What Do Americans Think About the Role of Quality of Care Information When Making Decisions About Their Health Care?

Highlights findings from an April 2006 survey on how Americans view quality-of-care information, including the importance of ratings in making healthcare-related decisions. Analyzes which indicators influence choices of doctors and practices

The need for integrated climate change action in sexual and reproductive health and gender based violence programming - evidence and recommendations for the Arab Region

Climate change is the greatest environmental challenge of our time and is a major threat to the vision of human-centred sustainable development as outlined in the International Conference on Population and Development (ICPD) Programme of Action. Climate change has also emerged as one of the most complex and important factors in the Arab region with dire impacts on water scarcity, food security and human health. The increasing frequency of natural disasters and extreme weather events is exacerbating the social, political, and economic challenges and is rendering the region even more vulnerable to instability and conflict. Extreme events fundamentally challenge the ways in which societies access, benefit from and interact with the environment with impacts on natural resources, food security, infrastructure, social and health services, and livelihoods. The indirect impacts of extreme weather events affect communities and the health and rights of women and girls, especially those who may already be vulnerable to multiple and intersecting forms of discrimination. In the Arab region, climate change-related extreme events, such as droughts and flooding, impact on sexual and reproductive health and reproductive rights (SRHRR) and gender-based violence (GBV) risks by exacerbating existing gender inequalities and unequal social and gender norms. The pace of climate change, expected to accelerate over the next decade, alongside gender inequalities, extremism, and acute and protracted crises may make it more challenging to achieve the 2030 Agenda for Sustainable Development including the ICDP Programme of Action in the Arab Region. In effect, climate change, gender equality, and SRHRR are inextricably linked. SRHRR has to be considered a key component of climate adaptation and resilience action and of climate justice. UNFPA’s value proposition on climate change outlines a multipronged approach via four pillars to integrate SRHRR into climate adaptation strategies, and thereby deliver for women and young people. This paper aims to review the existing evidence based on the linkages between climate change and SRHRR and intends to outline UNFPA opportunities for engagement with counterparts in governments and other organisations. The paper formulates recommendations in support of strengthening resilience to climate change for women and girls across various levels of operation and programmatic areas. Women and girls can be effective change-makers for climate resilience as their participation and involvement in sustainability initiatives is leading to more effective climate action

Gender-Based Violence in the Context of Climate Change in the Arab Region. Review of Evidence and Pathways.

The impact of climate change is not felt the same by everyone. As climate change impacts access to resources and livelihoods, women and girls, especially those experiencing multiple and intersecting forms of discrimination, face heightened risks of gender-based violence, including harmful practices, while their access to prevention and response services may be disrupted by extreme weather events and disasters. Gender-based violence also limits prevention and response efforts to climate change as it creates barriers for women and girls to participate in decision-making and resilience efforts to climate change. In line with the human centred sustainable development outlined in the International Conference on Population and Development (ICPD) Programme of Action and as reinforced by the 2030 Agenda for Sustainable Development, we have an obligation to address the gendered impacts of climate change to meet the internationally agreed commitments for achieving gender equality and fulfilling the human rights of all women and girls for a world where they can exercise their bodily autonomy and live up to their full potential, free from violence. As part of these efforts, this paper aims to present the evidence on the interlinkages between climate change and gender-based violence in the Arab region and to provide recommendations to support the international community, policy-makers, feminist and climate change advocates, researchers and professionals in the field of climate change and gender issues, in acting jointly to strengthen gender-responsive climate action as part of our collective efforts to achieve gender equality and the empowerment of all women and girls

Recent intimate partner violence against women and health: a systematic review and meta-analysis of cohort studies.

OBJECTIVE: We reviewed cohort studies to determine the magnitude and temporal direction of the association between recent intimate partner violence (IPV) and a range of adverse health outcomes or health risk behaviours. DESIGN: Systematic review and meta-analysis. METHODS: Medline, EMBASE and PsycINFO were searched from the first record to November 2016. Recent IPV was defined as occurring up to and including the last 12 months; all health outcomes were eligible for inclusion. Results were combined using random-effects meta-analysis. RESULTS: 35 separate cohort studies were retrieved. Eight studies showed evidence of a positive association between recent IPV and subsequent depressive symptoms, with a pooled OR from five estimates of 1.76 (95% CI 1.26 to 2.44, I2=37.5%, p=0.172). Five studies demonstrated a positive, statistically significant relationship between depressive symptoms and subsequent IPV; the pooled OR from two studies was 1.72 (95% CI 1.28 to 2.31, I2=0.0%, p=0.752). Recent IPV was also associated with increased symptoms of subsequent postpartum depression in five studies (OR=2.19, 95% CI 1.39 to 3.45, p=0.000), although there was substantial heterogeneity. There was some evidence of a bidirectional relationship between recent IPV and hard drug use and marijuana use, although studies were limited. There was no evidence of an association between recent IPV and alcohol use or sexually transmitted infections (STIs), although there were few studies and inconsistent measurement of alcohol and STIs. CONCLUSIONS: Exposure to violence has significant impacts. Longitudinal studies are needed to understand the temporal relationship between recent IPV and different health issues, while considering the differential effects of recent versus past exposure to IPV. Improved measurement will enable an understanding of the immediate and longer term health needs of women exposed to IPV. Healthcare providers and IPV organisations should be aware of the bidirectional relationship between recent IPV and depressive symptoms. PROSPERO REGISTRATION NUMBER: CRD42016033372

COVID-19 social distancing measures and informal urban settlements.

To slow down the community transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), context-appropriate measures are vital. The first COVID-19 cases in Kenya, Uganda and the United Republic of Tanzania were reported in March 2020. All three countries have introduced measures to slow the spread of the virus, such as encouraging washing and/or sanitizing hands frequently, staying at home, practising physical distancing when outside the home and partial lockdowns. Most of these prevention measures replicate those from high-income countries and implementation in these three countries has not been without added challenges. The blanket transfer of prevention measures to low-income countries is problematic, especially in urban informal settlements in eastern Africa, due to major contextual differences. Here we draw on examples of these three East African countries to illustrate the challenges that individuals and families face in adopting measures such as physical distancing to slow down the spread of SARS-CoV-2

A mixed-method review of cash transfers and intimate partner violence in low and middle-income countries

There is increasing evidence that cash transfer (CT) programs decrease intimate partner violence (IPV); however, little is known about how CTs achieve this impact. We conducted a mixed method review of studies in low- and middle-income countries. Fourteen quantitative and nine qualitative studies met our inclusion criteria, of which eleven and six respectively demonstrated evidence that CTs decrease IPV. We found little support for increases in IPV, with only two studies showing overall mixed or adverse impacts. Drawing on these studies, as well as related bodies of evidence, we developed a program theory proposing three pathways through which CT could impact IPV: 1) Economic security and emotional wellbeing, 2) intra-household conflict, and 3) women’s empowerment. The economic security and wellbeing pathway hypothesizes decreases in IPV, while the other two pathways have ambiguous effects depending on program design features and behavioural responses to program components. Future studies should improve IPV measurement, empirical analysis of program mechanisms, and fill regional gaps. Program framing and complementary activities, including those with the ability to shift intra-household power relations are likely to be important design features for understanding how to maximize and leverage the impact of CTs for reducing IPV, and mitigating potential adverse impacts

Hazardous Child Labour, Psychosocial Functioning, and School Dropouts among Children in Bangladesh: A Cross-Sectional Analysis of UNICEF’s Multiple Indicator Cluster Surveys (MICS)

Child labour is a common financial coping strategy in poor households, especially in low-and middle-income countries with many children working under hazardous conditions. Little is known about the linkages between hazardous work conditions and psycho-social and educational outcomes. We analysed the Bangladesh Multiple Indicator Cluster Survey (BMICS) round 6 to assess the association between the exposure variables, including child labour, hazardous child labour (HZCL) and hazardous work, and outcome variables, including psychosocial functioning difficulty and school dropout, in children aged 5 to 17 years. We conducted bivariable and multivariable analyses to examine the association. In the adjusted analyses, children engaged in HZCL had increased odds of psychosocial functioning difficulty (aOR: 1.41; 95% CI: 1.16–1.72) and school dropout (aOR: 5.65; 95% CI: 4.83–6.61) among 5–14-year-olds compared to children who did not engage in child labour and hazardous work. Other independent factors associated with psychosocial functioning difficulty and school dropout included being male, living in a deprived neighbourhood, being exposed to violent punishment, the caregiver’s attitude towards physical punishment, the mother’s functional difficulty and lower maternal education. The linkages between hazardous work and psychosocial functioning difficulty appear more prominent among children not in school. Further, the evidence on the relationship between hazardous work and school dropout is stronger among children with psychosocial functioning difficulty. Policies and programmes that target the most hazardous forms of work are likely to have the greatest benefits for children’s mental health, social well-being and educational attainment

Natural hazards, disasters and violence against women and girls: a global mixed-methods systematic review.

INTRODUCTION: Disasters triggered by climate and other natural hazards are increasing in frequency, severity and duration worldwide. Disasters disproportionately impact women and girls, with some evidence suggesting that violence against women and girls (VAWG) increases in disaster settings. Suggested risk factors for postdisaster VAWG include increased life stressors, failure of law enforcement, exposure to high-risk environments, exacerbation of existing gender inequalities and unequal social norms. We aim to systematically appraise the global literature on the association between disasters from natural hazards and VAWG. METHODS: We conducted a systematic review using the following databases: Embase, Global Health, Medline, PubMed and Social Policy and Practice and searched grey literature. We included quantitative, qualitative or mixed-methods studies published in English language that examined the association between disasters from natural hazards and VAWG. We summarised the findings using a narrative synthesis approach. RESULTS: Of 555 non-duplicate records, we included a total of 37 quantitative, qualitative and mixed-methods studies. Among the quantitative studies, eight studies found a positive association between disaster exposure and increased VAWG, and four additional studies found positive associations with some violence types but not others. Qualitative findings offered insights into three hypothesised pathways: disaster exposure associated with (1) an increase of stressors that trigger VAWG; (2) an increase of enabling environments for VAWG and (3) an exacerbation of underlying drivers of VAWG. CONCLUSION: As the first known global systematic review on the relationship between disasters from natural hazards and VAWG, this review contributes to the evidence base. We were limited by the quality of quantitative studies, specifically study designs, the measurement of variables and geographic scope. The severe health consequences of VAWG and increasing frequency of extreme events means that rigorously designed and better quality studies are needed to inform evidence-based policies and safeguard women and girls during and after disasters

Household decision-making and its association with intimate partner violence: Examining differences in men's and women's perceptions in Uganda.

INTRODUCTION: A vast body of evidence identifies intimate partner violence (IPV) as a public health and human rights issue with detrimental health consequences. The exploration of household decision-making, as an indicator of women's empowerment, and its association with IPV has so far yielded mixed results, mostly due to measurement issues. Given the sizeable investment in women's empowerment initiatives, and their potential to improve women's health, it is important to elucidate the relationship between household decision-making and IPV. METHODS: We conducted a secondary analysis of the 2011 Uganda Demographic and Health Survey (DHS) data to explore the relationship between women's household decision-making and experience of physical IPV. The dependent variable in our analysis was past year physical violence and it was constructed using men's reported perpetration of partner violence (men's questionnaire). Six independent variables were included - one each for men and women's perspectives on who usually makes decisions about the following domains: 1) how money earned is spent, 2) health care, and 3) large household purchases. We ran a probit model, controlling for variables featured in our theoretical framework. RESULTS: The association between household decision-making and women's likelihood of experiencing IPV depended on the decision-making domain and on who reported it. Women's reporting on decision-making did not predict their experience of IPV, whereas men's reporting on two decision-making domains (large household purchases and expenditure of husband's earnings) predicted likelihood of women experiencing IPV. Joint decision-making and women's decisions alone in both of these domains were associated with a lower probability of IPV compared to husband's making the decisions alone, where husband's reported decision-making. CONCLUSION: This study demonstrates that men's views on coupled dynamics should be included in program design and evaluation to provide a more holistic picture of the ecological framework and risk and protective factors of IPV

Intimate partner violence during pregnancy against adolescents in sub-Saharan Africa: a systematic review

BACKGROUND: Adolescent pregnancy and intimate partner violence (IPV) are major public health issues that are linked to poor health outcomes particularly during pregnancy. In sub-Saharan Africa (SSA), previous studies on IPV during pregnancy have primarily focused on adults. This review examines the available evidence on adolescents' experience of IPV during pregnancy in SSA. DESIGN: Systematic review. METHODS: We searched multiple databases for articles that met our inclusion criteria. Included studies investigated IPV during pregnancy, including prevalence, risk factors and health outcomes among ever-pregnant adolescents aged 10-19 years old or younger in SSA. Studies were peer-reviewed studies from SSA, quantitative and/or qualitative; and published in English regardless of the year of publication. RESULTS: Nine studies out of 570 abstracts screened, published between 2007 and 2020, met the inclusion criteria. The prevalence of IPV during pregnancy among adolescents in SSA ranged from 8.3% to 41%. Mental health symptoms, particularly depression, and anxiety, were associated with adolescent IPV during pregnancy and qualitatively linked to poor coping strategies when dealing with IPV. CONCLUSION: This review found evidence of a linkage between pregnancy and IPV during pregnancy among adolescents. Given the long-term negative effects of IPV during pregnancy on adolescents and children, this conclusion points to the critical need for developing interventions to improve IPV detection during pregnancy in SSA among adolescents to interrupt its continuation into adulthood