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Ferguson L, Emoto S, Gruskin S. Laws governing access to sexual health services and information: contents, protections, and restrictions. Sex Reprod Health Matters 2024; 32:2336770. [PMID: 38647261 PMCID: PMC11036897 DOI: 10.1080/26410397.2024.2336770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Access to sexual health services and information is critical to achieving the highest attainable standard of sexual health, and enabling legal environments are key to advancing progress in this area. In determining overall alignment with human rights standards to respect, protect, and fulfil sexual health-related rights without discrimination, there are many aspects of laws, including their specificity and content, which impact which sexual health services and information are availed, which are restricted, and for whom. To understand the nature of existing legal provisions surrounding access to sexual health services and information, we analysed the content of 40 laws in English, French, and Spanish from 18 countries for the specific sexual health services and information to which access is ensured or prohibited, and the non-discrimination provisions within these laws. Overall, there was wide variation across countries in the types of laws covering these services and the types and number of services and information ensured. Some countries covered different services through multiple laws, and most of the laws dedicated specifically to sexual health addressed only a narrow aspect of sexual health and covered a small range of services. The protected characteristics in non-discrimination provisions and the specificity of these provisions with regard to sexual health services also varied. Findings may inform national legal and policy dialogues around sexual health to identify opportunities for positive change, as well as to guide further investigation to understand the relationship between such legal provisions, the implementation of these laws within countries, and relevant sexual health outcomes.
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Affiliation(s)
- Laura Ferguson
- Director of Research, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sarah Emoto
- Program Specialist, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
| | - Sofia Gruskin
- Director, Institute on Inequalities in Global Health, University of Southern California, Los Angeles, CA, USA
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Mulubwa C, Zulu JM, Hurtig AK, Goicolea I. Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia. BMC Public Health 2024; 24:1228. [PMID: 38702694 PMCID: PMC11069181 DOI: 10.1186/s12889-024-18685-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
INTRODUCTION Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.
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Affiliation(s)
- Chama Mulubwa
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia.
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden.
- Centre for Infectious Disease Research in Zambia (CIDRZ), P.O Box 34681, Lusaka, Zambia.
| | - Joseph Mumba Zulu
- School of Public Health, University of Zambia, P.O. Box 50110, Lusaka, Zambia
| | - Anna-Karin Hurtig
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden
| | - Isabel Goicolea
- Department of Epidemiology and Global Health, Umeå University, Umeå, SE, Sweden
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Tiruneh MG, Fenta ET, Endeshaw D, Eshetu HB, Adal O, Tareke AA, Kebede N, Delie AM, Bogale EK, Anagaw TF. Six in ten female youths in low-income East African countries had problems in accessing health care: a multilevel analysis of recent demographic and health surveys from 2016-2021. BMC Health Serv Res 2024; 24:533. [PMID: 38671487 PMCID: PMC11046753 DOI: 10.1186/s12913-024-10934-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/31/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Access to health care services is a basic human right, and an individual's health and overall quality of life may suffer as a result of barriers to accessing health services. Access to comprehensive and quality health care is fundamental for promoting and maintaining health, preventing and treating diseases, and reducing premature deaths. However, only half of the African population has access to modern health services. Therefore, this study aimed to assess the health care access and associated factors among female youths in low-income East African countries. METHODS This study used secondary data from 2016 to 2021 demographic and health surveys of 7 low-income East African countries. A total weighted sample of 51,064 youths was included. A multilevel binary logistic regression was employed to identify the associated factors of access to health care since the data has a hierarchical structure. Adjusted Odds Ratio (AOR) with a 95% confidence interval (CI) at a p-value less than 0.05 was used to measure the association of variables whereas Intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), and proportional change in variance (PCV) were used to measure random effects. RESULT The overall magnitude of access to healthcare among female youths in low-income East African countries was 38.84% (95% CI: 38.41, 39.26). Youth's educational level, rich wealth status, media exposure, and community level education were the positive while higher youth's age and rural residence were the negative predictors of access to healthcare among female youths. Besides, living in different countries compared to Burundi was also an associated factor for accessing healthcare in low-income East African countries. CONCLUSION About six in ten female youths were not accessing health care in low-income East African countries. Therefore, to increase healthcare access, health managers and policymakers needed to develop strategies to improve the poor household wealth index, and redistribution of health services for rural residents. The decision-makers and program planners should also work on increasing access to education and media exposure for youths. Further research including health system and quality of service-related factors for accessing healthcare should also be considered by researchers.
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Affiliation(s)
- Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, College Medicine and Health Sciences, University of Gondar, Gondar, P.O. Box: 196, Ethiopia.
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Destaw Endeshaw
- Department of Adult Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ousman Adal
- Department of Emergency and Critical Care Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Abiyu Abadi Tareke
- Amref Health Africa in Ethiopia, SLL project COVID-19/EPI technical assistant at West Gondar Zonal Health Department, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Amare Mebrat Delie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Eyob Ketema Bogale
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tadele Fentabel Anagaw
- Department of Health Promotion and Behavioral Sciences, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Pincock K, Yadete W, Girma D, Jones N. Comprehensive sexuality education for the most disadvantaged young people: findings from formative research in Ethiopia. Sex Reprod Health Matters 2023; 31:2195140. [PMID: 37017582 PMCID: PMC10078123 DOI: 10.1080/26410397.2023.2195140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Comprehensive sexuality education (CSE) seeks to improve young people's knowledge, attitudes and practices in relation to sexual and reproductive health, sexual and social relationships, and dignity and rights. In Ethiopia, young people with disabilities and young women involved in sex work are particularly vulnerable to sexual violence and poor sexual health, yet face stigma and accessibility challenges that continue to exclude them from information, support and services. Because they are often out of school, these groups are also often excluded from programmes that are largely delivered in school settings. This paper explores the challenges faced by these groups of young people in accessing inclusive and age-appropriate sexual and reproductive health knowledge and services in the Ethiopian context and the implications for delivering CSE. The research included literature review, mapping analysis and interviews with young people from those two groups and with service providers and programme implementers. Our findings indicate that young people with disabilities and young women involved in sex work face myriad barriers to accessing information and services that support positive and healthy sexuality, relationships and rights. However, changes over the past decade to national and regional governance structures and a political environment in which CSE has become increasingly contested have generated siloed approaches to the provision of sexual and reproductive health information and services, and poor linkages to complementary services including violence prevention and social protection. It is vital that efforts to implement comprehensive sexuality education are informed by these challenges in the wider policy environment.
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Affiliation(s)
- Kate Pincock
- Qualitative Researcher, Gender and Adolescence: Global Evidence (GAGE), ODI, London, UK. Correspondence:
- Research Associate, Oxford Department of International Development, University of Oxford, Oxford, UK
| | - Workneh Yadete
- Country Research Uptake and Impact Coordinator and Qualitative Research Lead, Gender and Adolescence: Global Evidence (GAGE) Ethiopia, Addis Ababa, Ethiopia
- Executive Director, Quest Research, Training and Consultancy PLC, Addis Ababa, Ethiopia
| | - Darwit Girma
- Adolescent and Youth Development Programme Analyst, United Nations Population Fund (UNFPA), Addis Ababa, Ethiopia
| | - Nicola Jones
- Director, Gender and Adolescence: Global Evidence (GAGE), ODI, London, UK
- Principal Research Fellow, Gender Equality and Social Inclusion, ODI, London, UK
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Footman K, Goel K, Rehnström Loi U, Mirelman AJ, Govender V, Ganatra B. Inclusion of abortion-related care in national health benefit packages: results from a WHO global survey. BMJ Glob Health 2023; 8:e012321. [PMID: 37643800 PMCID: PMC10465905 DOI: 10.1136/bmjgh-2023-012321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Service inclusion in a country's health benefit package (HBP) is an important milestone towards universal health coverage. This study aimed to explore HBP inclusion of abortion interventions globally. METHODS Secondary analysis of the WHO HBP survey, in which officially nominated survey focal points were asked which interventions were included within the HBP of their country or area's largest government health financing scheme. Abortion inclusion was compared by region, income, legal status of abortion and HBP design process variables. Abortion inclusion was compared with other sexual and reproductive health (SRH) services. RESULTS Below half (45%) reported that abortion is included, but treatment of complications from unsafe abortion was more commonly included (63%). Fewer fully included essential abortion medications (22% mifepristone, 42% misoprostol). Abortion was less commonly included than any other SRH service in the survey. Unlike most SRH services, higher cost, higher technology care to treat complications of unsafe abortion was more commonly included than the relatively lower cost, lower technology service of induced abortion. Higher-income contexts and less restrictive legal environments had higher abortion inclusion. Some contexts had additional restrictions, with abortion inclusion dependent on the patient's reason for seeking care. CONCLUSION This global survey finds that abortion services and medications are often not included within HBPs, while treatment of complications from unsafe abortion is more commonly included. There are opportunities to improve HBP abortion inclusion across different legal contexts, which can improve health outcomes and reduce the need for higher cost treatment of complications from unsafe abortion.
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Affiliation(s)
- Katy Footman
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Kratu Goel
- Department of Health Financing and Economics, WHO, Geneva, Switzerland
| | - Ulrika Rehnström Loi
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Andrew J Mirelman
- Department of Health Financing and Economics, WHO, Geneva, Switzerland
| | - Veloshnee Govender
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Bela Ganatra
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
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Strong J, Coast E, Fetters T, Chiweshe M, Getachew A, Griffin R, Tembo L. "I was waiting for my period": Understanding pregnancy recognition among adolescents seeking abortions in Ethiopia, Malawi, and Zambia. Contraception 2023; 123:110006. [PMID: 36931547 DOI: 10.1016/j.contraception.2023.110006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES For a person seeking an abortion, the ability to recognize a pregnancy is a critical first step. Pregnancy recognition is complex and shaped by numerous factors. This paper explores the experiences of pregnancy recognition among adolescents in Ethiopia, Malawi, and Zambia. STUDY DESIGN The final sample included 313 adolescents aged 10 to 19 who had sought abortion-related care at urban public facilities in Ethiopia (N = 99), Malawi (N = 104), and Zambia (N = 110). Researchers collected mixed-method data on how adolescents came to recognize that they were pregnant and thematically analyzed qualitative data alongside descriptive statistics from quantitative data. RESULTS Most adolescents reported that their main mode of recognizing a pregnancy was medical pregnancy tests or late menstruation. Reasons for not recognizing a pregnancy included irregular menses or recent menarche and attribution of signs and symptoms to other medical conditions. Psychological barriers to pregnancy recognition were important, including the refusal to accept a pregnancy and denial of a pregnancy. Timing of recognition shaped the abortion care available for adolescents and the affordability of care. For some adolescents, their capacity to recognize their pregnancy led to involuntary or voluntary disclosure, which decreased their reproductive autonomy. CONCLUSIONS Adolescent experiences of pregnancy recognition complement existing evidence, illustrating critical barriers across age and context. Interrogating pregnancy recognition among adolescents exposed the critical implications for the availability, accessibility, affordability, and autonomy of their abortion trajectory. IMPLICATIONS Pregnancy recognition is complex and can influence adolescents' ability to exercise their reproductive rights and access abortion care of their choosing. Programmes to improve awareness of the signs of a pregnancy, increasing the provision of affordable and accessible pregnancy testing and further research on pregnancy recognition are necessary to support adolescents' reproductive autonomy.
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Affiliation(s)
- Joe Strong
- London School of Economics and Political Science, Department of Social Policy, London, UK.
| | - Ernestina Coast
- London School of Economics and Political Science, Department of International Development, London, UK
| | | | - Malvern Chiweshe
- Critical Studies in Sexualities and Reproduction, Rhodes University, Makhanda, South Africa
| | - Abrham Getachew
- St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Maruwo GB, Ng'ambi WF, Muula AS, Zonda K, Kachale F. Factors associated with long-acting and short-acting reversible contraceptives use among 10–24-years-old youths in Lilongwe, Malawi. FRONTIERS IN REPRODUCTIVE HEALTH 2022; 4:949458. [PMID: 36303663 PMCID: PMC9580680 DOI: 10.3389/frph.2022.949458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Evidence suggests that Malawi continues to register substantial progress on key Family Planning (FP) indicators. However, FP adoption is still low among married youth (15–24 years old), only 38% of married girls use modern contraceptive methods coupled with high-unmet needs (22%) in the same age group. Objective Identifying factors associated with long-acting (LARC) and short-acting (SARC) reversible contraceptive use among 10–24-years-old youth in Lilongwe, Malawi. Methodology A retrospective study using secondary data from 64 youth outreach clinic sites in the Lilongwe district. A quantitative approach using secondary data that was analyzed in STATA version 14 was used. A sample of 14,954 youth who accessed FP and Reproductive Health (RH) services during youth outreach clinics were included in the study. Results SARC uptake was higher than LARC (p < 0.01). Of the youths who accessed FP methods, LARC uptake was 25% (n = 3,735). Variations were noted in the uptake of LARC, especially on age, education level, client status occupation, and marital status. Factors associated with LARC uptake varied; new clients were almost twice likely to use LARC (AOR = 1.87, CI: 1.59–2.19, P < 0.01) while youth aged 20–24, the single, and student youth were less likely to use LARC. Compared to young women with formal occupations, students were less likely to use LARC (AOR = 0.30, CI: 0.158–0.58, P < 0.01). Related to the number of living children, youths with a living child were likely to use LARC (AOR = 6.40, CI: 3.91–10.48, P < 0.01). Conclusion This study showed that LARC uptake in youth outreach clinics in Lilongwe is low, though increasing over time. In addition to this, this study shows that SARC uptake is high among youth compared to LARC. Furthermore, LARC uptake varied by age education, client status (new, existing, and unknown client), occupation, number of living children, and marital status, and there were variations in LARC uptake by the clinic. Current outreach services reach youth with LARC services, but gaps exist for underserved youths.
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Affiliation(s)
- George Baxton Maruwo
- Management Sciences for Health, Lilongwe, Malawi
- Department of Public Health, College of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
- *Correspondence: George Baxton Maruwo
| | - Wingston Felix Ng'ambi
- Health Economics and Policy Unit, College of Medicine, Kamuzu University of Health Sciences, Lilongwe, Malawi
- Global Research and Analyses for Public Health (GRAPH) Network, University of Geneva, Geneva, Switzerland
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Adamson Sinjani Muula
- Department of Public Health, College of Medicine, Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Fannie Kachale
- Ministry of Health, Reproductive Health Directorate, Lilongwe, Malawi
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Mprah WK, Opoku MP, Duorinaah J, Nketsia W. Level of satisfaction and sexual and reproductive health needs of deaf persons in Ghana: a sequential explanatory mixed method study. BMC Health Serv Res 2022; 22:1152. [PMID: 36096825 PMCID: PMC9469610 DOI: 10.1186/s12913-022-08515-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background The intersection between deafness and culture in sub-Saharan African contexts such as Ghana has culminated in restricted access to sexual and reproductive health (SRH) services. While some attention has been given to the barriers faced by deaf persons in accessing SRH services, discussion of their needs and satisfaction with SRH services is at an embryonic stage. This lends support to the use of sequential mixed-method study design to assess the level of satisfaction and SRH needs of deaf persons. Methods This study was guided by explanatory sequential mixed-method study design. Thus, a two-phase data collection approach was adopted. In Phase I, a 32-item questionnaire with 16 items each for satisfaction regarding SRH services and SRH needs, was used for data collection from 288 deaf persons recruited from 3 of the 16 regions in Ghana. The data were subjected to the following computations: means, t-tests, analysis of variance, correlations, and multiple regression. In Phase II, a semi-structured interview guide was used to collect data from 60 participants who were drawn from the earlier pool. The interviews were subjected to thematic analysis. Results The results showed of correlation and multiple analyses showed a small relationship and significant contribution of needs in the variance of satisfaction. Also, there was a convergence between both the qualitative and quantitative data as participants confirmed the lack of consideration given to the needs of deaf persons regarding SRH service provisions. Conclusion Deaf persons who took part in this study were unsatisfied with SRH services due to barriers such as sign language interpreters and inaccessible information. Consequently, they expressed the need for preferred mode of communication and expedition of awareness creation on SRH. The study findings warrant the need for policymakers to inculcate the needs of deaf person in SRH services to improve access and thus, enhance satisfaction. For instance, recommendations such as the training of health professionals in the use of sign language could be considered in future SRH policy and other implications, are discussed.
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Nketsia W, Mprah WK, Opoku MP, Juventus D, Amponteng M. Achieving universal reproductive health coverage for deaf women in Ghana: an explanatory study of knowledge of contraceptive methods, pregnancy and safe abortion practices. BMC Health Serv Res 2022; 22:954. [PMID: 35897008 PMCID: PMC9327200 DOI: 10.1186/s12913-022-08323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background The first world conference on sexual and reproductive health (SRH) in 1994 helped create the awareness that reproductive health is a human right. Over the years, attempts have been made to extend services to all persons; however, lapses persist in service provision for all in need. Recently, countries have been encouraged to target minority groups in their reproductive health service provision. However, studies have rarely attempted to develop deeper insights into the experiences of deaf men and women regarding their knowledge of SRH. The purpose of this study was to develop an in-depth understanding of the knowledge of deaf persons regarding services such as knowledge of contraceptive methods, pregnancy and safe abortion practices. Methods A sequential explanatory mixed-methods approach was adopted for this study. In the first quantitative phase, 288 deaf persons recruited from three out of the 16 regions in Ghana participated in this study. They completed a 31-item questionnaire on the main issues (knowledge of contraceptive methods, pregnancy and safe abortion practices) addressed in this study. In the second phase, a semi-structured interview guide was used to collect data from 60 participants who took part in the first phase. The key trend emerging in the first phase underpinned the interview guide used for the data collection. While the quantitative data were subjected to the computation of means, t-tests, analyses of variance, correlations and linear regressions to understand the predictors, the in-depth interviews were analysed using the thematic method of analysis. Results The results showed a convergence between the quantitative and qualitative data. For instance, the interview material supported the initial findings that deaf women had little knowledge of contraceptive methods. The participants offered reasons explaining their inability to access services and the role of religion in their understanding of SRH. Conclusion The study concludes by calling on policymakers to consider the needs of deaf persons in future SRH policies. The study limitations and other implications for future policymaking are discussed.
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Affiliation(s)
- William Nketsia
- School of Education, Western Sydney University, Sydney, Australia
| | - Wisdom Kwadwo Mprah
- Centre for Disability and Rehabilitation Studies, Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Maxwell Peprah Opoku
- Special Education Department, United Arab Emirates University, P. O. Box 15551, Al-Ain, United Arab Emirates.
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Zahra F, Austrian K, Gundi M, Psaki S, Ngo T. Drivers of Marriage and Health Outcomes Among Adolescent Girls and Young Women: Evidence From Sub-Saharan Africa and South Asia. J Adolesc Health 2021; 69:S31-S38. [PMID: 34809897 DOI: 10.1016/j.jadohealth.2021.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/24/2021] [Accepted: 09/14/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Previous studies have examined the relationship between age at marriage and health outcomes, but few have explored how marriage drivers are associated with health outcomes. In this study, we examine the relationship between two marriage drivers, premarital pregnancy and agency, and several health outcomes (use of maternal health care services, child health outcomes, and change in depressive symptoms) among married adolescent girls and young women (AGYW) in sub-Saharan Africa and South Asia. METHODS We use three panel data sets collected by the Population Council: the Adolescent Girls Empowerment Program from Zambia (N = 660), the Malawi Schooling and Adolescent Study from Malawi (N = 1,041), and Understanding the Lives of Adolescents and Young Adults from India (N = 894 in Bihar, N = 599 in Uttar Pradesh). Our analytical models use logistic and multinomial logistic regression. RESULTS We find mixed evidence of the association between marriage drivers and health outcomes. Results show that having agency in marital partner choice in India is associated with both an increase and decrease in reported depressive symptoms. In addition, pregnancy before marriage is associated with fewer antenatal visits and hospital-based births in Malawi than pregnancy after marriage. However, we find no evidence that it is associated with worse child health outcomes than pregnancy after marriage in Malawi and Zambia. CONCLUSIONS Overall, our study suggests that the relationship between marriage drivers and AGYW's health outcomes after marriage is not consistent across contexts. We highlight the importance of interpreting marriage drivers within prevailing norms to understand their impact on married AGYW's health.
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Affiliation(s)
- Fatima Zahra
- GIRL Center, Population Council, Washington, DC.
| | | | - Mukta Gundi
- Poverty, Gender, and Youth, Population Council, Delhi, India
| | - Stephanie Psaki
- GIRL Center, Population Council, Washington, DC; Social and Behavioral Science Research, Population Council, New York, NY
| | - Thoai Ngo
- Poverty, Gender, and Youth, Population Council, Delhi, India
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Gruending A, Chapman P, Govender V. "Imagining the world anew": a transformative, rights-based agenda for UHC and SRHR in 2021 and beyond. Sex Reprod Health Matters 2021; 28:1883805. [PMID: 33645462 PMCID: PMC8018544 DOI: 10.1080/26410397.2021.1883805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Anna Gruending
- Consultant, Partnership for Maternal, Newborn & Child Health, World Health Organization, WHO, Geneva, Switzerland
| | - Pete Chapman
- Managing Editor, Sexual and Reproductive Health Matters, London, UK. Correspondence:
| | - Veloshnee Govender
- Scientist, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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