| ICRH Global Newsletter |
30th of June, 2016
INPAC Project Management Team meeting
The third project management team meeting of the INPAC project (INtegrating Post-Abortion family planning services into existing abortion services in hospital settings in China) took place from 13 until 15 May in Gent, Belgium.
26 members of the seven consortium partners attended the meeting, together with representatives of the Chinese embassy (Science and Technology), the Ghent University China Platform, the Faculty of Medicine of Ghent University, the Chinese Professional Association in Belgium and the editor of the Brussels based Chinese magazine ‘Key for the Best’. The meeting discussed the progress of the project and the future actions until January 2017.
Save the date
Launch event of the Academic network on SRHR Policy Research - 30 Nov – 2 Dec 2016.
ICRH Belgium is establishing, together with more than 15 partner institutions, the Academic Network on SRHR Policy Research. The Network aims to become a global resource for SRHR policy research, education and service delivery with a specific focus on linking research and policy. This Network will be officially launched on Wednesday 30 November 2016 in the evening, followed by a 2-day conference on December 1 and 2 in Ghent. More information will follow shortly.
Follow ICRH-Mozambique on Facebook!
As part of its communication strategy to raise awareness of ICRH-Mozambique, its activities and the issues it works on, ICRH-Mozambique has launched a Facebook page. Please visit the page (mainly in Portuguese) at https://www.facebook.com/icrhm.org.mz/home and send any suggestions for improvement to Elísio Maxhluza, firstname.lastname@example.org.
Commemoration of the International Day of Action for Women’s Health in Mozambique
ICRH-Mozambique participated in the commemoration on 28th May, organized by the Network for Sexual & Reproductive Rights (Rede DSR) at Polana Caniço health centre in Maputo.
The theme of the event was Violence and Health and involved a press release, interventions by civil society and government representatives, and drama. ICRH-M is an active member of the Rede DSR since 2015, contributing to its advocacy work on access to safe abortion, LGBT rights, sexual and gender-based violence and other SRH rights issues.
For more information contact Málica de Melo, email@example.com.
Training of community providers marks start of Linkages project
At the end of May a 4-day training workshop was held for 4 community counsellors and 22 peer educators, organized by ICRH-M with support from FHI360.
This activity marked the beginning of the new Linkages project, that will work with female sex workers and men who have sex with men in Tete City and Moatize, continuing from previous ICRH projects in this area. The training included theoretical and practical activities on sexual and reproductive health, HIV vulnerability, gender-based violence, and communication strategies, as well as training in micro-planning of peer education activities. For more information contact Alex Lucas, firstname.lastname@example.org.
Dr. Hu is spending six months at ICRH Belgium to do post-doctoral research.
YaYi Hu holds a PhD degree in clinical medicine of Sichuan University, where she teaches performs surgery and does research. She is an obstetrician and majors in perinatal medicine. She obtained several research grants in the field of perinatal medicine, including from the National Natural Science Foundation of China (A HIF-1?- REDD1- mTOR pathway regulates glucose metabolize in hypoxia in the intrahepatic cholestasis of pregnancy). She published 6 articles as first author or corresponding author.
Dr. Hu will spend a period of 6 months at ICRH for conducting a post-doc research on the adverse pregnancy outcomes related to advanced maternal age. She will also be involved in the INPAC project, an FP7 funded project on post-abortion family planning in China.
UWC professor Diane Cooper spent a week at ICRH Belgium to work on joint research proposals.
ICRH Belgium has a long standing cooperation with the University of the Western Cape (UWC), South Africa. Within the framework of the institutional tripartite cooperation between UWC, Ghent University and the University of Missouri (USA), ICRH invited Diane to spend some time at ICRH to discuss collaboration and to work together on specific research proposals. Diane is a professor at the UWC School of Public Health and is specialized in women's health, social determinants of women's health, gender issues and sexual and reproductive health, particularly young people's sexual and reproductive health.
ICRH researcher Heleen Vermandere defended her doctoral thesis on 'Introduction of HPV vaccination in Kenya' on 13 June 2016.
Cervical cancer poses a serious health threat to sexually active women, especially in low and middle income countries (LMIC) where screening opportunities are often low and treatment remains inaccessible for most of the affected women. Primary prevention through human papillomavirus (HPV) vaccination may therefore provide a turning point in the battle against cervical cancer. However, prior to implementing large-scale vaccination programmes, several knowledge gaps need to be addressed. Through her doctoral research, Heleen provides estimates of the acceptability and uptake of an HPV vaccination programme and an overview of potential barriers to its successful implementation.
You can watch the presentation here: http://icrhb.org/news/presentation-doctoral-thesis-introduction-hpv-vaccination-kenya-heleen-vermandere
Osvaldo Jocitala concludes Masters degree
In June, Osvaldo Inácio Jossitala graduated with a Master’s Degree in Management of HIV/AIDS and Health in June at the Catholic University of Mozambique in Beira.
His studies were supported by ICRH through the DIFFER project. The topic of his dissertation was: "ART adherence in Female Sex Workers eligible for treatment: A Case Study of Carbomoc Health Centre, Moatize”. Osvaldo is the Most-At Risk Population Project Officer at ICRH-Mozambique in Tete since May 2012. For more information contact Osvaldo Jossitala, email@example.com.
Copper intrauterine device versus injectable progestin contraception
A pragmatic randomized controlled trial of the copper intrauterine device versus injectable progestin contraception in South Africa.
The copper intrauterine device (IUD) is under-utilised in South Africa, where injectable progestin contraception (IPC) dominates contraception usage. There is a lack of robust comparative data on these contraceptive options to inform policy, programs, clinical counselling, and women’s choices.
Within the context of a South African program to increase women’s access to the IUD, we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial of the IUD versus IPC at two South African hospitals. The target sample size was 7,000 women and the randomisation ratio was 1:1. The random sequence was computer-generated and group allocation was concealed in sealed, opaque, consecutively-numbered envelopes. Counselled, consenting women attending termination of pregnancy services were randomly assigned to IUD or IPC immediately post-termination. Condoms were promoted for the prevention of sexually-transmitted infections. The primary outcome was pregnancy; secondary outcomes were discontinuation, side-effects, and HIV acquisition and disease progression. The trial closed early with 2,493 participants randomised (IUD = 1,247, IPC = 1,246), due to international concerns regarding a possible association between IPC and HIV acquisition. Median follow-up was 20 months; 982 and 1000 participants were followed up in the IUD and IPC groups, respectively. Baseline group characteristics were comparable. Pregnancy occurred significantly less frequently among women allocated to the IUD than IPC: 56/971 (5.8 %) versus 83/992 (8.4 %), respectively; risk ratio (RR) 0.69, 95 % confidence interval (CI) 0.50 to 0.96; P = 0.025.
There were more protocol violations in the IUD group; however, discontinuation rates were similar between IUD and IPC groups (141/855 [16.5 %] and 143/974 [14.7 %], respectively). Women in the IUD group were more likely to discontinue contraceptive use due to abdominal pain or backache and non-specific symptoms, and those in the IPC group due to oligo- or amenorhoea and lack of sexual activity.
The authors conclude that the IUD was significantly more effective in preventing pregnancy than IPC. Efforts to expand contraception options and improve access to the IUD in settings where it is under-utilised are worthwhile. This trial shows that randomising long-acting, reversible contraceptives is feasible.
G. Justus Hofmeyr, Mandisa Singata-Madliki, Theresa A. Lawrie, Eduardo Bergel and Marleen Temmerman. Effects of the copper intrauterine device versus injectable progestin contraception on pregnancy rates and method discontinuation among women attending termination of pregnancy services in South Africa: a pragmatic randomized controlled trial. Reproductive Health (2016) 13:42. DOI 10.1186/s12978-016-0153-9
Intimate partner violence in early adolescence
The role of gender, socioeconomic factors and the school background. This research aimed to explore the prevalence of physical and sexual IPV perpetration and victimisation by gender, and associated risk and protective factors. Young adolescents (N=2 839) from 41 randomly selected public high schools in the Western Cape region of South Africa (SA), participating in the PREPARE study, completed a self-administered questionnaire. The participants’ mean age was 13.65 years (standard deviation 1.01), with 19.1% (541/2 839) reporting being victims/survivors of IPV and 13.0% (370/2 839) reporting perpetrating IPV. Girls were less likely to report being a victim/survivor of physical IPV and less likely to be a perpetrator of sexual IPV than boys. Factors associated with perpetration of physical and sexual IPV were similar and included being a victim/survivor, being older, having lower scores on school connectedness and scoring lower on feelings of school safety.
The authors conclude that physical and sexual IPV was commonly reported among young adolescents in SA. Further qualitative exploration of the role of reciprocal violence by gender is needed, and the role of ‘school climate’-related factors should be taken into account when developing preventive interventions.
A J Mason-Jones, P De Koker, S M Eggers, C Mathews, M Temmerman, E Leye, P J de Vries, H de Vries. Intimate partner violence in early adolescence: the role of gender, socioeconomic factors and the school background. S Afr Med J 2016;106(5):502-509. DOI:10.7196/SAMJ.2016.v106i5.9770
Female genital mutilation
The crucial role of multidisciplinary counselling in clitoral reconstruction after female genital mutilation.
Objectives: Female genital mutilation (FGM) is becoming more widely seen in the West, due to immigration and population movement. Health services are being confronted with the need to provide care for women with FGM. One of the more recent trends is the provision of clitoral reconstruction. It remains unclear, however, what constitutes good practice with regard to this type of surgery. Based on a keynote presentation about reconstructive clitoral surgery, the authors briefly discuss the possible consequences of FGM and the findings from recent publications on clitoral reconstruction. Recognising individual differences in women, they suggest a multidisciplinary counselling model to provide appropriate care for women requesting clitoral reconstruction. The literature shows that FGM influences physical, mental and sexual health. Clitoral reconstructive surgery can lead to an increase in sexual satisfaction and orgasm in some, but not all, women. A multidisciplinary approach would enable a more satisfactory and individually tailored approach to care. The multidisciplinary team should consist of a midwife, a gynaecological surgeon, a psychologistpsychotherapist, a sexologist and a social worker. Comprehensive health counselling should be the common thread in this model of care. Our proposed care pathway starts with taking a thorough history, followed by medical, psychological and sexological consultations. Women with FGM requesting clitoral reconstruction might primarily be looking to improve their sexual life, to recover their identity and to reduce pain. Surgery may not always be the right answer. Thorough counselling that includes medical, psychological and sexual advice is therefore necessary as part of a multidisciplinary approach.
Lotte De Schrijver, Els Leye and Mireille Merckx. A multidisciplinary approach to clitoral reconstruction after female genital mutilation: the crucial role of counselling. Eur J Contracept Reprod Health Care. 2016 Apr 25:1-7. [Epub ahead of print]
WHO guidelines on FGM
The Department of Reproductive Health and Research (RHR), at the World Health Organisation, has produced the ‘WHO Guidelines on the management of health complications from female genital mutilation’.
The Guidelines were developed by RHR in collaboration with the Guideline Development Group, of which ICRH professor Els Leye was a member. The Guidelines consist of three statements of ‘guiding principles’, five recommendations and eight best practice statements, covering the use of deinfibulation, mental health, female sexual health, and information and education.
The Guidelines, together with a Policy Brief (for policy-makers and Ministry of Health professionals, Health systems managers and healthcare professionals) and summary are available in English, French and Arabic from the following website: www.who.int/reproductivehealth/topics/fgm/management-health-complications-fgm/en/
The Guidelines aim to provide up-to-date, evidence-informed recommendations on the management of health complications from FGM. The document also intends to provide standards that may serve as the basis for developing local and national guidelines and health-care provider training programmes. The Guidelines are intended primarily for health-care professionals involved in the care of girls and women who have been subjected to any form of FGM. The document also provides guidance for policy-makers, health-care managers and others in charge of planning, developing and implementing national and local health-care protocols and policies. The information will also be useful for designing job aids and pre- and in-service professional training curricula in the areas of medicine, nursing, midwifery and public health for health-care providers caring for girls and women with FGM.
Modern contraceptive use among migrant and non-migrant women in Kenya
Women who internally migrate within Kenya appear to be more likely to use modern contraception than non-migrant rural women.
Manifest socio-economic differences are a trigger for internal migration in many sub-Saharan settings including Kenya. An interplay of the social, political and economic factors often lead to internal migration. Internal migration potentially has significant consequences on an individual’s economic growth and on access to health services, however, there has been little research on these dynamics. In Kenya, where regional differentials in population growth and poverty reduction continue to be priorities in the post MDG development agenda, understanding the relationships between contraceptive use and internal migration is highly relevant.
Using data from the 2008–09 Kenya Demographic and Health Survey (DHS), data from 5,905 women aged 15–49 years who reported being sexually active in the last 12 months prior to the survey were analyzed. Bivariate and multivariate logistic regressions are fitted to predict correlates of contraceptive use in the presence of migration streams among other explanatory variables.
Modern contraceptive use was significantly higher among women in all migration streams (non-migrant urban (OR = 2.8, p < 0.001), urban-urban (OR = 2.0, p < 0.001), urban-rural (OR = 2.0, p < 0.001), rural-urban (OR = 2.6, p < 0.001), rural-rural (OR = 1.7, p < 0.001), than non-migrant rural women. The authors conclude that women who internally migrate within Kenya, whether from rural to urban or between urban centres, were more likely to use modern contraception than non-migrant rural women. This phenomenon appears to be due to selection, adaption and disruption effects which are likely to promote use of modern contraceptives. Programmatically, the differentials in modern contraceptive use by the different migration streams should be considered when designing family planning programmes among migrant and non-migrant women.
Rhoune Ochako, Ian Askew, Jerry Okal, John Oucho, and Marleen Temmerman. Modern contraceptive use among migrant and non-migrant women in Kenya. Reprod Health. 2016; 13: 67. Published online 2016 Jun 1. doi: 10.1186/s12978-016-0183-3
Engaging with community-based providers for promoting modern contraceptive methods
Results from two innovative birth spacing interventions in rural Pakistan.
Innovative family planning (FP) interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society - Pakistan implemented an operational research project - ‘Evidence for Innovating to Save Lives’, to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan.
A quasi-experimental (pre - and post-intervention with control arm) study was conducted to assess the effectiveness of each of the two intervention models, 1) Suraj model (meaning ‘Sun’ in English), which uses social franchises (SF) along with a demand-side financing (DSF) approach using free vouchers, and 2) Community Midwife (CMW) model, in promoting the use of modern contraceptive methods compared to respective controls.
Baseline and endline cross-sectional household surveys were conducted, 24 months apart, by recruiting 5566 and 6316 married women of reproductive age (MWRA) respectively. The Suraj model was effective in significantly increasing awareness about FP methods among MWRA by 14 % percentage points, current contraceptive use by 5 % percentage points and long term modern method - intrauterine device (IUD) use by 6 % percentage points. The CMW model significantly increased contraceptive awareness by 28 % percentage points, ever use of contraceptives by 7 % percentage points and, IUD use by 3 % percentage points. Additionally the Suraj intervention led to a 35 % greater prevalence (prevalence ratio: 1.35, 95 % CI: 1.22–1.50) of contraceptive use among MWRA.
Suraj intervention highlights the importance of embedding subsidized FP services within the communities of the beneficiaries. The outcomes of the CMW intervention also improved the use of long-term contraceptives. These findings indicate the necessity of designing and implementing FP initiatives involving local mid-level providers to expand contraceptive coverage in under-served areas.
Syed Khurram Azmat, Waqas Hameed, Hasan Bin Hamza, Ghulam Mustafa, Muhammad Ishaque, Ghazunfer Abbas, Omar Farooq Khan, Jamshaid Asghar, Erik Munroe, Safdar Ali, Wajahat Hussain, Sajid Ali, Aftab Ahmed, Moazzam Ali, and Marleen Temmerman. Engaging with community-based public and private mid-level providers for promoting the use of modern contraceptive methods in rural Pakistan: results from two innovative birth spacing interventions. Reprod Health. 2016; 13: 25. Published online 2016 Mar 17. doi: 10.1186/s12978-016-0145-9
The disease burden in sexual and gender minorities
A review of systematic reviews on evidence and knowledge gaps.
Sexual and gender minorities (SGM) include individuals with a wide range of sexual orientations, physical characteristics, and gender identities and expressions. Data suggest that people in this group face a significant and poorly understood set of additional health risks and bear a higher burden of some diseases compared to the general population. A large amount of data is available on HIV/AIDS, but far less on other health problems. This review aimed to synthesize the knowledge on the burden of communicable and non-communicable diseases, mental health conditions and violence experienced by SGM, based on available systematic reviews. A global review of systematic reviews was conducted, including searching the Cochrane and the Campbell Collaboration libraries, as well as PubMed, using a range of search terms describing the populations of interest, without time or language restrictions. Google Scholar was also scanned for unpublished literature, and references of all selected reviews were checked to identify further relevant articles. 30 systematic review were found, all originally written in English. Nine reviews provided data on HIV, 12 on other sexually transmitted infections (STIs), 4 on cancer, 4 on violence and 3 on mental health and substance use. A quantitative meta-analysis was not possible. The findings are presented in a narrative format. The review primarily showed that there is a high burden of disease for certain subpopulations of SGM in HIV, STIs, STI-related cancers and mental health conditions, and that they also face high rates of violence. Secondly, the review revealed many knowledge gaps. Those gaps partly stem from a lack of original research, but there is an equally urgent need to conduct systematic and literature reviews to assess what we already know on the disease burden in SGM. Additional reviews are needed on the non-biological factors that could contribute to the higher disease burden. In addition, to provide universal access to health-care for all, more information is needed on the barriers that SGM face in accessing health services, including the attitudes of health-care providers. Understanding these barriers and the additional health risks they impose is crucial to improving the health status of SGM.
Karel Blondeel, Lale Say, Doris Chou, Igor Toskin, Rajat Khosla, Elisa Scolaro, and Marleen Temmerman. Evidence and knowledge gaps on the disease burden in sexual and gender minorities: a review of systematic reviews. Int J Equity Health. 2016; 15: 16. Published online 2016 Jan 22. doi: 10.1186/s12939-016-0304-1.
The Modified Reasons for Smoking Scale
Factorial structure, validity and reliability in pregnant smokers.
Smoking during pregnancy can cause several maternal and neonatal health risks, yet a considerable number of pregnant women continue to smoke. The objectives of this study were to test the factorial structure, validity and reliability of the Dutch version of the Modified Reasons for Smoking Scale (MRSS) in a sample of smoking pregnant women and to understand reasons for continued smoking during pregnancy.
A longitudinal design was performed. Data of 97 pregnant smokers were collected during prenatal consultation. Structural equation modelling was performed to assess the construct validity of the MRSS: an exploratory factor analysis was conducted, followed by a confirmatory factor analysis. Test-retest reliability (<16 weeks and 32-34 weeks pregnancy) and internal consistency were assessed using the intraclass correlation coefficient and the Cronbach's alpha, respectively. To verify concurrent validity, Mann-Whitney U-tests were performed examining associations between the MRSS subscales and nicotine dependence, daily consumption, depressive symptoms and intention to quit. A factorial structure was found for the MRSS of 11 items within five subscales in order of importance: tension reduction, addiction, pleasure, habit and social function. Results for internal consistency and test-retest reliability were good to acceptable. There were significant associations of nicotine dependence with tension reduction and addiction and of daily consumption with addiction and habit.
The authors conclude that validity and reliability of the MRSS were shown in a sample of pregnant smokers. Tension reduction was the most important reason for continued smoking, followed by pleasure and addiction. Although the score for nicotine dependence was low, addiction was an important reason for continued smoking during pregnancy; therefore, nicotine replacement therapy could be considered. Half of the respondents experienced depressive symptoms. Hence, it is important to identify those women who need more specialized care, which can include not only smoking cessation counselling but also treatment for depression.
De Wilde, KS; Tency, I; Boudrez, H; Temmerman, M; Maes, L; Clays, E. The Modified Reasons for Smoking Scale: factorial structure, validity and reliability in pregnant smokers. Journal of evaluation in clinical practice, Vol. 22, 403-410, June 2016.