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Leiva L, Torres-Cortés B, Antivilo-Bruna A, Zavala-Villalón G. Gender-transformative school-based sexual health intervention: study protocol for a randomized controlled trial. Trials 2024; 25:360. [PMID: 38835035 DOI: 10.1186/s13063-024-08191-w] [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: 01/21/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND There is general agreement that sexuality is a central aspect of human development; it is key in sexual health and reproductive education during adolescence. However, in spite of the existing interventions on this topic and the evidence generated, the inclusion of a gender focus in sexuality is relatively recent and there is little evidence available, thus structured and corroborated interventions with a gender-transforming perspective in sexuality are required. METHODS We will use a mixed method experimental design with a parallel cluster-randomized trial (GRTs) that will evaluate the effectiveness of a comprehensive gender-transformative intervention of sexual education (ENFOCATE -Focus-on-), which will be complemented with qualitative studies to understand the implementation process. The participants will be 609 10th and 11th-grade students. The randomization will be by grade, and the data will be collected at three moments (pre-intervention, post-intervention, and a 3-month follow-up). DISCUSSION Comprehensive, gender-focused, and culturally pertinent interventions in sexuality are needed for adolescents of countries with high, middle, and low incomes. These produce better results in terms of sexual health, and including a gender-transformative focus contributes to equity in health. Focus-on is unique since it uses a comprehensive gender-transformative intervention in sexual education that will allow putting into practice a program based both on international evidence and that which arises from the object population. It also uses a culturally-sensitive focus, since it is designed based on the characteristics of the object population; it will allow adapting some activities to the needs of the context in which it is developed. TRIAL REGISTRATION The study was prospectively registered on June 6, 2023, at ClinicalTrials.gov ID: NCT05896540. Protocol version number 1.0. May 22, 2023.
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Affiliation(s)
- Loreto Leiva
- Department of Psychology, University of Chile, Santiago, Chile.
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Odii A, Akamike IC, Mbachu CO, Onwujekwe O. Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria. BMC Health Serv Res 2024; 24:643. [PMID: 38764028 PMCID: PMC11102607 DOI: 10.1186/s12913-024-11103-y] [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: 10/06/2023] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. METHODS The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. RESULTS The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. CONCLUSIONS The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.
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Affiliation(s)
- Aloysius Odii
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Sociology/Anthropology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ifeyinwa Chizoba Akamike
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria.
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi, Nigeria.
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Nsukka, Enugu, Nigeria
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Olson R, Lehman J, Mejia A, Ojeikhodion R, Osiecki K, Kathambi E, Kati SS, Randolph A. Just in case: undergraduate students identifying and mitigating barriers to their sexual and reproductive health needs. BMC Womens Health 2024; 24:96. [PMID: 38321420 PMCID: PMC10845645 DOI: 10.1186/s12905-023-02854-7] [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: 08/01/2023] [Accepted: 12/19/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Many U.S. colleges and universities offer access to a healthcare center that provides sexual and reproductive health (SRH) resources, services, and products. The importance of health centers in college and university settings in reducing sexual health disparities in student populations cannot be stressed enough. This article evaluates a student-led, mutual-aid, grassroots health promotion strategy for students with limited access to healthcare services, supplies, and tools via an anonymous and discrete distribution of SRH resources without charge. METHODS In partnership with faculty, undergraduate students worked to address their school's unmet SRH needs by increasing on-campus access to comprehensive, evidence-based, and sex-positive resources. Referred to as Just in Case, this student-led, grassroots health promotion program provided students with supply kits containing contraceptives, sexual health wellness products, basic hygiene supplies, and education materials. Students were surveyed in a pre- (n = 95) post- (n = 73) pilot study to identify contraception acquisition barriers, discern perceptions of on-campus SRH resources, and elucidate trends in this program's use and impact. Chi-square tests of independence were used to compare survey group responses, and association rule mining was employed in tandem to identify SRH items that students requested. RESULTS Students identified cost and privacy as significant barriers to acquiring sexual health products on campus. Of the 182 Just in Case supply kits requested by students during the 2022-2023 academic year, condoms were requested most frequently in 75% of fulfilled kits, while emergency contraception and pregnancy tests were asked most often in 61% of kits. 50% of students reported access to contraceptives on campus before this program's implementation, growing to 75% (p < 0.001) 1 year later post-implementation. Similar jumps were observed for reported access to sexual health education (30 to 73%, p < 0.001) and services (36 to 73%, p < 0.001). CONCLUSION A student-led SRH supply and resource delivery strategy may immediately reduce SRH inequities and decrease barriers to contraceptive use for students with limited access to on-site SRH product availability.
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Affiliation(s)
- Rachel Olson
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, USA
| | - Jonathan Lehman
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Angie Mejia
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA.
| | - Rachael Ojeikhodion
- Center for Learning Innovation, University of Minnesota Rochester, Rochester, MN, USA
| | - Kristin Osiecki
- Center for Health Equity, Minnesota Department of Health, Minneapolis, MN, USA
| | - Emily Kathambi
- University of Minnesota Twin Cities, Minneapolis, MN, USA
| | | | - Anita Randolph
- Community Engagement and Education (CEEd) Hub, Masonic Institute for the Developing Brain (MIDB), University of Minnesota Twin Cities, Minneapolis, MN, USA
- Department of Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN, USA
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Koch M, Tyson N, Bhuinneain GMN, Kasliwal A, Conry J, Sridhar A. FIGO position statement on comprehensive sexuality education. Int J Gynaecol Obstet 2024; 164:531-535. [PMID: 38219018 DOI: 10.1002/ijgo.15319] [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: 01/15/2024]
Abstract
Now is a pivotal moment in the fight for reproductive health and justice internationally. Well-established research has recognized the benefits of comprehensive sexuality education for youth and adolescents-including vast reproductive health benefits, decreased interpersonal violence, and improvements on measures of academic success and well-being. Despite these established benefits, challenges to the implementation of culturally sensitive and holistically framed sexuality education are intensifying across the globe. The International Federation of Gynecology and Obstetrics (FIGO) stands firmly in its support of comprehensive sexuality education and re-emphasizes the importance of the implementation of scientifically accurate, age-appropriate, culturally relevant, and inclusive education. Successful implementation relies on active youth leadership, physician involvement, and a renewed focus on high-quality monitoring mechanisms to assess impact and accountability at all levels. Most importantly, future efforts to improve and scale comprehensive sexuality education must emphasize the importance of an inclusive curriculum that addresses previously marginalized youth, such as LGTBQ+ and disabled individuals, through a reproductive justice lens. FIGO commits, and encourages the international healthcare community, to provide continued advocacy for the rights to health, education, and equality, in order to achieve improvement in health outcomes for young people across the globe.
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Affiliation(s)
- Mikaela Koch
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Nichole Tyson
- Stanford University School of Medicine, Stanford, California, USA
- FIGO Committee on Contraception, London, UK
| | - G Meabh Ni Bhuinneain
- Royal College of Physicians of Ireland (RCPI), Dublin, Ireland
- FIGO Committee on Well Woman Health Care, London, UK
| | - Asha Kasliwal
- FIGO Committee on Contraception, London, UK
- Manchester Foundation Trust, Manchester, UK
| | | | - Aparna Sridhar
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
- FIGO Committee on Contraception, London, UK
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Braverman-Bronstein A, Vidaña-Pérez D, Diez Roux AV, Pérez Ferrer C, Sánchez BN, Barrientos-Gutiérrez T. Association of service facilities and amenities with adolescent birth rates in Mexican cities. BMC Public Health 2023; 23:1321. [PMID: 37430299 PMCID: PMC10334546 DOI: 10.1186/s12889-023-16251-0] [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: 10/31/2022] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The association of the built environment and the structural availability of services/amenities with adolescent birth rates (ABR) has been overlooked in Latin America. We investigated the association of the availability, and changes in the availability, of services/amenities with ABR in 92 Mexican cities. METHODS We estimated ABR using data on live birth registration linked to municipality of residence at the time of birth from 2008-2017. The number of services/amenities were obtained from the National Statistical Directory of Economic Units in 2010, 2015, and 2020 and grouped as follows: education, health care, pharmacies, recreation, and on- and off-premises alcohol outlets. Data were linearly interpolated to obtain yearly estimates. We estimated densities per square km by municipality. We fitted negative binomial hybrid models, including a random intercept for municipality and city, and adjusted for other social environment variables. RESULTS After adjustment a 1-unit increase in the density of recreation facilities, pharmacies, and off-premises alcohol outlets within municipalities was associated with a 5%, 4% and 12% decrease in ABR, respectively. Municipalities with higher density of education, recreational and health care facilities had a lower ABR; in contrast, municipalities with a higher density of on-premises alcohol experienced a higher ABR. CONCLUSION Our findings highlight the importance of economic drivers and the need to invest in infrastructure, such as pharmacies, medical facilities, schools, and recreation areas and limit the availability of alcohol outlets to increase the impact of current adolescent pregnancy prevention programs.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana V Diez Roux
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | | | - Brisa N Sánchez
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Population Health Research, National Institute of Public Health, Av. Universidad 655, 62100, Cuernavaca, Mexico.
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Braverman-Bronstein A, Ortigoza AF, Vidaña-Pérez D, Barrientos-Gutiérrez T, Baldovino-Chiquillo L, Bilal U, Friche AADL, Diez-Canseco F, Maslowsky J, Vives V. A, Diez Roux AV. Gender inequality, women's empowerment, and adolescent birth rates in 363 Latin American cities. Soc Sci Med 2023; 317:115566. [PMID: 36446141 PMCID: PMC7613905 DOI: 10.1016/j.socscimed.2022.115566] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/10/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender inequality is high in Latin America (LA). Empowering girls and young women and reducing gender gaps has been proposed as a pathway to reduce adolescent pregnancy. We investigated the associations of urban measures of women's empowerment and gender inequality with adolescent birth rates (ABR) in 366 Latin American cities in nine countries. METHODS We created a gender inequality index (GII) and three Women Achievement scores reflecting domains of women's empowerment (employment, education, and health care access) using censuses, surveys, and political participation data at city and sub-city levels. We used 3-level negative binomial models (sub-city-city-countries) to assess the association between the GII and scores, with ABR while accounting for other city and sub-city characteristics. RESULTS We found within country heterogeneity in gender inequality and women's empowerment measures. The ABR was 4% higher for each 1 standard deviation (1-SD) higher GII (RR 1.04; 95%CI 1.01,1.06), 8% lower for each SD higher autonomy score (RR 0.92; 95%CI 0.86, 0.99), and 12% lower for each SD health care access score (RR 0.88; 95%CI 0.82,0.95) after adjustment for city level population size, population growth, homicide rates, and sub-city population educational attainment and living conditions scores. CONCLUSION Our findings show the key role cities have in reducing ABR through the implementation of strategies that foster women's socioeconomic progress such as education, employment, and health care access.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F. Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health Cuernavaca, Mexico
| | | | | | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alejandra Vives V.
- Department of Public Health, School of Medicine / CEDEUS. Pontificia Universidad Católica de Chile. Santiago de Chile, Chile
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA
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C. Millanzi W. Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.109048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.
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Stein RA, Grayon A, Katz A, Chervenak FA. The Zika virus: an opportunity to revisit reproductive health needs and disparities. Germs 2022; 12:519-537. [PMID: 38021183 PMCID: PMC10660223 DOI: 10.18683/germs.2022.1357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/24/2022] [Accepted: 12/29/2022] [Indexed: 12/01/2023]
Abstract
First isolated in 1947, the Zika virus was initially connected only to limited or sporadic human infections. In late 2015, the temporal clustering of a Zika outbreak and microcephaly in newborn babies from northeastern Brazil, and the identification of a causal link between the two, led to the characterization of the congenital Zika syndrome. In the wake of the epidemic, several countries from Latin America advised women to postpone pregnancies for periods ranging from six months to two years. These recommendations initiated critical conversations about the challenges of implementing them in societies with limited access to contraception, widespread socioeconomic inequalities, and high rates of unplanned and adolescent pregnancies. The messaging targeted exclusively women, despite a high prevalence of imbalances in the relationship power, and addressed all women as a group, failing to recognize that the decision to postpone pregnancies will impact different women in different ways, depending on their age at the time. Finally, in several countries affected by the Zika epidemic, due to restrictive reproductive policies, legally terminating a pregnancy is no longer an option even at the earliest time when brain malformations as part of the congenital Zika syndrome can be detected by ultrasonography. The virus continued to circulate after 2016 in several countries. Climate change models predict an expansion of the geographical area where local Zika transmission may occur, indicating that the interface between the virus, teratogenesis, and reproductive rights is a topic of considerable interest for medicine, social sciences, and public health for years to come.
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Affiliation(s)
- Richard A. Stein
- MD, PhD, NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Alexis Grayon
- NYU Tandon School of Engineering, Department of Chemical and Biomolecular Engineering, 6 MetroTech Center, Brooklyn 11201, NY, USA
| | - Adi Katz
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
| | - Frank A. Chervenak
- MD, Department of Obstetrics and Gynecology, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 110 E 77th Street, New York, NY, 10075, USA
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Burchett HED, Griffin S, de Melo M, Picardo JJ, Kneale D, French RS. Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14414. [PMID: 36361287 PMCID: PMC9658296 DOI: 10.3390/ijerph192114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sally Griffin
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | | | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Braverman-Bronstein A, Vidaña-Pérez D, Ortigoza AF, Baldovino-Chiquillo L, Diez-Canseco F, Maslowsky J, Sánchez BN, Barrientos-Gutiérrez T, Diez Roux AV. Adolescent birth rates and the urban social environment in 363 Latin American cities. BMJ Glob Health 2022; 7:bmjgh-2022-009737. [PMID: 36253017 PMCID: PMC9577896 DOI: 10.1136/bmjgh-2022-009737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/06/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction Latin America has the second-highest adolescent birth rate (ABR) worldwide. Variation between urban and rural areas and evidence linking country development to ABR points towards upstream factors in the causal pathway. We investigated variation in ABR within and between cities, and whether different features of urban social environments are associated with ABR. Methods We included 363 cities in 9 Latin American countries. We collected data on social environment at country, city and subcity levels and birth rates among adolescents (ages 15–19). We investigated variation in ABR within and between countries and cities along with associations between social environment and ABR by fitting three-level negative binomial models (subcities nested within cities nested within countries). Results The median subcity ABR was 58.5 per 1000 women 15–19 (IQR 43.0–75.3). We found significant variability in subcity ABR between countries and cities (37% of variance between countries and 47% between cities within countries). Higher homicide rates and greater population growth in cities were associated with higher ABR (rate ratio (RR) 1.09; 95% CI 1.06 to 1.12 and RR 1.02; 95% CI 1.00 to 1.04, per SD, respectively), while better living conditions and educational attainment in subcities were associated with lower ABR after accounting for other social environment characteristics (RR 0.95; 95% CI 0.92 to 0.98 and 0.78; 95% CI 0.76 to 0.79, per SD, respectively). Conclusions The large heterogeneity of ABR found within countries and cities highlights the key role urban areas have in developing local policies. Holistic interventions targeting education inequalities and living conditions are likely important to reducing ABR in cities.
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Affiliation(s)
- Ariela Braverman-Bronstein
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Dèsirée Vidaña-Pérez
- Center for Survey Research and Evaluation, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Julie Maslowsky
- Center of Excellence in Maternal and Child Health School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Brisa N. Sánchez
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | | | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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Câmara SMA, McGurk MD, Gigante D, Lima MDA, Shalaby AK, Sentell T, Pirkle CM, Domingues MR. Intersections between adolescent fertility and obesity-pathways and research gaps focusing on Latin American populations. Ann N Y Acad Sci 2022; 1516:18-27. [PMID: 35781886 PMCID: PMC9588536 DOI: 10.1111/nyas.14854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Latin America has notably elevated rates of adolescent fertility and obesity in women. Although numerous studies document associations between adolescent fertility and obesity across the life course, the pathways explaining their association are insufficiently theorized, especially regarding the factors in Latin America that may underpin both. Additionally, much of the existing research is from high-income countries, where fertility and obesity are trending down. In this paper, we review the various complex pathways linking adolescent fertility and obesity, highlighting research gaps and priorities, with a particular focus on Latin American populations. We carefully consider pregnancy's distinct impact on growth trajectories during the critical period of adolescence, as well as the cumulative effect that adolescent fertility may have over the life course. We also articulate a pathway through obesity as it may contribute to early puberty and thus, to adolescent fertility. If obesity is a cause of adolescent fertility, not a result of it, or if it is a mediator of early-life exposures to adulthood obesity, these are critical distinctions for policy aiming to prevent both obesity and early fertility. Research to better understand these pathways is essential for prevention efforts against obesity and undesired adolescent fertility in Latin America.
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Affiliation(s)
- Saionara M. A. Câmara
- Postgraduate program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Meghan D. McGurk
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Denise Gigante
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
- Postgraduate Program in Nutrition and Food, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Mateus D. A. Lima
- Postgraduate Program in Rehabilitation Sciences, Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Santa Cruz, RN, Brazil
| | - Alena K. Shalaby
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Tetine Sentell
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Catherine M. Pirkle
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Honolulu, HI, USA
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Di Giusto ML, Ertl MM, Ramos-Usuga D, Carballea D, Degano M, Perrin PB, Arango-Lasprilla JC. Sexual Health and Sexual Quality of Life Among Individuals With Spinal Cord Injury in Latin America. Top Spinal Cord Inj Rehabil 2022; 29:54-69. [PMID: 36819930 PMCID: PMC9936902 DOI: 10.46292/sci21-00080] [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] [Indexed: 11/19/2022]
Abstract
Background Sexual changes are an area of primary concern for individuals with spinal cord injury (SCI) and their partners, but the topic has gone largely unexplored in the research literature. Objectives This study examined how individuals with SCI in Latin America experience their sexuality and what issues they and their partners face in this area. Methods A total of 248 individuals with SCI from Latin America completed an online 60-item survey regarding sexuality. Results The majority of participants (87.7%) reported that they had noticed changes in sexuality after the injury, mainly physical problems (50.7%), emotional problems (38.7%), and changes in relationships with partners (27.5%). Regarding sexual desire, 47.2% indicated that desire remained the same after SCI. The majority of participants (81.9%) indicated not having received any information about sexuality after SCI during their hospital stay but reported that they would have liked to have received information (98.1%). Of all participants, 66.1% reported never having been asked about problems or difficulties in their sexual life after SCI by any health professional. Conclusion Interventions designed to educate individuals with SCI regarding the effect of injury on their sexual functioning, responsiveness, and expression, as well as to support them in maintaining and enhancing their sexual well-being, may be extremely beneficial, particularly in Latin America. Findings highlight the distinct need for professionals to introduce the topic of sexuality by discussing it in a straightforward, nonjudgmental manner and to integrate discussions about sex and related issues into assessment, planning, and ongoing treatment.
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Affiliation(s)
- Melina Longoni Di Giusto
- ReDel Rehabilitation Center, Buenos Aires, Argentina
- Universidad Abierta Interamericana, Rosario, Santa Fe, Argentina
| | - Melissa M Ertl
- Department of Psychiatry, HIV Center for Clinical and Behavioral Studies at Columbia University and New York State Psychiatric Institute, New York, New York
| | - Daniela Ramos-Usuga
- Biomedical Research Doctorate Program, University of the Basque Country, Leioa, Spain
| | | | | | - Paul B Perrin
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Juan Carlos Arango-Lasprilla
- Departments of Psychology and Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
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Burchett HED, Kneale D, Griffin S, de Melo M, Picardo JJ, French RS. Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11715. [PMID: 36141987 PMCID: PMC9517431 DOI: 10.3390/ijerph191811715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Sally Griffin
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | | | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Morales-Álvarez CT, Sáenz-Soto NE, Manjarrés-Posada NI, Barrera de León JC. m-Health en intervenciones para incrementar el uso de anticonceptivos en adolescentes latinas: revisión de alcance. Rev Salud Publica (Bogota) 2022. [DOI: 10.15446/rsap.v24n3.99674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
Objetivo Mapear la forma de uso y el efecto de las tecnologías m-Health en intervenciones a fin de incrementar el uso de anticonceptivos en adolescentes latinas.
Métodos Se realizó una revisióón de alcance a partir de Peters M en octubre de 2021; se recuperaron artículos del 2015 a 2021 en EBSCO Host, PubMed y BVS, LILACS, SciELO, Web of Science y Scopus, en inglés, español y portugués.
Resultados Se identificaron ocho artículos que emplearon las m-Health como potencializadoras. La forma de uso fue ampliamente heterogénea en dosis, intervalo e interacción. El efecto significativo para el uso de anticonceptivos fue reportado en tres diseños experimentales, con una buena aceptabilidad y viabilidad para futuros experimentos.
Discusión Las m-Health ofrecen una oportunidad de incrementar el uso de anticon-ceptivos en adolescentes. Al momento, su efecto es controversial debido a la escasez de intervenciones de este tipo. Por lo tanto, se requieren estudios rigurosos que consideren procesos de adaptación a contextos latinos
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Obach A, Sadler M, Cabieses B, Bussenius P, Muñoz P, Pérez C, Urrutia C. Strengths and challenges of a school-based sexual and reproductive health program for adolescents in Chile. PLoS One 2022; 17:e0265309. [PMID: 35320306 PMCID: PMC8942266 DOI: 10.1371/journal.pone.0265309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/28/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago.
Methods
We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis.
Results
Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers.
Conclusion
Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.
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Affiliation(s)
- Alexandra Obach
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- * E-mail:
| | - Michelle Sadler
- Departamento de Historia y Ciencias Sociales, Facultad de Artes Liberales, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Báltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Pascale Bussenius
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Patricia Muñoz
- Corporación Municipal de Lo Prado, Ilustre Municipalidad de Lo Prado, Santiago, Chile
| | - Claudia Pérez
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Carla Urrutia
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
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Hennis AJM, Coates A, Del Pino S, Ghidinelli M, Gomez Ponce de Leon R, Bolastig E, Castellanos L, Oliveira E Souza R, Luciani S. COVID-19 and inequities in the Americas: lessons learned and implications for essential health services. Rev Panam Salud Publica 2022; 45:e130. [PMID: 34987555 PMCID: PMC8713468 DOI: 10.26633/rpsp.2021.130] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/07/2021] [Indexed: 12/30/2022] Open
Abstract
The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.
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Affiliation(s)
- Anselm J M Hennis
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Anna Coates
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Sandra Del Pino
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Massimo Ghidinelli
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Rodolfo Gomez Ponce de Leon
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Edwin Bolastig
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Luis Castellanos
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Renato Oliveira E Souza
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
| | - Silvana Luciani
- Pan American Health Organization Washington, D.C. United States of America Pan American Health Organization, Washington, D.C., United States of America
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Larsson FM, Bowers-Sword R, Narvaez G, Ugarte WJ. Exploring sexual awareness and Decision-making among adolescent girls and boys in rural Nicaragua: A socio-ecological approach. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 31:100676. [PMID: 34775356 DOI: 10.1016/j.srhc.2021.100676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore how individual, relational, and social contexts influence adolescents' sexual awareness and decision-making in rural Nicaragua. METHODS Eighteen semi-structured interviews were conducted with adolescent boys and girls aged 15 to 19 years. Thematic analysis identified patterns of meaning applying a socio-ecological approach. A thematic map illustrates how the themes are organized according to the socio-ecological model and suggests their interactions. RESULTS Six main themes emerged as (1) Adolescence - a period of life changes, (2) Fears as a pathway to awareness and decision-making, (3) Awareness about protective measures, (4) Relational influences on adolescents' sexual health, (5) Service provision and institutional influences on awareness and decision-making and (6) Sociocultural determinants on adolescent sexual health. Informants of both genders expressed concern in several issues of their sexuality. They identified fear of pregnancy, STIs, and their impact on future goals, family communication, and school-based sexual education as protective factors for their sexual decision-making. Adolescents of both genders are challenging social and cultural norms by developing sexual agency. CONCLUSION These findings imply that personal and societal factors in rural Nicaragua produce a multi-dimensional effect on adolescent sexual self-efficacy. Our study is relevant for a wider discussion about sexual awareness to promote positive development and health outcomes particularly among adolescents' girls and boys living in rural settings.
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Affiliation(s)
- Frida M Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Gabriela Narvaez
- Faculty of Medicine, Nicaraguan National Autonomous University, León, Nicaragua
| | - William J Ugarte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Faculty of Medicine, Nicaraguan National Autonomous University, León, Nicaragua.
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18
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Del Risco-Sánchez O, Zambrano-Tanaka E, Guerrero-Borrego N, Surita F. Good prenatal care practices in teenage pregnancy from the perspective of healthcare professionals. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2021; 72:244-257. [PMID: 34851568 PMCID: PMC8616584 DOI: 10.18597/rcog.3695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/05/2021] [Indexed: 11/16/2022]
Abstract
Objective To systematize good prenatal care practices in a referral center for pregnant teenagers in Campinas, São Paulo, Brazil, from the perspective of healthcare professionals. Materials and Methods Qualitative study conducted between June and July 2017 using semi-structured interviews and a focus group with 10 healthcare professionals providing care to pregnant teenagers in a public hospital in the region of Campinas, São Paulo, Brazil. Data were examined using the thematic content analysis technique, which gave rise to new analytical categories. Triangulation of the results was used for validation. The theoretical and practical applicability of the main findings was identified. Results The study looked into three categories arising from the discourse of the professionals and the evidence found in the literature: 1) comprehensive analysis of pregnant teenagers; 2) professional experiences related to the care of pregnant teenagers reflecting service quality; and 3) strengths and improvement opportunities potentially replicable as a care model. Good practices in prenatal care are those which prioritize comprehensive care for pregnant teenagers, are coordinated by a multidisciplinary team and result in a multidimensional approach, valuing the complexity of motherhood in the teenage years. Conclusions It is advisable to develop education strategies, strengthen group care and involve the teenager’s support network as part of sexual and reproductive health services in order to promote a positive experience during prenatal care when the process of becoming a mother takes place during adolescence.
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Affiliation(s)
| | - Erika Zambrano-Tanaka
- Universidade Estadual de Campinas, Área da Saúde da Mulher e do Recém Nascido (UNICAMP), Campinas (Brasil). .
| | - Natividad Guerrero-Borrego
- Centro Nacional de Educación Sexual (CENESEX), Departamento de Investigación y Docencia, La Habana (Cuba)..
| | - Fernanda Surita
- Universidade Estadual de Campinas (UNICAMP), Campinas (Brasil)..
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López-Gómez A, Graña S, Ramos V, Benedet L. [Development of a comprehensive public policy for adolescent pregnancy prevention in UruguayDesenvolvimento de uma política pública abrangente de prevenção da gravidez na adolescência no Uruguai]. Rev Panam Salud Publica 2021; 45:e93. [PMID: 34394209 PMCID: PMC8359754 DOI: 10.26633/rpsp.2021.93] [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: 01/14/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
This article presents the main characteristics and achievements of Uruguay's National and Intersectoral Strategy for Prevention of Adolescent Pregnancy, implemented from 2016 to 2020. This strategy was implemented in a context in which unintentional adolescent pregnancy continues to be a major social problem for Uruguay and the Region, necessitating comprehensive, sustained, and evidence-based public policies. In Uruguay, adolescent fertility rates have remained high for over a decade. In addition to intersectoral action by government and civil society, the strategy received scientific assistance from the academic community, and technical and financial cooperation from regional and international organizations. Its actions and measures were adopted based on a socio-ecological vision, with cultural sensitivity, a gender-transformative approach, and a human rights perspective. Major barriers include social norms that value maternity as the main life project for women living in poverty, gender stereotypes (pregnancy as the exclusive responsibility of adolescent girls, without involving adolescent boys), the stigma of abortion, a lack of sexual and reproductive health services, and resistance to raising the visibility of pregnancy in girls under 15 years of age who are victims of structural and family violence. It is necessary to ensure the continuity of public policies--adjusted to a gender and human-rights approach--that take into account new scenarios such as the one imposed by the COVID-19 pandemic.
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Affiliation(s)
- Alejandra López-Gómez
- Universidad de la República Montevideo Uruguay Universidad de la República, Montevideo, Uruguay
| | - Silvia Graña
- Administración de Servicios de Salud del Estado Montevideo Uruguay Administración de Servicios de Salud del Estado, Montevideo, Uruguay
| | - Valeria Ramos
- Salud Sexual y Reproductiva, Fondo de Población de las Naciones Unidas Montevideo Uruguay Salud Sexual y Reproductiva, Fondo de Población de las Naciones Unidas, Montevideo, Uruguay
| | - Leticia Benedet
- Área de Género, Programa EUROsociAL+ Montevideo Uruguay Área de Género, Programa EUROsociAL+, Montevideo, Uruguay
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Agampodi TC, Wickramasinghe ND, Jayakodi HG, Amarasinghe GS, Warnasekara JN, Hettiarachchi AU, Jayasinghe IU, Koralegedara IS, Gunarathne SP, Somasiri DK, Agampodi SB. The hidden burden of adolescent pregnancies in rural Sri Lanka; findings of the Rajarata Pregnancy Cohort. BMC Pregnancy Childbirth 2021; 21:494. [PMID: 34233652 PMCID: PMC8265066 DOI: 10.1186/s12884-021-03977-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adolescent fertility is a main indicator of the Sustainable Developmental Goal (SGD) three. Although Sri Lanka is exemplary in maternal health, the utilization of Sexual and Reproductive Health services (SRH) by adolescents is less documented. We describe the hidden burden, associated biological and psychosocial factors and utilization patterns of pre-conceptional services among pregnant adolescents in rural Sri Lanka. METHODS The study is based on the baseline assessment of the Rajarata Pregnancy Cohort (RaPCo) in Anuradhapura. Pregnant women newly registered from July to September 2019 were recruited to the study. The period of gestation was confirmed during the second follow-up visit (around 25-28 weeks of gestation) using ultra sound scan data. A history, clinical examination, anthropometric measurements, blood investigations were conducted. Mental health status was assessed using the Edinburgh Postpartum Depression Scale (EPDS). RESULTS Baseline data on gestation was completed by 3,367 pregnant women. Of them, 254 (7.5%) were adolescent pregnancies. Among the primigravida mothers (n = 1037), 22.4% (n = 233) were adolescent pregnancies. Maternal and paternal low education level, being unmarried, and less time since marriage were statistically significant factors associated with adolescent pregnancies (p < 0.05). Contraceptive usage before pregnancy, utilization of pre-conceptional health care services, planning pregnancy and consuming folic acid was significantly low among adolescents (p < 0.001). They also had low body mass index (p < 0.001) and low hemoglobin levels (p = 0.03). Adolescent mothers were less happy of being pregnant (p = 0.006) and had significantly higher levels of anxiety (p = 0.009). CONCLUSION One fifth of women in their first pregnancy in this study population are adolescents. Nulli-parous adolescents exert poor social stability and compromised physical and mental health effects. The underutilization and/or unavailability of SRH services is clearly associated with adolescent pregnancies.
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Affiliation(s)
- Thilini Chanchala Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka.
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | | | - Gayani Shashikala Amarasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Janith Niwanthaka Warnasekara
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Ayesh Umeshana Hettiarachchi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Imasha Upulini Jayasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Iresha Sandamali Koralegedara
- Department of Anatomy, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, , Saliyapura, Sri Lanka
| | - Sajaan Praveena Gunarathne
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Dulani Kanchana Somasiri
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
| | - Suneth Buddhika Agampodi
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Saliyapura, 50008, Sri Lanka
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Aguía-Rojas K, Gallego-Ardila AD, Estrada Bonilla MV, Rodríguez-Niño JN. Individual and Contextual Factors Associated with Teenage Pregnancy in Colombia: A Multilevel Analysis. Matern Child Health J 2021; 24:1376-1386. [PMID: 32815078 DOI: 10.1007/s10995-020-02997-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze municipal- and individual-level factors related to the prevalence of teenage pregnancy in Colombia during 2015. METHODS We analyzed 660,767 births registers, of which 21.5% recorded adolescent women. At an individual level, marital status, educational level, area of residence, and access to health services were included in the analysis. At the contextual level, Colombian municipal socioeconomic characteristics and proxies of violence and poverty were analyzed. A multilevel logistic regression model was generated with a Markov Chain Monte Carlo estimation method using 100,000 simulations in MLwiN 2.32 software. RESULTS Multilevel modeling revealed an increased risk of teenage pregnancy in municipalities with the highest numbers of people expelled by forced displacement (OR 1.21; CI 95%, 1.13-1.29) and with unsatisfied basic needs (OR 1.09; CI 95%, 1.02-1.17). At an individual level, the majority of the teenage women were unmarried and/or had an unstable partnership, a low level of educational, a subsidized health regimen, and resided in the municipal seat. CONCLUSIONS Municipal contextual variables related to poverty, violence, and social inequity contribute to an increase in teenage pregnancy in Colombia. At the individual level, marital status, educational level, and area of residence is associated with teenage pregnancy. It is therefore imperative to include municipal contextual characteristics in the design of the national political agenda.
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Affiliation(s)
| | | | | | - Juan Nicolás Rodríguez-Niño
- Universidad del Rosario, Carrera 24 # 63c - 69, Bogotá, Colombia.,Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
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22
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Ituarte ML, López-Gómez A. [Adolescents faced with the decision to terminate a pregnancy in a context of legal abortion]. CAD SAUDE PUBLICA 2021; 37:e00235219. [PMID: 33729306 DOI: 10.1590/0102-311x00235219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 07/15/2020] [Indexed: 11/22/2022] Open
Abstract
The article presents the results of a study on the experiences of adolescents that decided to terminate a pregnancy in the context of legal abortion services in Montevideo, Uruguay, from 2016 to 2018. The main objective was to examine the decision-making process and access to legal abortion from the perspective of the adolescent girls themselves. This involved analyzing circumstances, motives, and persons that influenced the decision and the ways this was handled in the health services. A cross-sectional, exploratory, and descriptive study was designed, based on a qualitative methodology. The main technique used for collecting the information was a semi-structured interview with 14 adolescents 17 to 19 years of age who had voluntarily terminated a pregnancy in public healthcare services. The motives for the abortion reveal the weight of socially accepted reasons, incorporated as their own. The interviews showed that the adolescent's mother plays an important role as the reference for the decision. The adolescents reported that they had made the decision to have the abortion before going to the health service. The results highlight the positive role of a legal framework that enables voluntary abortion services. The results help understand the experiences of adolescents facing a difficult life decision, the family's role, particularly that of the adolescent's mother, the legal framework's place in the decision, the weight of stigma and moral sanctions, and expectations towards care in health services.
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Samadaee Gelehkolaee K, Maasoumi R, Azin SA, Nedjat S, Parto M, Zamani Hajiabadi I. Stakeholders' perspectives of comprehensive sexuality education in Iranian male adolescences. Reprod Health 2021; 18:26. [PMID: 33618726 PMCID: PMC7901096 DOI: 10.1186/s12978-021-01084-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perspectives and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (information, motivation, behavioral skills). Methods This study was a qualitative study that was analyzed through a directed content analysis approach. Individual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis. Results In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder’s partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers’ professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE. The most important of these was the change in macro policies, helping to create a culture against all forms of violence and breaking the taboo of sexuality education for children and adolescents. Conclusions The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers’ professional competence regarding the adolescents’ sexual health.
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Affiliation(s)
- Keshvar Samadaee Gelehkolaee
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Raziyeh Maasoumi
- Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. .,Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Ali Azin
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Saharnaz Nedjat
- Department of Epidemiology and Biostatistics, School of public health, Tehran University of Medical Sciences, Tehran, Iran
| | - Moslem Parto
- Faculty Member of Organization for Educational Research and Planning (OERP)-Research Institute for Education (RIE), Tehran, Iran
| | - Ilia Zamani Hajiabadi
- Student Research Committee, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
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Mutea L, Ontiri S, Kadiri F, Michielesen K, Gichangi P. Access to information and use of adolescent sexual reproductive health services: Qualitative exploration of barriers and facilitators in Kisumu and Kakamega, Kenya. PLoS One 2020; 15:e0241985. [PMID: 33180849 PMCID: PMC7660470 DOI: 10.1371/journal.pone.0241985] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/24/2020] [Indexed: 11/24/2022] Open
Abstract
Background Kenya has a high prevalence of adolescent pregnancy and low access to and use of adolescent sexual reproductive health services. Despite the enactment of evidence-based policies to address this problem, adolescents continue to face health problems and barriers to adolescent sexual reproductive health information and services. Main objective This study describes barriers to and facilitators of access to adolescent sexual and reproductive health services in Kisumu and Kakamega counties, Kenya. Methodology We used a qualitative design. Through 61 data collection sessions, 113 participants were engaged in key informant interviews, in-depth interviews, and/or focus group discussions. Trained Research Assistants (RAs) engaged adolescents, health care workers, teachers, county leaders, and community representatives. Data were captured using audio recorders and field notes. Socio-demographic data were analyzed for descriptive statistics, while audio recordings were transcribed, translated, and coded. Thematic analysis was done with NVivo. Results Findings show that the barriers of access to sexual reproductive health services and information were negative health workers’ attitudes, distance to the health facility, unaffordable cost of services, negative social cultural influences, lack of privacy and confidentiality. Facilitators to adolescent sexual reproductive health services were few and included getting priority for school going adolescents and enabling environment for partnerships on adolescent health issues. Conclusions Adolescents in Kakamega and Kisumu face a myriad of barriers when seeking sexual reproductive health information and/or health services. We recommend that counties sensitize all stakeholders on adolescent sexual reproductive health problems, and support development of multi-sectoral, sustainable solutions to adolescent health needs.
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Affiliation(s)
- Lilian Mutea
- U.S. Agency for International Development Kenya and East Africa, Nairobi, Kenya
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Susan Ontiri
- Jhpiego, John Hopkins University Affiliate, Nairobi, Kenya
- * E-mail:
| | - Francis Kadiri
- Jhpiego, John Hopkins University Affiliate, Nairobi, Kenya
| | | | - Peter Gichangi
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Apolot RR, Tetui M, Nyachwo EB, Waldman L, Morgan R, Aanyu C, Mutebi A, Kiwanuka SN, Ekirapa E. Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District- Uganda. Int J Equity Health 2020; 19:191. [PMID: 33131497 PMCID: PMC7604956 DOI: 10.1186/s12939-020-01267-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 01/15/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12-19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges. METHODS This qualitative study utilized in-depth interviews conducted in August 2018 among 15 purposively selected adolescent women who had given birth 2 years prior to the study and had attended CSC meetings. The study was conducted in six sub counties of Kibuku district where the CSC intervention was implemented. Research assistants transcribed the audio-recorded interviews verbatim, and data was analyzed manually using the framework analysis approach. FINDINGS This study found five major maternal health challenges faced by adolescents during pregnancy namely; psychosocial challenges, physical abuse, denial of basic human rights, unfriendly adolescent services, lack of legal and cultural protection, and lack of birth preparedness. The CSC addressed general maternal and new born health issues of the community as a whole rather than specific adolescent health related maternal health challenges. CONCLUSION The maternal health challenges faced by adolescents in Kibuku have a cultural, legal, social and health service dimension. There is therefore need to look at a multi-faceted approach to holistically address them. CSCs that are targeted at the entire community are unlikely to address specific needs of vulnerable groups such as adolescents. To address the maternal health challenges of adolescents, there is need to have separate meetings with adolescents, targeted mobilization for adolescents to attend meetings and deliberate inclusion of their maternal health challenges into the CSC.
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Affiliation(s)
- Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Moses Tetui
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
- Department of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Evelyne B. Nyachwo
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Linda Waldman
- Institute of Development Studies, Library Road, Brighton, BN1 9RE UK
| | - Rosemary Morgan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205 USA
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Suzanne N. Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
| | - Elizabeth Ekirapa
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O.Box 7072, Kampala, Uganda
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Gómez OSM, González KO. [Fertility in adolescent women and social inequalities in Mexico, 2015Fecundidade entre adolescentes e desigualdades sociais no México, 2015]. Rev Panam Salud Publica 2019; 42:e99. [PMID: 31093127 PMCID: PMC6386126 DOI: 10.26633/rpsp.2018.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 03/21/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To determine the association between teenage pregnancy and socioeconomic factors and to estimate social inequalities among adolescents in Mexico in 2015. Methods A study involving women from 15 to 19 years of age was conducted using data from birth records for 2015. The fertility rate was determined and disaggregated by quintiles for each socioeconomic variable. Absolute and relative measures of inequality were estimated; negative binomial regression analysis was used to obtain risk ratios and 95% confidence intervals. Results The fertility rate was 73.21 births per 1000 women between the ages of 15 and 19 years in Mexico. Coahuila was the state with the highest birth rate (99.3 per 1000 adolescents). A statistically significant association was found between fertility rate and the gap in access to health services, especially in quintile 5 (risk ratio [RR] = 45.68), whereas a greater association with the gap in education was found in quintile 4 (RR = 27.36). No significant differences were found in terms of the gap in access to social security. Conclusions Marginalization and poverty are significantly associated with teenage pregnancy and fertility rate. However, wide inequalities exist among the different social groups, making it necessary to implement actions geared towards promoting measures to improve the social, political, and economic environment.
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Affiliation(s)
| | - Karina Ortiz González
- Epidemiología Unidad Médica Familiar 15, Instituto Mexicano del Seguro Social, Ciudad de México, México
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Sentell T, da Câmara SMA, Ylli A, Velez MP, Domingues MR, Bassani DG, Guo M, Pirkle CM. Data gaps in adolescent fertility surveillance in middle-income countries in Latin America and South Eastern Europe: Barriers to evidence-based health promotion. SOUTH EASTERN EUROPEAN JOURNAL OF PUBLIC HEALTH 2019; 11:214. [PMID: 32432023 PMCID: PMC7236900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adolescent health is a major global priority. Yet, as recently described by the World Health Organization (WHO), increased recognition of the importance of adolescent health rarely transforms into action. One challenge is lack of data, particularly on adolescent fertility. Adolescent pregnancy and childbirth are widespread and affect lifetime health and social outcomes of women, men, and families. Other important components of adolescent fertility include abortion, miscarriage, and stillbirth. Access to reliable, consistently-collected data to understand the scope and complexity of adolescent fertility is critical for designing strong research, developing meaningful policies, building effective programs, and evaluating success in these domains. Vital surveillance data can be challenging to obtain in general, and particularly in low- and middle-income countries and other under-resourced settings (including rural and indigenous communities in high-income countries). Definitions also vary, making comparisons over time and across locations challenging. Informed by the Adolescence and Motherhood Research project in Brazil and considering relevance to the Southern Eastern European (SEE) context, this article focuses on challenges in surveillance data for adolescent fertility for middle-income countries. Specifically, we review the literature to: (1) discuss the importance of understanding adolescent fertility generally, and (2) highlight relevant challenges and complexity in collecting adolescent fertility data, then we (3) consider implications of data gaps on this topic for selected middle-income countries in Latin America and SEE, and (4) propose next steps to improve adolescent fertility data for evidence-based health promotion in the middle-income country context.
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Affiliation(s)
| | | | - Alban Ylli
- Department of Epidemiology and Health Systems, Institute of Public Health, Tirana, Albania
| | - Maria P. Velez
- Departments of Obstetrics and Gynaecology & Public Health Sciences, Queen’s University, Kingston General Hospital, Ontario, Canada
| | - Marlos R. Domingues
- Postgraduate Programme in Physical Education, Federal University of Pelotas, Pelotas, Brazil
| | - Diego G. Bassani
- Department of Paediatrics, Faculty of Medicine & Dalla Lana School of Public Health University of Toronto, Toronto, Canada
| | - Mary Guo
- Office of Public Health Studies, Honolulu, Hawaii, USA
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Parker JJ, Veldhuis CB, Hughes TL, Haider S. Barriers to contraceptive use among adolescents in two semi-rural Nicaraguan communities. Int J Adolesc Med Health 2019; 32:ijamh-2017-0228. [PMID: 30939115 DOI: 10.1515/ijamh-2017-0228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/01/2018] [Indexed: 06/09/2023]
Abstract
Objective To identify barriers to contraceptive use among adolescents in two neighboring semi-rural communities in Nicaragua. Methods We recruited and surveyed a convenience sample of 287 adolescents, ages 15-19 years old, in July and August, 2013 about barriers to contraceptive use. We compared adolescents by gender, sexually active status (sexual intercourse in the previous year) and frequency of contraceptive use. Results More than 40% (43.5%) of the adolescents surveyed reported that they had ever had sexual intercourse. The likelihood of ever having had sexual intercourse differed based on gender, relationship status, sexual activity of peers, and the presence of a father in the home. Contraceptive use was low and female adolescents were more likely than their male counterparts to report never or rarely using contraceptives (46.5% vs. 21.4%, p < 0.007). Contraceptive use for females was positively associated with discussing contraception with a healthcare professional (HCP) [adjusted odds ratio (AOR) 13.32; 95% confidence interval (CI) 1.35-139.98] and a family member (AOR 4.64; 95% CI 1.09-19.72). Reasons for non-use also varied significantly by gender. Low rates of contraceptive use in these two semi-rural Nicaraguan communities appear to be primarily related to gender norms, social stigma, and poor communication about family planning. Conclusions Interventions that focus on promoting gender equality and encouraging adolescent communication with HCPs, schools, families, and partners are imperative to combating adolescent pregnancy in Nicaragua and countries worldwide.
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Affiliation(s)
- J J Parker
- Center for Global Health, University of Illinois at Chicago, 1940 W Taylor Street, Room 214, Chicago, IL 60612, USA, Phone: +847.525.9882
| | - Cindy B Veldhuis
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
- School of Nursing, Columbia University, New York, NY, USA
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, NY, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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Obach A, Sadler M, Cabieses B. Intersectoral strategies between health and education for preventing adolescent pregnancy in Chile: Findings from a qualitative study. Health Expect 2019; 22:183-192. [PMID: 30369026 PMCID: PMC6433321 DOI: 10.1111/hex.12840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In Chile, despite its steady decrease overall, adolescent pregnancy is concentrated in the most vulnerable population. Efforts in intersectoral collaboration between health and education to address the problem are being developed, but they have not been assessed. OBJECTIVE To describe intersectoral strategies between health and education to address adolescent sexual and reproductive health, prevent adolescent pregnancy, and to explore adolescents' and health professionals' perceptions regarding those strategies. DESIGN A qualitative ethnographic study was carried out in five municipalities in the Metropolitan Region of Chile. A sample of five key informants, 23 health professionals and 50 adolescents participated in a total of 38 semi-structured interviews and five discussion groups. RESULTS Two intersectoral strategies to respond to adolescents' sexual and reproductive health needs were identified: (a) the "in-and-out" strategy, where health professionals provide health care mostly in health centres and carry out specific actions in schools and (b) the school-based strategy in which health professionals carry out continuous actions in schools as part of the curriculum. The second is perceived as responding better to adolescents' needs in sexual and reproductive health issues and in preventing adolescent pregnancy. DISCUSSION The school-based strategy, with the constant presence of health professionals and lack of bureaucratic procedures, facilitates adolescents to access sexual and reproductive health care. This strategy enables sexual and reproductive health to be understood as an integral dimension of adolescents' lives, and it reinforces a holistic idea of health in which it is approached as a whole.
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Affiliation(s)
- Alexandra Obach
- Social Studies in Health Research ProgrammeFacultad de Medicina Clínica AlemanaUniversidad del DesarrolloSantiagoChile
| | - Michelle Sadler
- Department of History and Social SciencesFaculty of Liberal ArtsUniversidad Adolfo IbáñezSantiagoChile
- Medical Anthropology Research CenterUniversitat Rovira i VirgiliTarragonaSpain
| | - Báltica Cabieses
- Social Studies in Health Research ProgrammeFacultad de Medicina Clínica AlemanaUniversidad del DesarrolloSantiagoChile
- Department of Health SciencesUniversity of YorkYorkUK
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González-Quiñones JC, Hernández-Pardo ÁM, Salamanca-Preciado JP, Guzmán-Castillo KA, Quiroz Rivera RM. [Changes in prevalence of knowledge, attitudes and practices of sexuality in teenage students, Bogotá, 2011-2015]. Rev Salud Publica (Bogota) 2019; 21:202-208. [PMID: 33027330 DOI: 10.15446/rsap.v21n2.73371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 02/22/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To present the changes in the prevalence of knowledge, attitudes and practices in high school adolescents in sexuality after an intervention process. METHODOLOGY Observational descriptive study. It was administered a questionnaire to 319 adolescents, attending three public schools, for five consecutive years as they progressed in school years (seventh to eleventh). Health promotion workshops were held. Changes in the prevalence were measured (identification of the menstrual cycle, emergency contraception and, condom protection, as well as parents' acceptance of contraception methods, having sex, reasons for do it and, whether they used protection in the first and last relationship). The results were compared by gender. RESULTS The identification of emergency contraception was increased from 52% in seventh to 70% in eleven; also, the certainty of the condom protection (from 45% to 62%, respectively). The average of the prevalence of sexual intercourse was 24%, protection in the first relationship 52% and, in the last one was 81%; no statistical differences of these variables were found when comparing them by gender. Parents' perception of acceptance of planning increased from 45% to 79%. CONCLUSION The program results highlighted the need to strengthen the educational processes.
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Affiliation(s)
- Juan C González-Quiñones
- JG: MD. M. Sc. Salud Pública. Fundación Universitaria Juan N Corpas. Profesor titular. Facultad de Medicina. Bogotá, Colombia.
| | - Ángela M Hernández-Pardo
- AH: MD. M. Sc. Educación. Fundación Universitaria Juan N Corpas. Profesora asociada. Facultad de Medicina. Bogotá, Colombia.
| | | | | | - Ruth M Quiroz Rivera
- RQ: Enf. M. Sc. Sexología. Fundación Universitaria Juan N. Corpas. Bogotá, Colombia.
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Johnson RK, Lamb M, Anderson H, Pieters-Arroyo M, Anderson BT, Bolaños GA, Asturias EJ. The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala. BMC Public Health 2019; 19:226. [PMID: 30795754 PMCID: PMC6387528 DOI: 10.1186/s12889-019-6539-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala. Methods In July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions. Results Five hundred fifty-four out of 620 (87%) students aged 12–18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95–4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation. Conclusions The GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.
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Affiliation(s)
- Randi K Johnson
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Molly Lamb
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Hillary Anderson
- Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | | | - Bradley T Anderson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Guillermo A Bolaños
- Center for Human Development, Fundacion para la Salud Integral de los Guatemaltecos, Quetzaltenango, Coatepeque, Guatemala
| | - Edwin J Asturias
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA. .,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA. .,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA. .,Section of Pediatric Infectious Diseases and Jules Amer Chair in Community Pediatrics, Children's Hospital Colorado, Aurora, CO, USA.
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Neal S, Harvey C, Chandra-Mouli V, Caffe S, Camacho AV. Trends in adolescent first births in five countries in Latin America and the Caribbean: disaggregated data from demographic and health surveys. Reprod Health 2018; 15:146. [PMID: 30157870 PMCID: PMC6114051 DOI: 10.1186/s12978-018-0578-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Adolescents in the Latin American and Caribbean region continue to experience poor reproductive health outcomes, including high rates of first birth before the age of 20 years. Aggregate national level data fails to identify groups where progress is particularly poor. This paper explores how trends in adolescent births have changed over time in five countries (Bolivia, Colombia, Dominican Republic, Haiti, and Peru) using data disaggregated by adolescent age group, wealth and urban / rural residence. Methods The study draws on Demographic and Health Survey data from five countries where three surveys are available since 1990, with the most recent after 2006. It examines trends in adolescent births by wealth status and urban/rural residence. Results There has been little progress in reducing adolescent first births over the last two decades in these countries. Adolescent first births continue to be more common among the poorest and rural residents, and births among the youngest age-group (< 16 years) are particularly concentrated among these populations. Conclusion Adolescent first births continue to be a major issue in these five countries, including amongst the youngest group (< 16 years), although the contexts in which it is occurring are changing over time. Efforts are needed to expand sexual education and services for adolescents and young people, as well as introduce and enforce legislation to provide effective protection from abuse or exploitation. Greater disaggregation of adolescent fertility data is needed if we are to measure progress towards the attainment of the Sustainable Development Goals to “leave no-one behind”.
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Affiliation(s)
- Sarah Neal
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK.
| | - Chloe Harvey
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Venkatraman Chandra-Mouli
- Human Reproduction Programme/Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sonja Caffe
- Pan American Health Organization, 525 23rd Street, NW, Washington DC, USA
| | - Alma Virginia Camacho
- SRH Team, Latin America and the Caribbean Regional Office, United Nations Population Fund, Panama City, Panama
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Cordova-Pozo K, Hoopes AJ, Cordova F, Vega B, Segura Z, Hagens A. Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis. Reprod Health 2018; 15:24. [PMID: 29422099 PMCID: PMC5806234 DOI: 10.1186/s12978-018-0461-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants. METHODS We reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results. RESULTS Strengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions. CONCLUSIONS This analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.
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Affiliation(s)
| | - Andrea J. Hoopes
- Kaiser Permanente Washington, 13451 SE 36th, Bellevue, WA 98006 USA
| | - Freddy Cordova
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Bernardo Vega
- University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Zoyla Segura
- Instituto Centroamericano de la Salud, Reparto Los Robles, Restaurante La Marsellaise 1 c. al norte 1 c. al este, casa #, 77 Managua, Nicaragua
| | - Arnold Hagens
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
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Khoori E, Jalaliaria K. Necessity of Providing Sexual and Reproductive Health Services to Adolescents and Young People in Iran: A Narrative Review. JOURNAL OF RESEARCH DEVELOPMENT IN NURSING AND MIDWIFERY 2017. [DOI: 10.29252/jgbfnm.14.2.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Caffe S, Plesons M, Camacho AV, Brumana L, Abdool SN, Huaynoca S, Mayall K, Menard-Freeman L, de Francisco Serpa LA, Gomez Ponce de Leon R, Chandra-Mouli V. Looking back and moving forward: can we accelerate progress on adolescent pregnancy in the Americas? Reprod Health 2017; 14:83. [PMID: 28705166 PMCID: PMC5512880 DOI: 10.1186/s12978-017-0345-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 07/04/2017] [Indexed: 11/14/2022] Open
Abstract
Adolescent fertility rates in Latin America and the Caribbean (LAC) remain unacceptably high, especially compared to the region's declining total fertility rates. The Region has experienced the slowest progress of all regions in the world, and shows major differences between countries and between subgroups in countries. In 2013, LAC was also noted as the only region with a rising trend in pregnancies in adolescents younger than 15 years. In response to the lack of progress in the LAC region, PAHO/WHO, UNFPA and UNICEF held a technical consultation with global, regional and country-level stakeholders to take stock of the situation and agree on strategic approaches and priority actions to accelerate progress. The meeting concluded that there is no single portrait of an adolescent mother in LAC and that context and determinants of adolescent pregnancy vary across and within countries. However, lack of knowledge about their sexual and reproductive health and rights, poor access to and inadequate use of contraceptives resulting from restrictive laws and policies, weak programs, social and cultural norms, limited education and income, sexual violence and abuse, and unequal gender relations were identified as key factors contributing to adolescent pregnancy in LAC. The meeting participants highlighted the following seven priority actions to accelerate progress: 1. Make adolescent pregnancy, its drivers and impact, and the most affected groups more visible with disaggregated data, qualitative reports, and stories. 2. Design interventions targeting the most vulnerable groups, ensuring the approaches are adapted to their realities and address their specific challenges. 3. Engage and empower youth to contribute to the design, implementation and monitoring of strategic interventions. 4. Abandon ineffective interventions and invest resources in applying proven ones. 5. Strengthen inter-sectoral collaboration to effectively address the drivers of adolescent pregnancy in LAC. 6. Move from boutique projects to large-scale and sustainable programs. 7. Create an enabling environment for gender equality and adolescent sexual and reproductive health and rights.
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Affiliation(s)
- Sonja Caffe
- Pan American Health Organization (PAHO/WHO), 525 23rd Street, NW, Washington, DC, USA
| | | | - Alma Virginia Camacho
- United Nations Population Fund (UNFPA), Regional Office for Latin America and the Caribbean, Panama City, Panama
| | - Luisa Brumana
- United Nations Children’s Fund (UNICEF), Regional Office for Latin America and the Caribbean, Panama City, Panama
| | - Shelly N. Abdool
- United Nations Children’s Fund (UNICEF), Regional Office for Latin America and the Caribbean, Panama City, Panama
| | - Silvia Huaynoca
- International Planned Parenthood Federation/ Western Hemisphere Region (IPPF/WHR), New York, USA
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de Haas B, van der Kwaak A. Exploring linkages between research, policy and practice in the Netherlands: perspectives on sexual and reproductive health and rights knowledge flows. Health Res Policy Syst 2017; 15:40. [PMID: 28494770 PMCID: PMC5427570 DOI: 10.1186/s12961-017-0201-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 04/17/2017] [Indexed: 11/26/2022] Open
Abstract
Background The attention to and demand for stronger linkages between research, policy and practice are increasing, especially in fields concerned with sensitive and challenging issues such as sexual and reproductive health and rights (SRHR). The study described in this article was conducted in the Netherlands among actors working in international development, especially the domain of SRHR. It explores the perceived flow of knowledge between research, policy and practice, the perceived impeding factors, and suggested strategies for improvement. Methods A narrative literature review was performed and 28 key informants were interviewed between May and August 2015. Most interviewees were either active or passive members of Share-Net Netherlands, an SRHR knowledge platform. All interviews, which lasted 70 minutes on average, were recorded, transcribed verbatim and coded in MAXQDA. Results Linkages between research, policy and practice are many and diffuse. The demands for and supplies of knowledge within and across the fields vary and do not always match, which is shown by participants’ research purposes and approaches. Participants identified various barriers to strengthening knowledge flows, including a lack of familiarity with practices in other fields, power relations and the undervaluation of tacit knowledge. They suggested a more visible and concrete demand for and supply of knowledge, the development of a joint knowledge agenda, more opportunities for the interdisciplinary creation of knowledge, and the development of a system for learning and sharing knowledge. Conclusion This study shows the willingness to undertake, and the perceived advantages of, interdisciplinary dialogues and joint creation of knowledge to advance SRHR research, policies and practices. Whereas barriers to the flow of knowledge may maintain present understandings of knowledge and of whose knowledge is valid, enabling factors, such as interactions between research, policy and practice in knowledge-sharing activities, may challenge such perceptions and create an enabling environment for generating innovative knowledge and increasing knowledge use. Knowledge platforms are recommended to place more emphasis on sharing and documenting tacit knowledge through interdisciplinary dialogues, to address power relations and to set criteria for interdisciplinary funding.
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Affiliation(s)
- Billie de Haas
- Independent researcher, Piri Reisplein 42, 1057 KH, Amsterdam, the Netherlands.
| | - Anke van der Kwaak
- Royal Tropical Institute, Mauritskade 63, 1092 AD, Amsterdam, the Netherlands
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Challa S, Manu A, Morhe E, Dalton VK, Loll D, Dozier J, Zochowski MK, Boakye A, Adanu R, Hall KS. Multiple levels of social influence on adolescent sexual and reproductive health decision-making and behaviors in Ghana. Women Health 2017; 58:434-450. [PMID: 28296626 DOI: 10.1080/03630242.2017.1306607] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is known about the multilevel social determinants of adolescent sexual and reproductive health (SRH) that shape the use of family planning (FP) among young women in Africa. We conducted in-depth, semi-structured, qualitative interviews with 63 women aged 15-24 years in Accra and Kumasi, Ghana. We used purposive, stratified sampling to recruit women from community-based sites. Interviews were conducted in English or local languages, recorded, and transcribed verbatim. Grounded theory-guided thematic analysis identified salient themes. Three primary levels of influence emerged as shaping young women's SRH experiences, decision-making, and behaviors. Interpersonal influences (peers, partners, and parents) were both supportive and unsupportive influences on sexual debut, contraceptive (non) use, and pregnancy resolution. Community influences included perceived norms about acceptability/unacceptability of adolescent sexual activity and its consequences (pregnancy, childbearing, abortion). Macro-social influences involved religion and abstinence and teachings about premarital sex, lack of comprehensive sex education, and limited access to confidential, quality SRH care. The willingness and ability of young women in our study to use FP methods and services were affected, often negatively, by factors operating within and across each level. These findings have implications for research, programs, and policies to address social determinants of adolescent SRH.
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Affiliation(s)
- Sneha Challa
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , Michigan , USA
| | - Abubakar Manu
- b School of Public Health , University of Ghana , Legon , Ghana
| | - Emmanuel Morhe
- c Department of Obstetrics and Gynecology , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Vanessa K Dalton
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Dana Loll
- a Department of Health Behavior and Health Education , University of Michigan School of Public Health , Ann Arbor , Michigan , USA
| | - Jessica Dozier
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Melissa K Zochowski
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
| | - Andrew Boakye
- c Department of Obstetrics and Gynecology , Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Richard Adanu
- b School of Public Health , University of Ghana , Legon , Ghana
| | - Kelli Stidham Hall
- d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA
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Svanemyr J, Guijarro S, Riveros BB, Chandra-Mouli V. The health status of adolescents in Ecuador and the country's response to the need for differentiated healthcare for adolescents. Reprod Health 2017; 14:29. [PMID: 28245855 PMCID: PMC5331697 DOI: 10.1186/s12978-017-0294-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/22/2017] [Indexed: 12/02/2022] Open
Abstract
Background Adolescents face a range of health problems but many barriers block their access to health services, and in particular to sexual and reproductive health services. The objective of this study was to assess the health needs of adolescents in Ecuador and to draw lessons from the ways the country has responded to their need for differentiated care. Methods We conducted a literature review and consulted key stakeholders. Results Adolescents in Ecuador today have a wide range of health care needs, in particular related to sexual and reproductive health. A major concern is the high rates of adolescent pregnancy. A national programme was established in 2007 to offer differentiated health care for adolescents—an effort that featured specially trained staff, enclaved facilities, respect for adolescents’ privacy and confidentiality, a friendly atmosphere, and a dedication to establishing trust. It resulted in rapid increases in visits by young persons both for preventive and curative services. In 2011, the government initiated a model for “integrated family and community health care” which led to a disruption of the central support for capacity building and follow-up of adolescent friendly services. Conclusion The Ecuadorian experience has demonstrated the need for institutionalised differentiated care for adolescents who are facing a wide range of health issues. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0294-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joar Svanemyr
- Chr. Michelsen Institute, P.O. Box 6033 Bedriftssenteret, N-5892, Bergen, Norway.
| | - Susana Guijarro
- Adolescent Health, Standardization, Ministry of Public Health Ecuador, Av. República del Salvador 36-64, Quito, Ecuador
| | - Betzabe Butron Riveros
- PAHO Ecuador, Edificio de Naciones Unidas piso 8, Av Amazonas y República, Quito, Ecuador
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva 27, Switzerland
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Guieu A, Zhang WH, Lafort Y, Decat P, De Meyer S, Wang S, Kerstens B, Duysburgh E. Practical lessons for bringing policy-makers on board in sexual and reproductive health research. BMC Health Serv Res 2016; 16:649. [PMID: 27835973 PMCID: PMC5106764 DOI: 10.1186/s12913-016-1889-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanisms in the field of sexual and reproductive health (SRH) outside North American or European contexts. This paper seeks to give an overview of the existing knowledge on this topic as well as to document practical challenges and remedies from the perspectives of researchers involved in four SRH research consortium projects in Latin America, sub-Saharan Africa, China and India. METHODS A literature review and relevant project documents were used to develop an interview guide through which researchers could reflect on their experiences in engaging with policy-makers, and particularly on the obstacles met and the strategies deployed by the four project consortia to circumvent them. RESULTS Our findings confirm current recommendations on an early and steady involvement of policy-makers, however they also suggest that local barriers between researchers and policy-making spheres and individuals can represent major hindrances to the realization of translation objectives. Although many of the challenges might be common to different contexts, creating locally-adapted responses is deemed key to overcome them. Researchers' experiences also indicate that - although inevitable - recognizing and addressing these challenges is a difficult, time- and energy-consuming process for all partners involved. Despite a lack of existing knowledge on translation efforts in SRH research outside North American or European contexts, and more particularly in low and middle-income countries, it is clear that existing pressure on health and policy systems in these settings further complicates them. CONCLUSIONS This article brings together literature findings and researchers' own experiences in translating research results into policy and highlights the major challenges research conducted on sexual and reproductive health outside North American or European contexts can meet. Future SRH projects should be particularly attentive to these potential obstacles in order to tailor appropriate and consistent strategies within their existing resources.
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Affiliation(s)
- Aurore Guieu
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium. .,MOMI consortium, . .,DIFFER consortium, .
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium.,INPAC consortium
| | - Yves Lafort
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,DIFFER consortium
| | - Peter Decat
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,CERCA consortium
| | - Sara De Meyer
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,CERCA consortium
| | - Shuchen Wang
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,INPAC consortium
| | - Birgit Kerstens
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium
| | - Els Duysburgh
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium
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Lara LAS, Abdo CHN. Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls. J Pediatr Adolesc Gynecol 2016; 29:417-423. [PMID: 26655691 DOI: 10.1016/j.jpag.2015.11.012] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/20/2015] [Accepted: 11/24/2015] [Indexed: 10/22/2022]
Abstract
Adolescence is characterized by marked changes in the body, psychology, and sexual behavior due to increasing production of hormones. In this review we aimed to assess the effect of age at the time of first sexual intercourse (sexarche) on the health of adolescent girls, and identify factors that might protect against early initiation of sexual relations in girls. The PubMed, Lilacs, and Google Scholar databases were searched for clinical trials, comparative studies, case-control studies, cross-sectional studies, cohort studies, multicenter studies, observational studies, meta-analyses, and systematic reviews published up to December 2014 on this theme. The search terms were: "sexual debut," "coitarche," "sexarche," and "young people," "adolescent," "unplanned pregnancy," "adolescent contraception," and "STDs." Data were extracted from 28 studies and 41 references were used to introduce the theme and to support the discussion. Sexarche has been occurring in increasingly younger girls. A young age at sexarche can lead to subsequent risky sexual behavior. Girls who have sexarche when they are 14 years old or younger are less likely to use contraception on this occasion, take more time before they start using contraception in subsequent sexual relations, are more likely to have several sex partners, have a higher risk for depression, have lower self-esteem and more episodes of repentance, and have a higher risk for a sexually transmitted disease and cervical cancer. Girls with low educational, socioeconomic, and cultural status, little parental monitoring, parental separation, and absence of religiosity tend to experience sexarche at a younger age. Adolescent girls who postpone sexarche until they are 16 years old are physically and psychologically healthier than those who have sexarche at a younger age. This suggests that providing adolescent girls with appropriate education about sexual relations might reduce the negative effect of sexual relations at a young age.
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Affiliation(s)
- Lúcia A S Lara
- Sexual Medicine Service, Human Reproduction Sector, Department of Gynaecology and Obstetrics, Ribeirão Preto Medical School, São Paulo University, Ribeirão Preto, São Paulo, Brazil.
| | - Carmita H N Abdo
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
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Ivanova O, Cordova-Pozo K, Segura ZE, Vega B, Chandra-Mouli V, Hindin MJ, Temmerman M, Decat P, De Meyer S, Michielsen K. Lessons learnt from the CERCA Project, a multicomponent intervention to promote adolescent sexual and reproductive health in three Latin America countries: a qualitative post-hoc evaluation. EVALUATION AND PROGRAM PLANNING 2016; 58:98-105. [PMID: 27347640 PMCID: PMC4987454 DOI: 10.1016/j.evalprogplan.2016.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 04/16/2016] [Accepted: 06/03/2016] [Indexed: 06/06/2023]
Abstract
The Community-Embedded Reproductive Health Care for Adolescents (CERCA) Project was implemented in Bolivia, Ecuador and Nicaragua (2011-2014) to test the effectiveness of interventions preventing teenage pregnancies. As the outcome evaluation showed limited impact, a post-hoc process evaluation was carried out to determine if and how CERCA's design, implementation, monitoring and evaluation affected the results. We did a document analysis and conducted 18 in-depth interviews and 21 focus group discussions with stakeholders and beneficiaries. Transcripts were analyzed using directed content analysis. Data showed that CERCA sensitized stakeholders and encouraged the discussion on this sensitive issue. In terms of design, a strong point was the participatory approach; a weak point was that the detailed situation analysis was completed too late. In terms of implementation, a strong point was that multifaceted activities were implemented; a weak point was that the activities were not pilot tested for feasibility/acceptability and evolved substantially throughout the Project. In terms of monitoring, strong points were that regular monitoring kept the Project on track administratively/financially; a weak point was that monitoring indicators did not change as the intervention package changed. In terms of evaluation, weak points were the substantial attrition rate and narrow focus on adolescents. This study provides recommendations for future projects.
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Affiliation(s)
- Olena Ivanova
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | | | | | - Bernardo Vega
- University of Cuenca (UC), Av. 12 de Abril y Agustín Cueva, Cuenca, Ecuador.
| | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Michelle J Hindin
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Marleen Temmerman
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, 20 avenue Appia, 1211 Geneva 27, Switzerland.
| | - Peter Decat
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | - Sara De Meyer
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP 114, Ghent 9000, Belgium.
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Affiliation(s)
- R A Stein
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, USA.
- Department of Natural Sciences, La Guardia Community College, City University of New York, Queens, NY, USA.
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