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Askew I, Raney L, Kerrigan M, Sridhar A. Family planning saves maternal and newborn lives: Why universal access to contraception must be prioritized in national maternal and newborn health policies, financing, and programs. Int J Gynaecol Obstet 2024; 164:536-540. [PMID: 37740702 DOI: 10.1002/ijgo.15127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023]
Abstract
SynopsisWe highlight why integrating contraceptive services within maternal and newborn health programs is essential for improving outcomes. We offer effective, actionable recommendations that can be implemented easily.
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Affiliation(s)
- Ian Askew
- FIGO Committee on Contraception, FIGO, London, UK
| | - Laura Raney
- Family Planning 2030, Washington, District of Columbia, USA
| | | | - Aparna Sridhar
- FIGO Committee on Contraception, FIGO, London, UK
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
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2
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Akselrod S, Banerjee A, Collins TE, Acharya S, Artykova N, Askew I, Berdzuli N, Diorditsa S, Eggers R, Farrington J, Jakab Z, Ferreira-Borges C, Mikkelsen B, Azzopardi-Muscat N, Olsavszky V, Park K, Sobel H, Tran H, Vujnovic M, Weber M, Were W, Yaqub N, Berlina D, Dunlop CL, Allen LN. Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era. Front Public Health 2023; 11:1183712. [PMID: 37483915 PMCID: PMC10362386 DOI: 10.3389/fpubh.2023.1183712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/06/2023] [Indexed: 07/25/2023] Open
Abstract
Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action.
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Affiliation(s)
| | - Anshu Banerjee
- Maternal, Newborn, Child and Adolescent Health, and Ageing, World Health Organization, Geneva, Switzerland
| | - Téa E. Collins
- Global NCD Platform, World Health Organization, Geneva, Switzerland
| | - Shambhu Acharya
- Country Strategy and Support, World Health Organization, Geneva, Switzerland
| | - Nazira Artykova
- WHO European Region Country Office in Kyrgyzstan, Bishkek, Kyrgyzstan
| | - Ian Askew
- Sexual and Reproductive Health, World Health Organization, Geneva, Switzerland
| | - Nino Berdzuli
- Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Sergey Diorditsa
- WHO Representative's Office, WHO European Region Country Office in Belarus, Minsk, City of Minsk, Belarus
| | - Rudolf Eggers
- Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Jill Farrington
- Deputy Director-General Office, World Health Organization, Geneva, Switzerland
| | - Zsuzsanna Jakab
- Deputy Director-General Office, World Health Organization, Geneva, Switzerland
| | - Carina Ferreira-Borges
- Division of Country Health Programmes, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Bente Mikkelsen
- NCD Department, World Health Organization, Geneva, Switzerland
| | - Natasha Azzopardi-Muscat
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Victor Olsavszky
- WHO European Region Tajikistan Country Office, Dushanbe, Tajikistan
| | - Kidong Park
- Data, Strategy and Innovation Group, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Howard Sobel
- WHO Regional Office for the Western Pacific Country Office in the Solomon Islands, Manila, Philippines
| | - Huong Tran
- Division of Programmes for Disease Control, World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Melita Vujnovic
- WHO European Region Office for the Russian Federation, Moscow, Russia
| | - Martin Weber
- Division of Country Health Policies and Systems, World Health Organization Regional Office for Europe Country Office in Greece, Copenhagen, Denmark
| | - Wilson Were
- Child Health and Development, World Health Organization, Geneva, Switzerland
| | - Nuhu Yaqub
- Child Health and Development, World Health Organization, Geneva, Switzerland
| | - Daria Berlina
- Global NCD Platform, World Health Organization, Geneva, Switzerland
| | - Catherine L. Dunlop
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
| | - Luke N. Allen
- Global NCD Platform, World Health Organization, Geneva, Switzerland
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3
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Schaaf M, Boydell V, Topp SM, Iyer A, Sen G, Askew I. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Glob Health 2022; 7:bmjgh-2022-008438. [PMID: 35443940 PMCID: PMC9021801 DOI: 10.1136/bmjgh-2022-008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. METHODS Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. RESULTS The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. CONCLUSION This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, USA
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Victoria Boydell
- School of Health and Social Care, University of Essex Faculty of Science and Health, Colchester, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
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4
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Stratton S, Hardee K, Houghtaling E, Malarcher S, Askew I, Carrasco M, Chandra-Mouli V, de Leon RGP, Greaney J, Maggwa B, McCarraher DR, Peterson JM, Raney L. Expanding equity measurements of family planning beyond wealth status and contraceptive use. Bull World Health Organ 2021; 99:747-749. [PMID: 34621093 PMCID: PMC8477424 DOI: 10.2471/blt.20.279604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 06/09/2021] [Accepted: 06/24/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Sara Stratton
- Palladium, Health Policy Plus Project, 1331 Pennsylvania Ave, NW, Suite 600, Washington, DC, 20004, United States of America (USA)
| | | | - Erika Houghtaling
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA
| | - Shawn Malarcher
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA
| | - Ian Askew
- Department of Sexual Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Maria Carrasco
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA
| | - Venkatraman Chandra-Mouli
- Department of Sexual Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rodolfo Gomez Ponce de Leon
- Latin American Center for Perinatology, Women and Reproductive Health, Pan American Health Organization, Washington, DC, USA
| | - Jennie Greaney
- United Nations Population Fund, Commodity Security Branch, New York, USA
| | - Baker Maggwa
- Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA
| | | | | | - Laura Raney
- FP2030, North America and Europe Hub, Washington, DC, USA
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5
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Amin A, Remme M, Allotey P, Askew I. Gender equality by 2045: reimagining a healthier future for women and girls. BMJ 2021; 373:n1621. [PMID: 34183331 PMCID: PMC8237157 DOI: 10.1136/bmj.n1621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Gender equality is achievable and an imperative
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Affiliation(s)
- Avni Amin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Michelle Remme
- International Institute for Global Health at the United Nations University, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- International Institute for Global Health at the United Nations University, Kuala Lumpur, Malaysia
| | - Ian Askew
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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6
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Shaffer N, Taylor M, Newman M, Nuwagira I, Bigirimana F, Regis MD, Mushavi A, Doherty M, Bulterys M, Askew I, Hirnschall G. WHO's path to elimination of mother-to-child transmission of HIV and syphilis. BMJ 2020; 368:m562. [PMID: 32066590 DOI: 10.1136/bmj.m562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Melanie Taylor
- World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Morkor Newman
- World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Innocent Nuwagira
- World Health Organization Regional Office for Africa, 86 Enterprise Road, Harare, Zimbabwe
| | - Francoise Bigirimana
- World Health Organization, Regional Office for Africa, cite du Djoue, PO Box 06/Office 279, Brazzaville, Congo
| | - Merceline Dahl Regis
- Commonwealth of the Bahamas, Bahamas Medical Council, # 37 Collins Avenue, Nassau, Bahamas
| | - Angela Mushavi
- Ministry of Health and Child Care, Mukwati Building, 5th Street and Livingstone, Harare, Zimbabwe
| | - Meg Doherty
- World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Marc Bulterys
- World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
| | - Ian Askew
- World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland
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Thorson A, Aslanyan G, Brizuela V, Perez F, Gómez Ponce de León R, Reeder JC, Serruya SJ, Espinal M, Askew I. Research and research capacity strengthening in the context of an emerging epidemic: Zika virus in Latin America. Int J Gynaecol Obstet 2020; 148 Suppl 2:1-3. [PMID: 31975399 DOI: 10.1002/ijgo.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garry Aslanyan
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Freddy Perez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | | | - John C Reeder
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Suzanne J Serruya
- Center for Perinatology, Women's Health, and Reproduction (CLAP/PAHO), Montevideo, Uruguay
| | - Marcos Espinal
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | - Ian Askew
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Khosla R, Amin A, Allotey P, Barroso C, George A, Hardon A, Askew I. "Righting the wrongs": addressing human rights and gender equality through research since Cairo. Sex Reprod Health Matters 2019; 27:1676529. [PMID: 31746277 PMCID: PMC7887975 DOI: 10.1080/26410397.2019.1676529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Rajat Khosla
- Human Rights Adviser, Human Reproduction Programme (HRP), World Health Organization, Geneva, Switzerland
| | - Avni Amin
- Scientist, Human Reproduction Programme (HRP), World Health Organization, Geneva, Switzerland
| | - Pascale Allotey
- Director, United Nations University - International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Carmen Barroso
- Interim Executive Director, Global Doctors for Choice, Portland, OR, USA
| | - Asha George
- SARChI Professor Health Systems, Complexity and Social Change, School of Public Health, University of Western Cape, Cape Town, South Africa
| | - Anita Hardon
- Professor, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Ian Askew
- Director, Human Reproduction Programme (HRP), World Health Organization, Geneva, Switzerland
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Abstract
Empowering and supporting people to manage their own health benefits everyone
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Affiliation(s)
| | | | - Ian Askew
- World Health Organization, Geneva, Switzerland
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10
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Thatte N, Cuzin-Kihl A, May AV, D'Adamo M, Addico G, Kiarie J, Askew I. Leveraging a Partnership to Disseminate and Implement What Works in Family Planning and Reproductive Health: The Implementing Best Practices (IBP) Initiative. Glob Health Sci Pract 2019; 7:12-19. [PMID: 30926735 PMCID: PMC6538130 DOI: 10.9745/ghsp-d-18-00236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 01/08/2019] [Indexed: 11/21/2022]
Abstract
The IBP initiative, a WHO-based partnership of NGOs, civil society organizations, governments, academic institutions, and other implementing partners, promotes evidence-based global guidelines, tools, and other interventions for local application, and incorporates implementation experience and learning back into the global discourse.
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Affiliation(s)
- Nandita Thatte
- Implementing Best Practices Initiative, World Health Organization, Geneva, Switzerland.
| | - Asa Cuzin-Kihl
- Implementing Best Practices Initiative, World Health Organization, Geneva, Switzerland
| | - Ados Velez May
- Implementing Best Practices Initiative, STAR Fellow, Washington, DC, USA
| | - Margaret D'Adamo
- United States Agency for International Development, Washington, DC, USA. Now an independent consultant, Baltimore, MD, USA
| | - Gifty Addico
- United Nations Population Fund, New York, NY, USA
| | | | - Ian Askew
- World Health Organization, Geneva, Switzerland
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11
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Moller AB, Newby H, Hanson C, Morgan A, El Arifeen S, Chou D, Diaz T, Say L, Askew I, Moran AC. Measures matter: A scoping review of maternal and newborn indicators. PLoS One 2018; 13:e0204763. [PMID: 30300361 PMCID: PMC6177145 DOI: 10.1371/journal.pone.0204763] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A variety of global-level monitoring initiatives have recommended indicators for tracking progress in maternal and newborn health. As a first step supporting the work of WHO's Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR) Technical Advisory Group, we aimed to compile and synthesize recommended indicators in order to document the landscape of maternal and newborn measurement and monitoring. METHODS We conducted a scoping review of indicators proposed by global multi-stakeholder groups to suggest next steps to further support maternal and newborn measurement and monitoring. Indicators pertaining to pregnancy, childbirth, and postpartum/postnatal and newborn care were extracted and included in the indicator compilation, together with key indicator metadata. We examined patterns and relationships across the compiled indicators. RESULTS We identified 140 indicators linked to maternal and newborn health topics across the continuum of service provision. Fifty-five indicators relate to inputs and processes, 30 indicators relate to outputs, outcomes comprise 37 indicators in the database, and 18 impact indicators. A quarter of indicators proposed by global groups is either under development/discussion or is considered "aspirational", highlighting the currently evolving monitoring landscape. Although considerable efforts have been made to harmonize indicator recommendations, there are still relatively few indicators shared across key monitoring initiatives and some of those that are shared may have definitional variation. CONCLUSION Rapid, wide-ranging work by a number of multi-stakeholder groups has resulted in a substantial number of indicators, many of which partially overlap and many are not supported with adequate documentation or guidance. The volume of indicators, coupled with the number of initiatives promoting different indicator lists, highlight the need for strengthened coordination and technical leadership to harmonize recommendations for improved measurement and monitoring of data related to maternal and newborn heath.
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Affiliation(s)
- Ann-Beth Moller
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- * E-mail:
| | | | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Doris Chou
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Theresa Diaz
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
| | - Lale Say
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ian Askew
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Allisyn C. Moran
- Department of Maternal, Newborn, Child and Adolescent Health World Health Organization, Geneva, Switzerland
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Narasimhan M, Pillay Y, García PJ, Allotey P, Gorna R, Welbourn A, Remme M, Askew I, Nordström A, Haufiku B. Investing in sexual and reproductive health and rights of women and girls to reach HIV and UHC goals. Lancet Glob Health 2018; 6:e1058-e1059. [PMID: 30031731 DOI: 10.1016/s2214-109x(18)30316-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 06/19/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland.
| | - Yogan Pillay
- National Department of Health, Pretoria, South Africa
| | - Patricia J García
- School of Public Health and Administration, Cayetano Heredia University, Lima, Peru
| | - Pascale Allotey
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | | | | | - Michelle Remme
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland
| | - Anders Nordström
- UN Policy Department, Ministry for Foreign Affairs, Stockholm, Sweden
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13
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Ochako R, Okal J, Kimetu S, Askew I, Temmerman M. Female sex workers experiences of using contraceptive methods: a qualitative study in Kenya. BMC Womens Health 2018; 18:105. [PMID: 29925361 PMCID: PMC6011601 DOI: 10.1186/s12905-018-0601-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/07/2018] [Indexed: 11/23/2022]
Abstract
Background Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore the experiences of female sex workers with using existing contraceptive methods, assess individual and health facility-level barriers and document inter-partner relationship in the use of contraceptives. Methods We focus on women aged 15–49, who reported current sex work, defined as ‘providing sexual services in exchange for money or other material compensation as part of an individual’s livelihood.’ Results Findings reveal that while some FSWs know about modern contraceptives, others have limited knowledge or out rightly refuse to use contraceptives for fear of losing clients. The interaction with different client types act as a barrier but also provide an opportunity for contraceptive use among FSWs. Most FSWs recognize the importance of dual protection for HIV/STI and pregnancy prevention. However, myths and misconceptions, fear of being tested for HIV at the family planning clinic, wait time, and long queues at the clinics all act in combination to hinder uptake of contraceptives. Conclusions We recommend a targeted approach to address the contraceptive needs of FSWs to help remove barriers to contraceptive uptake. We also support the introduction of counseling services to provide information on the benefits of non-barrier contraceptive methods and thereby enhance dual use for both pregnancy and STI/HIV prevention.
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Affiliation(s)
- Rhoune Ochako
- School of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Population Council, Nairobi, Kenya.
| | | | - Steven Kimetu
- School of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ian Askew
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
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14
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Thompson J, Undie CC, Amin A, Johnson BR, Khosla R, Ouedraogo L, Nkurunziza T, Rich S, Westley E, Garcia M, Birungi H, Askew I. Correction to: Harmonizing national abortion and pregnancy prevention laws and policies for sexual violence survivors with the Maputo Protocol: proceedings of a 2016 regional technical meeting in sub-Saharan Africa. BMC Proc 2018; 12:7. [PMID: 29932170 PMCID: PMC5989408 DOI: 10.1186/s12919-018-0103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
[This corrects the article DOI: 10.1186/s12919-018-0101-5.].
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Affiliation(s)
- Jill Thompson
- Public Counsel, 610 South Ardmore Avenue, Los Angeles, CA 90005 USA
| | - Chi-Chi Undie
- Population Council, P.O. Box 17643-00500, Nairobi, Kenya
| | - Avni Amin
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 27 Geneva, Switzerland
| | - Brooke Ronald Johnson
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 27 Geneva, Switzerland
| | - Rajat Khosla
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 27 Geneva, Switzerland
| | - Leopold Ouedraogo
- Regional Office for Africa, World Health Organization, BP 06 Brazzaville, Republic of Congo
| | - Triphonie Nkurunziza
- Regional Office for Africa, World Health Organization, BP 06 Brazzaville, Republic of Congo
| | - Sarah Rich
- Women’s Refugee Commission, 15 West 37th Street, 9th Floor, New York, NY 10018 USA
| | - Elizabeth Westley
- International Consortium for Emergency Contraception (hosted by Management Sciences for Health), 45 Broadway, Suite 320, New York, NY 10006 USA
| | - Melissa Garcia
- International Consortium for Emergency Contraception (hosted by Management Sciences for Health), 45 Broadway, Suite 320, New York, NY 10006 USA
| | | | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1211 27 Geneva, Switzerland
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Toskin I, Peeling RW, Mabey D, Holmes K, Ballard R, Kiarie J, Askew I. Point-of-care tests for STIs: the way forward. Sex Transm Infect 2018; 93:S1-S2. [PMID: 29223958 DOI: 10.1136/sextrans-2016-053074] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/21/2017] [Accepted: 07/02/2017] [Indexed: 11/03/2022] Open
Affiliation(s)
- Igor Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rosanna W Peeling
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - David Mabey
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - King Holmes
- Department of Global Health & Medicine, University of Washington, Seattle, Washington, USA
| | - Ronald Ballard
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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16
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Adeniran A, Likaka A, Knutsson A, Costello A, Daelmans B, Maliqi B, Burssa D, Freer J, Askew I, Bowen L, Kak L, McDougall L, Zaka N, Tunçalp Ö, Tenhoope-Bender P, Syed SB, Peterson SS, Luchesi T, Zeck W, Were W, Barker P, Naimy Z. Leadership, action, learning and accountability to deliver quality care for women, newborns and children. Bull World Health Organ 2018. [PMID: 29531422 PMCID: PMC5840625 DOI: 10.2471/blt.17.197939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Abosede Adeniran
- Child Health Division, Federal Ministry of Health, Abuja, Nigeria
| | | | - Anneka Knutsson
- United Nations Population Fund, New York, United Sates of America (USA)
| | - Anthony Costello
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Bernadette Daelmans
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Blerta Maliqi
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Joseph Freer
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ian Askew
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Lily Kak
- United States Agency for International Development, Washington DC, USA
| | - Lori McDougall
- The Partnership for Maternal, Newborn & Child Health, World Health Organization, Geneva, Switzerland
| | - Nabila Zaka
- United Nations Children's Fund, New York, USA
| | - Özge Tunçalp
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | | | - Shamsuzzoha Babar Syed
- Department of Service Delivery and Safety, World Health Organization, Geneva, Switzerland
| | | | | | | | - Wilson Were
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Pierre Barker
- Institute for Healthcare Improvement, Cambridge, USA
| | - Zainab Naimy
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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17
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Moran AC, Moller AB, Chou D, Morgan A, El Arifeen S, Hanson C, Say L, Diaz T, Askew I, Costello A. 'What gets measured gets managed': revisiting the indicators for maternal and newborn health programmes. Reprod Health 2018; 15:19. [PMID: 29394947 PMCID: PMC5797384 DOI: 10.1186/s12978-018-0465-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/23/2018] [Indexed: 11/21/2022] Open
Abstract
Background The health of women and children are critical for global development. The Sustainable Development Goals (SDG) agenda and the Global Strategy for Women’s, Children’s, and Adolescent’s Health 2016–2030 aim to reduce maternal and newborn deaths, disability, and enhancement of well-being. However, information and data on measuring countries’ progress are limited given the variety of methodological challenges of measuring care around the time of birth, when most maternal and neonatal deaths and morbidities occur. Main body In 2015, the World Health Organization launched Mother and Newborn Information for Tracking Outcomes and Results (MoNITOR), a technical advisory group to WHO. MoNITOR comprises 14 independent global experts from a variety of disciplines selected in a competitive process for their technical expertise and regional representation. MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals. Short conclusion Ultimately, MoNITOR will provide technical guidance to WHO to ensure harmonized guidance, messages, and tools so that countries can collect useful data to track progress toward achieving the Sustainable Development Goals.
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Affiliation(s)
- A C Moran
- World Health Organization, Geneva, Switzerland.
| | - A B Moller
- World Health Organization, Geneva, Switzerland
| | - D Chou
- World Health Organization, Geneva, Switzerland
| | - A Morgan
- University of Melbourne, Melbourne, Australia
| | | | - C Hanson
- Karolinska Institutet, Stockholm, Sweden
| | - L Say
- World Health Organization, Geneva, Switzerland
| | - T Diaz
- World Health Organization, Geneva, Switzerland
| | - I Askew
- World Health Organization, Geneva, Switzerland
| | - A Costello
- World Health Organization, Geneva, Switzerland
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18
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Affiliation(s)
- Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Özge Tunçalp
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Susan L Norris
- Guidelines Review Committee Secretariat, World Health Organization, Geneva, Switzerland
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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19
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Wekesa E, Askew I, Abuya T. Ambivalence in pregnancy intentions: The effect of quality of care and context among a cohort of women attending family planning clinics in Kenya. PLoS One 2018; 13:e0190473. [PMID: 29315327 PMCID: PMC5760043 DOI: 10.1371/journal.pone.0190473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/24/2017] [Indexed: 11/18/2022] Open
Abstract
Context Ambivalence in pregnancy intentions is well-documented in sub-Saharan African (SSA) settings and has been associated with inconsistent use of contraception, thereby exposing women using contraception to the possibility of unintended pregnancies. A better understanding of the potential role for client counseling interventions in enabling women to achieve their pregnancy intentions is essential for aiding program efforts to reduce unintended pregnancies. Objective To measure ambivalence in pregnancy intentions longitudinally and determine its association with the quality of care received, controlling for demographic, socio-economic and contextual factors among a cohort of family planning (FP) clients in Kenya. Methods This paper uses data drawn from a prospective cohort study of FP clients to investigate the relationship between the quality of care received during FP service delivery and the decisiveness of their pregnancy intentions over time. The study tests the hypothesis that higher quality of care enables women to be less ambivalent about their pregnancy intentions. Binary logistic regression with random effects and multinomial logistic regression were used to assess the predictive effect of the quality of care received by a woman on the decisiveness or ambivalence of her pregnancy intentions, and on any shifts in ambivalence over time, controlling for background characteristics. The study recruited 1,957 women aged 15–49 years attending twelve family planning clinics in four counties in Central Kenya; of these, 1,053 women were observed for four rounds of data collection over a period of 24 months and form the sample for analysis. Findings A substantial proportion (43%) of women expressed ambivalence about their intentions to become pregnant at some point during the study period, while over half (57%) remained unequivocal throughout the study. Almost one third of women (31%) shifted from being unequivocal to ambivalent and 12% shifted from ambivalence to being unequivocal. Women experiencing higher quality of care have lower odds of ever expressing ambivalence and higher odds of remaining unequivocal over time, net of other factors. Quality of care was not associated with a shift in ambivalence over time. Conclusion FP programs offering higher quality of care are likely to support women to be more decisive in their pregnancy intentions. Improving the quality of care can contribute to reduced ambivalence and consequently reduced likelihood of unintended pregnancy among contraceptive users. This study provides further evidence of the benefits gained through providing high quality services. Trial registration ClinicalTrials.gov NCT01694862
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Affiliation(s)
- Eliud Wekesa
- School of Humanities and Social Sciences, South Eastern Kenya University, Kitui, Kenya
- Department of Reproductive Health, Population Council, Nairobi, Kenya
- * E-mail:
| | - Ian Askew
- Department of Reproductive Health, Population Council, Nairobi, Kenya
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Timothy Abuya
- Department of Reproductive Health, Population Council, Nairobi, Kenya
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20
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Askew I, Weinberger M, Dasgupta A, Darroch J, Smith E, Stover J, Yahner M. Harmonizing Methods for Estimating the Impact of Contraceptive Use on Unintended Pregnancy, Abortion, and Maternal Health. Glob Health Sci Pract 2017; 5:658-667. [PMID: 29217695 PMCID: PMC5752611 DOI: 10.9745/ghsp-d-17-00121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 10/17/2017] [Indexed: 11/15/2022]
Abstract
Five models estimate the impact of family planning on health outcomes, but the estimates previously have diverged because the models used different assumptions, inputs, and algorithms. After a collective harmonization process, the models now produce more similar estimates although they retain some minimal differences. These models assist in planning, resource allocation, and evaluation. Estimates of the potential impacts of contraceptive use on averting unintended pregnancies, total and unsafe abortions, maternal deaths, and newborn, infant, and child deaths provide evidence of the value of investments in family planning programs and thus are critically important for policy makers, donors, and advocates alike. Several research teams have independently developed mathematical models that estimate the number of adverse health outcomes averted due to contraceptive use. However, each modeling approach was designed for different purposes, and as such the methodological assumptions, data inputs, and mathematical algorithms initially used in each model differed; consequently, the models did not produce comparable estimates for the same outcome indicators. To address this, a series of expert group meetings took place in which 5 models—Adding it Up, Impact 2, ImpactNow, Reality Check, and FamPlan/Lives Saved Tool (LiST)—were reviewed and harmonized where possible. The group identified the main reasons for the inconsistencies in the estimates generated by the models for each of the adverse health outcome indicators. The group then worked together to align the methodologies for estimating numbers of unintended pregnancies, abortions, and maternal deaths averted due to contraceptive use, and reviewed the challenges with estimating the impact of contraceptive use on newborn, infant, and child deaths, including the lack of a conceptually clear pathway and rigorous evidence. The assumption that most influenced harmonization was the comparison pregnancy rate used by the models to estimate the counterfactual scenario—that is, if women who are currently using contraception were not using a method, how many would become pregnant? All the models now base this on the number of unintended pregnancies among women with unmet contraceptive need, bringing the estimates for unintended pregnancies, total and unsafe abortion, and maternal deaths much closer together. The agreed approaches have already been adopted by the Family Planning 2020 (FP2020) initiative and Track20, a project that supports FP2020. The experts will continue to update their models collaboratively to ensure that the most current estimation methodologies and data available are used. Valid and reliable methodologies for estimating these impacts from family planning are critically important, not only for advocacy to sustain resource allocation commitments but also to enable measurement and tracking of global development indicators. Conflicting estimates can be counterproductive to generating support for family planning programs, and this harmonization process has created a more unified voice for quantifying the benefits of family planning.
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Affiliation(s)
- Ian Askew
- Population Council, New York, NY, USA. Now with the World Health Organization, Geneva, Switzerland.
| | - Michelle Weinberger
- Marie Stopes International, Washington, DC, USA. Now with Avenir Health, Washington, DC, USA
| | - Aisha Dasgupta
- Marie Stopes International, London, UK. Now with the United Nations Population Division, New York, NY, USA
| | | | | | | | - Melanie Yahner
- EngenderHealth, New York, NY, USA. Now with Save the Children, Fairfield, CT, USA
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21
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Warren CE, Hopkins J, Narasimhan M, Collins L, Askew I, Mayhew SH. Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response. Health Policy Plan 2017; 32:iv102-iv107. [PMID: 29194542 PMCID: PMC5886280 DOI: 10.1093/heapol/czx052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charlotte E Warren
- Population Council, Suite 280, 4301 Connecticut Avenue NW, Washington, DC 20008, USA
| | - Jonathan Hopkins
- International Planned Parenthood Foundation, 4 Newhams Row, London SE1 3UZ, UK
| | | | - Lynn Collins
- UNFPA, 605 Third Avenue, New York, NY 10158, USA and
| | - Ian Askew
- World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Susannah H Mayhew
- Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK
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22
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Affiliation(s)
- Rob Stephenson
- Department of Health Behavior and Biological Sciences, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Lianne Gonsalves
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland
| | - Lale Say
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva 27, Switzerland.
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23
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Ochako R, Temmerman M, Mbondo M, Askew I. Determinants of modern contraceptive use among sexually active men in Kenya. Reprod Health 2017; 14:56. [PMID: 28449723 PMCID: PMC5408470 DOI: 10.1186/s12978-017-0316-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 04/08/2017] [Indexed: 12/04/2022] Open
Abstract
Background Research in Kenya has focussed on family planning from women’s perspectives, with the aim of helping reduce the burden of unintended pregnancies. As such, the determinants of modern contraceptive use among sexually active women are well documented. However, the perspectives of men should be considered not only as women’s partners, but also as individuals with distinct reproductive histories and desires of their own. This study seeks to understand the determinants of modern contraceptive use among sexually active men, by exploring factors that are correlated with modern contraceptive use. Methods The data source is the nationally representative 2014 Kenya Demographic and Health Survey (DHS) of men aged 15–54 years. The analysis is restricted to 9,514 men who reported being sexually active in the past 12 months prior to the survey, as they were likely to report either doing something or not to avoid or delay pregnancy. We use bivariate and multinomial logistic regression to assess factors that influence modern contraceptive use among sexually active men. Results Findings from the bivariate and multinomial logistic regression indicate that region of residence, marital status, religion, wealth, interaction with a health care provider, fertility preference, number of sexual partners and access to media were all significantly associated with modern contraceptive use among sexually active men. Conclusion Provider-client interaction as well as dissemination of information through mass media has the potential to increase knowledge and uptake of modern contraceptives. Similar efforts targeting segments of the population where contraceptive uptake is low are recommended.
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Affiliation(s)
- Rhoune Ochako
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Population Council, P.O. Box 17643, 00100, Nairobi, Kenya.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.,Aga Khan University, Nairobi, Kenya
| | - Mwende Mbondo
- CIVITRA Research and Consulting Company Ltd., Nairobi, Kenya
| | - Ian Askew
- World Health Organization, Geneva, Switzerland
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24
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Narasimhan M, Celum C, Askew I, Kiarie J, van der Poel S. Supporting people living with HIV in serodiscordant partnerships to attempt a desired pregnancy by integrating sexual and reproductive health and HIV interventions. J Int AIDS Soc 2017; 20:21829. [PMID: 28361499 PMCID: PMC5461117 DOI: 10.7448/ias.20.2.21829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Connie Celum
- International Clinical Research Center, School of Public Health, University of Washington, Seattle, WA, USA
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - James Kiarie
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sheryl van der Poel
- Independent Researcher, Geneva, Switzerland
- Population Council, Washington, DC, USA
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25
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Narasimhan M, Askew I, Vermund SH. Advancing sexual and reproductive health and rights of young women at risk of HIV. Lancet Glob Health 2016; 4:e684-5. [PMID: 27633425 PMCID: PMC10767708 DOI: 10.1016/s2214-109x(16)30151-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/01/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Manjulaa Narasimhan
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland.
| | - Ian Askew
- Department of Reproductive Health and Research, World Health Organization, 1211 Geneva, Switzerland
| | - Sten H Vermund
- Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
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26
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Affiliation(s)
- Ian Askew
- Department of Reproductive Health and Research, WHO
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27
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Affiliation(s)
- Nathalie Roos
- Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland.
| | - Özge Tunçalp
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Kate Kerber
- Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
| | - Emma Allanson
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Anthony Costello
- Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland
| | - Ian Askew
- Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Matthews Mathai
- Department of Maternal, Newborn, Child and Adolescent Health, Geneva, Switzerland; Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK
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28
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Ochako R, Izugbara C, Okal J, Askew I, Temmerman M. Contraceptive method choice among women in slum and non-slum communities in Nairobi, Kenya. BMC Womens Health 2016; 16:35. [PMID: 27405374 PMCID: PMC4941019 DOI: 10.1186/s12905-016-0314-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 07/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Understanding women's contraceptive method choices is key to enhancing family planning services provision and programming. Currently however, very little research has addressed inter and intra-regional disparities in women's contraceptive method choice. Using data from slum and non-slum contexts in Nairobi, Kenya, the current study investigates the prevalence of and factors associated with contraceptive method choice among women. METHODS Data were from a cross-sectional quantitative study conducted among a random sample of 1,873 women (aged 15-49 years) in two non-slum and two slum settlement areas in Nairobi, Kenya. The study locations were purposively sampled by virtue of being part of the Nairobi Urban Health and Demographic Surveillance System. Bivariate and multivariate logistic regression were used to explore the association between the outcome variable, contraceptive method choice, and explanatory variables. RESULTS The prevalence of contraceptive method choice was relatively similar across slum and non-slum settlements. 34.3 % of women in slum communities and 28.1 % of women in non-slum communities reported using short-term methods. Slightly more women living in the non-slum settlements reported use of long-term methods, 9.2 %, compared to 3.6 % in slum communities. Older women were less likely to use short-term methods than their younger counterparts but more likely to use long-term methods. Currently married women were more likely than never married women to use short-term and long-term methods. Compared to those with no children, women with three or more children were more likely to report using long term methods. Women working outside the home or those in formal employment also used modern methods of contraception more than those in self-employment or unemployed. CONCLUSION Use of short-term and long-term methods is generally low among women living in slum and non-slum contexts in Nairobi. Investments in increasing women's access to various contraceptive options are urgently needed to help increase contraceptive prevalence rate. Thus, interventions that focus on more disadvantaged segments of the population will accelerate contraceptive uptake and improve maternal and child health in Kenya.
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Affiliation(s)
- Rhoune Ochako
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | | | | | - Ian Askew
- World Health Organization, Geneva, Switzerland
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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29
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Ochako R, Askew I, Okal J, Oucho J, Temmerman M. Modern contraceptive use among migrant and non-migrant women in Kenya. Reprod Health 2016; 13:67. [PMID: 27246329 PMCID: PMC4888625 DOI: 10.1186/s12978-016-0183-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 05/11/2016] [Indexed: 11/10/2022] Open
Abstract
Background Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual’s economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant. Methods Using data from the 2008–09 Kenya Demographic and Health Survey (DHS), we analyze data from 5,905 women aged 15–49 years who reported being sexually active in the last 12 months prior to the survey. Bivariate and multivariate logistic regressions are fitted to predict correlates of contraceptive use in the presence of migration streams among other explanatory variables. Results Modern contraceptive use was significantly higher among women in all migration streams (non-migrant urban (OR = 2.8, p < 0.001), urban-urban (OR = 2.0, p < 0.001), urban-rural (OR = 2.0, p < 0.001), rural-urban (OR = 2.6, p < 0.001), rural-rural (OR = 1.7, p < 0.001), than non-migrant rural women. Conclusion Women who internally migrate within Kenya, whether from rural to urban or between urban centres, were more likely to use modern contraception than non-migrant rural women. This phenomenon appears to be due to selection, adaption and disruption effects which are likely to promote use of modern contraceptives. Programmatically, the differentials in modern contraceptive use by the different migration streams should be considered when designing family planning programmes among migrant and non-migrant women.
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Affiliation(s)
- Rhoune Ochako
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Ian Askew
- World Health Organization, Geneva, Switzerland
| | - Jerry Okal
- Population Council, P.O. Box 17643, 00100, Nairobi, Kenya
| | - John Oucho
- Population Studies and Research Institute, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
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30
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Askew I, Khosla R, Daniels U, Krause S, Lofthouse C, Say L, Gilmore K, Zeid S. Sexual and reproductive health and rights in emergencies. Bull World Health Organ 2016; 94:311. [PMID: 27147755 PMCID: PMC4850544 DOI: 10.2471/blt.16.173567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ian Askew
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Rajat Khosla
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Ugochi Daniels
- United Nations Population Fund, New York, United States of America (USA)
| | | | - Clare Lofthouse
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Lale Say
- Family, Women's and Children's Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Kate Gilmore
- Office of the High Commissioner for Human Rights, Geneva, Switzerland
| | - Sarah Zeid
- United Nations Foundation, New York, USA
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31
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Sedgh G, Filippi V, Owolabi OO, Singh SD, Askew I, Bankole A, Benson J, Rossier C, Pembe AB, Adewole I, Ganatra B, MacDonagh S. Insights from an expert group meeting on the definition and measurement of unsafe abortion. Int J Gynaecol Obstet 2016; 134:104-6. [PMID: 27062249 PMCID: PMC6434901 DOI: 10.1016/j.ijgo.2015.11.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 11/03/2015] [Accepted: 02/18/2016] [Indexed: 12/03/2022]
Abstract
Until recently, WHO operationally defined unsafe abortion as illegal abortion. In the past decade, however, the incidence of abortion by misoprostol administration has increased in countries with restrictive abortion laws. Access to safe surgical abortions has also increased in many such countries. An important effect of these trends has been that, even in an illegal environment, abortion is becoming safer, and an updated system for classifying abortion in accordance with safety is needed. Numerous factors aside from abortion method or legality should be taken into consideration in developing such a classification system. An Expert Meeting on the Definition and Measurement of Unsafe Abortion was convened in London, UK, on January 9–10, 2014, to move toward developing a classification system that both reflects current conditions and acknowledges the gradient of risk associated with abortion. The experts also discussed the types of research needed to monitor the incidence of abortion at each level of safety. These efforts are urgently needed if we are to ensure that preventing unsafe abortion is appropriately represented on the global public health agenda. Such a classification system would also motivate investment in research to accurately measure and monitor abortion incidence across categories of safety.
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Affiliation(s)
| | - Veronique Filippi
- London School of Hygiene and Tropical Medicine, Department of Infectious Diseases Epidemiology, London, UK
| | - Onikepe O Owolabi
- London School of Hygiene and Tropical Medicine, Department of Infectious Diseases Epidemiology, London, UK
| | | | - Ian Askew
- At time of expert meeting: Population Council, New York, NY, USA; World Health Organization, Geneva, Switzerland
| | | | | | - Clementine Rossier
- University of Geneva, Institute of Demographic and Life Course Studies, Geneva, Switzerland
| | - Andrea B Pembe
- Muhimbili University of Health and Allied Sciences, Department of Obstetrics and Gynaecology, Dar es Salaam, Tanzania
| | - Isaac Adewole
- University of Ibadan, Department of Obstetrics and Gynaecology College, College of Medicine, Ibadan, Nigeria
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Undie CC, Maternowska MC, Mak'anyengo M, Askew I. Is Routine Screening for Intimate Partner Violence Feasible in Public Health Care Settings in Kenya? J Interpers Violence 2016; 31:282-301. [PMID: 25381272 DOI: 10.1177/0886260514555724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
More than a third of women worldwide have experienced either physical and/or sexual intimate partner violence (IPV) or non-partner sexual violence. The short- and long-term health effects of violence can be disabling if left undetected. A recent World Health Organization (WHO) report indicates that Africa is one of the regions with the highest prevalence of physical and/or sexual IPV among ever-partnered women. Routine screening for IPV can potentially improve the care and treatment of women suffering from violence. Although routine screening is commonplace in European and American countries, health systems barriers in developing countries have deterred introduction of this practice. Results from this feasibility study indicate that providers are willing and able to incorporate IPV screening into their practice and that IPV screening in a variety of health care settings in a public hospital is feasible and welcomed by clients. Referral uptake by women suffering from IPV was low compared with provider referral rates, but ways in which referral and management services could be improved were identified.
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Undie CC, Maternowska MC, Mak'anyengo M, Askew I. What women think: hypothetical notions of screening for intimate partner violence in Kenyan hospital settings. BMC Proc 2015. [PMCID: PMC4496636 DOI: 10.1186/1753-6561-9-s4-a6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Kimani J, Warren CE, Abuya T, Ndwiga C, Mayhew S, Vassall A, Mutemwa R, Askew I. Use of HIV counseling and testing and family planning services among postpartum women in Kenya: a multicentre, non-randomised trial. BMC Womens Health 2015; 15:104. [PMID: 26563220 PMCID: PMC4643518 DOI: 10.1186/s12905-015-0262-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 11/07/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Addressing the postnatal needs of new mothers is a neglected area of care throughout sub-Saharan Africa. The study compares the effectiveness of integrating HIV and family planning (FP) services into postnatal care (PNC) with stand-alone services on postpartum women's use of HIV counseling and testing and FP services in public health facilities in Kenya. METHODS Data were derived from samples of women who had been assigned to intervention or comparison groups, had given birth within the previous 0-10 weeks and were receiving postnatal care, at baseline and 15 months later. Descriptive statistics describe the characteristics of the sample and multivariate logistic regression models assess the effect of the integrated model of care on use of provider-initiated testing and counseling (PITC) and FP services. RESULTS At the 15-month follow-up interviews, more women in the intervention than comparison sites used implants (15 % vs. 3 %; p < 0.001), while injectables were the most used short-term method by women in both sites. Women who wanted to wait until later to have children (OR = 1.3; p < 0.01; 95 % CI: 1.1-1.5), women with secondary education (OR = 1.2; p < 0.05; 95 % CI: 1.0-1.4), women aged 25-34 years (OR = 1.2; p < 0.01; 95 % CI: 1.1-1.4) and women from poor households (OR = 1.6; p < 0.001; 95 % CI: 1.4-1.9) were associated with FP use. Nearly half (47 %) and about one-third (30 %) of mothers in the intervention and comparison sites, respectively, were offered PITC. Significant predictors of uptake of PITC were seeking care in a health center/dispensary relative to a hospital, having a partner who has tested for HIV and being poor. CONCLUSIONS An integrated delivery approach of postnatal services is beneficial in increasing the uptake of PITC and long-acting FP services among postpartum women. Also, interventions aimed at increasing male partners HIV testing have a positive effect on the uptake of PITC and should be encouraged. TRIAL REGISTRATION ClinicalTrials.gov NCT01694862.
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Affiliation(s)
- James Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Charlotte E Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Timothy Abuya
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Charity Ndwiga
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Susannah Mayhew
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Anna Vassall
- London School of Hygiene & Tropical Medicine, Department of Population Studies, Keppel Street, London, WC1E 7HT, UK.
| | - Richard Mutemwa
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Ian Askew
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
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Hounton S, Winfrey W, Barros AJD, Askew I. Patterns and trends of postpartum family planning in Ethiopia, Malawi, and Nigeria: evidence of missed opportunities for integration. Glob Health Action 2015; 8:29738. [PMID: 26562144 PMCID: PMC4642460 DOI: 10.3402/gha.v8.29738] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 09/27/2015] [Accepted: 10/08/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The first 12 months following childbirth are a period when a subsequent pregnancy holds the greatest risk for mother and baby, but also when there are numerous contacts with the healthcare system for postnatal care for mother and baby (immunisation, nutrition, etc.). The benefits and importance of postpartum family planning are well documented. They include a reduction in risk of miscarriage, as well as mitigation of (or protection against) low birth weight, neonatal and maternal death, preterm birth, and anaemia. OBJECTIVES The objectives of this paper are to assess patterns and trends in the use of postpartum family planning at the country level, to determine whether postpartum family planning is associated with birth interval and parity, and to identify the health services most closely associated with postpartum family planning after adjusting for socio-economic characteristics. DESIGN Data were used from Demographic and Health Surveys that contain a reproductive calendar, carried out within the last 10 years, from Ethiopia, Malawi, and Nigeria. All women for whom the calendar was completed and who gave birth between 57 and 60 months prior to data collection were included in the analysis. For each of the births, we merged the reproductive calendar with the birth record into a survey for each country reflecting the previous 60 months. The definition of the postpartum period in this paper is based on a period of 3 months postpartum. We used this definition to assess early adoption of postpartum family planning. We assessed variations in postpartum family planning according to demographic and socio-economic variables, as well as its association with various contact opportunities with the health system [antenatal care (ANC), childbirth in facilities, immunisation, etc.]. We did simple descriptive analysis with tabular, graphic, and 'equiplot' displays and a logistic regression controlling for important background characteristics. RESULTS Overall, variation in postpartum use of modern contraception was not affected over the years by age or marital status. One contrast to this is in Ethiopia, where the data show a significant increase in uptake of postpartum contraception among adolescents from 2005 to 2011. There are systematic and pervasive equity issues in the use of modern postpartum family planning by education level, place of residence, and wealth quintile, especially in Ethiopia where the gaps are very large. Disaggregation of data also point to significant sub-national variations. After adjusting for socio-economic variables, the most consistent health sector services associated with modern postpartum contraception are institutional childbirth and child immunisation. ANC is less likely to be associated with the use of modern postpartum family planning. CONCLUSION Postpartum use of modern family planning has remained very low over the years, including for childbearing adolescents. Our results indicate that improving postpartum family planning requires policies and strategies to address the inequalities caused by socio-economic factors and the integration of family planning with maternal and newborn health services, particularly with childbirth in facilities and child immunisation. Scaling up systematic screening, training of providers, and generation of demand are some possible ways forward.
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Affiliation(s)
| | | | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Capão do Leão, Brazil
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Kimani J, Warren C, Abuya T, Mutemwa R, Mayhew S, Askew I. Family planning use and fertility desires among women living with HIV in Kenya. BMC Public Health 2015; 15:909. [PMID: 26381120 PMCID: PMC4574729 DOI: 10.1186/s12889-015-2218-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/03/2015] [Indexed: 11/12/2022] Open
Abstract
Background Enabling women living with HIV to effectively plan whether and when to become pregnant is an essential right; effective prevention of unintended pregnancies is also critical to reduce maternal morbidity and mortality as well as vertical transmission of HIV. The objective of this study is to examine the use of family planning (FP) services by HIV-positive and HIV-negative women in Kenya and their ability to achieve their fertility desires. Methods Data are derived from a random sample of women seeking family planning services in public health facilities in Kenya who had declared their HIV status (1887 at baseline and 1224 at endline) and who participated in a longitudinal study (the INTEGRA Initiative) that measured the benefits/costs of integrating HIV and sexual/reproductive health services in public health facilities. The dependent variables were FP use in the last 12 months and fertility desires (whether a woman wants more children or not). The key independent variable was HIV status (positive and negative). Descriptive statistics and multivariate logistic regression analysis were used to describe the women’s characteristics and to examine the relationship between FP use, fertility desires and HIV status. Results At baseline, 13 % of the women sampled were HIV-positive. A slightly higher proportion of HIV-positive women were significantly associated with the use of FP in the last 12 months and dual use of FP compared to HIV-negative women. Regardless of HIV status, short-acting contraceptives were the most commonly used FP methods. A higher proportion of HIV-positive women were more likely to be associated with unintended (both mistimed and unwanted) pregnancies and a desire not to have more children. After adjusting for confounding factors, the multivariate results showed that HIV-positive women were significantly more likely to be associated with dual use of FP (OR = 3.2; p < 0.05). Type of health facility, marital status and household wealth status were factors associated with FP use. Factors associated with fertility desires were age, education level and household wealth status. Conclusions The findings highlight important gaps related to utilization of FP among WLHIV. Despite having a greater likelihood of reported use of FP, HIV-positive women were more likely to have had an unintended pregnancy compared to HIV-negative women. This calls for need to strengthen family planning services for WLHIV to ensure they have better access to a wide range of FP methods. There is need to encourage the use of long-acting reversible contraceptive (LARC) to reduce the risk of unintended pregnancy and prevention of vertical transmission of HIV. However, such policies should be based on respect for women’s right to informed reproductive choice in the context of HIV/AIDS. Trial registration NCT01694862
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Affiliation(s)
- James Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Charlotte Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Timothy Abuya
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | - Richard Mutemwa
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
| | | | - Susannah Mayhew
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Ian Askew
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
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Bellows NM, Askew I, Bellows B. Review of performance-based incentives in community-based family planning programmes. J Fam Plann Reprod Health Care 2015; 41:146-51. [PMID: 25037703 PMCID: PMC4392304 DOI: 10.1136/jfprhc-2014-100883] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/05/2014] [Accepted: 05/20/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND One strategy for improving family planning (FP) uptake at the community level is the use of performance-based incentives (PBIs), which offer community distributors financial incentives to recruit more users of FP. This article examines the use of PBIs in community-based FP programmes via a literature search of the peer-reviewed and grey literature conducted in April 2013. RESULTS A total of 28 community-based FP programmes in 21 countries were identified as having used PBIs. The most common approach was a sales commission model where distributors received commission for FP products sold, while a referral payment model for long-term methods was also used extensively. Six evaluations were identified that specifically examined the impact of the PBI in community-based FP programmes. Overall, the results of the evaluations are mixed and more research is needed; however, the findings suggest that easy-to-understand PBIs can be successful in increasing the use of FP at the community level. CONCLUSION For future use of PBIs in community-based FP programmes it is important to consider the ethics of incentivising FP and ensuring that PBIs are non-coercive and choice-enhancing.
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Affiliation(s)
- Nicole M Bellows
- Independent Consultant, Riverside Park Westlands, Nairobi, Kenya
| | - Ian Askew
- Director, Reproductive Health Program, Population Council, Nairobi, Kenya
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Juma M, Askew I, Alaii J, Bartholomew LK, van den Borne B. Cultural practices and sexual risk behaviour among adolescent orphans and non-orphans: a qualitative study on perceptions from a community in Western Kenya. BMC Public Health 2014; 14:84. [PMID: 24467940 PMCID: PMC3912900 DOI: 10.1186/1471-2458-14-84] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study explored community perceptions of cultural beliefs and practices that may increase sexual risk behaviour of adolescents, to understand more about meaning they hold within the culture and how they expose adolescent orphans and non-orphans to higher risks in a high HIV and teenage pregnancy prevalence context. METHODS Using a qualitative descriptive cross-sectional design 14 focus group discussions were conducted with 78 adolescents and 68 parents/guardians purposively selected to represent their communities. Thirteen key informant interviews were also conducted with community leaders, health care and child welfare workers, and adolescents who were also selected purposively. The two methods were used to explore how cultural beliefs and practices predispose adolescent orphans and non- orphans to risky sexual behaviours. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes. RESULTS Identified cultural practices that predisposed adolescents orphans and non-orphans to risky sexual behaviours included: adolescent sleeping arrangements, funeral ceremonies, replacing a deceased married daughter with her younger sister in marriage, widow inheritance among boys, early marriage among girls, and preference for boys/sons. Cultural risks perceived to equally affect both orphans and non-orphans were sleeping arrangements, funeral ceremonies, and sister replacement. Factors associated more with orphans than non-orphans were widow inheritance among boys and a preference for boy over girl children. CONCLUSIONS Adolescent sexual risk reduction programs should be developed considering the specific cultural context, using strategies that empower communities to challenge the widely accepted cultural norms that may predispose young people in general to sexual risks while targeting those that unequally influence orphans.
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Affiliation(s)
- Milka Juma
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
| | - Ian Askew
- Population Council, P.O. Box 17643, Nairobi 00500, Kenya
| | - Jane Alaii
- Context Factor Solutions, P.O. Box 27598, Nairobi, Kenya
| | - L Kay Bartholomew
- University of Texas School of Public Health Houston, Houston, TX, USA
| | - Bart van den Borne
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
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Obare F, Warren C, Abuya T, Askew I, Bellows B. Assessing the population-level impact of vouchers on access to health facility delivery for women in Kenya. Soc Sci Med 2013; 102:183-9. [PMID: 24565156 DOI: 10.1016/j.socscimed.2013.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 11/05/2013] [Accepted: 12/05/2013] [Indexed: 11/28/2022]
Abstract
Although available evidence indicates that vouchers improve service utilization among the target populations, we do not know whether increased utilization results from improved access (new clients who would not have used services without the voucher) or from shifting clients from non-accredited to contracted service providers. This paper examines whether the safe motherhood voucher program in Kenya is associated with improved access to health facility delivery using information on births within two years preceding the survey in voucher and comparison sites. Data were collected in 2010-2011 and in 2012 among 2933 and 3094 women aged 15-49 years reporting 962 and 1494 births within two years before the respective surveys. Analysis entails cross-tabulations and estimation of multilevel random-intercept logit models. The results show that the proportion of births occurring at home declined by more than 10 percentage points while the proportion of births delivered in health facilities increased by a similar margin over time in voucher sites. The increase in facility-based births occurred in both public and private health facilities. There was also a significant increase in the likelihood of facility-based delivery (odds ratios [OR]: 2.04; 95% confidence interval [CI]: 1.40-2.98 in the 2006 voucher arm; OR: 1.72; 95% CI: 1.22-2.43 in the 2010-2011 voucher arm) in voucher sites over time. In contrast, there were no significant changes in the likelihood of facility-based delivery in the comparison arm over time. These findings suggest that the voucher program contributed to improved access to institutional delivery by shifting births from home to health facilities. However, available evidence from qualitative data shows that some women who purchased the vouchers did not use them because of high transportation costs to accredited facilities. The implication is that substantial improvements in service uptake could be achieved if the program subsidized transportation costs as well.
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Affiliation(s)
| | | | | | - Ian Askew
- Population Council, P.O. Box 17643, Nairobi, Kenya
| | - Ben Bellows
- Population Council, P.O. Box 17643, Nairobi, Kenya
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Eichler R, Agarwal K, Askew I, Iriarte E, Morgan L, Watson J. Performance-based incentives to improve health status of mothers and newborns: what does the evidence show? J Health Popul Nutr 2013; 31:36-47. [PMID: 24992802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Performance-based incentives (PBIs) aim to counteract weak providers' performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.
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Kanya L, Obare F, Warren C, Abuya T, Askew I, Bellows B. Safe motherhood voucher programme coverage of health facility deliveries among poor women in South-western Uganda. Health Policy Plan 2013; 29 Suppl 1:i4-11. [PMID: 24173430 PMCID: PMC4095921 DOI: 10.1093/heapol/czt079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There has been increased interest in and experimentation with demand-side mechanisms such as the use of vouchers that place purchasing power in the hands of targeted consumers to improve the uptake of healthcare services in low-income settings. A key measure of the success of such interventions is the extent to which the programmes have succeeded in reaching the target populations. This article estimates the coverage of facility deliveries by a maternal health voucher programme in South-western
Uganda and examines whether such coverage is correlated with district-level characteristics such as poverty density and the number of contracted facilities. Analysis entails estimating the voucher coverage of health facility deliveries among the general population and poor population (PP) using programme data for 2010, which was the most complete calendar year of implementation of the Uganda safe motherhood (SM) voucher programme. The results show that: (1) the programme paid for 38% of estimated deliveries among the PP in the targeted districts, (2) there was a significant negative correlation between the poverty density in a district and proportions of births to poor women that were covered by the programme and (3) improving coverage of health facility deliveries for poor women is dependent upon increasing the sales and redemption rates. The findings suggest that to the extent that the programme stimulated demand for SM services by new users, it has the potential of increasing facility-based births among poor women in the region. In addition, the significant negative correlation between the poverty density and the proportions of facility-based births to poor women that are covered by the voucher programme suggests that there is need to increase both voucher sales and the rate of redemption to improve coverage in districts with high levels of poverty.
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Affiliation(s)
- Lucy Kanya
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
| | - Francis Obare
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
| | - Charlotte Warren
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
| | - Timothy Abuya
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
| | - Ian Askew
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
| | - Ben Bellows
- Population Council, P. O. Box 17643-00500 Nairobi, Kenya and Population Council, 4301 Connecticut Avenue, NW, Washington, DC 20008 USA
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Okal J, Kanya L, Obare F, Njuki R, Abuya T, Bange T, Warren C, Askew I, Bellows B. An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda. Health Res Policy Syst 2013; 11:38. [PMID: 24139603 PMCID: PMC3853937 DOI: 10.1186/1478-4505-11-38] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/09/2013] [Indexed: 11/20/2022] Open
Abstract
Background Continued inequities in coverage, low quality of care, and high out-of-pocket expenses for health services threaten attainment of Millennium Development Goals 4 and 5 in many sub-Saharan African countries. Existing health systems largely rely on input-based supply mechanisms that have a poor track record meeting the reproductive health needs of low-income and underserved segments of national populations. As a result, there is increased interest in and experimentation with results-based mechanisms like supply-side performance incentives to providers and demand-side vouchers that place purchasing power in the hands of low-income consumers to improve uptake of facility services and reduce the burden of out-of-pocket expenditures. This paper describes a reproductive health voucher program that contracts private facilities in Uganda and explores the policy and implementation issues associated with expansion of the program to include public sector facilities. Methods Data presented here describes the results of interviews of six district health officers and four health facility managers purposefully selected from seven districts with the voucher program in southwestern Uganda. Interviews were transcribed and organized thematically, barriers to seeking RH care were identified, and how to address the barriers in a context where voucher coverage is incomplete as well as opportunities and challenges for expanding the program by involving public sector facilities were investigated. Results The findings show that access to sexual and reproductive health services in southwestern Uganda is constrained by both facility and individual level factors which can be addressed by inclusion of the public facilities in the program. This will widen the geographical reach of facilities for potential clients, effectively addressing distance related barriers to access of health care services. Further, intensifying ongoing health education, continuous monitoring and evaluation, and integrating the voucher program with other services is likely to address some of the barriers. The public sector facilities were also seen as being well positioned to provide voucher services because of their countrywide reach, enhanced infrastructure, and referral networks. The voucher program also has the potential to address public sector constraints such as understaffing and supply shortages. Conclusions Accrediting public facilities has the potential to increase voucher program coverage by reaching a wider pool of poor mothers, shortening distance to service, strengthening linkages between public and private sectors through public-private partnerships and referral systems as well as ensuring the awareness and buy-in of policy makers, which is crucial for mobilization of resources to support the sustainability of the programs. Specifically, identifying policy champions and consulting with key policy sectors is key to the successful inclusion of the public sector into the voucher program.
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Affiliation(s)
- Jerry Okal
- Population Council, Ralph Bunche Road, P,O, Box 17643, Nairobi 00500, Kenya.
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Juma M, Alaii J, Bartholomew LK, Askew I, Van den Born B. Understanding orphan and non-orphan adolescents' sexual risks in the context of poverty: a qualitative study in Nyanza Province, Kenya. BMC Int Health Hum Rights 2013; 13:32. [PMID: 23886019 PMCID: PMC3725178 DOI: 10.1186/1472-698x-13-32] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 07/19/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Some studies show orphanhood to be associated with increased sexual risk-taking while others have not established this relationship, but have found factors other than orphanhood as predictors of sexual risk behaviours and outcomes among adolescents. This study examines community members' perceptions of how poverty influences adolescent sexual behaviour and outcomes in four districts of Nyanza Province, Kenya. METHODS Eight study sites within the four districts were randomly selected. Focus group discussions were conducted with a purposive sample of adolescents, parents and caregivers. Key informant interviews were undertaken with a purposive sample of community leaders, child welfare and healthcare workers, and adolescents. The two methods elicited information on factors perceived to predispose adolescent orphans and non-orphans to sexual risks. Data were analysed through line-by-line coding, grouped into families and retrieved as themes and sub-themes. RESULTS Participants included 147 adolescents and parents/caregivers in 14 focus groups and 13 key informants. Poverty emerged as a key predisposing factor to sexual risk behaviour among orphans and non-orphans. Poverty was associated with lack of food, poor housing, school dropout, and engaging in income generating activities, all of which increase their vulnerability to transactional sex, early marriage, sexual experimentation, and the eventual consequences of increased risk of unintended pregnancies and STI/HIV. CONCLUSION Poverty was perceived to contribute to increasing sexual risks among orphan and non-orphan adolescents through survival strategies adopted to be able to meet their basic needs. Policies for prevention and intervention that target adolescents in a generalized poverty and HIV epidemic should integrate economic empowerment for caregivers and life skills for adolescents to reduce vulnerabilities of orphan and non-orphan adolescents to sexual risk behaviour.
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Affiliation(s)
- Milka Juma
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
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Njuki R, Obare F, Warren C, Abuya T, Okal J, Mukuna W, Kanya L, Askew I, Bracke P, Bellows B. Community experiences and perceptions of reproductive health vouchers in Kenya. BMC Public Health 2013; 13:660. [PMID: 23866044 PMCID: PMC3721984 DOI: 10.1186/1471-2458-13-660] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 07/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on demand-side health care financing approaches such as output-based aid (OBA) programs have focused on evaluating the role of the programs improving such outcomes as utilization of services and quality of services with limited focus on the experiences and perceptions of the target communities. This paper examines community members' views of the output-based aid voucher program in Kenya. METHODS A household survey was conducted in 2010 among 1,336 women aged 15-49 years living in the catchment areas of contracted health facilities in three districts participating in the voucher program (Kisumu, Kiambu and Kitui). Twenty seven focus group discussions were conducted with voucher users, non-users, opinion leaders and voucher distributors in the three districts as well as in Nairobi. Analysis of the quantitative data involved frequency distributions and cross-tabulations. Qualitative data were transcribed and analyzed by adopting framework analysis and further triangulation of themes across respondents. RESULTS Majority (84%) of survey respondents had heard about the safe motherhood voucher compared to 24% and 1% that had heard about the family planning and gender-based violence recovery services (GBVRS) vouchers respectively. Similarly, 20% of the respondents had used the safe motherhood voucher compared to 2% for family planning and none for the GBVRS vouchers. From the community members' perspectives, the voucher program is associated with improvements in access to health services for poor women, improved quality of care, and empowerment of women to make health care decisions. However, community members cited difficulties in accessing some accredited health facilities, limitations with the system of selling vouchers, lack of male involvement in women's reproductive health issues, and poor understanding of the benefits associated with purchasing the voucher. CONCLUSION The findings of this paper showed that the voucher program in Kenya is viewed by the community members as a feasible system for increasing service utilization, improving quality of care, and reducing financial barriers to accessing reproductive health services. However, the techniques of program execution such as proper information and availability of the distributors as well as local attitudes influence whether vouchers are purchased and used.
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Affiliation(s)
- Rebecca Njuki
- Population Council, P,O, Box 17643-00200, Nairobi, Kenya.
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Warren CE, Abuya T, Askew I. Family planning practices and pregnancy intentions among HIV-positive and HIV-negative postpartum women in Swaziland: a cross sectional survey. BMC Pregnancy Childbirth 2013; 13:150. [PMID: 23855776 PMCID: PMC3720191 DOI: 10.1186/1471-2393-13-150] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 07/11/2013] [Indexed: 12/04/2022] Open
Abstract
Background In settings where sexually transmitted infection (STI) and HIV prevalence is high, the postpartum period is a time of increased biological susceptibility to pregnancy related sepsis. Enabling women living with HIV to avoid unintended pregnancies during the postpartum period can reduce vertical transmission and maternal mortality associated with HIV infection. We describe family planning (FP) practices and fertility desires of HIV-positive and HIV-negative postpartum women in Swaziland. Methods Data are drawn from a baseline survey of a four-year multi country prospective cohort study under the Integra Initiative, which is measuring the benefits and costs of providing integrated HIV and sexual and reproductive health (SRH) services in Kenya and Swaziland. We compare data from 386 HIV-positive women and 483 HIV-negative women recruited in Swaziland between February and August 2010. Data was collected on hand-held personal digital assistants (PDAs) covering fertility desires, mistimed or unwanted pregnancies and contraceptive use prior to their most recent pregnancy. Data were analysed using Stata 10.0. Descriptive statistics were conducted using the chi square test for categorical variables. Measures of effect were assessed using multivariate fixed effects logistic regression model accounting for clustering at facility level and the results are presented as adjusted odds ratios. Results Majority (69.2%) of postpartum women reported that their most recent pregnancy was unintended with no differences between HIV-positive and HIV-negative women: OR: 0.96 (95% CI) (0.70, 1.32). Although, there were significant differences between HIV-positive and HIV-negative women who reported that their previous pregnancy was unwanted, (20.7% vs. 13.5%, p = 0.004), when adjusted this was not significant OR: 1.43 (0.92, 1.91). 47.2% of HIV-positive women said it was mistimed compared to 52.5%, OR: 0.79 (0.59, 1.06). 37.9% of all women said they do not want another child. Younger women were more likely to have unwanted pregnancies: OR: 1.12 (1.07, 1.12), while they were less likely to have mistimed births; OR: 0.82 (0.70, 0.97). Those with tertiary education were less likely to have unwanted or mistimed pregnancies OR: 0.30 (0.11, 0.86). Half of HIV-positive women and more than a third of HIV-negative women reported that they had been using a FP method when they became pregnant with no differences between the groups: OR: 1.61 (0.82,3.41). Only short-acting methods were available to these women before the most recent pregnancy; and available during the postpartum visit. One fifth of all women received an FP method during the current visit. Among the four fifths who did not receive a method 17.3% reported they were already using a method or were breastfeeding. HIV-positive women were more likely to have already started a method than HIV-negative women (20% vs. 15%, p = 0.089). Conclusion There are few differences overall between the experiences of both HIV-positive and negative women in terms of FP experiences, unintended pregnancy and services received during the early postpartum period in Swaziland. Women attending postpartum facilities are receiving satisfactory care. Access to a wider range of effective methods is urgently needed if high levels of unintended pregnancy are to be reduced among HIV-positive and HIV-negative women living in Swaziland.
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Affiliation(s)
- Charlotte E Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya.
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Juma M, Alaii J, Bartholomew LK, Askew I, Van den Borne B. Risky sexual behavior among orphan and non-orphan adolescents in Nyanza Province, Western Kenya. AIDS Behav 2013; 17:951-60. [PMID: 23073645 DOI: 10.1007/s10461-012-0336-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A household survey of male and female adolescents was conducted to establish whether orphanhood or other factors contribute to risky sexual behavior. Results show that orphanhood was not associated with risky sexual behavior. Sleeping in a different house from the household head and attending social activities at night were positively associated with sexual activity and transactional sex among boys and girls. Older adolescents were more likely to be sexually active while urban residents, and those who perceived their caregivers as able to provide for their basic needs, were less likely to have ever engaged in sex. Condom use at last sex was associated with older age and having talked with parents/caregivers about sexual risks. Interventions should address these predictors, promote risk reduction among all adolescents irrespective of orphan status, and strengthen parents'/guardians' capacity to discuss sexuality with adolescents and to provide for their basic needs.
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Affiliation(s)
- Milka Juma
- Department of Health Promotion, Maastricht University, Maastricht, The Netherlands.
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Warren CE, Mayhew SH, Vassall A, Kimani JK, Church K, Obure CD, du-Preez NF, Abuya T, Mutemwa R, Colombini M, Birdthistle I, Askew I, Watts C. Study protocol for the Integra Initiative to assess the benefits and costs of integrating sexual and reproductive health and HIV services in Kenya and Swaziland. BMC Public Health 2012; 12:973. [PMID: 23148456 PMCID: PMC3529107 DOI: 10.1186/1471-2458-12-973] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 10/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa (SSA) there are strong arguments for the provision of integrated sexual and reproductive health (SRH) and HIV services. Most HIV transmissions are sexually transmitted or associated with pregnancy, childbirth, and breastfeeding. Many of the behaviours that prevent HIV transmission also prevent sexually transmitted infections and unintended pregnancies. There is potential for integration to increase the coverage of HIV services, as individuals who use SRH services can benefit from HIV services and vice-versa, as well as increase cost-savings. However, there is a dearth of empirical evidence on effective models for integrating HIV/SRH services. The need for robust evidence led a consortium of three organizations - International Planned Parenthood Federation, Population Council and the London School of Hygiene & Tropical Medicine - to design/implement the Integra Initiative. Integra seeks to generate rigorous evidence on the feasibility, effectiveness, cost and impact of different models for delivering integrated HIV/SRH services in high and medium HIV prevalence settings in SSA. METHODS/DESIGN A quasi-experimental study will be conducted in government clinics in Kenya and Swaziland - assigned into intervention/comparison groups. Two models of service delivery are investigated: integrating HIV care/treatment into 1) family planning and 2) postnatal care. A full economic-costing will be used to assess the costs of different components of service provision, and the determinants of variations in unit costs across facilities/service models. Health facility assessments will be conducted at four time-periods to track changes in quality of care and utilization over time. A two-year cohort study of family planning/postnatal clients will assess the effect of integration on individual outcomes, including use of SRH services, HIV status (known/unknown) and pregnancy (planned/unintended). Household surveys within some of the study facilities' catchment areas will be conducted to profile users/non-users of integrated services and demand/receipt of integrated services, before-and-after the intervention. Qualitative research will be conducted to complement the quantitative component at different time points. Integra takes an embedded 'programme science' approach to maximize the uptake of findings into policy/practice. DISCUSSION Integra addresses existing evidence gaps in the integration evaluation literature, building on the limited evidence from SSA and the expertise of its research partners. TRIAL REGISTRATION Current Controlled Trials NCT01694862.
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Affiliation(s)
- Charlotte E Warren
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya
| | - Susannah H Mayhew
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Anna Vassall
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - James Kelly Kimani
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya
| | - Kathryn Church
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Carol Dayo Obure
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Natalie Friend du-Preez
- London School of Hygiene & Tropical Medicine, Department of Population Studies, Keppel Street, WC1E 7HT, London, UK
| | - Timothy Abuya
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya
| | - Richard Mutemwa
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Manuela Colombini
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
| | - Isolde Birdthistle
- London School of Hygiene & Tropical Medicine, Department of Population Studies, Keppel Street, WC1E 7HT, London, UK
| | - Ian Askew
- Population Council, General Accident Insurance House, Ralph Bunche Road, P.O. Box 17643-00500, Nairobi, Kenya
| | - Charlotte Watts
- London School of Hygiene & Tropical Medicine, Department of Global Health and Development, 15-17 Tavistock Place, WC1H 9SH, London, UK
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Abuya T, Njuki R, Warren CE, Okal J, Obare F, Kanya L, Askew I, Bellows B. A policy analysis of the implementation of a Reproductive Health Vouchers Program in Kenya. BMC Public Health 2012; 12:540. [PMID: 22823923 PMCID: PMC3490771 DOI: 10.1186/1471-2458-12-540] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 07/04/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovative financing strategies such as those that integrate supply and demand elements like the output-based approach (OBA) have been implemented to reduce financial barriers to maternal health services. The Kenyan government with support from the German Development Bank (KfW) implemented an OBA voucher program to subsidize priority reproductive health services. Little evidence exists on the experience of implementing such programs in different settings. We describe the implementation process of the Kenyan OBA program and draw implications for scale up. METHODS Policy analysis using document review and qualitative data from 10 in-depth interviews with facility in-charges and 18 with service providers from the contracted facilities, local administration, health and field managers in Kitui, Kiambu and Kisumu districts as well as Korogocho and Viwandani slums in Nairobi. RESULTS The OBA implementation process was designed in phases providing an opportunity for learning and adapting the lessons to local settings; the design consisted of five components: a defined benefit package, contracting and quality assurance; marketing and distribution of vouchers and claims processing and reimbursement. Key implementation challenges included limited feedback to providers on the outcomes of quality assurance and accreditation and budgetary constraints that limited effective marketing leading to inadequate information to clients on the benefit package. Claims processing and reimbursement was sophisticated but required adherence to time consuming procedures and in some cases private providers complained of low reimbursement rates for services provided. CONCLUSIONS OBA voucher schemes can be implemented successfully in similar settings. For effective scale up, strong partnership will be required between the public and private entities. The government's role is key and should include provision of adequate funding, stewardship and looking for opportunities to utilize existing platforms to scale up such strategies.
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Affiliation(s)
| | | | | | - Jerry Okal
- Population Council Nairobi, Nairobi, Kenya
| | | | - Lucy Kanya
- Population Council Nairobi, Nairobi, Kenya
| | - Ian Askew
- Population Council Nairobi, Nairobi, Kenya
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