Provision of adolescent reproductive and sexual health services in India: Provider perspectives

The recently launched Rashtriya Kishor Swasthya Karyakram (RKSK) program seeks to enable all adolescents and youth to realize their full potential by making informed decisions concerning their health and well-being and by accessing the services and support they need to implement their decisions. To realize this vision, the RKSK framework acknowledges the strengthening of Adolescent Friendly Health Clinics (AFHCs) and providing correct knowledge and information through counseling services as two of its seven critical components. As the government makes an effort to roll out the RKSK program at scale across the country, reviewing the experiences of the AFHCs established under the National Adolescent Reproductive and Sexual Health Strategy, the predecessor of RKSK, can provide useful lessons. With this in view, at the request of the Ministry of Health and Family Welfare, the Population Council conducted an assessment of AFHCs from the perspectives of adolescents and youth and of health care providers in three states in India. This report presents the findings of the study conducted among health care providers

Feasibility of screening and referring women experiencing marital violence by engaging frontline workers: Evidence from rural Bihar

The Population Council, together with partners, the Centre for Catalyzing Change, and the London School of Hygiene and Tropical Medicine, with support from UKaid, implemented the Do Kadam Barabari Ki Ore (Two Steps Towards Equality) project in rural areas of Patna district in Bihar, India. The project engaged frontline workers (FLWs) to screen women for their experience of marital violence, inform them about their options in case of such an experience, and provide basic counseling and referral to women reporting the experience. Overall, the findings from the implementation of the Do Kadam program have been encouraging. They suggest that interactions between FLWs and women on violence-related issues increased significantly and that project activities could be incorporated into the regular responsibilities of FLWs. Yet, several recommendations emerge, including the need to recognize that domestic violence is both a public health concern and a violation of women’s rights, on the one hand; and to understand, on the other, the importance of incorporating screening, counseling, and referrals of women experiencing violence into the responsibilities of FLWs

Modifying behaviours and notions of masculinity: Effect of a programme led by locally elected representatives

The Population Council, together with the Centre for Catalyzing Change and the London School of Hygiene and Tropical Medicine, and with support from UKaid, implemented the Do Kadam Barabari Ki Ore (Two Steps Towards Equality) program. The project, situated in Patna district, India aimed to orient and engage locally elected leaders—namely, members of Gram Panchayats and Gram Kachehris—in changing community norms relating to the acceptability of violence against women, and preventing violence against women as well as one factor closely associated with the perpetration of such violence, namely alcohol abuse. Specifically, it assessed: 1) the feasibility of sensitizing and training members of the Panchayati Raj Institutions (PRIs, local self-governance bodies) to act as change agents to transform gender norms among men and women in their communities; 2) the effect of the intervention on generating egalitarian gender-role attitudes among PRI members and a reduction in violence against women and girls (VAWG) perpetrated/experienced by them; and 3) the effect of the intervention on changing gender-role attitudes, including attitudes about marital violence among men and women at the community level, and reduction in VAWG and alcohol misuse at the community level

The effect of a gender transformative life skills education and sports-coaching programme on the attitudes and practices of adolescent boys and young men in Bihar

The importance of starting young to change youths’ attitudes and behaviors—especially of young boys—has been widely acknowledged, but a key challenge has been the limited evidence on the kinds of programs that have succeeded in making such changes. In order to fill this gap, the Population Council, together with partners, the Centre for Catalysing Change and the London School of Hygiene and Tropical Medicine, and with support from UKaid, implemented the Do Kadam Barabari Ki Ore (Two Steps Towards Equality) project among boys. Implemented in rural areas of Patna district, India this project sought to promote, among adolescent boys and young men who were members of youth clubs supported by the Ministry of Youth Affairs and Sports, egalitarian gender attitudes and abhorrence of violence against women and girls. This report describes the Do Kadam Barabari Ki Ore project and its implementation and examines the extent to which it transformed gender-role attitudes of boys

Towards messages that matter: Understanding and addressing HIV and SRH risks among married young people in India

Although there is increasing interest in young people\u27s sexual and reproductive health (SRH) situations and needs in India, married young people have received little attention as a vulnerable group with distinct needs because marriage is assumed to be safe and because married youth are assumed to face none of the stigma that their unmarried counterparts experience in accessing SRH services. However, emerging evidence shows that within this subpopulation, married young women and men constitute groups with distinct risks of HIV and other poor SRH outcomes. There remains a need to better understand their unique vulnerabilities and to design programs that take into account their special circumstances. The Population Council and the Family Planning Association of India undertook a research project intended to better understand the situation and vulnerabilities faced by married young women and men, and to develop communication materials for married young women and men and training materials for providers to address HIV and other SRH risks experienced by these subpopulations. The study was conducted in rural settings in Guntur district of Andhra Pradesh, and in Dhar and Guna districts of Madhya Pradesh

Empowering women and addressing violence against them through self-help groups (SHGs)

This report details results of a program implemented by the Population Council, together with the Centre for Catalyzing Change and the London School of Hygiene and Tropical Medicine: Do Kadam Barabari Ki Ore (Two Steps Towards Equality). The primary objective of the program was to test whether strengthening existing village-level self-help groups (SHGs); orienting members on violence against women and girls, and supporting them in prevention activities; and helping women who experience violence had changed their gender-role attitudes and reduced the experience of marital violence. On the whole, findings show that the program was acceptable and effective in many ways. Its gender-transformative group-learning curriculum was effectively transacted and tested, its quality commended by study participants; and its effect in improving SHG members’ agency, financial literacy, and access to social support and changing their gender role attitudes was observed. Indeed, the program implemented among SHG members holds considerable promise for replication and upscaling, with perhaps some modification, and can be easily incorporated within the SHG structure at state level

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Transforming the attitudes of young men about gender roles and the acceptability of violence against women, Bihar

Although the importance of working with young men to transform traditional gender norms has been widely acknowledged, programmes for young men remain sparse in highly gender stratified settings such as India, and those that have been implemented have not reached those in rural areas and those out-of-school. Drawing on data from a cluster randomised controlled trial with panel surveys, of a gender-transformative life skills education and sports-coaching programme conducted among young men aged 13–21 who were members of youth clubs, this paper examines the extent to which it transformed the gender role attitudes of young men and instilled in them attitudes rejecting violence against women and girls. The intervention succeeded in changing gender role attitudes and notions of masculinity, attitudes about men’s controlling behaviours over women/girls, attitudes about men’s perpetration of violence on a woman/girl and perceptions about peer reactions to young men acting in gender-equitable ways. Effects were particularly significant among young men who attended regularly, underscoring the importance of regular attendance in such programmes

Factors Associated with Long-Term Cardiac Dysfunction in Neonatal Lupus

OBJECTIVES: Cardiac manifestations of neonatal lupus (NL) have been associated with significant morbidity and mortality; however, there is minimal information on long-term outcomes of affected individuals. This study was initiated to evaluate the presence of and the risk factors associated with cardiac dysfunction in NL after birth in multiple age groups to improve counselling, to further understand pathogenesis and to provide potential preventative strategies. METHODS: Echocardiogram reports were evaluated in 239 individuals with cardiac NL: 143 from age 0-1 year, 176 from age \u3e1-17 years and 64 from age \u3e17 years. Logistic regression analyses evaluated associations of cardiac dysfunction at each age group with demographic, fetal and postnatal factors, using imputation to address missing data. RESULTS: Cardiac dysfunction was identified in 22.4% at age 0-1 year, 14.8% at age \u3e1-17 years and 28.1% at age \u3e17 years. Dysfunction in various age groups was significantly associated with male sex, black race, lower fetal heart rates, fetal extranodal cardiac disease and length of time paced. In 106 children with echocardiograms at ages 0-1 year and \u3e1-17 years, 43.8% with dysfunction at age 0-1 year were also affected at age \u3e1-17 years, while the others reverted to normal. Of children without dysfunction at age 0-1 year, 8.9% developed new dysfunction between ages \u3e1 and 17 years. Among 34 with echocardiograms at ages \u3e1-17 years and \u3e17 years, 6.5% with normal function at age \u3e1-17 years developed dysfunction in adulthood. CONCLUSIONS: Risk factors in fetal life can influence cardiac morbidity into adulthood.Although limited by a small number of cases, cardiac dysfunction in the first year often normalises by later childhood. New-onset dysfunction, although rare, can occur de novo after the first year