Newsletter September 2014


 ICRH Global Newsletter

30th of September, 2014


ICRH Conference 4 and 5 December 2014: registrations are open!

On the occasion of its 20th anniversary, ICRH organizes a two-day international conference focusing on the state of the art and remaining challenges in sexual and reproductive health worldwide. We hope to welcome many of the numerous friends and colleagues who have contributed –and still are contributing- to ICRH’s work and success.

The conference will be clustered around themes which are among our core areas of expertise:

  • adolescent sexual and reproductive health and well-being
  • HPV, related diseases and vaccination
  • harmful cultural practices such as female genital mutilation and forced marriages
  • maternal health, with focus on family planning and quality of maternal and newborn care.

In addition, one thematic session will deal with behavioral change interventions, a cross-cutting element in most of our research projects. The conference will take place in Het Pand, Ghent, Belgium on 4 and 5 December 2014 and will be followed by a celebration event Friday 5 December at 4 pm. For more information and registration, go to


Most at Risk Populations Project in Tete, Mozambique

As part of the monitoring and oversight role of projects funded by USAID, Ambassador Griffiths from the US Embassy in Mozambique visited the Night Clinic in Moatize on June 30, 2014.

ICRH Mozambique implements comprehensive sexual and reproductive health and rights services including HIV prevention in Moatize District and inner city Tete targeting sex workers and their male clients and long distance truck drivers. These activities are largely funded by the United States Agency for International Development (USAID) and the Flanders International Cooperation Agency (FICA).
The visit was kicked off with a walk-about at the Zambian turn-off in Matema a hotspot for sex workers, truck drivers and miners. The Ambassador interacted with sex workers from their workplace and place of residence. Upon visiting Matema, the Ambassador proceeded to Moatize to visit the Night Clinic where he was met by the Director for Tete Provincial Health, Dr Carla, Medical Chief for Tete Provincial Health, Dr Mullasua, Night Clinic staff, ICRH-M Program staff, community members, peer educators, and youth traditional dancers. While visiting the Night Clinic, a flash mob interrupted the visit to perform a skit that included messages about the Night Clinic including services offered, hours of operation, funders, gender-based violence, family planning, misconceptions about free services, and male involvement in seeking health services for their partners. As with the visit at Matema, the Ambassador also interacted with peer educator in a separate room. While peer educators were grateful for the MARP Project they asked whether USAID had any plans of expanding the minimum package of care to include TB treatment. They were concerned with the referral set up, many patients have to walk far to receive TB treatment.  They also suggested accessing hard to reach areas using mobile outreach services to complement the Night Clinic.

The culmination of the Ambassador’s visit was a youth play about HIV/AIDS focusing on behaviors that put people at risk for HIV infection, correct and consistent condom usage, and the importance of seeking HIV treatment services from clinics and health centers instead of traditional healers.

More information: John Mkandawire

Implementation of the WHO antenatal care model in Mozambique

Health Centre Number 2 in Tete City officially launched the project on August 1, 2014.

The Team Leader explaining the benefits of the project.The launching ceremony was attended by among others Dr Carla, Provincial Health Director; Dr Armando Melo, Mozambique Ministry of Health; and Sally Griffin, International Centre for Reproductive Health.

ICRH-M continues to work with the Provincial Health Directorate of Tete to reduce maternal and perinatal morbidity and mortality by conducting operations research. One such study is the implementation of WHO antenatal care (ANC) model conducted at 10 ANC clinics in three regions in Mozambique including two health facilities in Tete City and Songo in Tete Province. These clinics account for a significant proportion of the annual ANC visits in the country.

WHO developed an ANC model that recommends the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used.

More information: Sally Griffin

Establishment of a new community health unit in Kwale, Kenya in August 2014

MOMI Project supports the training of community health workers in Kwale

New community health workers in Kwale County discussing during an  interactive training sessionICRH Kenya, through the MOMI project, recently supported the training of 50 new community health workers and 15 community health committee members in Tiwi sub-division of Kwale County. This training was conducted as part of capacity building activities for the project which seeks to reduce maternal and childhood morbidity and mortality in the year after childbirth using combined health facility and community-based interventions. The new community health unit brings to 12, the number of units in Matuga sub-county of Kwale. Kwale County as embraced the community health strategy as its flagship project for improving health outcomes in its health sector strategic plan (2013-2017). Acknowledging the contribution by the MOMI project, Dr. Hajara El-Busaidy, the Kwale county director of health said that the new community unit will go a long way in improving service delivery at the community level which will positively impact maternal and child health outcomes. Kwale County targets to have a total of 150 community units over 4 sub-counties including Matuga. Dr. El-Busaidy requested for additional support in training new community units especially in areas where none exist.

More information: Vernon Mochache


Female Genital Mutilation

ICRH is signatory to the Girl Charter on Ending FGM and Child, Early and Forced Marriage

Els Leye attended the Girl Summit 2014, hosted by the UK Government and the United Nations Children's Fund (UNICEF), in London on July 22 2014. The summit aimed at building on current efforts and rallying a global movement to end female genital mutilation (FGM) and child, early and forced marriage (CEFM). It brought together young people, community members, activists, traditional and faith leaders, governments and international leaders, civil society, and the private sector. The summit showcased initiatives that have aimed to reduce FGM and CEFM, whether at local or national levels, and was a forum for sharing learning and discussing the most pressing challenges, opportunities and successes in accelerating change at scale.

ICRH signed the Girl Summit Charter on Ending FGM and Child, Early and Forced Marriage and committed to work with others to end FGM and CEFM.

Prior to the summit, Els Leye attended the Pre-Summit Research and Evidence Meeting on the 21st of July, co-hosted by DFID, WHO and UNICEF. The meeting brought together expert researchers, implementers, donors and policy makers to discuss existing evidence as well as priorities and opportunities for future research on FGM and CEFM. The objective of the meeting were to discuss existing evidence and share priorities and opportunities for future research on issues that are cross-cutting and specific to FGM and CEFM and to start a dialogue on mechanisms to enable research/policy coordination and collaboration and to take forward support for research on these priorities.

More information:

Summer School Network Statistics in Health Research

The Scientific Research Community ‘Network Statistics for Sexually Transmitted Infections Epidemiology’ and Ghent University organized an international summer school Network Statistics in Health Research from 18 to 22 August 2014 in Ghent. 

Network statistics is a rapidly expanding branch in statistics that is concerned with the description and inference of network properties. Analyses of sexual network data have made crucial contributions to an improved understanding of the epidemiology and sociology behind the transmission of sexually transmitted infections. Further, social network analyses have been conducted to study how individuals’ social networks influence their health behaviors and how the social structure of health systems influence the delivery and quality of health care services. To address the lack of postgraduate training in network statistics in health research in Flanders (and more generally worldwide), the Scientific Research Community ‘Network Statistics for Sexually Transmitted Infections Epidemiology’ and Ghent University organized the international summer school Network Statistics in Health Research at the Ghent University Hospital from 18 to 22 August 2014. This initiative was  funded by the Research Foundation - Flanders, the UGent Doctoral Schools Program and the National Institutes of Health. Martina Morris, Steve Goodreau and Sam Jenness, the three main lecturers from the University of Washington who taught the brunt of the lectures and computer labs, are world-leading experts in network statistics and HIV/STI epidemiology. Kate Sabot (London School of Hygiene and Tropical Medicine) and Per Block (University of Oxford) gave additional guest lectures on Social Network Analysis to improve maternal and newborn health, and on Stochastic Actor Oriented Models, respectively. Given that we received many more applications (from fourteen countries!) than there were available places, and noting the very positive post-course feedback from participants, we plan to organize a second edition of this summer school next year around the same period.

More information:



Ines Keygnaert

On 20 June 2014, Ines Keygnaert successfully defended het PhD research on Sexual Violence and Sexual Health in Refugees, Asylum Seekers and Undocumented Migrants.

The research was conducted in 8 European countries (Belgium, the Netherlands, Ireland, Hungary, Portugal, Spain, Greece and Malta) and in one European neighborhood country (Morocco). 1001 (in-depth) interviews have been conducted with refugees, asylum seekers, undocumented migrants and with professionals of the European asylum sector and Moroccan healthcare sector. Quantitative and qualitative analysis of the data highlight the vulnerability of both female and male members of the research populations to sexual violence –which very frequently consists of gang or multiple rape- and sexual ill-health. Ines Keygnaert argues that it is paramount that future sexual health promotion and sexual violence prevention actions address the root causes by assuring that human rights are enforced and upheld without exception. The development of a true rights-based approach to health for all requires rethinking the current European paradigm on violence as solely directed towards women into a more gender-balanced paradigm as well as the one on migration into one that considers migration as an opportunity rather than a threat to public health.

Furthermore, health promotion and violence prevention actions should stem from a positive view on sexual health and sexuality, and they should be radical, integral and democratic. Finally, Ines Keygnaert stresses that applying desirable prevention and response policies is a matter of public health in which all health workers have a co-responsibility in promoting good health and prevention of violence in all people regardless of the status one has or not.

The full thesis, entitled ‘Sexual Violence and Sexual Health in Refugees, Asylum Seekers and Undocumented Migrants  in Europe and the European Neighborhood: Determinants and Desirable Prevention’ can be downloaded from the ICRH website: PhD thesis Ines Keygnaert

More information: Ines Keygnaert,

Zhang Xu Dong wins Women, Girls and HIV Investigator’s Prize

ICRH PhD fellow Zhang Xu Dong’s abstract entitled ‘Sexual and reproductive health in adolescent female sex workers: Kunming, China’, submitted to the  20th International AIDS Conference, has been selected for the Women, Girls and HIV Investigator’s Prize.

The purpose of the Women, Girls and HIV Investigator’s Prize is to encourage research in low- or middle-income countries that can benefit women and girls affected by HIV and AIDS. The prize is offered by the IAS and UNAIDS, and supported by the International Centre for Research on Women (ICRW) and the International Community of Women Living with HIV/AIDS (ICW). The prize was presented at the award ceremony at the beginning of the AIDS 2014 conference on 22 July 2014.

Co-authors of the winning abstract are Megan S C Lim, Elissa Kennedy, Yan Li, Yin Yang, Lin Li, Yun-Xia Li, Marleen Temmerman and Stanley Luchters.

A video of Zhang Xu Dong’s presentation can be watched at

More information: Zhang Xu Dong


ICRH Belgium Activity Report 2013

A PDF of the report can be downloaded from the ICRH website: activity report ICRHB 2013.

Sex workers in Africa

A Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa.

Female sex workers (FSW) projects in many settings have demonstrated effective ways of reducing the heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.

149 articles describing 54 projects were located through searches in Web of Science, MEDLINE, non-indexed publications and websites of international organizations. Most projects were localized and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counseling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.

The authors conclude that sex work programs in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs' health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.

Dhana A, Luchters S, Moore L, Lafort Y, Roy A, Scorgie F, Chersich M. Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa. Global Health. 2014 Jun 10;10:46. doi: 10.1186/1744-8603-10-46.

Sex workers in China

A cross-sectional study examining characteristics of adolescent female sex workers (FSWs) associated with contraceptive use and abortion in Kunming, China.

This cross-sectional study was conducted between July 2010 and February 2011. Adolescent FSWs were recruited using snowball and convenience sampling. The researchers present descriptive statistics, comparative analyses of socio-demographic and reproductive character­istics of respondents who had or had not used modern contraceptives, and assessed factors associated with prior abortion using simple odds ratios and multivariate logistic regres­sion adjustments.

Twenty-seven percent of adolescent FSWs had never used any modern contracep­tive. Condoms (69%) and oral contraceptives (38%) were most commonly reported, and less than 3% had ever relied on an intrauterine device. Low rates of dual protection (34%) were found. About half of the respondents reported one or more lifetime abortions. Inconsistent condom use, frequent alcohol use and longer-term cohabitation were associated with prior abortion.

The authors conclude that low consistent utilization of modern contraceptives and of dual protection, and high rates of abortion, highlight the urgent need for early contact and continuous provision of comprehensive reproductive health services for adolescent FSWs.

Xu-Dong Zhang, Elissa Kennedy, Marleen Temmerman, Yan Li, Wei-Hong Zhang and Stanley Luchters. High rates of abortion and low levels of contraceptive use among adolescent female sex workers in Kunming, China: A cross-sectional analysis Eur J Contracept Reprod Health Care. 2014 Jul 1:1-11. [Epub ahead of print]

Sex work and soccer

A multi-method study on the impact of the 2010 soccer world cup on sex work in South Africa.

Sports mega-events have expanded in size, popularity and cost. Fuelled by media speculation and moral panics, myths proliferate about the increase in trafficking into forced prostitution as well as sex work in the run-up to such events. This qualitative enquiry explored the perceptions of male, female and transgender sex workers of the 2010 Soccer World Cup held in South Africa, and the impact it had on their work and private lives.

A multi-method study design was employed. Data consisted of 14 Focus Group Discussions, 53 sex worker diaries, and responses to two questions in surveys with 1059 male, female and transgender sex workers in three cities.

Overall, a minority of participants noted changes to the sex sector due to the World Cup and nothing emerged on the feared increases in trafficking into forced prostitution. Participants who observed changes in their work mainly described differences, both positive and negative, in working conditions, income and client relations, as well as police harassment. The accounts of changes were heterogeneous - often conflicting in the same research site and across sites.

The authors conclude that no major shifts occurred in sex work during the World Cup, and only a few inconsequential changes were noted. Sports mega-events provide strategic opportunities to expand health and human rights programs to sex workers. The 2010 World Cup missed that opportunity.

Richter ML, Scorgie F, Chersich MF, Luchters S. ’There are a lot of new people in town: but they are here for soccer, not for business' a qualitative inquiry into the impact of the 2010 soccer world cup on sex work in South Africa. Global Health. 2014 Jun 10;10(1):45. doi: 10.1186/1744-8603-10-45.

Young Rwandans' perceptions on sexuality and relationships

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 sexual and reproductive health (SRH) topics. The letters were analyzed 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 behaviors concerning sexuality. In conclusion, the authors formulate several recommendations for SRH interventions.

Kristien Michielsen, Pieter Remes, John Rugabo, Ronan Van Rossem & Marleen Temmerman. Rwandan young people's perceptions on sexuality and relationships: Results from a qualitative study using the ‘mailbox technique’. SAHARA-J: Journal of Social Aspects of HIV/AIDS. Published online: 20 Jun 2014

Gender attitudes among adolescents in Bolivia and Ecuador

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.

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 behavior, 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 behavior, 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 than sexually experienced adolescents who are less positively inclined toward gender equality. These correlations remained consistent whether the respondent was a boy or a girl. 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.

The 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 such as unwanted teenage pregnancies and sexual pleasure among adolescents worldwide.

Sara De Meyer, Lina Jaruseviciene, Apolinaras Zaborskis, Peter Decat, Bernardo Vega, Kathya Cordova, Marleen Temmerman, Olivier Degomme, Kristien Michielsen. 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, 7: 24089

Forced marriage

An analysis of legislation and political measures in Europe.

Forced marriage is of current international concern in Europe. As many cases involve a transnational component linked to migration, it is increasingly receiving attention at the government level. The serious consequences for women, including sexual violence, and the physical and psychological health risks associated with it, seem to receive little consideration. Recent years have seen a rise in initiatives and measures taken by policy makers throughout Europe. As the focus is placed on criminalization and stringent immigration policies, ethnic minority population groups bear the greatest burden. It is argued that specific criminal laws make it more difficult for victims to come forward, while offering very little or no protection in return. The widespread 21-year age rule in immigration law has been denounced by scholars, institutes and magistrates alike for infringing on the fundamental human right to family life guaranteed by article 8 ECHR. The discourse on forced marriage appears to have reached a crossroads. European governments are faced with the challenge to create policies that protect and support victims, while simultaneously cracking down on perpetrators and safeguarding their borders from abuses in obtaining visas. There is a very pressing need to work more closely with those at risk, involving service provisions to directly support them, instead of a one-side top-down policy framework through which minority communities feel targeted and stigmatized.

Alexia Sabbe, Marleen Temmerman, Eva Brems & Els Leye.  Forced marriage: an analysis of legislation and political measures in Europe. Crime Law Soc Change, Volume 62 No. 1 2014. ISSN 0925-4994, DOI 10.1007/s10611-014-9534-6. Published online 15 Aug. 2014.

Vaginal microbiota

A systematic review of the Medline database to determine if consistent molecular vaginal microbiota (VMB) composition patterns can be discerned after a decade of molecular testing, and to evaluate demographic, behavioral and clinical determinants of VMB compositions.

Studies were eligible when published between 1 January 2008 and 15 November 2013, and if at least one molecular technique (sequencing, PCR, DNA fingerprinting, or DNA hybridization) was used to characterize the VMB. Sixty three eligible studies were identified. These studies have now conclusively shown that lactobacilli-dominated VMB are associated with a healthy vaginal micro-environment and that bacterial vaginosis (BV) is best described as a polybacterial dysbiosis. The extent of dysbiosis correlates well with Nugent score and vaginal pH but not with the other Amsel criteria. Lactobacillus crispatus is more beneficial than L. iners. Longitudinal studies have shown that a L. crispatus-dominated VMB is more likely to shift to a L. iners-dominated or mixed lactobacilli VMB than to full dysbiosis. Data on VMB determinants are scarce and inconsistent, but dysbiosis is consistently associated with HIV, human papillomavirus (HPV), and Trichomonas vaginalis infection. In contrast, vaginal colonization with Candida spp. is more common in women with a lactobacilli-dominated VMB than in women with dysbiosis.

Cervicovaginal mucosal immune responses to molecular VMB compositions have not yet been properly characterized. Molecular techniques have now become more affordable, and the authors make a case for incorporating them into larger epidemiological studies to address knowledge gaps in etiology and pathogenesis of dysbiosis, associations of different dysbiotic states with clinical outcomes, and to evaluate interventions aimed at restoring and maintaining a lactobacilli-dominated VMB.

Van de Wijgert JH(1), Borgdorff H(2), Verhelst R(3), Crucitti T(4), Francis S(5), Verstraelen H(6), Jespers V(4). The vaginal microbiota: what have we learned after a decade of molecular characterization? PLoS One. 2014 Aug 22;9(8):e105998. doi: 10.1371/journal.pone.0105998.eCollection 2014. PMID: 25148517.

Female Genital Mutilation

A study on the assessment of Female Genital Mutilation (FGM) in the EU.

Due to migration, FGM became an issue in countries where it was formerly inexistent, including in European countries. The prevalence of FGM in Europe is however unknown. This paper reports on the results of the assessment of FGM prevalence in the EU, which was undertaken as part of a broader study to map FGM in the EU. The overall study was entitled “Study to map the current situation and trends of female genital mutilation in 27 EU Member States and Croatia”, and was carried out by the authors from December 2011 to December 2012 for the European Institute for Gender Equality.

A pool of native speaking researchers performed a desk research in the 28 EU countries.

The desk study consisted of a systematic web-based and documents search along with enquiries of key institutions and individuals in order to collect and confirm all the information and data available on prevalence, among others. No ongoing, systematic, representative surveys were identified that use a harmonized approach to gather comparable data on FGM prevalence similar to the DHS or MICS surveys in the EU Member States. However, a number of countries have undertaken prevalence or other studies, aiming at understanding the extent of FGM. None of these studies and assessments generated comparable data between the Member States due to the variations in methodologies and approaches utilized.

The authors conclude that absence of information on FGM prevalence appears to be a conspicuous gap, particularly the impossibility to capture and analyze the trends and changes in relation to national FGM prevalence figures over time. The main reasons for this gap are the lack of studies on the subject, the non-use of administrative datasets and the complexity of calculating accurate up-to-date FGM prevalence figures. The lack of funding, agreed working definitions, expertise and common methodologies may also be factors. National statistical institutes could play an important role in contributing to the knowledge on FGM in Member States by utilizing and sharing the data they collect, in particular population censuses data. The willingness of countries to learn from each other and share data collection tools, methodologies and expertise should be harnessed.

Els Leye, Lut Mergaert, Catarina Arnaut, siobán O’Brien Green. Female genital mutilation in the European Union. Towards a better estimation of prevalence of female genital mutilation in the European Union: interpreting existing evidence in all EU Member States. GENUS, LXX (No. 1), 99-121.

Intimate partner violence

A cross-sectional study into the prevalence and evolution of intimate partner violence before and during pregnancy.

Intimate partner violence (IPV) before and during pregnancy is associated with a broad range of

adverse health outcomes. Describing the extent and the evolution of IPV is a crucial step in developing interventions to reduce the health impact of IPV. 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. Ethical clearance was obtained in all participating hospitals.

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 this 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.

An-Sofie Van Parys, Ellen Deschepper, Kristien Michielsen, Marleen Temmerman and Hans Verstraelen. Prevalence and evolution of intimate partner violence before and during pregnancy:

a cross-sectional study. BMC Pregnancy and Childbirth 2014, 14:294

Female sex workers in Africa

A systematic review on community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa.

Female sex workers (FSWs) experience high levels of sexual and reproductive health (SRH) morbidity, violence and discrimination. Successful SRH interventions for FSWs in India and elsewhere have long prioritized community mobilization and structural interventions, yet little is known about similar approaches in African settings.

Medline and Web of Science for studies of FSW health services in Africa were searched in November 2012, and experts and websites of international organizations were consulted. Titles and abstracts were screened to identify studies describing relevant services, using a broad definition of empowerment. Data were extracted on service-delivery models and degree of FSW involvement, and analyzed with reference to a four-stage framework developed by Ashodaya. This conceptualizes community empowerment as progressing from (1) initial engagement with the sex worker community, to (2) community involvement in targeted activities, to (3) ownership, and finally, (4) sustainability of action beyond the community.

Of 5413 articles screened, 129 were included, describing 42 projects. Targeted services in FSW 'hotspots' were generally isolated and limited in coverage and scope, mostly offering only free condoms and STI treatment. Many services were provided as part of research activities and offered via a clinic with associated community outreach. Empowerment processes were usually limited to peer-education (stage 2 of framework). Community mobilization as an activity in its own right was rarely documented and while most projects successfully engaged communities, few progressed to involvement, community ownership or sustainability. Only a few interventions had evolved to facilitate collective action through formal democratic structures (stage 3). These reported improved sexual negotiating power and community solidarity, and positive behavioral and clinical outcomes. Sustainability of many projects was weakened by disunity within transient communities, variable commitment of programmers, low human resource capacity and general resource limitations.

The article concludes that most FSW SRH projects in Africa implemented participatory processes consistent with only the earliest stages of community empowerment, although isolated projects demonstrate proof of concept for successful empowerment interventions in African settings.

Moore L, Chersich MF, Steen R, Reza-Paul S, Dhana A, Vuylsteke B, Lafort Y, Scorgie F. Community empowerment and involvement of female sex workers in targeted sexual and reproductive health interventions in Africa: a systematic review. Global Health. 2014 Jun 10;10:47. doi: 10.1186/1744-8603-10-47.

Doctoral students in North-South partnerships

A qualitative study on challenges and facilitating factors for ‘nesting’ doctoral students in collaborative North-South partnerships for health systems research.

The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programs and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured platform for doctoral level studies as a way of strengthening health system research capacity in sub-Saharan Africa (SSA).

The aim of this study was to explore the challenges of, and facilitating factors for, 'nesting' doctoral students in North-South collaborative research projects. The term nesting refers to the embedding of the processes of recruiting, supervising, and coordinating doctoral students in the overall research plan and processes.

This cross-sectional qualitative study was undertaken by the EU-funded QUALMAT Project. A questionnaire was implemented with doctoral students, supervisors, and country principal investigators (PIs), and content analysis was undertaken.

Completed questionnaires were received from nine doctoral students, six supervisors, and three country PIs (86% responses rate). The doctoral students from SSA described high expectations about the input they would receive (administrative support, equipment, training, supervision). This contrasted with the expectations of the supervisors for proactivity and self-management on the part of the students. The rationale for candidate selection, and understandings of the purpose of the doctoral students in the project were areas of considerable divergence. There were some challenges associated with the use of the country PIs as co-supervisors. Doctoral student progress was at times impeded by delays in the release of funding installments from the EU. The paper provides a checklist of essential requirements and a set of recommendations for effective nesting of doctoral students in joint North-South projects.

There are considerable challenges to the effective nesting of doctoral students within major collaborative research projects. However, ways can be found to overcome them. The nesting process ultimately helped the institutions involved in this example to take better advantage of the opportunities that collaborative projects offer to foster North-South partnerships as a contribution to the strengthening of local research capacity.

Loukanova S, Prytherch H, Blank A, Duysburgh E, Tomson G, Gustafsson LL, Sié A, Williams J, Leshabari M, Haefeli WE, Sauerborn R, Fonn S. Nesting doctoral students in collaborative North-South partnerships for health systems research. Glob Health Action. 2014 Jul 15;7:24070. doi: 10.3402/gha.v7.24070. eCollection 2014.