| ICRH Global Newsletter |
12th of June, 2018
Message from the Chair
In 2015, the UN unveiled the Sustainable Development Goals to address unfinished business from earlier agreements, and to promote global prosperity in an inclusive way. While multilateral agreements like this one have driven critical progress over the past few decades, the international community remains divided on a crucial issue – sexual and reproductive health and rights. In fact, world leaders have never committed to a collective program of action that even mentions sexual rights.
The unwillingness to openly and comprehensively address issues related to sexuality in communities and countries around the world—and in global fora—in a very real way undermines global goals to achieve health, equitable development and human rights for all people.
Sexual and reproductive health and rights are fundamental to people’s health and survival, to gender equality and to the well-being of humanity. In recognition of past failures and to move the world forward on these issues in a meaningful way, in 2016, the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights convened 16 multidisciplinary experts from Africa, Asia, Europe, the Middle East, and North and South America. As a lifelong champion of sexual and reproductive health and rights, I was proud to join the Guttmacher-Lancet Commission to help develop a bold new agenda for achieving universal sexual and reproductive health and rights that is evidence-based and rooted in human rights.
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Gender based violence
ICRH Kenya participates in a gender based violence advocacy event in Nairobi, Kenya
On Friday May 25, ICRHK in partnership with the Belgian Embassy in Kenya, UNFPA and ICAP held a gender based violence advocacy event in Nairobi. The main objective was to highlight the lessons learned from services provided for gender based violence survivors by ICRHK in Mombasa and ICAP in Kisumu, its implications for community services, prevention and legal protection. The event also flagged-off a social-media campaign dubbed ‘#Tuongee’ meaning ‘Let’s talk’ with the intention of engaging at great depth in honest conversation around the issue of Gender Based Violence.
ICRH Global Board Chair Prof. Marleen Temmerman urged the stakeholders present to involve the mainstream media to push for policy formation and intervention in all sectors across Kenya.
Her sentiments were supported by the Ambassador of Belgium, Nicolas Nihon who asked the participants to speak more about gender based violence which was still rampant in the country.
UN AIDS Executive Director, Dr. Michel Sidibe called for the inclusion of boys and men in gender based violence advocacy.
Dr. Griffins Manguro of ICRHK shared data generated from the Gender Based Violence Recovery Centre (GBVRC) located at Coastal General Hospital, Mombasa which showed that 74% of the Sexual Gender Based Violence perpetrators were known to the victims. Among the over 7300 Sexual Gender Based Violence survivors who had visited the centre, 85% were women and girls. 80% of them were under 18 and more than half younger than 15 years old. The GBVRC offers medical, psycho-social and legal care for the victims and survivors of sexual and gender based violence.
The perinatal mental health toolkit won the 2018 PRof Award.
Mental problems during the perinatal period are associated with a range of negative consequences such as preterm birth, mother-infant interactional deficits and negative infant developmental outcome. Research indicates that perinatal mental health (PMH) problems are highly prevalent (20%). In Flanders however, a large majority is currently not being detected nor getting the appropriate treatment.
To address this shortage, the Ghent Network for Perinatal Mental Health (of which ICRH’s An-Sofie Van Parys is a member) developed a PMH toolkit that consists of a risk taxation instrument, a screening tool, a guideline, a care pathway and a training pack. The innovative aspects of the project lie in: the integration of mental health care in routine perinatal care, the strong interdisciplinary approach, a potential broad implementation (generic version) and the strong scientific basis and evaluation of the project’. The PRof award was organised by the Medical Innovation Chair of Ghent University for innovative projects in the broad domain of healthcare applications. The prize-money will be used to develop a professional sensitisation movie on PMH. The film would be aimed at a large audience of women and men of childbearing age and would aim to transcend the stigma surrounding PMH, open up the discussion and stimulate childbearing families to find help.
More information: An-Sofie Van Parys, AnSofie.VanParys@ugent.be.
Summer Schools in Ghent
The applications are open for the LAST SPOTS on the Summer School Ghent programs 2018!
This summer, students from all over the world are invited for two 12-day educational programs, along with various social and cultural activities from 1-12 July 2018. The programme ‘Reproductive Health & Rights’ is open for students of the faculty of medicine and health science, Psychology, Social and political sciences, Law, Linguistics and Philosophy. The programme ‘Health & Migration’ is open only to health science and medical students. Participants attend interesting lectures taught by renowned doctors, professors and high-ranking officials connected to Ghent University as well as other international institutions.
Summer School Reproductive Health & Rights
Summer School Health & Migration
Jana Verplancke joined ICRH in May 2018 to work with dr. Ines Keygnaert and Saar Baert on the further implementation and evaluation of the sexual assult care centres in Belgium.
She will focus on the development of a telephone and chat line to facilitate the access to these centres.
Jana has a Master degree of Educational Sciences. She worked for 15 years in the social and welfare sector in different projects. The last 5 years she worked at ‘Tele-Onthaal’ where she focused on the formation, education and individual coaching of the people who provide psycho-social assistance.
Integration of postpartum services
An intervention time trend analysis on Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso)
The Missed Opportunities in Maternal and Infant Health (MOMI) project aimed at reducing maternal and newborn mortality and morbidity within the year after childbirth in four sub-Saharan African countries. MOMI interventions including the integration of maternal and infant services in the postpartum (PP) period at day 6–10, week 6–8, and month 9 were implemented from September 2013 to December 2015. We hereby assess the effect of integrating maternal postpartum care (PPC) in infant immunization services in Kaya health district in Burkina Faso.
A longitudinal mixed method was applied on monthly monitoring data collected from 12 months before the project start to the end. Outcome indicators were: attendance of PPC at day 6–10 and week 6–8, provision of PP family planning counselling, and management of PP morbidity in mother and infant. The researchers tested the significance level of changes in the different indicators by performing an interrupted time series analysis with Newey–West standard errors and one lag. Additional data were extracted at the individual level which allowed to link infant immunization with maternal PPC from September 2013 to August 2014 in the health facilities’ (HF) PP and immunization registers. A review of documents was conducted that allowed for a qualitative evaluation of the effects.
Results show an increasing trend of all monitored indicators during the interventions, particularly at day 6–10 when PPC increased from 61% in 2013 to 81% in 2015 and especially in rural areas (p < 0.05). Large improvements were found in the detection and management of PP maternal hemorrhage, sepsis and newborn fever or low temperature. However, the intervention was less successful in raising PPC at week 6–8 and later due to the existence of structural barriers, caused for instance by the lack of collaboration among health workers and high turnover in the staff of HF.
The authors conclude that the overall package of community and facility interventions contributed to improve integrated PPC at day 6–10, particularly the role of community health workers. While the integration of maternal and child health services seems to be a valid concept, it needs to be rethought within the primary health care system.
Yugbaré Belemsaga D, Goujon A, Tougri H, Coulibaly A, Degomme O, Duysburgh E, Temmerman M, Kouanda S. Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis. BMC Health Serv Res. 2018 Apr 23;18(1):298.
Female sex workers and uptake of HIV/SRH services
Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities.
Female sex workers’ (FSWs) access to adequate HIV and SRH services is hampered by their marginalised position. The DIFFER project piloted and tested an innovative approach, combining FSW-targeted interventions with improving access to the general health services, and establish linkages between both. The article presents the effect the approach had on service uptake in the three African DIFFER sites: Durban, South Africa; Tete, Mozambique; and Mombasa, Kenya, as measured by pre- and post-intervention interviews with a representative sample of FSWs. In all cities overall uptake of services increased. Having used all services for contraception, STI care, HIV testing, HIV care, cervical cancer screening and sexual violence, if needed, increased from 12.5% to 41.5% in Durban, 25.0% to 40.1% in Tete, and 44.9% to 69.1% in Mombasa. Across cities, the effect was greatest in having been tested for HIV in the past six months which increased from 40.9% to 83.2% in Durban, 56.0% to 76.6% in Tete, and 70.9% to 87.6% in Mombasa. In Tete and Mombasa rise in SRH service use was almost entirely due to a greater uptake of targeted services. Only in Durban was there additionally an increase in the utilization of general health services. The results show that it is possible to improve service utilization in the short term, but primarily through targeted interventions. The long?term effectiveness of the approach, and in particular how to further improve the use of the general health services, needs further investigation.
Lafort Y, Greener L, Lessitala F, Chabeda S, Greener R, Beksinska M, Gichangi P, Griffin S, Smit JA, Chersich M, Delva W. Effect of a 'diagonal' intervention on uptake of HIV and reproductive health services by female sex workers in three sub-Saharan African cities. Trop Med Int Health. 2018 May 12. doi: 10.1111/tmi.13072. [Epub ahead of print]
Uptake of three doses of HPV vaccine by primary school girls
A prospective cohort study in a malaria endemic setting in Eldoret, Kenya.
All women are potentially at risk of developing cervical cancer at some point in their life, yet it is avoidable cause of death among women in Sub- Saharan Africa with a world incidence of 530,000 every year. It is the 4th commonest cancer affecting women worldwide with over 260,000 deaths reported in 2012. Low resource settings account for over 75% of the global cervical cancer burden. Uptake of HPV vaccination is limited in the developing world. WHO recommended that 2 doses of HPV vaccine could be given to young girls, based on studies in developed countries. However in Africa high rates of infections like malaria and worms can affect immune responses to vaccines, therefore three doses may still be necessary. The aim of this study was to identify barriers and facilitators associated with uptake of HPV vaccine.
A cross-sectional survey was conducted at Eldoret, Kenya involving 3000 girls aged 9 to 14 years from 40 schools. Parents/guardians gave consent through a questionnaire. Of all 3083 the school girls 93.8% had received childhood vaccines and 63.8% had a second HPV dose, and 39. 1% had a third dose. Administration of second dose and HPV knowledge were both strong predictors of completion of the third dose. Distance to the hospital was a statistically significant risk factor for non-completion (P: 0.01). The authors conclude that distance to vaccination centers requires a more innovative vaccine-delivery strategy and education of parents/guardians on cervical screening to increase attainment of the HPV vaccination.
Hillary Mabeya, Sonia Menon, Steven Weyers, Violet Naanyu, Emily Mwaliko, Elijah Kirop, Omenge Orango, Heleen Vermandere and Davy Vanden Broeck. Uptake of three doses of HPV vaccine by primary school girls in Eldoret, Kenya; aprospective cohort study in a malaria endemic setting. BMC Cancer. 2018 May 11;18(1):557. doi: 10.1186/s12885-018-4382-x.
Accelerate progress-sexual and reproductive health and rights for all
Report of the Guttmacher-Lancet Commission.
The full article is available HERE
Starrs AM, Ezeh AC, Barker G, Basu A, Bertrand JT, Blum R, Coll-Seck AM, Grover A, Laski L, Roa M, Sathar ZA, Say L, Serour GI, Singh S, Stenberg K, Temmerman M, Biddlecom A, Popinchalk A, Summers C, Ashford LS. Accelerate progress-sexual and reproductive health and rights for all: report of the Guttmacher-Lancet Commission. Lancet. 2018 May 8. pii: S0140-6736(18)30293-9. doi: 10.1016/S0140-6736(18)30293-9. [Epub ahead of print]
Intimate partner violence, forced first sex and adverse pregnancy outcomes
Cross sectional study in a sample of Zimbabwean women accessing maternal and child health care.
Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. A cross sectional study was conducted with 2042 women aged 15-49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. Logistic regression models were applied to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and during pregnancy) and maternal and newborn health outcomes.
Of the recent pregnancies 27.6% were not planned, 50.9% booked (registered for antenatal care) late and 5.6% never booked. A history of miscarriage was reported by 11.5%, and newborn death by 9.4% of the 2042 women while 8.6% of recent livebirths were low birth weight (LBW) babies. High prevalence of emotional (63,9%, 40.3%, 43.8%), physical (37.3%, 21.3%, 15.8%) and sexual (51.7%, 35.6%, 38.8%) IPV ever, 12 months before and during pregnancy were reported respectively. 15.7% reported forced first sex (FFS). Each form of lifetime IPV (emotional, physical, sexual, physical/sexual) was associated with a history of miscarrying (aOR ranges: 1.26-1.38), newborn death (aOR ranges: 1.13-2.05), and any negative maternal and newborn health outcome in their lifetime (aOR ranges: 1.32-1.55). FFS was associated with a history of a negative outcome (newborn death, miscarriage, stillbirth) (aOR1.45 95%CI: 1.06-1.98). IPV in the last 12 months before pregnancy was associated with unplanned pregnancy (aOR ranges 1.31-2.02) and booking late for antenatal care. Sexual IPV (aOR 2.09 CI1.31-3.34) and sexual/physical IPV (aOR2.13, 95%CI: 1.32-3.42) were associated with never booking for antenatal care. Only emotional IPV during pregnancy was associated with low birth weight (aOR1.78 95%CI1.26-2.52) in the recent pregnancy and any recent pregnancy negative outcomes including LBW, premature baby, emergency caesarean section (aOR1.38,95%CI:1.03-1.83).
The authors conclude that forced first sex (FFS) and intimate partner violence (IPV) are associated with adverse maternal and newborn health outcomes. Strengthening primary and secondary violence prevention is required to improve pregnancy-related outcomes.
Shamu S, Munjanja S, Zarowsky C, Shamu P, Temmerman M, Abrahams N. Intimate partner violence, forced first sex and adverse pregnancy outcomes in a sample of Zimbabwean women accessing maternal and child health care. BMC Public Health. 2018 May 3;18(1):595. doi: 10.1186/s12889-018-5464-z.