Social and Behavioral Sciences Commons^™

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 …

Tracing Change In Female Genital Mutilation/Cutting Through Social Networks: An Intersectional Analysis Of The Influence Of Gender, Generation, Status, And Structural Inequality, Amadou Moreau, Bettina Shell-Duncan

Reproductive Health

Policies and programs designed to eliminate female genital mutilation/cutting (FGM/C) in Senegal have been implemented over several decades, but the practice has been surprisingly tenacious. Strategies for accelerating abandonment have been informed by theories of change, and social norms theory, in particular, has become a prominent framework for understanding behavior change dynamics. FGM/C is held in place by interdependent normative expectations: what one family chooses to do is linked to expectations of others and reinforced through social sanctions. Hence, a key strategy for promoting behavior change rests on coordinating change in norms and behavior among people who interact with one …

Exploring The Nature And Extent Of Normative Change In Fgm/C In Somaliland, Richard A. Powell, Mohamed Yussuf, Bettina Shell-Duncan, Caroline W. Kabiru

Reproductive Health

More than 200 million girls and women alive today have undergone FGM/C across 30 countries in Africa, Asia, and the Middle East. While most affected countries have adopted legal frameworks prohibiting FGM/C, these have been varyingly effective in preventing the practice or significantly accelerating its abandonment. The success of programmatic interventions to address FGM/C has also been variable. One possible reason for the limited success of these initiatives is the neglect of the collectively held social norms underpinning the practice’s continuation. This study, conducted in 30 villages in Somaliland, aimed to investigate: 1) if the norms associated with FGM/C are …

Provider Behavior Change Approaches To Improve Family Planning Services In The Ouagadougou Partnership Countries: A Landscaping Review, Kathryn Spielman, Elizabeth Tobey, Martha Silva, Leanne Dougherty

Reproductive Health

This landscaping review summarizes available evidence (as of 2020) on the effectiveness of provider behavior change interventions for improving family planning services in Ouagadougou Partnership countries and presents current or recent provider behavior change interventions not formally evaluated. The findings are summarized along with reflections about possible research and programming investments to address challenges and opportunities.

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 …

Recherche Formative Exhaustive Sur Les Croyances, Les Pratiques Et Les Comportements En Matière De Santé Au Mali, Breakthrough Research

Reproductive Health

Breakthrough RESEARCH, in conjunction with the Centre d’Etudes et de Recherche sur l’Information en Population et Santé (CERIPS), designed and conducted a mixed method formative study to inform USAID Mali’s health and nutrition programming for the next five years. This project aimed to increase demand for and use of health, nutrition, water and sanitation services; increase individual and household adoption of healthy behaviors; and improve household and community capacities to plan, finance, and manage their own health and health systems. This formative research comprised three phases of data collection to reveal the contexts of health behaviors and determinants, motivators, and …

Comprehensive Formative Research On Health Beliefs, Practices, And Behaviors In Mali, Breakthrough Research

Reproductive Health

Breakthrough RESEARCH, in conjunction with the Centre d’Etudes et de Recherche sur l’Information en Population et Santé (CERIPS), designed and conducted a mixed method formative study to inform USAID Mali’s health and nutrition programming for the next five years. This project aimed to increase demand for and use of health, nutrition, water, sanitation and health services; increase individual and household adoption of healthy behaviors; and improve household and community capacities to plan, finance, and manage their own health and health systems. This formative research comprised three phases of data collection to reveal the contexts of health behaviors and determinants, motivators, …

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 Business Case For Investing In Social And Behavior Change For Family Planning, James Rosen, Nicole M. Bellows, Lori Bollinger, Willyanne Decormier Plosky, Michelle Weinberger

Reproductive Health

Although the development field generally considers social and behavior change interventions essential parts of quality health programs, lack of synthesized information on costs and effectiveness means that decision-makers under-appreciate and under-fund social and behavior change efforts. This business case uses evidence to answer questions about the effectiveness, cost, cost-effectiveness, and return on investment from social and behavior change efforts. To develop this family planning social and behavior change business case, nearly 200 studies were evaluated. All USAID strategic priorities for global health—preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious diseases—employ social and behavior change approaches to …

Family Planning And Youth In West Africa: Mass Media, Digital Media, And Social And Behavior Change Communication Strategies, Sarah Castle, Martha Silva

Reproductive Health

This review presents evidence about the impact of mass media and digital media on young people’s family planning attitudes and behaviors. It primarily focuses on the Ouagadougou Partnership countries, but also describes lessons from other initiatives implemented more widely in Africa and elsewhere. Due to the paucity of family planning evidence, the review also includes material from higher income countries where mass and digital media have been used in communication initiatives to prevent non-communicable diseases. In addition, it draws on studies from low- and middle income countries where such media have been used to create demand for maternal and child …

Enhancing Respectful Maternal Care During Labor And Delivery, Breakthrough Research

Reproductive Health

This brief informs national ministries of Health, health system officials, staff and clients, implementing partners, and donors of innovative ways to improve women's experiences during labor and delivery. ideas42, in partnership with Safe Motherhood 360+ and the Chipata District Health Office in Zambia, under the Breakthrough RESEARCH project, used behavioral design to analyze contextual features and behavioral barriers to respectful maternal care in urban and rural health care settings. Behavioral design revealed new insights into why health care providers may not follow best practices for respectful maternal care, and resulted in a set of simple, adaptable low cost solutions to …

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 Nigeria, Pooja Sripad, 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 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 …

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 …

Post-Intervention Analysis Of Pre-Eclampsia And Eclampsia In Three Nigerian States, Salisu Mohammed Ishaku, Emmanuel Nwala, Gloria Adoyi, Charles Nwigwe, Solomon Kongyamba, Udochisom Anaba, Caroline Johnson, Karen Kirk, Pooja Sripad, Charlotte E. Warren

Reproductive Health

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but …

Fgm/C And Ecm: Drawing Lessons From Research, Jacinta Muteshi-Strachan

Reproductive Health

No abstract provided.

Hypertensive Disorders In Pregnancy: Assessing Postnatal Quality Of Care And Outcomes For Women And Their Infants In Bangladesh, Sharif M.I. Hossain, Kanij Sultana, Salma Rouf, Rabeya Akter, Shongkour Roy, Sumaiya Anwar, Karen Kirk, Charlotte E. Warren

Reproductive Health

Hypertensive disorders in pregnancy (HDPs) are the second leading cause of maternal mortality in Bangladesh, responsible for 24 percent of maternal deaths. Various factors, such as lack of health-care provider capacities for detecting, preventing, and managing pre-eclampsia and eclampsia (PE/E), late referrals, late (or lack of) antenatal care (ANC), and poor awareness of PE/E, are factors in most of these deaths. While some information was available on the prenatal and postnatal periods, an evidence gap existed in information after delivery through the first year postnatal, and beyond. In this prospective cohort study, the Ending Eclampsia project recruited married women ages …

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 …

Implementing Components Of The Phc For Pe/E Model In Pakistan: A Cost Analysis, Ali M. Mir, Mumraiz Khan, Pooja Sripad, Sara Chace Dwyer

Reproductive Health

Pre-eclampsia/Eclampsia (PE/E) is the third leading cause of maternal mortality in Pakistan. Women with PE are at increased risk for organ damage or failure, pre-term birth, loss of pregnancy, and stroke. PE can progress to eclampsia, which is characterized by seizures, and may be associated with kidney and liver damage, as well as maternal death. The risks of PE/E can be mitigated with regular screening during antenatal care and the postnatal period. Regular monitoring of PE can lessen progression to severe PE/E, and severe PE/E can be managed through administration of magnesium sulfate and antihypertensive drugs. Between 2016 and 2018, …

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 …

Engaging Men For Effective Family Planning Through Couple Communication: An Assessment Of Two Mcsp Couple Communication Approaches In Togo, Natacha Stevanovic-Fenn, Bethany Arnold, Sanyukta Mathur, Catherine Tier, Anne Pfitzer, Rebecka Lundgren

Reproductive Health

On behalf of Breakthrough RESEARCH, the Institute for Reproductive Health of Georgetown University, in collaboration with the Population Council, assessed two of three couple's communication approaches for family planning being implemented by Maternal and Child Survival Program in Togo’s Kloto district: in home couple's counseling (either individual in home counseling or with the couple together) and group discussions. IRH’s overall goal was to assess the benefits and feasibility of these two approaches as well as to determine which elements of each are best suited for roll-out on a broader scale. The two models—home-based couple counseling and group discussions—were implemented in …

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 …

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. …

Associations Between Fgm/C And Hiv In Ethiopia, The Gambia, Kenya, And Sierra Leone: A Limited Analysis Of Demographic And Health Survey Data, Yetunde A. Noah Pinheiro, Zhuzhi Moore, David Gathara

Reproductive Health

Studies investigating the association between male circumcision and HIV have demonstrated the protective effect of male circumcision. In some settings, FGM/C and male circumcision are considered “equivalent” procedures. This working paper presents findings of a study that investigates the effect of FGM/C on the likelihood of HIV infection for women in practicing communities in Ethiopia, Gambia, Kenya, and Sierra Leone.

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 …

Assessment Of In-Service Training And Continuing Education (Ist/Ce) For Frontline Health Workers In Bauchi And Cross River States, Nigeria, Ekechi Okereke, Iliyasu Zubairu, Udoh Nsekpong, Godwin Unumeri, Ibrahim Suleiman, Aisha Jibril

Reproductive Health

Training contributes tremendously to the development and sustenance of health workers’ competencies for quality healthcare services. Although Nigeria has a higher stock of human resources for health compared to other African countries, the World Health Organization argues that its distribution is highly skewed toward urban areas. Building and maintaining staff capacities requires continuing professional development through in-service training (IST) and continuing education (CE). This study assesses current IST and CE for health workers in Bauchi and Cross River states to provide evidence to inform policy and planning and improve implementation of capacity-building for health workers in Nigeria.

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya—Brief, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

This policy brief summarizes key findings from a study that examined whether there are shifts in norms and practices related to FGM/C among communities in Narok (predominantly inhabited by Maasai) and Kisii (predominantly inhabited by Abagusii) counties in Kenya. Although Kisii and Narok are FGM/C hotspots, practicing communities in these counties are reassessing norms and traditions in light of the current social and legal climate. These changes may provide a useful starting point for intervention programs that seek to create dialogue and critical reflection on the practice of FGM/C in an effort to accelerate its abandonment. Programmatic recommendations include: engaging …

"No To Circumcision": The Road To Effective Social Marketing Campaigns In Egypt, Salma Abou Hussein, Sarah Ghattass

Reproductive Health

To inform the design and scale up of initiatives that can drive a change in attitudes and behaviors toward FGM/C abandonment, there is a rising need to understand the perspectives of individuals who are exposed to social marketing campaigns (SMCs), which are a key intervention to promote the abandonment of the practice. This working paper presents the findings of a study that sought to understand how, where, and why SMCs for FGM/C abandonment are working, and with what impact, to inform design and scale-up of campaigns that can foster new perspectives, expectations, and behaviors.