International Public Health Commons^™

Considerations For Collecting And Documenting Fgm/C Data By Health Care Providers, Dennis Matanda

Reproductive Health

Data on female genital mutilation/cutting (FGM/C) are rarely collected in health facilities, yet routine collection of facility-based data through other health-seeking visits (e.g., during antenatal care) is considered good medical practice and can be an important source of data. Clinical exams provide an opportunity to identify women and girls who have undergone FGM/C, which is an important step in aiding the prevention of chronic complications that can be difficult to manage later in life. These exams also make it possible to refer those with FGM/C-related complications for specialized treatment. Clinical visits also present an opportunity to discuss prevention of the …

Female Genital Mutilation/Cutting In Senegal: Is The Practice Declining? Descriptive Analysis Of Demographic And Health Surveys, 2005–2017, Dennis Matanda, Glory Atilola, Zhuzhi Moore, Paul Komba, Lubanzadio Mavatikua, Chibuzor Christopher Nnanatu, Ngianga-Bakwin Kandala

Reproductive Health

To achieve the Sustainable Development Goals, female genital mutilation/cutting (FGM/C) is one of the most prominent issues world leaders and governments must address. In Senegal, estimates from the 2017 Senegal Demographic and Health Survey show that almost a quarter of women aged 15–49 have undergone FGM/C, while 14 percent of girls aged 0–14 years have been cut. Given the many interventions that have been implemented in Senegal with the intention of scaling down FGM/C rates, the key question is: To what extent has the practice declined? The aim of this study, as presented in this working paper, was to generate …

Understanding Female Genital Mutilation/Cutting Abandonment In Egypt, Nada Wahba, Hania El Banhawi, Amira El Ayouti

Reproductive Health

Although the prevalence of female genital mutilation/cutting (FGM/C) in Egypt among married women aged 15–49 years is high (92 percent), in the most recent (2014) Demographic and Health Survey, prevalence rates appear to be declining among younger cohorts of girls and women. Support for the discontinuation of the practice is more widespread in younger generations, among females, and among those living in urban areas. Variations in attitudes toward FGM/C by education level and wealth status are also documented. While numerous studies have examined the reasons why people practice FGM/C, few studies have examined the characteristics of the individuals who have …

Assessing The Role Of Law In Reducing The Practise Of Fgm/C In Kenya, Agnes K. Meroka-Mutua, Daniel Mwanga, Charles Owuor Olungah

Reproductive Health

Criminalization is an important aspect of anti-FGM/C policies and programs. In countries where FGM/C is practiced, the enactment of a law prohibiting the practice is an important indicator of progress toward abandonment. Criminalization is often seen as playing an important role in the declining prevalence of FGM/C. However, there is not much research on the link between the enactment of laws that prohibit and criminalize FGM/C and declining prevalence of the practice. The objectives of this study, therefore, were to assess the extent to which people obey the law on FGM/C; to investigate the reasons and causes that motivate people …

Health Care Providers' And Mothers' Perceptions About The Medicalization Of Female Genital Mutilation Or Cutting In Egypt: A Cross-Sectional Qualitative Study [Arabic], Omaima El-Gibaly, Mirette Aziz

Reproductive Health

The medicalization of FGM/C has been increasing significantly in Egypt making it the country with the highest rate of medicalization. In this qualitative study, we explore the drivers and motives behind why health-care professionals perform FGM/C and why mothers rely on them to perform the practice on their daughters.

No To Circumcision’: The Road To Effective Social Marketing Campaigns In Egypt [Arabic], Salma Abou Hussein, Sarah Ghattass

Reproductive Health

This study sought to understand how, where, and why social marketing campaigns (SMCs) supporting abandonment of female genital mutilation/cutting (FGM/C) are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors.

A Diagnostic Assessment Of The Health System's Response To Fgm/C Management And Prevention In Nigeria—Brief, Osasuyi Dirisu, Adetayo Adetunji, Mayokun Adediran, Otibho Obianwu

Reproductive Health

Globally, over 200 million women have been cut and are living with FGM/C-related consequences. In Africa, an estimated 27 million, 24 million, and 20 million girls/women have undergone FGM/C in Egypt, Ethiopia, and Nigeria respectively, the countries with the highest prevalence of FGM/C on the continent. In Nigeria, although the practice is considered widespread, national surveys suggest a gradual decline of FGM/C prevalence among women aged 15–49 years from 30 percent in 2008 to 20 percent in 2018. While these statistics suggest progress, the prevalence is still as high as 67 percent in some states. Nigeria’s National Strategic Health Development …

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 …

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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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.

Enhancing Customer Satisfaction For Health Services, Deepa Rajamani, Saumya Ramarao

Reproductive Health

The Family Planning (FP) 2020 global partnership has achieved significant gains since its inception, and while it strives to accelerate uptake of voluntary FP services, women in developing countries continue to face an unmet need for modern contraceptive services. Critical opportunities for action exist in the area of understanding the effects of quality of family planning services and continued contraceptive use. Measuring and tracking the quality of FP services is an important aspect of improving service delivery, and client feedback also offers critical insight into the design of demand generation and uptake strategies for a contraceptive. In this report, we …

Positioning Family Planning Quality Within Health Financing For Uhc: Connecting The Discourse, Gabrielle Appleford, Saumya Ramarao, Benjamin Bellows, Leah Jarvis

Reproductive Health

Financing is a major challenge and concern for the future of the delivery of voluntary family planning (FP) services to clients, particularly in low- and middle-income countries with high unmet need and limited method choice. As countries commit to universal health coverage (UHC), it is crucial that UHC schemes include FP and other reproductive health (RH) services. Strategic purchasing of quality FP services from public and private—including for profit and not-for-profit—health-care providers could accelerate progress toward UHC. It is increasingly recognized that the FP2020 goals will not be met without adequate attention to quality, and that a sustained focus on …

Antihypertensive Drugs, Population Council

Reproductive Health

Pre-eclampsia (PE) is a condition in pregnant women marked by an increase in blood pressure and protein in the urine after 20 weeks gestation. Eclampsia is a life-threatening condition characterized by convulsions in women with PE. PE/E and other hypertensive disorders in pregnancy increase risk of preterm births. Providing high-quality and regular antenatal care improves the prevention and early detection of PE and can prevent its progression to eclampsia. Prescribing low-dose aspirin and calcium to at-risk women can prevent PE and eclampsia. PE and eclampsia can be managed by administering antihypertensive drugs and magnesium sulphate (MgSO4). MgSO4 is the safest …

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

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate 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 (ANC) 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. …

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Ethiopia, 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 (ANC) 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. …

Assessing The Effect Of A Primary Health Care Intervention For Improving Pre-Eclampsia And Eclampsia Knowledge And Practice In Bangladesh, Sharif M.I. Hossain, Shongkour Roy, Kanij Sultana, Charlotte E. Warren

Reproductive Health

In resource-poor countries such as Bangladesh, proven life-saving commodities for pregnant women have not been optimally examined, such as magnesium sulphate (MgSO4) to manage severe pre-eclampsia/eclampsia, use of anti-hypertensives to manage high blood pressure during pregnancy, aspirin prophylaxis for pregnant women at high risk of PE/E, as well as task shifting to lower health-worker cadres, and community involvement. There has been no systematic review of research and programming on PE/E prevention, early detection, and treatment in Bangladesh. With support from USAID, the Ending Eclampsia project has been expanding access to proven, underutilized interventions and commodities for PE/E prevention, early detection, …

Engaging Community Women’S Groups To Improve Maternal Health Care Delivery In Cross River: Implementation Research Report, Pooja Sripad, Emmanuel Nwala, Tracy Mcclair, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Ending Eclampsia’s main objective is to improve access to underutilized interventions and commodities by training community health extension workers in preventing, detecting (screening), and managing pre-eclampsia and eclampsia. While the broader project emphasizes primary health care interventions, this implementation research (IR) study focused on a community intervention in one state, in areas where the facility interventions were active. This final research report describes IR testing the feasibility and utility of employing women’s groups as community platforms to increase women’s access to quality antenatal service utilization, using pre-eclampsia screening as the entry point. The study was conducted in 48 communities in …

Feasibility And Acceptability Of Community Health Extension Workers To Identify And Treat Hypertension Associated With Pregnancy: Implementation Research Report, Emmanuel Nwala, Udochisom Anaba, Pooja Sripad, Salisu Mohammed Ishaku, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing …