Newsletter March 2018

 

 ICRH Global Newsletter

15th of March, 2018

 

Message from the Chair
Happy International Women’s Day to all the wonderful women and men working with ICRH in many parts of the world! Gender- equity, women’s health and rights are key components of ICRH goals as reflected by some of the studies and publications in this newsletter. Sexual and Reproductive health, in particular of adolescents is another priority.
New global partnerships are important and ICRH is proud to enter into new collaborations with Aga Khan University and with Ipas in Mozambique.
Unfortunately ICRH is also suffering from the ‘Global Gag rule’ or ‘Mexico City Policy’, and more specifically the 'Protecting Life in Global Health Assistance' plan through which the Trump administration dramatically reduces U.S. funding for global health assistance to organisations and institutions involved in reproductive health, family planning, abortion... This is directly impacting our work in Mozambique. We are looking for solutions and hope to get alternative funding from global partners who are truly concerned with women’s health and wellbeing.

PROJECTS
New partnership between ICRH-Mozambique and Ipas
ICRH-Mozambique is working with Ipas to carry out a study into facilitators and barriers to safe abortion options in Nampula and Zambézia provinces, Mozambique.

It is a qualitative study that will involve interviews and participatory research methodologies with young women, community leaders, and informal providers. Ipas, which works globally to ensure that women and girls have access to safe abortion and contraceptive care, is working with the Ministry of Health to support the roll out safe abortion services under the recent relaxation of the legislation, and will use the findings to develop community-based interventions for reducing unsafe abortions.
Base line study on gender based violence in teacher colleges and training institutions in Uganda
ICRH has signed an agreement with ENABEL and will provide technical support for the baseline study in Uganda.
In 2012 the Ugandan Ministry of Education and Sports (MoES) published the results of a study on violence at primary and secondary schools, entitled ‘Assessing Child Protection, Safety and Security Issues for Children in Ugandan Primary and Secondary Schools’. One of the key findings of the study indicated that children at primary and secondary schools are subjected to many forms of physical, emotional and sexual violence and teachers were the main perpetrators.  In this context, the MoES, and more specifically the Teacher/tutor, Instructor Education and Training (TIET) Department has received the support of the Study Fund in order to realise a baseline study on Gender Based Violence in the National Teacher Colleges (NTCs) and Business, Technical and Vocational Education and Training (BTVET) institutions in Uganda to fill the gap with the non-existence of any baseline study on prevalence of GBV in post-secondary learning institutions.
This baseline study will serve as a starting point for developing policies, guidelines and tools in order to ultimately contribute to violence prevention and response and gender responsive learning environments.
ENABEL, the Belgian Development Agency, is a major partner of the Ugandan MoES in supporting the training of future teachers for secondary schools through the NTCs and the improvement of technical and vocational training in Uganda. Within this context, ENABEL concluded an agreement with ICRH to provide technical support for the baseline study.
More information: els.leye@ugent.be
EVENTS
ICRH Mozambique victim of Global Gag Rule
A programme that has worked for 7 years to ensure that key populations, in particular sex workers, have access to HIV and sexual and reproductive health services and protection against violence and discrimination will have to be stopped at the end of March.

The Global Gag Rule, reinstated by Donald Trump just over one year ago, is gradually being rolled out across the many countries where the US government is supporting HIV and other programmes. It prohibits all non-US organisations that receive US health funding from carrying out any activities, even with other funding, that are considered by the US government to ‘promote abortion’, including promotion of legal and safe abortion services. This leaves many organizations with a cruel choice between stopping their programmes that are dependent on US funding, or closing down other programmes which may promote access to safe abortion, in order to maintain US funding. This is particularly problematic in Mozambique, where the government has recently decriminalized safe abortion in recognition of persistently high levels of unsafe abortion which contribute to high maternal mortality, and where local partners are aligning their actions with national policy in this area.
ICRH-Mozambique is part of the body of organisations that promote access to safe abortion, and as a consequence lost its US funding. The affected project provides services to over 2,000 sex workers in 5 districts of Tete province, including through the Moatize Night Clinic, and has trained and supported 432 health providers and 37 health facilities across 8 provinces to provide non-discriminatory, rights-based services to key populations, and supported 6 local partners in 7 provinces to provide community counselling and testing services. All these activities will be forced to cease on 31 March.
Global Minds Sensitizing Event
On 30 March 2018, ICRH will organize a conference on social (gender) norms and adolescent (sexual) health.

This event fits within the framework of the Global Minds Sensitizing Events of Ghent University and Belmundo, the international solidarity festival of the city of Ghent. During the morning session various (research) experiences on the influence of social norms on adolescent health will be shared. The afternoon session starts with presentations that illustrate how  gender norms and adolescent sexual health are interconnected. Subsequently, we will debate on how we need to transform gender norms to improve adolescent sexual health.
For more information on the complete program: http://icrh.org/news/invitation-conference-social-gender-norms-and-sexual-health-adolescents-march-30th-2018-ghent or contact SaraA.DeMeyer@ugent.be
25th anniversary of the Ganjoni Cohort
From 16th to 19th January 2018, ICRH Kenya participated in a research symposium to celebrate the 25th anniversary of the Ganjoni Cohort.

The Ganjoni Cohort is a female sex workers cohort that helped change the landscape of HIV transmission research in Kenya. It is supported by collaborations between the University of Washington and the University of Nairobi. The first participants enrolled in February 1993. The symposium was held in honor of Dr. King Holmes and Dr. Scott McClelland, both of whom have contributed immensely to the project. The meeting began on Wednesday evening with a session on mentorship in research.  A panel of senior researchers and mentors from both The University of Washington and The University of Nairobi provided valuable insights on the mentor-mentee relationship. They also outlined expectations mentors should have from their mentees and vice versa.
Symposium presentations were on Thursday and Friday and included two ICRH Kenya contributions:  Griffins Manguro presented on the characteristics of survivors, and gaps in management of sexual and gender based violence based on data and lessons from the Gender Based violence and Recovery Center at Coast Provincial General Hospital in Mombasa, Kenya, and Caroline Gichuki presented on the Whisper/shout clinical trial, currently ongoing at the site.
ICRHK continues to collaborate with other research institutions within the coast to build research capacity and maintain a collaborative spirit, with the aim to drive forward the research agenda in Mombasa and counties along the coast.
VLIR-UOS partnership with Moi University Kenya
After 12 years, the partnership between VLIR-UOS and the Moi University Kenya (Eldoret, Kenya) came to an end.

A summarizing closing event was organized to highlight the successes and to build foundation for future collaborations. ICRH has played a key role in the Health project, prof. dr. Davy Vanden Broeck being the project leader for this theme. In addition, Prof. dr. Marleen Temmerman has been promoting multiple PhD research projects and strongly supported the project to reach the goals initially set.
During the past 12 years, important milestones in (human) capacity building have been reached. Not only the program has invested in multiple MSc and PhD degrees, it also supported the first HPV  vaccine outreach countrywide, picked up by the Kenyan Ministry of Health. In collaboration with industrial partners, dr. Hillary Mabeya led a demonstration project distributing 10,000 vaccines. The project has been rolled out and a molecular testing laboratory has been established. Multiple PhD projects were completed, and three will be defended in the near future at Ghent University.
Horizon ‘Birth day’ Prize
On 13 February 2018, the European Commission, the Bill and Melinda Gates Foundation and MSD for Mothers awarded the ‘Horizon Prize for the Birth day’.

This prize is awarded to a solution that best demonstrates a reduction in maternal and/or newborn morbidity and mortality and/or stillbirths during facility-based deliveries.
The 'Birth day' Prize is an initiative of the European Commission which has committed 1 million EUR, with the Bill & Melinda Gates Foundation pledging another 1 million EUR and a further 500 000 EUR donated by the MSD for Mothers.
The first award went to the research team from the Institut de Recherche pour le Développement in France. The solution, QUARITE (Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali), developed a method of analysing and tracing the causes of maternal deaths in hospitals in these two low-income countries, and then applied that knowledge to prevent more deaths. This reduced maternal deaths in hospitals overall by 15%, and by as much as 35% in district hospitals.
CHAI MNH Nigeria was the second winner, with a managerial intervention at district level, involving health centres and hospitals and skilled birth attendants. The third winner, the WOMAN Trial run by the London School of Hygiene and Tropical Medicine, tested and validated the use of a blood clot stabilising drug as a first line treatment for post-delivery bleeding, the leading cause of maternal mortality around the world. Prof. Marleen Temmerman gave the keynote lecture at the award ceremony.
China-Africa collaboration
ICRH staff from Belgium and Kenya participated in the Population Health Symposium, organized by the Aga Khan Development Network (AKDN) and Aga Khan University (AKU) on 1 and 2 February in Mombasa.

This initiative brought together the interest, experiences, and strengths of leading universities in China (Tsinghua University in Beijing and Fudan University in Shanghai) with the AKDN/AKU, as well as selected partners such as ICRH. The symposium explored lesson learned from past and new collaborative model and collaboration strategies between Chinese and Canadian, European and African institutions. China’s Belt & Road Initiative and the focus of AKDN on Central/South Asia and East Africa provide the framework for collaboration.   Participating ICRH members chaired a session and gave a keynote presentation.
ICRH Kenya Fun Day 2017
Bamburi beach animators engaged in providing a one day team building program to ICRH Kenya staff members on 20th December, 2017 at Bamburi beach hotel.

Team work is mandatory for result driven, high performance and a nurturing working environment. This calls for means and ways of growing and enhancing team work in every organization and one major way is having the team members engage in theme based team building program. The team building activities challenge team members to solve tasks at hand and in the process learn vital skills necessary for a good team and provide opportunities to share ideas in a fun relaxed environment. The team building was conducted in the liveliest manner in accompaniment ice breaker, hearty discussions and group fun activities.
ICRH PEOPLE
Katrina Perehudoff
Katrina joined the ICRH in January 2018 as a temporary doctoral assistant.

At the ICRH she contributes to development of various grant proposals and to the Academic Network for Sexual and Reproductive Health Rights Policy. In her spare time Katrina is finalizing her PhD research of human rights-based law and policy for universal access to medicines in low- and middle-income countries at the University of Groningen in the Netherlands. During this research she developed an interest in access to sexual and reproductive health services and medicines. Prior to pursing her doctoral research, Katrina was a consumer advocate for access to medicines and their rational use at the NGOs Health Action International (Amsterdam) and The European Consumer Organisation (Brussels). In 2017 she was awarded a Visiting Fellowship in Health & Human Rights at the Munk School of Global Affairs, University of Toronto.
PhD Roxanne Beauclair
On 2 March, Roxanne Beauclair defended her PhD thesis at Ghent University.

The title of the thesis is ‘Age differences in sexual relationships and HIV transmission: statistical analysis of bio-behavioural survey data from Southern Africa. Supervisors were prof. Wim Delva, prof. Marleen Temmerman and prof. Niel Hens.
 PUBLICATIONS
Involving men to improve maternal and newborn health
A systematic review of the effectiveness of interventions.
Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes. The objective of this study is to determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships.
Using a comprehensive, highly sensitive mapping of maternal health intervention studies conducted in low- and middle-income countries between 2000 and 2012, interventions were identified that have engaged men to improve maternal and newborn health. Primary outcomes were care-seeking for essential services, mortality and morbidity, and home care practices. Secondary outcomes relating to couple relationships were extracted from included studies.
Thirteen studies from nine countries were included. Interventions to engage men were associated with improved antenatal care attendance, skilled birth attendance, facility birth, postpartum care, birth and complications preparedness and maternal nutrition. The impact of interventions on mortality, morbidity and breastfeeding was less clear. Included interventions improved male partner support for women and increased couple communication and joint decision-making, with ambiguous effects on women's autonomy.
The authors conclude that interventions to engage men in maternal and newborn health can increase care-seeking, improve home care practices, and support more equitable couple communication and decision-making for maternal and newborn health. These findings support engaging men as a health promotion strategy, although evidence gaps remain around effects on mortality and morbidity. Findings also indicate that interventions to increase male involvement should be carefully designed and implemented to mitigate potential harmful effects on couple relationship dynamics.
Tokhi M, Comrie-Thomson L, Davis J, Portela A, Chersich MF, Luchters S. Involving men to improve maternal and newborn health: A systematic review of the effectiveness of interventions. PLoS One. 2018 Jan 25;13(1):e0191620. doi: 10.1371/journal.pone.0191620. eCollection 2018.
Task shifting
A mixed-method study on the potential of task shifting selected maternal interventions to auxiliary midwives in Myanmar
An estimated 282 women die for every 100,000 live births in Myanmar, most due to preventable causes. Auxiliary Midwives (AMWs) in Myanmar are responsible for providing a package of care during pregnancy and childbirth to women in rural hard to reach areas where skilled birth attendants (Midwives) are not accessible. This study aims to examine the role of AMWs in Myanmar and to assess the current practices of three proposed essential maternal interventions (oral supplement distribution to pregnant women; administration of misoprostol to prevent postpartum haemorrhage; management of puerperal sepsis with oral antibiotics) in order to facilitate a formal integration of these tasks to AMWs in Myanmar.
A mixed methods study was conducted in Magwe Region, Myanmar involving a survey of 262 AMWs, complemented by 15 focus group discussions with midwives (MWs), AMWs, mothers and community members, and 10 key informant interviews with health care providers at different levels within the health care system. According to current government policy, AMWs are responsible for identifying pregnant women, screening for danger signs and facilitating early referral, provision of counselling on nutrition and birth preparedness for women in hard-to-reach areas. AMWs also assist at normal deliveries and help MWs provide immunization services. In practice, they also provide oral supplements to pregnant women (84%), provide antibiotics to mothers during the puerperium (43%), and provide misoprostol to prevent postpartum haemorrhage (41%). The current practices of AMWs demonstrate the potential for task shifting on selected essential maternal interventions. However, to integrate these interventions into formal practice they must be complemented with appropriate training, clear guidelines on drug use, systematic recording and reporting, supportive monitoring and supervision and a clear political commitment towards task shifting.
With the current national government's commitment towards one AMW in one village, this study highlights the potential for shifting specific maternal lifesaving tasks to AMWs.
Than KK, Tin KN, La T, Thant KS, Myint T, Beeson JG, Luchters S, Morgan A. The potential of task shifting selected maternal interventions to Auxiliary Midwives in Myanmar: a mixed-method study. BMC Public Health. 2018 Jan 3;18(1):99. doi: 10.1186/s12889-017-5020-2.
Female genital mutilation/cutting in Italy
An enhanced estimation for first generation migrant women based on 2016 survey data.
Migration flows of women from Female Genital Mutilation/Cutting practicing countries have generated a need for data on women potentially affected by Female Genital Mutilation/Cutting. The paper presents enhanced estimates for foreign-born women and asylum seekers in Italy in 2016, with the aim of supporting resource planning and policy making, and advancing the methodological debate on estimation methods.
The estimates build on the most recent methodological development in Female Genital Mutilation/Cutting direct and indirect estimation for Female Genital Mutilation/Cutting non-practicing countries. Direct estimation of prevalence was performed for 9 communities using the results of the survey FGM-Prev., held in Italy in 2016. Prevalence for communities not involved in the FGM-Prev. survey was estimated using to the ‘extrapolation-of-FGM/C countries prevalence data method’ with corrections according to the selection hypothesis.
It is estimated that 60 to 80 thousand foreign-born women aged 15 and over with Female Genital Mutilation/Cutting are present in Italy in 2016. The presence also estimated of around 11 to 13 thousand cut women aged 15 and over among asylum seekers to Italy in 2014–2016. Due to the long established presence of female migrants from some practicing communities Female Genital Mutilation/Cutting is emerging as an issue also among women aged 60 and over from selected communities. Female Genital Mutilation/Cutting is an additional source of concern for slightly more than 60% of women seeking asylum.
The authors conclude that reliable estimates on Female Genital Mutilation/Cutting at country level are important for evidence-based policy making and service planning. This study suggests that indirect estimations cannot fully replace direct estimations, even if corrections for migrant socioeconomic selection can be implemented to reduce the bias.
Ortensi LE, Farina P, Leye E. Female genital mutilation/cutting in Italy: an enhanced estimation for first generation migrant women based on 2016 survey data. BMC Public Health. Springer Nature; 2018;18(1).
‘Girls Have More Challenges; They Need to Be Locked Up
A qualitative study of gender norms and the sexuality of young adolescents in Uganda.
Unequal power and gender norms expose adolescent girls to higher risks of HIV, early marriages, pregnancies and coerced sex. In Uganda, almost half of the girls below the age of 18 are already married or pregnant, which poses a danger to the lives of young girls. This study explores the social construction of gender norms from early childhood, and how it influences adolescents’ agency. Contrary to the mainstream theory of agency, which focuses on the ability to make informed choices, adolescents’ agency appears constrained by context-specific obstacles. This study adopted qualitative research approaches involving 132 participants. Of these, 44 were in-depth interviews and 11 were focus group discussions, parceled out into separate groups of adolescents (12–14 years), teachers, and parents (n = 88), in Western Uganda. Data were analyzed manually using open and axial codes, and conclusions were inductive. Results show that gender norms are established early in life, and have a very substantial impact on the agency of young adolescents. There were stereotypical gender norms depicting boys as sexually active and girls as restrained; girls’ movements were restricted; their sexual agency constrained; and prevention of pregnancy was perceived as a girl’s responsibility. Programs targeting behavioral change need to begin early in the lives of young children. They should target teachers and parents about the values of gender equality and strengthen the legal system to create an enabling environment to address the health and wellbeing of adolescents.
Ninsiima A, Leye E, Michielsen K, Kemigisha E, Nyakato V, Coene G. “Girls Have More Challenges; They Need to Be Locked Up”: A Qualitative Study of Gender Norms and the Sexuality of Young Adolescents in Uganda. Int. J. Environ. Res. Public Health. MDPI AG; 2018;15(2). 
Adolescents’ Sexual Wellbeing in Southwestern Uganda
A cross-sectional assessment of body image, self-esteem and gender equitable norms.
Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). The study noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.
Kemigisha E, Nyakato V, Bruce K, Ndaruhutse Ruzaaza G, Mlahagwa W, Ninsiima A, et al. Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms. Int J Environ Res Public Health. MDPI AG; 2018;15(2). 
Responding to Domestic Violence
Emerging challenges for policy, practice and research in Europe.
This book offers a critical overview of established and emerging manifestations of domestic violence across Europe. It describes how countries within and outside the EU are responding to the problem in policy, practice and research. Eminent academics and professionals from a range of European countries share their findings from new groundbreaking victim surveys, and weigh up the legal, social and healthcare challenges. The issues addressed include: - the cultural challenges of combating abuse forms most prevalent in migrant communities such as female genital mutilation and forced marriage; - emerging problems such as child-to-parent violence, teenage relationship violence and digital intimate partner abuse; and - barriers to help-seeking faced by marginalized victims such as LGBTQ and older people. By showcasing the most effective responses formulated in Europe and exploring innovative ways to research and understand domestic violence, this book is a crucial resource for all those with responsibility for implementing social policy and good practice. The book also contains a chapter by ICRH Prof. Els Leye on ‘Forced Marriage in Europe: the case of Belgium’.
Holt S, Overlien C, Devaney J, editors. Responding to Domestic Violence: Emerging Challenges for Policy, Practice and Research in Europe. Jessica Kingsley Publishers; 2017. 
Abortion
Factors influencing abortion decision-making processes among young women.
Decision-making about if and how to terminate a pregnancy is a dilemma for young women experiencing an unwanted pregnancy. Those women are subject to sociocultural and economic barriers that limit their autonomy and make them vulnerable to pressures that influence or force decisions about abortion. The objective of this study was to explore the individual, interpersonal and environmental factors behind the abortion decision-making process among young Mozambican women.
A qualitative study was conducted in Maputo and Quelimane. Participants were identified during a cross-sectional survey with women in the reproductive age (15–49). In total, 14 women aged 15 to 24 who had had an abortion participated in in-depth interviews. A thematic analysis was used. The study found determinants at different levels, including the low degree of autonomy for women, the limited availability of health facilities providing abortion services and a lack of patient-centeredness of health services. Based on the results of the study, the authors suggest strategies to increase knowledge of abortion rights and services and to improve the quality and accessibility of abortion services in Mozambique.
Frederico M, Michielsen K, Arnaldo C, Decat P. Factors Influencing Abortion Decision-Making Processes among Young Women. Int. J. Environ. Res. Public Health 2018, 15(2), 329; doi:10.3390/ijerph15020329.