Sexual Reproductive Health
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2021 ◽  
pp. 002190962110439
Nelson Muparamoto ◽  
Tsitsi Batsirai Chakanya ◽  
Isabel Shamu

Drawing on interviews and focus group discussions with 26 participants aged between 10 and 17, the paper describes sexual reproductive health problems, health-seeking behaviour, access to and utilisation of sexual reproductive health services among children living on the street in Harare. An intersectionality approach showed how participants’ social location, age and gender created vulnerabilities leading to STIs, maternal complications and sexual violence among others. Additionally, these factors contributed to challenges in accessing sexual reproductive health services among children living on the street. Thus there is need for tailor-made interventions to influence better health outcomes among children living on the street.

2021 ◽  
Vol 50 (Supplement_1) ◽  
Janaina Calu Costa ◽  
Giovanna Gatica-Dominguez ◽  
Cesar Victora ◽  
Aluisio Barros

Abstract Background African descendants continue to be affected by discrimination in the Americas. We assessed ethnic inequalities in sexual/reproductive health (SRH) in Latin American countries. Methods Using data from national surveys we analyzed SRH in nine countries. Absolute differences in coverage for Afro women and the country-specific reference group (usually full or mixed European ancestry) were estimated for contraception with modern methods (CPmo), family planning needs satisfied with modern methods (FPSmo), 4+ antenatal care visits (ANC4), and antenatal care start in the first trimester (ANC1st). The slope index of inequality (SII) was used to assess wealth-based inequalities. Results Afrodescendants represented from 2.4% of the sample (Costa Rica) to 56.4% (Brazil) and SRH coverage was lower for Afros compared to the reference. Average difference was of 4 percent points (pp) for CPmo and 6pp for FPSmo, and respectively 7pp and 11pp in the poorest group. The lower average difference (0.64) was found for ANC4, however Colombia had a gap of 7pp. For ANC1st, ethnic differences were >5pp in Brazil, Colombia, Ecuador and Suriname. Suriname had systematically lower coverage among Afros. In Honduras Afros presented similar/higher coverage than the reference. Positive SII revealed coverage concentrated in the richest group for all indicators, however the wealth-based inequalities were much greater among Afros, especially for ANC1st (mean SII = 23pp). Conclusion Lower coverage for Afro women is pervasive and worse for the poorest ones. Key messages Such evidence can help overcome ethnic long-term disadvantage in the Americas.

Karen Hardee

The International Conference on Population and Development (ICPD), which has guided programming on sexual reproductive health and rights (SRHR) for 25 years, reinforced that governments have a role to play in addressing population issues but in ways that respect human rights and address social and gender inequities. The shift at ICPD was partly in response to excesses that had occurred in some family planning programs, resulting in human rights abuses. The 2012 London Summit on Family Planning refocused attention on family planning as a crucial component of SRHR and, in part due to significant pushback on the announcement of a goal of reaching an additional 120 million women and girls with contraception by 2020 in the world’s poorest countries, ignited work to ensure that programming to achieve this ambitious goal would be grounded in respecting, protecting, and fulfilling human rights. This attention to human rights has been maintained in Family Planning 2030 (FP2030), the follow on to Family Planning 2020 (FP2020). While challenges remain, particularly in light of pushback on reproductive rights, widespread work over the past decade to identify human rights principles and standards related to family planning, integrate them into programming, strengthen accountability, and incorporate rights into monitoring and evaluation has improved family planning programs.

Warren Simangolwa ◽  
Kaymarlin Govender

There is a systematic exclusion of gender-based violence, safe abortion, reproductive cancers, infertility services, comprehensive sexuality education, sexuality services, and STI’s other than HIV in essential health packages in LMICs. To accelerate progress on sexual reproductive health (SRH), the Guttmacher–Lancet Commission proposed the adoption of these interventions into an essential health package of SRH services that should be universally available. In this commentary, we use a healthcare priority-setting processes lens to review the importance of these services for universal health coverage. We isolate inherent challenges in social value judgments for terminal, process and content evidence for their healthcare priority-setting. We then advance promising emerging practical examples from low to middle-income countries on evidence-informed decision-making processes. We recommend capacity development through regional support, generating equity and efficiency evidence and strengthening political and publicly acceptable processes to institutionalise and operationalise evidence-informed decision-making.

2021 ◽  
Vol 21 (1) ◽  
Melvin Simuyaba ◽  
Bernadette Hensen ◽  
Mwelwa Phiri ◽  
Chisanga Mwansa ◽  
Lawrence Mwenge ◽  

Abstract Background Meeting the sexual and reproductive health (SRH) needs of adolescents and young people (AYP) requires their meaningful engagement in intervention design. We describe an iterative process of engaging AYP to finalise the design of a community-based, peer-led and incentivised SRH intervention for AYP aged 15–24 in Lusaka and the lessons learnt. Methods Between November 2018 and March 2019, 18 focus group discussions, eight in-depth interviews and six observations were conducted to assess AYP’s knowledge of HIV/SRH services, factors influencing AYP’s sexual behaviour and elicit views on core elements of a proposed intervention, including: community-based spaces (hubs) for service delivery, type of service providers and incentivising service use through prevention points cards (PPC; “loyalty” cards to gain points for accessing services and redeem these for rewards). A total of 230 AYP (15 participated twice in different research activities) and 21 adults (only participated in the community mapping discussions) participated in the research. Participants were purposively selected based on age, sex, where they lived and their roles in the study communities. Data were analysed thematically. Results Alcohol and drug abuse, peer pressure, poverty, unemployment and limited recreation facilities influenced AYP’s sexual behaviours. Adolescent boys and young men lacked knowledge of contraceptive services and all AYP of pre and post exposure prophylaxis for HIV prevention. AYP stated a preference for accessing services at “hubs” located in the community rather than the health facility. AYP considered the age, sex and training of the providers when choosing whom they were comfortable accessing services from. PPCs were acceptable among AYP despite the loyalty card concept being new to them. AYP suggested financial and school support, electronic devices, clothing and food supplies as rewards. Conclusions Engaging AYP in the design of an SRH intervention was feasible, informative and considered responsive to their needs. Although AYP’s suggestions were diverse, the iterative process of AYP engagement facilitated the design of an intervention that is informed by AYP and implementable. Trial registration This formative study informed the design of this trial:, NCT04060420. Registered 19 August, 2019.

This study was aimed at examining the knowledge and perceptions of adolescents on Adolescent Sexual and Reproductive Health (ASRH) rural Zimbabwe. Adolescents in Zimbabwe faces limited access to health information and services. Different factors like poverty, gender inequality, socio-cultural and economic status play a crucial role in determining adolescent’s access to ASRH knowledge. Qualitative research methodology was used in the study. Data was gathered through key informant interviews and Focus Group Discussions (FGDs). The culture of communicating ASRH problems with parents was non-existent in most cases save for girls who indicated that they got information from their mothers during menstruation periods. Adolescents indicated that they had limited access to ASRH services available in their community. They further indicated that they were not utilising these services for various reasons such as social stigma, lack of information, poor quality service and the negative attitude displayed by some nurses and counsellors at the nearest health centre.

2021 ◽  
Vol 5 ◽  
pp. 104
Alison Kutywayo ◽  
Sasha Frade ◽  
Kerry Gordon ◽  
Tshepo Mahuma ◽  
Nicolette P. Naidoo ◽  

Background: Empowerment is when a person gains mastery of their life and environment. This paper describes three central elements of empowerment (agency, resources, and institutional structures) expressed by adolescents, discussing implications for strengthening adolescent sexual reproductive health, HIV, and violence prevention programming. Methods: A cross-sectional survey was conducted (April 2017 – May 2018) as part of the GAP Year trial among grade eight learners (12 – 18 years) from 26 lowest quintile public high schools in Khayelitsha, Soweto and Thembisa townships, South Africa. Data were on empowerment experiences using a knowledge, attitudes, and practices survey. Descriptive and chi-square test statistics were employed, assessing the association between sociodemographic and domains of empowerment. Results: A total of 2383 adolescents in 26 schools completed the baseline survey: 63.1% female, mean age 13.7 years, 96.9% Black African. Agency: Males (4.04 vs 3.94, p=0.008) and those 15 – 18 years (4.10 vs 3.95, p=0.027) expressed stronger decision-making capacity. Females (3.18 vs 2.92, p<0.001) indicated a greater sense of collective action. Females (0.77 vs 0.72, p=0.008), those aged 12 -14 years (0.76 vs 0.71, p=0.027) and those with at least one parent/guardian employed (p=0.014) had stronger leadership confidence. Resources: Those 12-14 years expressed higher self-esteem (2.18 vs 2.08, p=0.017). Males (2.24 vs 1.87, p<0.001) and those who had at least one parent/guardian employed (p=0.047) had a higher perception of freedom from gender-based violence. Males showed greater mobility (2.89 vs 2.66, p=<0.001). Institutional structures: Coloured participants showed more positive norms than their Black counterparts (5.38 vs 2.12, p=0.005). Conclusions: Males expressed greater empowerment around decision-making, gender-based violence and mobility; females expressed greater collective action and leadership. Working across the ecological model, interventions addressing sex differences, targeting adolescents of all ages, and parental unemployment may strengthen expressions of empowerment, especially adolescents’ safety, mobility, aspirations, and future hopes.

2021 ◽  
Emeka Chukwu ◽  
Sonia Gilroy ◽  
John Sesay ◽  
Lalit Garg ◽  
Kim Eva Dickson

BACKGROUND UNFPA launched two one-month campaigns to reach Sierra Leoneans at scale with critical Sexual Reproductive Health and gender-based violence messages during the Coronavirus 2019 pandemic. OBJECTIVE The intervention objective was to deliver Sexual Reproductive Health (SRH) and gender-based violence (GBV) messages to mobile phone subscribers in Sierra Leone. This paper presents the intervention’s messaging campaign design, deployment methodologies, and design-decisions; shows campaign effectiveness; and share lessons learned, including call pickup rates and listening-duration. METHODS We designed and deployed a two-phased campaign – phase one targeted Freetown (urban) residents, and phase two targeted Sierra Leoneans nationwide (urban and rural). Phase one delivered Family Planning, Maternal Health, Gender Based Violence (GBV), and Coronavirus 2019 messages through automated voice calls, SMS, radio jingles, and social media. Phase two of the campaign delivered national GBV only campaign messages through SMS and Radio jingles. RESULTS In phase one, only 31% of the 1,093,606 initiated automated calls to 290,000 subscribers were picked up, and this dropped significantly at 95% confidence (p=1) after each of the four weeks. Also, at 95% confidence levels, a significant number of subscribers did not listen to the complete messages when repeated (p=1). Thirty-one million two hundred (31.2 million) SMS messages were sent to all 3.9 million active Africell subscribers in Sierra Leone during the second phase. Also, SRH and GBV messages were aired on thirteen national radio stations in Sierra Leone during the second phase. The national toll free helpline for GBV cases reported an increase in calls and attributed it to the campaign. Automated call interventions are cost and human resource intensive. Call pickup rates, listening duration, language, and consideration for users’ ability to re-reference messages are key factors when selecting scalable messaging campaign channels. The drop in the number of subscribers picking up automated calls from the first to fourth week was significant at a confidence level of 95%. According to the GBV helpline operators, the increase in calls reporting GBV was attributable to our campaign. CONCLUSIONS Only a third of subscribers called with pre-recorded messages picked up their calls. When automated calls are repeated, it leads to a significant drop in call completion rates. There was an increase in demand for service to the GBV helpline in the month following the campaign. A multi-channel messaging campaign helped reach different groups of young people.

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