Rapid evidence assessment: Quality of studies assessing interventions to support FGM/C abandonment

The last decade has seen increased focus and investment in interventions to eliminate female genital mutilation/cutting (FGM/C), along with the need to accelerate its abandonment. The UK Department for International Development (DFID) commissioned the Evidence to End FGM/C: Research to Help Girls and Women Thrive project to: 1) assess the quality of studies that have evaluated different interventions for the prevention of FGM/C, and 2) describe the FGM/C interventions that were evaluated by high-quality studies. The quality of evidence on the effectiveness and impact of FGM/C interventions is generally moderate to low. In addition, few baseline surveys are conducted prior to implementing interventions, making assessment of effect and generalizability difficult. Despite a high concentration of studies evaluating anti-FGM/C interventions from sub-Saharan Africa, few emphasize adequate reporting on cultural sensitivity and contexts during the design stage, or interpretation of findings for local policy. This rapid evidence assessment provides valuable methodological lessons for the design of future high-quality assessments or evaluations of FGM/C interventions

Health impacts of female genital mutilation/cutting: A synthesis of the evidence

The Africa Coordinating Centre for the Abandonment of Female Genital Mutilation/Cutting, with support from the Population Council, sought to synthesize the evidence on the health impacts of female genital mutilation/cutting (FGM/C), identify recommended interventions, and compile and analyze the existing reference materials. The goal of this review is to inform the development of a comprehensive set of training guidelines and materials for frontline healthcare providers so they can manage the care of women and girls who have undergone FGM/C, prevent the practice at the community level, and accelerate abandonment of FGM/C practices. This analysis underscores the health impacts associated with FGM/C and compelling reasons for intervention. Overall, the recommended interventions were informed by best practices based on study reports, experts, and the strength of the available evidence. Moving forward, the Evidence to End FGM/C program plans to collaboratively review existing curricula and related materials for health professionals before these much-needed training materials and guidelines for healthcare providers can be drafted; and to conduct new research to deepen understanding on all the health impacts of FGM/C and their interventions

Impact of COVID-19 on maternal healthcare in Africa and the way forward COMMENT

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

Female genital cutting among the Somali of Kenya and management of its complications

The Somali community living in Kenya (and in their native Somalia) has practiced the severest form of female genital cutting (FGC)—infibulation—for centuries. To understand the context within which the practice takes place, and how its complications are managed, the Population Council’s Frontiers in Reproductive Health Program undertook a diagnostic study that confirmed that FGC is a deeply rooted and widely supported cultural practice. Several closely related reasons are used to sustain the practice: religious obligation, family honor, and virginity as a prerequisite for marriage; an aesthetic preference for infibulated genitalia was also mentioned. The study also found that the health sector is ill equipped to serve women who have been cut, particularly infibulated pregnant women. Specific recommendations were made about the ways in which the health system could strengthen its handling of FGC among the Somali: policymakers should seek to improve management of associated complications within the framework of improving safe motherhood generally, contribute to abandonment efforts through ensuring that staff adhere to MOH policy, and become involved in community-level discussions to create a climate for behavior change

A multi-sectoral approach to providing reproductive health information and services to young people in Western Kenya: The Kenya adolescent reproductive health project

Informing adolescents about appropriate and acceptable behaviors, and ways to protect themselves against unwanted and unprotected sex, has proved problematic in Kenya. Education programs for in- and out-of-school adolescents are lacking, there is controversy about providing services to sexually active adolescents, and a pervasive concern that sexuality education and contraceptive services leads to promiscuity. Unbiased and accurate information and services are needed if adolescents are to delay becoming sexually active, to resist pressures to engage in nonconsensual sex, and to protect themselves against unwanted pregnancies and infections if they do have sex. Moreover, strategies for providing such information and services need to be acceptable to the community and sustainable over time. The Population Council’s Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Health Kenya office collaborated with three government of Kenya ministries to design and implement a multisectoral project to improve knowledge about reproductive health and encourage a responsible and healthy attitude toward sexuality among adolescents, delay the onset of sexual activity among younger adolescents, and decrease risky behaviors among sexually active adolescents. Three interventions were implemented and evaluated in two districts in Western Province and this report presents findings that directly evaluate and cost the interventions

Contributing towards efforts to abandon female genital mutilation/cutting in Kenya: A situation analysis

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious requirements, family honor, and for cultural and ethnic identity. Respondents were all in agreement that there is an urgent need for a National Coordinating Agency that could bring together all stakeholders working toward the abandonment of FGM/C in Kenya and offered suggestions about the role, structure, and responsibilities of such an agency

Porn video shows, local brew, and transactional sex: HIV risk among youth in Kisumu, Kenya

Background: Kisumu has shown a rising HIV prevalence over the past sentinel surveillance surveys, and most new infections are occurring among youth. We conducted a qualitative study to explore risk situations that can explain the high HIV prevalence among youth in Kisumu town, Kenya Methods: We conducted in-depth interviews with 150 adolescents aged 15 to 20, held 4 focus group discussions, and made 48 observations at places where youth spend their free time. Results: Porn video shows and local brew dens were identified as popular events where unprotected multipartner, concurrent, coerced and transactional sex occurs between adolescents. Video halls - rooms with a TV and VCR - often show pornography at night for a very small fee, and minors are allowed. Forced sex, gang rape and multiple concurrent relationships characterised the sexual encounters of youth, frequently facilitated by the abuse of alcohol, which is available for minors at low cost in local brew dens. For many sexually active girls, their vulnerability to STI/HIV infection is enhanced due to financial inequality, gender-related power difference and cultural norms. The desire for love and sexual pleasure also contributed to their multiple concurrent partnerships. A substantial number of girls and young women engaged in transactional sex, often with much older working partners. These partners had a stronger socio-economic position than young women, enabling them to use money/gifts as leverage for sex. Condom use was irregular during all types of sexual encounters. Conclusions: In Kisumu, local brew dens and porn video halls facilitate risky sexual encounters between youth. These places should be regulated and monitored by the government. Our study strongly points to female vulnerabilities and the role of men in perpetuating the local epidemic. Young men should be targeted in prevention activities, to change their attitudes related to power and control in relationships. Girls should be empowered how to negotiate safe sex, and their poverty should be addressed through income-generating activities.</p

Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney&rsquo;s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants

La santé de la reproduction : étude sur la négociation des risques chez les jeunes mères en milieu populaire à Kisumu, Kenya

Cette étude socio-anthropologique a été réalisée dans le cadre d'un projet collectif avec l'équipe de recherche du SHADYC-CNRS/IRD1 sur la santé reproductive dans les systèmes de santé. Le thème s'intitule La négociation des risques. Une approche comparative dans trois systèmes de santé : France, Kenya et Niger. Le cas de la santé sexuelle et reproductive. Dans le cadre de ce projet, nous avons réalisé une enquête dans la ville de Kisumu (Ia troisième ville du Kenya après Nairobi et Mombasa). Cette ville est peuplée de près de 400000 habitants. L’activité la plus importante est la pêche. Au niveau épidémiologique, la ville de Kisumu est reconnue comme la région la plus touchée par l'épidémie du VIH au Kenya avec un taux moyen de 26%. L'enquête s'est déroulée en plusieurs étapes, du mois d'août au mois de septembre 2000. Nous avons mené une enquête qualitative (entretiens et observations) dans les centres de santé et en milieu populaire urbain. Nous avons étudié les risques en matière de grossesse, d'accouchement, d'avortement, de MST (dont l'infection par le VIH) rencontrés par les jeunes femmes, les interactions entre les jeunes mères et le personnel soignants ainsi que les attitudes, les pratiques de gestion de risques auxquels ces jeunes mères sont exposées (durant la grossesse, l'accouchement, les complications obstétricales, l'avortement et les MST (dont l'infection par le VIH]). Nous avons également interviewé le personnel soignant à l'hôpital et les sages femmes à domicile afin de connaître les attitudes, les relations et expériences vis-à-vis des risques auxquels les jeunes mères sont exposées. II s'agissait donc de contribuer à la problématique générale concernant les risques en santé de la reproduction et leur « gestion » effective