlotte Greenbaum

Reproductive Health

From 2015 to 2019, the Evidence to End FGM/C research consortium took a fresh approach to examining the longstanding practice of female genital mutilation/cutting (FGM/C). The African-led program developed innovative research methods and uncovered new evidence about the practice and how it is changing—focusing on families and communities, and health and legal systems. This report documents the consortium’s research methods, the key lessons learned, capacity strengthening efforts, enhanced advocacy for research uptake, and recommendations. The research sheds light on key areas for future investments that would ensure that FGM/C policies and programs are informed by rigorous evidence. The recommendations stem …

Understanding Local Variation In How Female Genital Mutilation/Cutting Declines, Changes, Or Persists: Analysis Of Household Survey Data For Kenya, Nigeria, And Senegal, Population Reference Bureau

Reproductive Health

Efforts to eliminate female genital mutilation/cutting (FGM/C) intensified in many parts of Africa following a 2012 United Nations General Assembly Resolution, but change has been uneven. Important evidence gaps remain in our understanding of why the practice declines, changes, or persists in specific locations. Policymakers and program planners need such information to better tailor interventions to address local patterns and focus resources on abandonment efforts in areas with the greatest needs. To fill these gaps, researchers with the Evidence to End FGM/C consortium analyzed nationally representative household survey data for Kenya, Nigeria, and Senegal. The results of their research identify …

Female Genital Mutilation/Cutting In Nigeria: Is The Practice Declining? A Descriptive Analysis Of Successive Demographic And Health Surveys And Multiple Indicator Cluster Surveys (2003–2017), Ngianga-Bakwin Kandala, Glory Atilola, Chibuzor Christopher Nnanatu, Emmanuel Ogundimu, Lubanzadio Mavatikua, Paul Komba, Zhuzhi Moore, Dennis Matanda

Reproductive Health

This report gives insight into the scale and scope of the practice of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years in Nigeria. It also presents evidence on where FGM/C occurs and highlights the dynamics of change as well as the context surrounding the practice. The report explores in detail the practice of FGM/C from all available sources of nationally representative survey data from 2003 to 2017 and the most relevant contextual information on key factors associated over time with FGM/C. The ultimate objective of the report is to generate evidence to inform …

Associations Between Female Genital Mutilation/Cutting And Early/Child Marriage: A Multi-Country Dhs/Mics Analysis, Jamlick Karumbi, David Gathara

Reproductive Health

Over the last several decades, global efforts to end female genital mutilation/cutting (FGM/C) have intensified through the combined efforts of international and nongovernmental organizations (NGOs), governments, and religious and civil society groups. Evidence of the wider impacts of FGM/C and interventions for its abandonment is small but emerging. The practice of FGM/C has frequently been linked to a girl’s marriageability and is thought to be associated with child marriage, either directly, as a cause of early/child marriage, or vice versa, or indirectly, resulting from common causes. Evidence of the relationships between these two practices to inform programming and policy for …

Modelling And Mapping Of Regional Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Senegal: Evidence From Senegal (Sdhs) Surveys 2005–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda

Reproductive Health

Between 2005 and 2017, Senegal experienced a slight national decline in the prevalence of female genital mutilation/cutting (FGM/C) among women aged 15–49 years and girls younger than 15 years. However, significant differences in prevalence exist as a result of multifarious risk factors. Our previous research in Senegal described the national trends in FGM/C, showing where, when, and why FGM/C is practiced in Senegal. However, no recent study exists to analyze the geographical patterns of FGM/C and the effect of individual-and community-level risk factors on the likelihood of cutting among girls younger than 15 years. This working paper presents results from …

Modelling And Mapping Of State Disparities Associated With Female Genital Mutilation/Cutting Prevalence Among Girls Aged 0–14 Years In Nigeria: Evidence From Dhs And Mics 2003–2017, Ngianga-Bakwin Kandala, Paul Komba, Chibuzor Christopher Nnanatu, Glory Atilola, Lubanzadio Mavatikua, Zhuzhi Moore, Dennis Matanda

Reproductive Health

The practice of female genital mutilation/cutting (FGM/C) has been positioned as a gender and global development issue that national and international organizations must address for girls and women to thrive in good health and enjoy their fundamental rights. Consequently, many efforts have been made to promote the abandonment of the practice. Despite evidence of a decline in FGM/C, there are significant variations in its prevalence in many sub-Saharan African countries, where the practice persists due to the combined effects of factors among individuals as well as communities. This working paper presents findings from a study that analyzed existing data using …

Population Council Annual Evaluation Report: Opening Futures (Abriendo Futuros) For Indigenous Girls In Yucatan, Mexico, Silvana Larrea

Poverty, Gender, and Youth

This Population Council Annual Evaluation Report includes evaluation activities from December 1, 2015 to December 1, 2019, and future evaluation plans (2019–21), as part of the Opening Futures (Abriendo Futuros) project for indigenous girls in Yucatan, Mexico. The first section describes the finalized analysis of the impact evaluation of the pilot phase; the second section reports the progress of evaluation activities; and the third section includes an evaluation of future plans for the period December 1, 2019 to November 30, 2021.

Les Pharmacies Privées Dans L’Offre De Services De Planification Familiale Au Sénégal : Une Étude Pilote, Fatou Mbow, Dela Nai, Sara Chace Dwyer, Aparna Jain, Babacar Mane

Reproductive Health

Sur la base de l'étude exploratoire menée par le Projet Evidence au Sénégal entre 2015 et 2016, avec un soutien financier supplémentaire de la Fondation William et Flora Hewlett, ce rapport technique documente les résultats d'une étude pilote sur l’offre des services de planification familiale (FP) par les pharmacies privées dans la région de Dakar. Le rapport détaille également les enseignements de valeur tirés de la mise en œuvre de l’étude dans le contexte du Sénégal. Ces résultats contribuent aux discussions politiques en cours au Sénégal concernant l'intégration des pharmacies privées dans la prestation des services de PF.

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Reaching Key Populations With Community-Based Hiv Test And Start Services In Lagos And Benue States In Nigeria: Baseline Findings, Project Soar

HIV and AIDS

Key populations (KPs), such as men who have sex with men (MSM), female sex workers (FSWs), and people who inject drugs, remain disproportionately affected by HIV compared to the general population. In Nigeria, HIV prevalence declined among the general population from 2007–18. Among key populations from 2007–14, HIV also decreased among FSWs, but increased among MSM. Evidence-based strategies to sustain the decline among the general population and FSWs, and mitigate the increase among MSM, are needed. Nigeria has adopted the World Health Organization’s “test and start” (TnS) strategy, which recommends initiating antiretroviral therapy (ART) by persons living with HIV as …

Meeting The Needs Of Orphans And Other Vulnerable Children: Learnings From Project Soar, Project Soar

HIV and AIDS

Orphans and other vulnerable children (OVC), including those living with HIV, often have a range of unmet needs, such as education, food security, psychosocial support, and access to health care. Project SOAR is documenting the unique vulnerabilities of OVC and their caregivers, and examining strategies to mitigate the impacts of HIV on them. This brief presents a summary of the SOAR portfolio, including a prospective cohort study of young people living with HIV in Zambia, an evaluation of an HIV risk screening tool among OVC in Tanzania, and a systematic review of promising interventions to support engagement and treatment adherence …

Women And Hiv: Understanding And Addressing Stigma—Evidence From The Population Council, Population Council

HIV and AIDS

Over the last 20 years, the Population Council has carried out extensive work examining the intersection of stigma and gender and its impact on HIV-related outcomes. This brief summarizes key Population Council findings from a range of studies which elucidate the experiences of stigma among women and highlights avenues for addressing stigma to mitigate women’s risk and burden of HIV.

Strengthening Capacity To Prevent Hiv Among Adolescent Girls And Young Women: Supporting Dreams Programming, Project Soar

HIV and AIDS

The Population Council, with funding from Girl Effect, worked in seven Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Partnership countries to strengthen the capacity of implementing partners to develop new approaches to reach AGYWs at highest risk of HIV infection, link them with essential resources, and empower them with social and protective assets for a safe and healthy entry into adulthood. This technical assistance was informed by the Population Council’s decades of research and experience determining “what works”—and what doesn’t work—in girl-centered programming. Through Project SOAR, the Population Council provided technical assistance to implementing partners in five additional countries …

Implementing And Scaling-Up Stepping Stones In Kwazulu-Natal, South Africa: Lessons From Working In Informal Settlements, Cecilia Milford, M. Mtshali, Mags Beksinska, Julie Pulerwitz

HIV and AIDS

KwaZulu-Natal (KZN), a major epicenter of the South African HIV epidemic, has large informal settlements where thousands of people live. The settlements are often underserved by municipal services and lack accessible health care. Given high rates of HIV, there is a critical need to assess the successes and challenges of implementing HIV prevention and treatment in this context. Stepping Stones is a widely used life-skills training intervention focused on curbing gender-based violence and reducing HIV risk. The program addresses issues such as communication about HIV, relationship skills, and assertiveness. The manual-based curriculum encourages participants to engage in critical reflection through …

The People Living With Hiv Stigma Index: Dominican Republic, Red Dominicana De Personas Que Viven Con Vih/Sida, Alianza Solidaria Para La Lucha Contra El Vih Y Sida, Population Council

HIV and AIDS

The People Living with HIV Stigma Index, developed in 2008, is a survey instrument used to highlight stigma and discrimination experienced by PLHIV. Developed and administered by and for PLHIV, the Stigma Index is not merely a measurement tool, its implementation is intended to be an empowering experience for PLHIV. In 2016–17, the Population Council–led research consortium Project SOAR updated the Stigma Index to reflect changes in the global HIV response in the past decade. The new version (Stigma Index 2.0) now has an increased focus on PLHIV’s experiences accessing HIV services; using and adhering to antiretroviral services; mental health …

Índice De Estigma En Personas Viviendo Con Vih 2.0: Resultados Preliminares Para La República Dominicana, Project Soar

HIV and AIDS

El estigma y la discriminación hacia las personas que viven con el VIH (PVVIH) contribuyen a la pobre calidad de servicios de salud, coerción y violencia, desempleo y exclusión de las reuniones sociales. Abordar el estigma que afecta a las PVVIH es una prioridad mundial, dado su impacto en la epidemia del VIH. En 2008, la Red mundial de personas que viven con el VIH, la Comunidad internacional de mujeres que viven con el VIH, la Federación Internacional de Planificación de la Familia y ONUSIDA lanzaron el Índice de Estigma para proveer evidencia sobre estigma y discriminación que sirva para …

Índice De Estigma En Personas Que Viven Con Vih: República Dominicana, Red Dominicana De Personas Que Viven Con Vih/Sida, Alianza Solidaria Para La Lucha Contra El Vih Y Sida, Population Council

HIV and AIDS

El Índice de Estigma de las personas que viven con el VIH, desarrollado en 2008, es una encuesta utilizada para identificar el estigma y la discriminación que enfrentan las PVVIH. Desarrollado y administrado por y para las PVVIH, el Índice de Estigma es más que un simple instrumento de medición, e espera que su ejecución empodere a PVVIH. En 2016-17, el consorcio de investigación liderado por el Population Council, el Proyecto SOAR, actualizó el Índice de Estigma a modo de reflejar los cambios en la respuesta mundial ante el VIH durante la última década. La nueva versión (Stigma Index 2.0) …

The People Living With Hiv Stigma Index 2.0: Preliminary Results From The Dominican Republic, Project Soar

HIV and AIDS

Stigma and discrimination among people living with HIV (PLHIV) contributes to poor quality health care, coercion and violence, job loss, and exclusion from social gatherings. Addressing stigma affecting PLHIV is a global priority, given its impact on the HIV epidemic. In 2008, the Global Network of People Living with HIV, the International Community of Women Living with HIV, the International Planned Parenthood Federation, and UNAIDS launched the People Living with HIV Stigma Index (Stigma Index) to provide evidence on stigma and discrimination that can be used to advocate for the rights of PLHIV. As of November 2017, more than 100,000 …

The Medicalisation Of Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Population Council

Reproductive Health

This evidence brief summarizes key findings from a study that sought to understand the shifts in FGM/C including medicalization among several communities Kenya. The study finds that medicalization is increasing because: 1) it is perceived to be safer because the procedure is reportedly performed under sterile conditions by trained health professionals; 2) it is believed to shorten the recovery period; and 3) it is a response to the law prohibiting the practice because it allows FGM/C to be performed in secret. These findings indicate that medicalization is an adaptation to awareness of the health complications associated with FGM/C and the …

The Global Compact On Refugees: How The Sauti/Voice Project Fits, Josephine Ngebeh, Chi-Chi Undie, Joanina Karugaba

Reproductive Health

How can stakeholders support refugees in the present-day unprecedented global refugee crisis? At least one way is by entering into a clearly defined compact to do so. Developed in 2018, the Global Compact on Refugees is a nonbinding agreement among United Nations Member States and other relevant stakeholders, including international organizations. A symbol of political will, the Compact demonstrates the commitment of the international community to enhanced cooperation and solidarity with both refugees and their host communities. The Global Compact on Refugees provides the international community with guidance for supporting present-day refugee communities, characterized by large populations and protracted refugee …

Sauti/Voice Project: First Unhcr-Population Council Regional Workshop, Josephine Ngebeh, Chi-Chi Undie, Joanina Karugaba, George Odwe, Nachela Chelwa, Harriet Birungi, Michael Mbizvo

Reproductive Health

In 2014, the UNHCR East and Horn of Africa and Great Lakes (EHAGL) Africa Bureau in Nairobi, and the Population Council/Nairobi established technical cooperation for Improving Evidence-based Programming for Sexual and Gender-based Violence (SGBV) in Refugee Operations in the East and Horn of Africa. The Africa Bureau works closely with the Council to initiate appropriate interventions for the prevention of, and response to, SGBV in refugee operations. The Council’s technical team is represented by the Council-led Africa Regional SGBV Network. Technical cooperation between the Africa Bureau and the Council has resulted in a new initiative: VOICE—Violence Prevention and Response Through …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Kenya, Charlotte E. Warren, Pooja Sripad, Charity Ndwiga

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically disadvantage women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

Reference Guide: Factorial Focus Group Analysis Methods For Studying Social Norm Change, Bettina Shell-Duncan, Amadou Moreau, Katherine Wander, Sarah Smith

Reproductive Health

The factorial focus group methodology described in this guide provides a powerful means of illuminating the social norms that uphold female genital mutilation/cutting (FGM/C), and the ways in which meanings have at times become contested or rejected. The methods described here can be applied to the study of a wide range of behaviors influenced by social norms, such as early marriage, adoption of contraception, and more.

« More Than Brides Alliance (Mtba) » : Rapport D’Évaluation À Mi-Parcours Au Mali Et Au Niger, Andrea J. Melnikas, Grace Saul, Mouhamadou Gueye, Aissa Diarra, Sajeda Amin

Poverty, Gender, and Youth

L’Alliance « Plus qu’une épouse » (More Than Brides Alliance—MTBA) a été formée, rassemblant les forces d’une équipe diversifiée, compétente pour la mise en œuvre et la recherche de programmes destinés aux adolescents. Le volet recherche de l’Alliance MTBA vise à fournir des preuves et des connaissances sur ce qui fonctionne pour retarder le mariage des enfants en Inde, au Malawi, au Mali, au Niger et au Pakistan en évaluant le programme d’intervention de l’Alliance MTBA et en examinant les facteurs spécifiques du mariage des enfants dans chaque contexte. Dans ce rapport, nous visons à évaluer les succès du programme …

The Girl Roster: A Practical Tool For Strengthening Girl-Centered Programming, Population Council

Poverty, Gender, and Youth

This brief describes the Girl Roster^TM, a practical tool designed by the Population Council to help practitioners understand their program areas and elicit foundational information to intentionally link girls—especially highly marginalized adolescent girls—to the vital resources, facilities, and services to which they are entitled but often have limited or no access. The tool is a user-friendly, efficient, and cost-effective way to collect program-relevant information about girls in a community, using a mobile phone–based questionnaire (or, where resources do not permit, paper and pencil). The tool enables users to see a fuller view of girls’ lived realities in defined …

Examining Early Marriage In India: Qualitative Findings, Neelanjana Pandey, Komal Saxena, Andrea J. Melnikas

Poverty, Gender, and Youth

The More Than Brides Alliance (MTBA) implements the “Marriage: No Child’s Play” program (2016–20) in India, Malawi, Mali, Niger, and Pakistan. The MTBA is a holistic program that addresses early marriage through multiple strategies, including: sexual and reproductive health and rights, livelihoods, education, and prevalent community social norms around marriage. Furthermore, the program operates at multiple levels (girl, family, community, block, and district) to address individual, familial, and structural barriers to reducing child marriage in these communities. This report first looks at the legal environment in which programs operate by examining participants’ awareness of laws, acts, and programs related to …

Accelerating Action To End Child Marriage In Bangladesh—Project Brief, Population Council

Poverty, Gender, and Youth

Bangladesh ranks among the five countries with the highest rate of child marriage in the world. Community norms and values are among the underlying factors that support the practice of child marriage in Bangladesh. The Population Council is partnering with the Ministry of Women and Children Affairs to delay marriage as part of the UNFPA-UNICEF Global Program to Accelerate Action to End Child Marriage. This program is being implemented to generate evidence on reduction of child marriage through an adolescent skills-building program. The project works to empower girls with life-skills and livelihood and gender-awareness trainings, as well as engaging communities …

Building Assets Toolkit: Developing Positive Benchmarks For Adolescent Girls—Asset Cards [Spanish], Judith Bruce, Sarah Engebretsen, Kimberly Glazer

Poverty, Gender, and Youth

La Caja de herramientas: Fortalecimiento de habilidades del Population Council ayuda a los profesionales, los encargados de formular políticas y los defensores a crear contenido personalizado, significativo y positivo para ayudar a subpoblaciones específicas de niñas. La caja de herramientas guía a los profesionales a través de una serie de pasos que deben tomarse para definir objetivos de sentido común: qué información, habilidad o activo físico (como una tarjeta de identificación) debe tener una niña en un entorno particular para una edad en particular. Este documento consta de las tarjetas de activos que forman parte de la Caja de herramientas: …