scholarly journals “Burnt by the scorching sun”: climate-induced livelihood transformations, reproductive health, and fertility trajectories in drought-affected communities of Zambia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joseph G. Rosen ◽  
Drosin Mulenga ◽  
Lyson Phiri ◽  
Natasha Okpara ◽  
Caila Brander ◽  
...  

Abstract Background Climate-induced disruptions like drought can destabilize household and community livelihoods, particularly in low- and middle-income countries. This qualitative study explores the impact of severe and prolonged droughts on gendered livelihood transitions, women’s social and financial wellbeing, and sexual and reproductive health (SRH) outcomes in two Zambian provinces. Methods In September 2020, in-depth interviews (n = 20) and focus group discussions (n = 16) with 165 adult women and men in five drought-affected districts, as well as key informant interviews (n = 16) with civic leaders and healthcare providers, were conducted. A team-based thematic analysis approach, guided by the Framework Method, was used to code transcript text segments, facilitating identification and interpretation of salient thematic patterns. Results Across districts, participants emphasized the toll drought had taken on their livelihoods and communities, leaving farming households with reduced income and food, with many turning to alternative income sources. Female-headed households were perceived as particularly vulnerable to drought, as women’s breadwinning and caregiving responsibilities increased, especially in households where women’s partners out-migrated in search of employment prospects. As household incomes declined, women and girls’ vulnerabilities increased: young children increasingly entered the workforce, and young girls were married when families could not afford school fees and struggled to support them financially. With less income due to drought, many participants could not afford travel to health facilities or would resort to purchasing health commodities, including family planning, from private retail pharmacies when unavailable from government facilities. Most participants described changes in fertility intentions motivated by drought: women, in particular, expressed desires for smaller families, fearing drought would constrain their capacity to support larger families. While participants cited some ongoing activities in their communities to support climate change adaptation, most acknowledged current interventions were insufficient. Conclusions Drought highlighted persistent and unaddressed vulnerabilities in women, increasing demand for health services while shrinking household resources to access those services. Policy solutions are proposed to mitigate drought-induced challenges meaningfully and sustainably, and foster climate resilience.

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.


2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Bright Opoku Ahinkorah ◽  
Abdul-Aziz Seidu ◽  
Carolyne Njue

Abstract Background The impact of COVID-19 is weighing heavily on many African countries. As of November 14th 2021, 6,109,722 cases had been recorded with 151,173 deaths and 2.5% case fatality rate. Studies reveal substantial morbidity and socioeconomic impacts when accessing quality maternal healthcare including fear of infection and the containment measures in place, including social distancing and community containment. The pandemic has put additional strain on healthcare systems that are overburdened and under-resourced even in normal times and has exposed the vulnerabilities of high-risk population groups in addressing critical healthcare concerns. This study presents a mini review of how COVID-19 has disrupted maternal healthcare in Africa, and it further proposes ways to improve the situation. Main body COVID-19 has disrupted antenatal, skilled birth, and postnatal family planning services. Women and girls are vulnerable to the impact of COVID-19 on several fronts and represent a group whose needs including antenatal, skilled birth, and postnatal family planning services have been disrupted, leading to unmet needs for contraception and an increase in unintended pregnancies. Restricted travel due to the fear and anxiety associated with contracting COVID-19 has resulted in delays in accessing prompt skilled care and essential healthcare services such as pregnancy care, immunisation, and nutritional supplementation. Misconceptions relating to COVID-19 have prompted concerns and created distrust in the safety of the healthcare system. Innovative measures are required to address these obstacles and ensure women are not denied access to available, accessible, acceptable, and quality maternal healthcare services in spite of COVID-19. Conclusions In the immediate term while physical distancing measures remain in force, deliberate effort must be made to provide evidence-based guidelines, good practice and expert advice that addresses the unique sexual and reproductive health context of African countries. Efforts to train and motivate healthcare providers to adopt online, remote approaches such as use of telemedicine, and expand the involvement of frontline maternal healthcare providers to deliver information on the availability of services through phone-based referral networks, culturally appropriate social media, community radio and folklore messaging strategies are critical to mobilise and secure community confidence in the safety of sexual and reproductive health and maternal care services.


2019 ◽  
Vol 7 (2) ◽  
pp. 53-67
Author(s):  
Emmanuel Banchani ◽  
Liam Swiss

In 2010, the G8 placed renewed focus on maternal health via the Muskoka Initiative by committing to spend an additional $5 billion on maternal, newborn, and child health before 2015. Following the end of the Millennium Development Goals and the advent of the Sustainable Development Goals, maternal health issues have continued to feature prominently on the global health agenda. Despite these substantial investments of foreign aid over the past decade, there is limited evidence on the effectiveness of foreign aid in reducing maternal mortality in low- and middle-income countries (LMICs). Using data from the Organisation for Economic Cooperation and Development, the World Development Indicators and the Institute of Health Metrics and Evaluation, this study analyzes the effects of aid on maternal health in a sample of 130 LMICs from 1996 through 2015. Our results show that the effects of total foreign aid on maternal mortality are limited, but that aid allocated to the reproductive health sector and directly at maternal health is associated with significant reductions in maternal mortality. Given these targeted effects, it is important to channel more donor assistance to the promotion of reproductive health and contraceptive use among women as it serves as a tool towards the reduction of maternal mortality.


Author(s):  
Salima Meherali ◽  
Bisi Adewale ◽  
Sonam Ali ◽  
Megan Kennedy ◽  
Bukola (Oladunni) Salami ◽  
...  

Adolescents living in low- and middle-income countries (LMICs) are struggling with accessing sexual and reproductive health (SRH) services, and COVID-19 has escalated the problem. The purpose of this review was to identify and assess the existing literature on the impact of the pandemic on SRH needs and access to services by adolescents in LMICs. A scoping review was conducted to collate findings on the topic. Searches were performed on eight databases. Data were extracted and categorized into various themes. After removing duplicates and performing a full-text reading of all articles, nine articles were included in our review. Our findings generated several themes related to adolescents’ sexual and reproductive health during the COVID-19 pandemic. These include (1) limited access to sexual and reproductive health services, (2) school closure and increased rate of early marriages, (3) sexual or intimate partner violence during COVID-19, (4) disruption in maternity care, (5) adolescents’ involvement in risky or exploitative work, (6) intervention to improve sexual and reproductive health services during COVID-19, and (7) policy development related to adolescent sexual and reproductive health. Several recommendations were made on policies—for instance, the use of telemedicine and community-based programs as a way to deliver SRH services to adolescents during and after a pandemic.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Flore Deboscker ◽  
Mathieu Nacher ◽  
Antoine Adenis ◽  
Florence Huber ◽  
Aude Lucarelli ◽  
...  

Purpose Incarcerated women are a vulnerable population in terms of sexual and reproductive health. In French Guiana, most incarcerated women come from unsafe environments and are incarcerated because of drug trafficking. Medical follow-up processes used in prison (medical assessment on arrival, and then two half-days per week upon request but without an obstetrician-gynecologist) does not allow for a thorough assessment of the impact of incarceration on women prisoners’ health to take place. In the absence of data, the purpose of this study was to describe incarcerated women’s experiences in relation to sexual and reproductive health. Design/methodology/approach Semi-structured interviews were conducted among French-speaking adult women who had been incarcerated for at least four months in a French Guianan prison. Menstruation, contraception, pregnancy, abortion, sexually transmitted infections and sexuality were described by means of interpretative phenomenological analysis. Findings A total of 14 women were interviewed. They suffered from menstrual cycle disorders, poor hygiene and menstrual insecurity. They appeared to have emotionally disinvested sexuality. However, intra-prison sexual activity existed for some (masturbation, conjugal prison visits, homosexual intercourse between fellow prisoners). Homosexual relations were a source of discrimination. Being pregnant while incarcerated was viewed negatively. A lack of knowledge about sexual and reproductive health and high-risk behaviors such as piercing and tattooing practices were widespread. Originality/value Incarceration is a vulnerable time for women’s sexual and reproductive health. Sexual activity exposes women to risks and discrimination that should be taken into account in a multidisciplinary approach adapted to the prison environment.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Kingsley Appiah Bimpong ◽  
Benjamin Demah Nuertey ◽  
Anwar Sadat Seidu ◽  
Stephanie Ajinkpang ◽  
Alhassan Abdul-Mumin

At the beginning of the COVID-19 pandemic, early modelling studies estimated a reduction in childhood vaccinations in low- and middle-income countries. Regular provision of both curative and preventive services such as antenatal care and childhood immunizations has been negatively affected since the onset of the pandemic. Our study was aimed at examining the impact that the pandemic had on childhood vaccination services at the Tamale Teaching Hospital (TTH). A mixed methods study design was employed for the study, which was conducted at the Child Welfare Clinic (CWC) of the TTH. With quantitative approach, we retrospectively looked at the uptake of the various vaccines during the pandemic era, defined as the period between 1st March 2020 and 28th February, 2021, and the prepandemic era defined as the period 1st March 2019 to 29th February, 2020. The qualitative approach was used to understand the perspective of five healthcare providers at the CWC and the four caregivers of children who have missed a vaccine or delayed in coming, on the factors accounting for any observed change. Data analysis was done using Microsoft Excel 2016 and thematic content analysis. Quantitative data were presented in frequencies, percentages, and line graphs. With the exception of the Measles Rubella (MR) 2 vaccine, we observed a decline ranging from 47% (2298) to 10.5% (116), with the greatest decline seen in the BCG and the least decline seen in the MR1 vaccine. The month of May 2020 saw the greatest decline, that is, 70.6% (813). A decline of 38.3% (4473) was noted when comparison was made between the designated prepandemic and pandemic eras, for all the vaccines in our study. Fear of COVID-19 infection and misinformation were commonly given as reasons for the decline. Catch-up immunization schedule should be instituted to curtail possible future outbreaks of vaccine-preventable diseases.


2020 ◽  
Author(s):  
Naikhoba Munabi ◽  
Allyn Auslander ◽  
Meredith D. Xepoleas ◽  
Libby D. Bunker ◽  
Kella L. Vangsness ◽  
...  

Abstract Background: Low- and middle-income countries (LMICs) have the greatest need for additional healthcare providers, and women outside the workforce could help address the need. Women in healthcare need more mentorship and leadership training to advance their careers. This study evaluates how women working together on a medical team impacts mentorship, leadership and empowerment. Methods: An all-female volunteer team participating in a cleft surgery mission in Oujda, Morocco were surveyed before and after the mission. Responses were analyzed according to country of origin, national gender equality ranking, volunteer role, and prior mentorship experiences. Statistical analysis with student’s t-test or chi-squared were performed with significance defined as p<0.05. Results: 95 female volunteers from 23 countries participated and 85% completed surveys. Volunteers from HICs (32%) and LMICs (68%) had similar mission roles (p=0.58) and duration of volunteerism (p=0.69). Experience as a mission volunteer (p=0.47), team leader (p=0.28), and educator (p=0.18) were equivalent between cohorts. 73% of women had previously received mentorship but 98% wanted more. 75% had previously mentored others, but 97% wanted to be mentors. Over 90% of past mentor-mentee relationships were between women. 73% of volunteers who had no prior mentorship found their first mentor during the mission. All participants found a long-term peer relationship and felt motivated to mentor women at home. All volunteers felt empowered and enjoyed the mission. Over 95% were inspired to pursue leadership positions, advance professionally, and work with other women at home.Conclusion: Female healthcare professionals in HICs and LMICs desire more mentorship than is available. An all-female healthcare environment can provide opportunities for mentorship and create lasting motivation to teach, lead, and advance professionally. Increasing the visibility of female professionals may effectively empower women in healthcare.


2020 ◽  
Author(s):  
Naikhoba Munabi ◽  
Allyn Auslander ◽  
Meredith D. Xepoleas ◽  
Libby D. Bunker ◽  
Kella L. Vangsness ◽  
...  

Abstract Background: Low- and middle-income countries (LMICs) have the greatest need for additional healthcare providers, and women outside the workforce could help address the need. Women in healthcare need more mentorship and leadership training to advance their careers. This study evaluates how women working together on a medical team impacts mentorship, leadership and empowerment. Methods: An all-female volunteer team participating in a cleft surgery mission in Oujda, Morocco were surveyed before and after the mission. Responses were analyzed according to country of origin, national gender equality ranking, volunteer role, and prior mentorship experiences. Statistical analysis with student’s t-test or chi-squared were performed with significance defined as p<0.05. Results: 95 female volunteers from 23 countries participated and 85% completed surveys. Volunteers from HICs (32%) and LMICs (68%) had similar mission roles (p=0.58) and duration of volunteerism (p=0.69). Experience as a mission volunteer (p=0.47), team leader (p=0.28), and educator (p=0.18) were equivalent between cohorts. 73% of women had previously received mentorship but 98% wanted more. 75% had previously mentored others, but 97% wanted to be mentors. Over 90% of past mentor-mentee relationships were between women. 73% of volunteers who had no prior mentorship found their first mentor during the mission. All participants found a long-term peer relationship and felt motivated to mentor women at home. All volunteers felt empowered and enjoyed the mission. Over 95% were inspired to pursue leadership positions, advance professionally, and work with other women at home.Conclusion: Female healthcare professionals in HICs and LMICs desire more mentorship than is available. An all-female healthcare environment can provide opportunities for mentorship and create lasting motivation to teach, lead, and advance professionally. Increasing the visibility of female professionals may effectively empower women in healthcare.


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