Newsletter December 2014


 ICRH Global Newsletter

22nd of December, 2014


ICRH+20 conference was a great success!

ICRH celebrated its 20th anniversary on 4 and 5 December with a well-attended  international conference on ‘Sexual and reproductive health and rights today and tomorrow’.


During these two days, some 250 scholars, experts and colleagues gathered to consider  the state of the art in some of our main fields of activity, and to discuss the remaining challenges and the ways forward.

The conference consisted of six symposia: Adolescent sexual and reproductive health and well-being (co-funded by VLIR-UOS); HPV, related diseases and vaccination (in collaboration with Gent University Hospital); Female genital mutilation (In collaboration with the Reference Centre Genital Mutilation of Ghent University Hospital); Forced marriages (In collaboration with RHEA, Centre for Gender and Diversity, Free University Brussels); Maternal health; and behavioural change interventions. This yielded new ideas and insights that will inspire and inform our future work and will undoubtedly also lead to new partnerships.

At the end of the conference, a celebration event took place in the presence of the Belgian minister of development cooperation (see picture), the Belgian secretary of state for science policy and numerous colleagues and friends of ICRH. At this event, the new ICRH research strategy for the coming years was presented.

Pictures and presentations are available at


New project: Estimation of FGM prevalence in the EU

On November 15th 2014 the project ‘Towards a better estimation of prevalence of female genital mutilation in the European Union (FGM-PREV)’ has started at ICRH.

The project is funded by the DAPHNE program of the European Commission and is conducted in collaboration with the Institut National d’Etudes Démographiques in Paris and The Department of Sociology of the Università degli Studi di Milano-Bicocca in Italy. The general aim is to develop a common definition on FGM prevalence, a common methodology and minimum standards for prevalence estimates of FGM in the EU, in order to generate comparable data. The project includes a pilot study in France and Italy. As a result it will be possible to support a number of initiatives developed to fight and prevent this specific form of violence. Moreover, it will guide policy making, contribute to better target resources, plan interventions, substantiate claims for funds, monitor progress and assess trends. Target groups include civil society organizations, health care providers, child protection, police, school teachers and policy makers. The project will run for two years until November 2016.

More information: Els Leye,

The MOMI Consortium meeting

The MOMI Consortium gathered in Lilongwe, Malawi, for its fourth Project Management Team (PMT) meeting, on 24-26 September.

The main objective of the meeting was to discuss the implementation and evaluation of the interventions in Burkina Faso, Kenya, Malawi, and Mozambique. Other topics such as capacity building, dissemination, and relationships with stakeholders were also covered. On the last day, the Consortium had the opportunity to visit some health facilities and communities in Ntchisi, the district where MOMI activities are implemented in Malawi. The MOMI project is now entering its last year. For more information about MOMI, you can visit our website:

MOMI field visit

Els Duysburgh and Aurore Guieu (ICRH-Belgium) visited Burkina Faso and the IRSS team in charge of MOMI in Burkina Faso (28 October – 5 November).

ICRHB MOMI team, a midwife and 3 community health workers This field visit consisted of meetings between the teams and visits to some of the health facilities and communities where the project is implemented in Kaya district. Topics included the implementation of the intervention activities, evaluation and monitoring data collection, and discussion of any arising issue. Despite some changes due to political unrest, most of the visit program could be carried out.  

The DIFFER Consortium meeting

The DIFFER Consortium met for its fourth Project Management Team (PMT) meeting in London, UK, on October 14-16.

meeting at Secteur 6 health facility (in the town of Kaya)The objectives of the meeting were to discuss the progress in the implementation of the interventions as well as other activities linked with the interventions as such (cost collection, monitoring, etc..). The PMT meeting was also an opportunity to discuss the evaluation to take place at the end of the intervention activities as well as dissemination plans, and consequently the timeline for the remainder of the project. The partners had the opportunity to discuss collectively and during one-on-one sessions to tackle specific issues. For more information on the DIFFER project, please visit .


Launch of special Journal of Adolescent Health Supplement

Within the margin of the ICRH+20 conference, ICRH and WHO jointly organized a launch of the supplement entitled ‘Where are we in Adolescent Sexual & Reproductive Health and Rights 20 years from the ICPD’.

Dr Marleen Temmerman, Director Department of Reproductive Health and Research, WHO, made an introductory presentation in which she spoke about the ICPD, about the place of ASRH in the global agenda, about the limited progress made in ASRH since the ICPD, about the importance of taking stock of the progress we have made before we set our sights ahead, and about WHO’s commitment to working with partners to move the agenda forward in research and action. She then launched the Special Supplement.

Dr. Dr Venkatraman Chandra-Mouli presented key messages on each of the five papers – progress and implications for research and action.

Ms Jennifer Blum, Program Officer. Population and Reproductive Health, David and Lucile Packard Foundation then spoke about why she believed the Special Supplement was timely and important, and about the positive feedback she had received from the colleagues and collaborators she has sent the Special Supplement to.   

Network statistics and STIs

In December 2014, the inaugural meeting of a so-called "Scientific Research Community” (SRC) in the field of Network Statistics for Sexually Transmitted Infections Epidemiology took place in Hasselt, Belgium.

This consortium is funded by the Research Foundation - Flanders (FWO) for a period of five years. The SRC will formalise the joining of forces between groups that are internationally acclaimed primarily for their work in STI and HIV epidemiology, microbiology and public health and groups that have an international track record in developing and applying advanced statistical methodology and computer simulations for network analysis. In doing so, the SRC aims to advance science and strengthen academic capacity in network statistics and STI epidemiology. Besides ICRH, the SRC consists of SACEMA at Stellenbosch University, CenStat at Hasselt University, the HIV/AIDS Centre at the Antwerp Institute of Tropical Medicine, the Theoretical Biology Lab at McMaster University, and the Research Methodology Centre at the Human Sciences Research Council (HSRC).

More information:


Tizta Tilahun Degfie

on 7 November, dr Tizta Tilahun successfully defended het PhD thesis  on ‘Marital dynamics in family planning: the role of couple interaction in Jimma zone, Southwest Ethiopia’.

In Ethiopia, contraceptive prevalence is less than 30% and the unmet need for family planning is 25%. This is echoed in the country’s population growth which does not match the country´s development, as illustrated by the poor living condition among women. Tizta Tilahun investigated marital dynamics concerning family planning, and assessed the effect that family planning education has on a couple’s interaction and contraceptive use.

Study results suggest the importance of involving men in family planning program and shows that empowering women to speak about family planning with their husband helps to enhance their decision making power regarding contraceptive use within the couple.

The thesis can be downloaded at

More information:

Mireille Merckx

On 7 November 2014, dr. Mireille Merckx successfully defended her PhD thesis on prevention of human papillomavirus and related disease in underage children.

HPV infections are worldwide an important cause of morbidity and mortality, also for children and early adolescents. Mireille Merckx’ PhD research aimed to describe the prevalence of HPV infections in underage children and to understand the mechanisms of infection.

The findings were promising: there is a considerable decrease in HPV 16-incidence in girls aged under 19. For HPV 18 the decrease is not significant, but this may be due to the low prevalence of the genotype.  In young women between 19 and 25 years, HPV prevalence did not change. Vaccination in this group is less frequent.

The research indicates the positive impact of preventive vaccination, and concludes among others that the development of new preventive and therapeutic vaccines should be priority.

The thesis can be downloaded at

More information:

Wei-Hong Zhang

Wei-Hong Zhang, senior researcher and senior project coordinator at ICRH, has recently been appointed +Scientific Advisor to the Overseas Chinese Affairs Office of the State Council for a period of three years.

The Scientific Advisors were selected on the basis of their expertise in the field of competence with the significant accomplishments and well-known internationally, and who are in charge of making suggestions and recommendations to the Chinese government on the polities and the strategies related to their expertise. These selected experts represent all the scientific fields. Wei-Hong Zhang is specialized in women’s reproductive health, and is one of 11 females among 120 experts. These experts, coming from 17 countries, met in Beijing between 27 September and 1 October 2014. They also  attended the reception on the occasion of the 65th Anniversaries of the Funding of the People's Republic of China on 30 September in the Great hall of the people in Beijing.


HPV vaccination
A study on the early effects of human papillomavirus vaccination in Belgium.
Human papillomavirus (HPV) vaccination has been reimbursed in Belgium since 2007 for girls (12–15 years), extended to girls up to 18 years in 2008. This study assesses the trend of HPV 16/18 infections in women less than 25 years of age participating in opportunistic cervical cancer screening. A significant reduction in the prevalence of HPV 16 and a non-significant reduction in HPV 18 was found in the youngest group (15–19 years). The prevalence in the older age group did not change significantly. These findings show the early effects of HPV vaccination and confirm the effectiveness of immunization in a real-life setting.
Mireille Merckx, Davy Vanden Broeck, Ina Benoy, Christophe Depuydt, Steven Weyers and Marc Arbyn.  Early effects of human papillomavirus vaccination in Belgium. Eur J Cancer Prev. 2014 Aug 11. [Epub ahead of print]

 Bacterial vaginosis
A cross-sectional study on prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa.

A longitudinal study was conducted in Kenya, Rwanda and South-Africa. Women were recruited into pre-defined study groups including adult, non-pregnant, HIV-negative women; pregnant women; adolescent girls; HIV-negative women engaging in vaginal practices; female sex workers; and HIV-positive women. Consenting women were interviewed and underwent a pelvic exam. Samples of vaginal fluid and a blood sample were taken and tested for bacterial vaginosis (BV), HIV and other reproductive tract infections (RTIs). This paper presents the cross-sectional analyses of BV Nugent scores and RTI prevalence and correlates at the screening and the enrolment visit.

At the screening visit 38% of women had BV defined as a Nugent score of 7–10, and 64% had more than one RTI (N. gonorrhoea, C. trachomatis, T. vaginalis, syphilis) and/or Candida. At screening the likelihood of BV was lower in women using progestin-only contraception and higher in women with more than one RTI. At enrolment, BV scores were significantly associated with the presence of prostate specific antigen (PSA) in the vaginal fluid and with being a self-acknowledged sex worker. Further, sex workers were more likely to have incident BV by Nugent score at enrolment.

The authors conclude that their study confirmed some of the correlates of BV that have been previously reported but that the most salient finding was the association between BV and the presence of PSA in the vaginal fluid which is suggestive of recent unprotected sexual intercourse.
Vicky Jespers, Tania Crucitti, Joris Menten, Rita Verhelst, Mary Mwaura, Kishor Mandaliya,Gilles F. Ndayisaba, Sinead Delany-Moretlwe, Hans Verstraelen, Liselotte Hardy, Anne Buve, Janneke van de Wijgert, for the Vaginal Biomarkers Study Group. Prevalence and Correlates of Bacterial Vaginosis in Different Sub-Populations of Women in Sub-Saharan Africa: A Cross-Sectional Study. PLoS ONE 9(10): e109670. doi:10.1371/journal.pone.0109670.

 Antenatal and childbirth care in northern Ghana
A quality assessment of antenatal and childbirth care in health centres in northern Ghana.
The QUALMAT research project aims to improve maternal and new-born health by improving the quality of antenatal and childbirth care provided in primary healthcare facilities. Within the frame of this project, a comprehensive quality assessment took place in selected health centres in northern Ghana. The results of this assessment showed that overall quality of routine antenatal and childbirth care was satisfactory, although some critical gaps were identified. Counselling and health education practices need to be improved; laboratory investigations are often not performed; examination and monitoring of mother and new-born during childbirth are inadequate; partographs are often not used and poorly completed; and equipment to provide assisted vaginal deliveries was absent.
Duysburgh E, Williams A, Williams J, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in northern Ghana. BJOG. 2014 Sep;121 Suppl 4:117-26. doi: 10.1111/1471-0528.12905.

Intimate partner violence and pregnancy
A cross-sectional study on prevalence and evolution of intimate partner violence before and during pregnancy.
Between June 2010 and October 2012, a cross-sectional study was conducted in 11 antenatal care clinics in Belgium. Consenting pregnant women were asked to complete a questionnaire (available in Dutch, French and English) in a separate room.

The overall percentage of IPV was 14.3% 12 months before pregnancy and 10.6% during pregnancy. Physical partner violence before as well as during pregnancy was reported by 2.5% of the respondents (n = 1894), sexual violence by 0.9%, and psychological abuse by 14.9%. Risk factors identified for IPV were being single or divorced, having a low level of education, and choosing another language than Dutch to fill out the questionnaire. The adjusted analysis showed that physical partner violence  and psychological partner abuse were significantly lower during pregnancy compared to the period of 12 months before pregnancy. The difference between both time periods is greater for physical partner violence (65%) compared to psychological partner abuse (30%). The analysis of the frequency data showed a similarly significant evolution for physical partner violence and psychological partner abuse, but not for sexual violence.

The IPV prevalence rates in are study are slightly lower than what can be found in other Western studies, but even so IPV is to be considered a prevalent problem before and during pregnancy. The study found evidence, however, that physical partner violence and psychological partner abuse are significantly lower during pregnancy.
Van Parys AS, Deschepper E, Michielsen K, Temmerman M, Verstraelen H. Prevalence and evolution of intimate partner violence before and during pregnancy: a cross-sectional study. BMC Pregnancy Childbirth. 2014 Aug 28;14:294. doi: 10.1186/1471-2393-14-294

Gender equality and sexuality among adolescents in Bolivia and Ecuador
A cross-sectional study on attitudes toward gender equality and sexual behaviour  among sexually active and non-sexually active adolescents in Bolivia and Ecuador.

It is widely agreed upon that gender is a key aspect of sexuality however, questions remain on how gender exactly influences adolescents' sexual health. The aim of this research was to study correlations between gender equality attitudes and sexual behaviour, sexual experiences and communication about sex among sexually active and non-sexually active adolescents in 2 Latin American countries.

In 2011, a cross-sectional study was carried out among 5,913 adolescents aged 14-18 in 20 secondary schools in Cochabamba (Bolivia) and 6 secondary schools in Cuenca (Ecuador). Models were built using logistic regressions to assess the predictive value of attitudes toward gender equality on adolescents' sexual behaviour, on experiences and on communication.

The analysis shows that sexually active adolescents who consider gender equality as important report higher current use of contraceptives within the couple. They are more likely to describe their last sexual intercourse as a positive experience and consider it easier to talk with their partner about sexuality. Non-sexually active adolescents, who consider gender equality to be important, are more likely to think that sexual intercourse is a positive experience. They consider it less necessary to have sexual intercourse to maintain a relationship and find it easier to communicate with their girlfriend or boyfriend than sexually non-active adolescents who consider gender equality to be less important. Comparable results were found for boys and girls.

These results suggest that gender equality attitudes have a positive impact on adolescents' sexual and reproductive health (SRH) and wellbeing. Further research is necessary to better understand the relationship between gender attitudes and specific SRH outcomes.
De Meyer S, Jaruseviciene L, Zaborskis A, Decat P, Vega B, Cordova K, Temmerman M, Degomme O, Michielsen K. A cross-sectional study on attitudes toward gender equality, sexual behavior, positive sexual experiences, and communication about sex among sexually active and non-sexually active adolescents in Bolivia and Ecuador. Glob Health Action. 2014 Jul 11;7:24089. doi: 10.3402/gha.v7.24089. eCollection 2014.


Preterm birth
A study to determine inflammatory markers in maternal serum during preterm labour.

Preterm birth?(PTB), defined as a delivery before 37?weeks of gestation, is the leading cause of perinatal morbidity and mortality worldwide. Diagnosis of preterm labour as well as accurate prediction of PTB is notoriously difficult. Preterm birth is initiated by multiple mechanisms including infection or inflammation which is the only pathological process for which a firm causal link with PTB has been established. Intrauterine infection evokes an immune response that involves the release of cytokines and chemokines, prostaglandins and matrix-degrading enzymes. These substances trigger uterine contractions, membrane rupture and cervical ripening. Most intra-uterine infections are chronic and subclinical in nature and consequently hard to diagnose before labour or rupture of the membranes. The best studied site of infection is amniotic fluid, but this requires an invasive procedure. A non-invasive approach seems to be more relevant to clinical practice. However, few studies have investigated the maternal inflammatory response during preterm labour. Therefore, the overall objective of this study was to determine several inflammatory markers in maternal serum from pregnant women in labour?(either term or preterm) vs. non-labouring controls. A nested case control study was conducted in which singleton pregnancies were recruited at Ghent University Hospital and divided into groups according to gestational age and labour status. Multiple proteins were evaluated in maternal serum using enzyme-linked or multiplex bead immunoassays including soluble triggering receptor expressed on myeloid cells-1?(sTREM-1), matrix metalloproteinases?(MMP)-9 and MMP-3, tissue inhibitor of metalloproteinases?(TIMP)-1, TIMP-2, TIMP-3 and TIMP-4 and a panel of 30?cytokines, chemokines and growth factors.

Tency , Temmerman M, Vaneechoutte M. Inflammatory response in maternal serum during preterm labour. Facts Views Vis Obgyn. 2014;6(1):19-30.

Rwandan young people's perceptions on sexuality and relationshipsA study aimed at gaining insight into young Rwandans' perceptions on sex and relationships, which is essential for formulating effective sexual and reproductive health (SRH) promotion interventions. Using a 'mailbox technique', this paper studies the spontaneous thoughts of Rwandan young people on sexuality. Mailboxes were installed in five secondary schools in the Bugesera district and students were invited to write about their ideas, secrets, wishes, desires and fears on sexuality and relationships. Of the 186 letters collected, 154 addressed SRH topics. The letters were analysed in NVivo 9 using a theoretical model on vulnerability. Two stereotypical sexual interactions co-exist: experimental sex, taking place unprepared, driven by desire among young people of the same age, and transactional sex, occurring after negotiation between older men/women and younger girls/boys in exchange for money or goods. Both types expose young people to poor, though different, SRH outcomes. Young people have little capacity to manage their vulnerability in these relationships: they have limited knowledge on SRH topics, lack adult guidance or support and have difficult access to condoms. They apply seemingly contradictory norms and behaviours concerning sexuality. In conclusion, the authors formulate several recommendations for SRH interventions.Michielsen K, Remes P, Rugabo J, Van Rossem R, Temmerman M. Rwandan young people's perceptions on sexuality and relationships: Results from a qualitative study using the 'mailbox technique'. SAHARA J. 2014 Jun 20:51-60. [Epub ahead of print]

Maternal and child health
SACEMA Quarterly has issued as special edition on maternal and child health.
SACEMA Quarterly is an online magazine produced by SACEMA (South African Centre for Epidemiological Modelling and Analysis). The aim is to provide articles reviewing developments in quantitative epidemiology. The intention of the magazine is to present this work in a way that it is accessible to the interested health professional and policy-maker.
The latest issue focuses on maternal and child health and is available at

HPV vaccination
A study on determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya.
The development of Human Papillomavirus (HPV) vaccines provides new opportunities in the fight against cervical cancer. Many factors, at personal, community and provider level, may inhibit the translation of willingness to vaccinate into actual uptake. Through a longitudinal study in Eldoret, Kenya, HPV vaccine acceptability was measured before a vaccination program (n?=?287) and vaccine uptake, as reported by mothers, once the program was finished (n?=?256). In between baseline and follow-up, a pilot HPV vaccination program was implemented via the GARDASIL Access Program, in which parents could have their daughter vaccinated for free at the referral hospital. Even though baseline acceptance was very high (88.1%), only 31.1% of the women reported at follow-up that their daughter had been vaccinated. The vaccine was declined by 17.7%, while another 51.2% had wanted the vaccination but were obstructed by practical barriers. Being well-informed about the program and baseline awareness of cervical cancer were independently associated with vaccine uptake, while baseline acceptance was correlated in bivariate analysis. Side effects were of great concern, even among those whose daughter was vaccinated. Possible partner disapproval lowered acceptance at baseline, and women indeed reported at follow-up that they had encountered his opposition. In this study, uptake was more determined by program awareness than by HPV vaccine acceptance. School-based vaccination might improve coverage since it reduces operational problems for parents. In addition, future HPV vaccination campaigns should address concerns about side effects, targeting men and women, given both their involvement in HPV vaccination decision-making.
Vermandere H, Naanyu V, Mabeya H, Vanden Broeck D, Michielsen K, Degomme O. Determinants of acceptance and subsequent uptake of the HPV vaccine in a cohort in Eldoret, Kenya. PLoS One. 2014 Oct 9;9(10):e109353. doi: 10.1371/journal.pone.0109353. eCollection 2014.

'Women at risk'
See comment in PubMed Commons below
Study  on the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India.
Needle and syringe sharing is common among people who inject drugs and so is unprotected sex, which consequently puts their sex partners at risk of sexually transmitted infections (STIs) including HIV and other blood-borne infections, like hepatitis. We undertook a nested study with the regular female partners of men who inject drugs participating in a longitudinal HIV incidence study in Delhi, India. In-depth interviews were conducted with female partners of 32 men. The interviews aimed to gather focused and contextual knowledge of determinants of safe sex and reproductive health needs of these women. Information obtained through interviews was triangulated and linked to the baseline behavioural data of their partner (index men who injected drugs). The study findings illustrate that women in monogamous relationships have a low perception of STI- and HIV-related risk. Additionally, lack of awareness about hepatitis B and C is a cause of concern. Findings also suggest impact of male drug use on the fertility of the female partner. It is critical to empower regular female partners to build their self-risk assessment skills and self-efficacy to negotiate condom use. Future work must explore the role of drug abuse among men who inject drugs in predicting fertility and reproductive morbidity among their female partners.
Sharma, Sarna A, Luchters S, Sebastian M, Degomme O, Saraswati LR, Madan I, Thior I, Tun W.
'Women at risk': the health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India. Cult Health Sex. 2014 Dec 2:1-15. [Epub ahead of print]

Breastfeeding and morbidity in infants
Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 months of life.
HIV-infected pregnant women from 5 sites in Burkina Faso, Kenya, and South Africa were enrolled in the prevention of mother-to-child transmission Kesho Bora trial and counselled to either breastfeed exclusively and cease by 6 months postpartum or formula feed exclusively. Maternal-reported morbidity (fever, diarrhoea, and vomiting) and serious infectious events (SIEs) (gastroenteritis and lower respiratory tract infections) were investigated for 751 infants for 2 age periods (0-2.9 and 3-6 months) by using generalized linear mixed models with breastfeeding as a time-dependent variable and adjustment for study site, maternal education, economic level, and cotrimoxazole prophylaxis.
Reported morbidity was not significantly higher in nonbreastfed compared with breastfed infants. Between 0 and 2.9 months of age, never-breastfed infants had increased risks of morbidity compared with those of infants who were exclusively breastfed. The adjusted excess risk of SIEs in nonbreastfed infants was large between 0 and 2.9 months. Of 52 SIEs, 3 mothers reported changes in feeding mode during the SIE although none of the mothers ceased breastfeeding completely.
Bork KA, Cournil A, Read JS, Newell ML, Cames C, Meda N, Luchters S, Mbatia G, Naidu K, Gaillard P, de Vincenzi I. Morbidity in relation to feeding mode in African HIV-exposed, uninfected infants during the first 6 mo of life: the Kesho Bora study. Am J Clin Nutr. 2014 Dec;100(6):1559-68. doi: 10.3945/ajcn.113.082149. Epub 2014 Oct 22.