Refugee women's and providers' perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad.

BACKGROUND: Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. METHODS: We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. RESULTS: Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. CONCLUSIONS: Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.

Contraceptive access and use among women with migratory experience living in high-income countries: a scoping review.

BACKGROUND: Women who have migrated often encounter difficulties in accessing healthcare and experience inequitable sexual and reproductive health outcomes in destination countries. These health inequities include contraceptive access and use. To better understand what influences contraceptive access and use, this scoping review set out to synthesize the evidence on contraceptive access and use and on associated interventions among women with migratory experience in high-income countries (HICs) in Europe, North America and Australasia. METHODS: The scientific databases PubMed, Web of Science and CINAHL were searched for peer-reviewed quantitative, qualitative and mixed method articles published between January 2000 and June 2023. Articles were included if they reported on studies exploring contraceptive use to prevent pregnancies among women of reproductive age with migratory experience living in HICs. Two researchers independently screened and extracted data from the articles. Findings were categorized by patient and health system level factors according to Levesque et al.'s framework of access to health care. RESULTS: A total of 68 articles were included, about half (n = 32) from North America. The articles focused on the individual level rather than the health system level, including aspects such as women's contraceptive knowledge, the influence of culture and religion on accessing and using contraception, partner involvement, and differing health insurance coverage. On the health system level, the articles highlighted lack of information on contraceptive services, cultural (in)adequacy of services and communication aspects, contraceptives' side effects, as well as geographic availability and cost of services. The review further identified three articles reporting on interventions related to contraceptive counselling. CONCLUSIONS: There is a lack of knowledge regarding how health systems impose obstacles to contraceptive services for women with migratory experience on an organizational level, as research has focused heavily on the individual level. This review's findings may serve as a foundation for further research and advances in policy and practice, specifically recommending early provision of health system related information and contraceptive education, engagement of male partners in contraceptive discourses, cultural competency training for healthcare professionals, and strengthening of interpretation services for contraceptive counselling.

Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.

INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.

Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data.

BACKGROUND: Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions. METHODS: We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020-2021 (n = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex. RESULTS: A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive "SRHR Support Index", standardized on a 1-100 scale (mean = 39.19, SD = 15.27, Cronbach's alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only. CONCLUSION: The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective - addressing the need for a common measure to track progress over time.

Sexual and reproductive health and rights (SRHR) are becoming increasingly polarized worldwide, but researchers have previously not been able to fully measure what people think about SRHR. More research about this topic is needed to address discriminatory norms and advance SRHR for all. In this study, we added new questions to the World Values Survey collected in Ethiopia, Kenya, and Zimbabwe during 2020­2021. We used statistical methods to develop an index capturing to what extent individuals' attitudes were supportive of SRHR. This index, which we call the SRHR Support Index, included 23 survey questions reflecting support for five related dimensions of SRHR. Those dimensions were (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. We found that individuals in Kenya were more supportive of SRHR, followed by Ethiopia and then Zimbabwe. There were no differences in support of SRHR between men and women, but individuals who were single and those with higher education were more supportive of SRHR, except in Ethiopia. Younger men living in urban areas were also more supportive. Our SRHR Support Index enables researchers, policymakers, and others to measure attitudes to SRHR in countries across the world and over time, based on new data from the World Values Survey that are readily available online. If combined with other sources of data, researchers can also investigate how people's support of SRHR is linked to, for example, health and policy.

Socioecologies in shaping migrants and refugee youths' sexual and reproductive health and rights: a participatory action research study.

OBJECTIVE: This study explores socioecological factors facilitating the sexual and reproductive health and rights (SRHR) experiences of migrant and refugee youth (MRY) in Greater Western Sydney, Australia. MRY may be at higher risk for poorer SRH outcomes due to cultural, linguistic, and systemic barriers. METHODS: Using participatory action research, 17 focus groups were conducted with 87 MRY aged 15-29 from diverse cultural backgrounds. Data were analysed thematically, using socioecological framework. RESULTS: Key facilitators of MRY's SRHR were identified at the microsystem and exosystem levels, including (1) Peer dynamics and support, with friends serving as trusted confidants and sources of advice; (2) Safety and contraceptive choices, highlighting the importance of access to contraception and STI prevention; and (3) Digital platforms for SRHR information access, with online resources filling knowledge gaps. CONCLUSION: Findings suggest the need for SRHR interventions to leverage peer support networks, expand access to contraceptive options, and develop culturally appropriate digital resources for MRY. Further research is needed to identify and enhance facilitators across all socioecological levels to comprehensively support MRY's SRHR needs.

Migrants and refugee youth often struggle to access sexual and reproductive health information and services in their new countries. This study is an attempt to understand what helps young migrants and refugee maintain their sexual and reproductive health and rights in Greater Western Sydney, Australia. Our aim was to identify the positive factors in their environment that make it easier for them to access and use sexual health resources. We talked to 87 migrants and refugee youth aged 15­29 from various cultural backgrounds, conducting 17 group discussions about their experiences with sexual health. Our main results show three important factors that help these young people. The results were, that (1) Many young people trust their friends for advice and information about sexual health, (2) Having choices about contraception and ways to prevent sexually transmitted infections was important, and (3) The internet, especially social media and search engines, is a major source of sexual health information for young people. Understanding these helpful factors can guide better support for young migrants and refugees. It shows sexual health programs need to use peer support in sexual health programs, make sure young people can easily access contraception and protection and create trustworthy online resources about sexual health that are culturally appropriate. Our findings show more research is needed to find other ways to support young migrants and refugees with their sexual and reproductive health. This will help create better health services and education programs for these young people.

Celebrating Africa's first endowed chair in sexual and reproductive health and rights.

This month, April 2024, the University of Benin, a federally-funded university in Southern Nigeria announced the first endowed professorial chair in sexual and reproductive health and rights (SRHR) in sub-Saharan Africa, and possibly the first such chair globally. This professorship is named in honour of Friday Okonofua1, the irrepressible champion who is a trailblazer in women's health, social advocate for women's social advancement, lead founder of the University's African Centre of Excellence in Reproductive Health, and founder of Nigeria's leading non-governmental organization, the Women's Health and Action Research Centre and the African Journal of Reproductive Health. The new professorship will be crucial in deepening and scaling up reproductive health curricula at the University of Benin, by drawing upon the principles and models of transparency, excellence, and accountability that Friday Okonofua has championed over several years. The University's Registrar alluded to this approach by explaining that the endowment "will strengthen the leadership of the University of Benin in Nigeria in this area of public health and educational delivery.

Ce mois-ci, en avril 2024, l'Université du Bénin, une université financée par le gouvernement fédéral dans le sud du Nigéria, a annoncé la création de la première chaire professorale dotée en santé et droits sexuels et reproductifs (SDSR) en Afrique subsaharienne, et peut-être la première chaire de ce type au monde. Cette chaire est nommée en l'honneur de Friday Okonofua1, champion irrépressible, pionnier de la santé des femmes, défenseur social de la promotion sociale des femmes, fondateur principal du Centre d'excellence africain en santé reproductive de l'université et fondateur de la principale organisation non gouvernementale du Nigeria, le Centre de recherche sur la santé et l'action des femmes et l'African Journal of Reproductive Health. La nouvelle chaire sera cruciale pour approfondir et élargir les programmes de santé reproductive à l'Université du Bénin, en s'appuyant sur les principes et les modèles de transparence, d'excellence et de responsabilité que Friday Okonofua défend depuis plusieurs années. Le registraire de l'Université a fait allusion à cette approche en expliquant que la dotation « renforcera le leadership de l'Université du Bénin au Nigeria dans ce domaine de la santé publique et de l'enseignement.

Positive masculinity programmes and sexual and reproductive health behaviours among boys and men in poor urban settlements in Democratic Republic of Congo, Nigeria, and Rwanda.

As Positive Masculinity (PM) Programmes continue to develop globally, it is important to examine their role in Sexual and Reproductive Health and Rights (SRHR) outcomes. This multi-country qualitative study was conducted using in-depth interviews (IDI) and focus group discussions (FGDs) with community members, beneficiaries and implementers of PM programmes. The findings show that PM programmes are designed using a gender lens to make boys and men more aware and conscious of harmful masculinity traits and their effect on SRHR. The beneficiaries of the interventions report imbibing positive SRHR behaviours by being sexually responsible - upholding sexual rights, taking precautions against sexually transmitted Infections (STIs) and learning proper communication with their partners. They also report acting as vanguards of positive gender norms to their families and peers. Although there are challenges in implementing PM programmes, the results of the study suggest that interventions targeting boys and men hold promise for improving boys' and men's health behaviours and promoting gender equality in poor urban settings.

Alors que les programmes de masculinité positive (PM) continuent de se développer à l'échelle mondiale, il est important d'examiner leur rôle dans les résultats en matière de santé et de droits sexuels et reproductifs (SDSR). Cette étude qualitative multi pays a été menée à l'aide d'entretiens approfondis (IDI) et de discussions de groupe (FGD) avec des membres de la communauté, des bénéficiaires et des responsables de la mise en œuvre des programmes PM. Les résultats montrent que les programmes PM sont conçus en utilisant une optique de genre pour rendre les garçons et les hommes plus conscients des traits de masculinité néfastes et de leurs effets sur la SDSR. Les bénéficiaires des interventions déclarent avoir adopté des comportements positifs en matière de SDSR en étant sexuellement responsables ­ en respectant leurs droits sexuels, en prenant des précautions contre les infections sexuellement transmissibles (IST) et en apprenant une bonne communication avec leurs partenaires. Ils déclarent également agir en tant qu'avant-gardes des normes de genre positives auprès de leurs familles et de leurs pairs. Bien que la mise en œuvre des programmes PM présente des difficultés, les résultats de l'étude suggèrent que les interventions ciblant les garçons et les hommes sont prometteuses pour améliorer les comportements de santé des garçons et des hommes et promouvoir l'égalité des sexes dans les milieux urbains pauvres.

Positive masculinity programmes and attitudes towards nonconforming gender identities among young males in urban Democratic Republic of Congo, Nigeria, and Rwanda.

Implementing programmes on sexual and reproductive health and rights (SRHR) in sub-Saharan Africa often involves promoting inclusive sexual identity/orientation. However, whether and how the programmes are changing gender norms in the target populations have not been established. This study was designed to determine whether participation in Positive Masculinity (PM) programmes can change attitudes associated with prevailing gender norms. We explored attitudes towards nonconforming sexual identity/orientation among young males in selected informal settlements in Democratic Republic of the Congo (DRC), Nigeria and Rwanda. The key variables we tested included "country of participation" and other socio-demographics such as "education", "marital status" and "prior residential location" (rural or urban). We found no significant association between participation in PM programmes with attitudes towards nonconforming sexual identities/orientations across our target populations irrespective of educational qualification, marital status, and previous location of residence. By contrast, religious teachings showed up in the qualitative responses as a significant factor influencing young people's resistance to PM programmes' advocating for inclusive sexuality. Additionally, negative masculinity attributes had significant negative association with attitudes towards nonconforming sexual identity, while respondents with violent tendencies showed significant positive attitudes. We conclude that current PM interventions do not significantly contribute to positive attitudes towards inclusive sexuality in DRC, Nigeria, and Rwanda.

La mise en œuvre de programmes sur la santé et les droits sexuels et reproductifs (SDSR) en Afrique subsaharienne implique souvent la promotion d'une identité/orientation sexuelle inclusive. Cependant, il n'a pas été établi si et comment les programmes modifient les normes de genre dans les populations cibles. Cette étude a été conçue pour déterminer si la participation à des programmes de masculinité positive (PM) peut changer les attitudes associées aux normes de genre dominantes. Nous avons exploré les attitudes à l'égard de l'identité/orientation sexuelle non conforme chez les jeunes hommes dans des quartiers informels sélectionnés en République démocratique du Congo (RDC), au Nigeria et au Rwanda. Les variables clés que nous avons testées comprenaient le « pays de participation ¼ et d'autres données sociodémographiques telles que « l'éducation ¼, « l'état civil ¼ et « le lieu de résidence antérieur ¼ (rural ou urbain). Nous n'avons trouvé aucune association significative entre la participation à des programmes de PM et les attitudes à l'égard des identités/orientations sexuelles non conformes au sein de nos populations cibles, indépendamment du diplôme, de l'état civil et du lieu de résidence précédent. En revanche, les enseignements religieux sont apparus dans les réponses qualitatives comme un facteur important influençant la résistance des jeunes aux programmes PM prônant une sexualité inclusive. De plus, les attributs négatifs de la masculinité présentaient une association négative significative avec les attitudes à l'égard d'une identité sexuelle non conforme, tandis que les répondants ayant des tendances violentes montraient des attitudes positives significatives. Nous concluons que les interventions actuelles de PM ne contribuent pas de manière significative à des attitudes positives envers une sexualité inclusive en RDC, au Nigeria et au Rwanda.

Community bylaws concerning sexual and reproductive health and rights in Machinga District, Malawi: to what extent are they responsive to young people's needs?

BACKGROUND: Community bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga District in southern Malawi are responsive to young people's realities and SRHR needs. METHODS: In Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15-24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people's SRHR (Phase 2). The drama was performed in the community, after which young women (18-24 years), young men (17-24 years), female and male parents discussed on what they saw in the drama, focusing on young people's SRHR, in four focus group discussions (Phase 3). All transcripts were coded and thematically analysed and narratives were written on main themes. RESULTS: Three community SRHR bylaws, related to teenage pregnancy, child marriage, and sexual harassment and rape were identified and commonly accepted in the community. While these bylaws intend to reduce SRHR-related issues among young people, they are often not involved in bylaw formulation. The bylaws were associated with protection of girls, and a good reputation for boys, young men and traditional leaders. Bylaw enforcement faced problems, as fines were not in line with national laws, and wealthy offenders could avoid them through bribes. Effects of bylaws on teenage pregnancy rates seemed limited, while some positive effects on school readmission, prevention of child marriage, and reporting sexual harassment were reported. CONCLUSIONS: The study revealed that community bylaws were accepted but not owned by young people, and had different effects on the rich versus the poor, and girls versus young men. Bylaws were associated with punishment in terms of money, which seemed to overpower their potential to promote rights and address social norms underlying SRHR issues of the youth.

Negative consequences of conflict-related sexual violence on survivors: a systematic review of qualitative evidence.

BACKGROUND: Conflicts exacerbate dynamics of power and inequalities through violence normalization, which acts as a facilitator for conflict-related sexual violence. Literature addressing its negative outcomes on survivors is scant. The aim of this systematic review was to analyze the qualitative evidence reported in scientific literature and focusing on the negative consequences of conflict-related sexual violence on victims' physical, psychological, and social dimensions of health in a gender-inclusive and disaggregated form. METHODS: A literature search was conducted on January 13, 2023 on Pubmed, Scopus, and PsychArticles. The search strings combined two blocks of terms related to sexual violence and conflict. A time filter was applied, limiting the search to studies published in the last ten years. Information regarding the main characteristics and design of the study, survivors and their experience, and about conflict-related sexual violence was collected. The negative consequences of conflict-related sexual violence on the physical, psychological, and social dimension of victims were extracted according to the Biopsychosocial model of health. The review followed the Joanna Briggs Institute methodology for systematic reviews and relied on the Preferred Reporting Items for Systematic reviews and Meta-Analyses. RESULTS: After full text review, 23 articles met the inclusion criteria, with 18 of them reporting negative repercussions on physical health, all of them highlighting adverse psychological outcomes, and 21 disclosing unfavorable social consequences. The negative outcomes described in multiple studies were sexual and reproductive health issues, the most mentioned being pregnancy, manifestations of symptoms attributable to post-traumatic stress disorder, and stigma. A number of barriers to access to care were presented as emerging findings. CONCLUSIONS: This review provided an analysis of the negative consequences of conflict-related sexual violence on survivors, thus highlighting the importance of qualitative evidence in understanding these outcomes and addressing barriers to access to care. Conflict-related sexual violence is a sexual and reproductive health issue. Sexuality education is needed at individual, community, and provider level, challenging gender norms and roles and encompassing gender-based violence. Gender-inclusive protocols and services need to be implemented to address the specific needs of all victims. Governments should advocate for SRHRs and translate health policies into services targeting survivors of CRSV.

The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review.

By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.

Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It.

Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.

Person-centred sexual and reproductive health: A call for standardized measurement.

Person-centred sexual and reproductive health (PCSRH) care refers to care that is respectful of and responsive to people's preferences, needs, and values, and which empowers them to take charge of their own sexual and reproductive health (SRH). It is an important indicator of SRH rights and quality of care. Despite the recognition of the importance of PCSRH, there is a gap in standardized measurement in some SRH services, as well as a lack of guidance on how similar person-centred care measures could be applied across the SRH continuum. Drawing on validated scales for measuring person-centred family planning, abortion, prenatal and intrapartum care, we propose a set of items that could be validated in future studies to measure PCSRH in a standardized way. A standardized approach to measurement will help highlight gaps across services and facilitate efforts to improve person-centred care across the SRH continuum. PATIENT OR PUBLIC CONTRIBUTION: This viewpoint is based on a review of validated scales that were developed through expert reviews and cognitive interviews with services users and providers across the different SRH services. They provided feedback on the relevance, clarity, and comprehensiveness of the items in each scale.

Remote training for strengthening capacity in sexual and reproductive health and rights research: a systematic review.

BACKGROUND: Training has been used to develop research skills among sexual and reproductive health and rights (SRHR) researchers. Remote education may accelerate transfer of skills and reduce barriers to strengthening research capacity. This systematic review aimed to assess the effectiveness of remote training on SRHR research and describe enablers and barriers of effective remote training. METHODS: PubMed, Embase, and Scielo were searched up to December 2022 for studies that evaluated in any language online research training programmes either on a SRHR topic or tailored for professionals working in SRHR published since 1990. Characteristics of included studies, the programmes they evaluated, the programme's effectiveness, and reported barriers and enablers to remote learning were extracted. Three researchers synthesized and described findings on effectiveness, impact and outcomes mapping them against the Kirkpatrick model. Additionally, thematic analysis from qualitative data was conducted to identify themes relating to the barriers and enablers of remote learning. RESULTS: Of 1,510 articles retrieved, six studies that included 2,058 remote learners met the inclusion criteria. Five out of six studies described empirical improvements in participant research knowledge/skills and three studies reported improvements in attitudes/self-efficacy towards research. Follow-up surveys from four studies revealed frequent application of new research skills and improved opportunities for career advancement and publication following online trainings. Cited barriers to effective online SRHR research training included time management challenges and participants' competing professional obligations; limited opportunities for interaction; and lack of support from home institutions. Cited enablers included well-structured and clear courses, learning objectives and expectations with participants; ensuring a manageable workload; facilitating interactions with mentors and hands-on experience; and selecting programme topics relevant to participants' jobs. CONCLUSION: Remote SRHR training can lead to improvements in research knowledge, skills, and attitudes, particularly when course learning objectives, structure, and expectations are outlined clearly, and ongoing mentorship is provided.

Knowledge of the abortion law and key legal issues of sexual and reproductive health and rights among recently arrived migrants in Sweden: a cross-sectional survey.

BACKGROUND: Sexual and reproductive health and rights (SRHR), including access and information on the laws and policies related to abortion, varies considerably between countries. Migrants may have limited knowledge of SRHR and related resources in their new country. This study investigates migrants' knowledge of the right to safe and legal abortion and other associated factors including the recent law on sexual consent, the legal age for sexual consent and age to marry in Sweden. METHODS: We conducted a cross-sectional study from 2018 to 2019 among recent migrants attending high schools or Swedish language schools. Descriptive statistics were computed on the knowledge of the Swedish abortion law and other legal aspects. Univariable and multivariable logistic regression analyses were conducted to assess if migrants' socio-demographic characteristics were associated with knowledge (i.e. correct/incorrect) of the Swedish abortion law and other key SRHR-related legal issues. RESULTS: Of the total 6,263 participants, 3,557 (57%) responded about whether it is legal to have an induced abortion in Sweden, and of these, 2,632 (74%) answered incorrectly. While more than half (61%) of the respondents knew the sexual consent law, nearly half (48%) did not know that sexual consent is also required for married couples. About 90% correctly responded that it is illegal to have sex with a minor (under the age of 15) and were aware of the legal age (18 years) to marry in Sweden. Incorrect knowledge of the Swedish abortion law was associated with being religious (adjusted odds ratio (AOR), 2.12; 95% confidence interval (CI), 1.42-3.15), not having previous sexual health education (AOR, 1.68; 95% CI, 1.38-2.05), coming from a country with predominantly restrictive abortion laws (AOR, 1.46; 95% CI, 1.16-1.84), low level of education (AOR, 1.29; 95% CI, 1.04-1.61) and having a temporary residence permit (AOR, 1.27; 95% CI, 1.02-1.57). CONCLUSION: We found a substantial lack of knowledge among migrants of reproductive age in Sweden regarding important laws and policies of SRHR, particularly the right to abortion. SRHR-related programmes and comprehensive sexual health education for recently arrived migrants could include components to increase knowledge of legal and safe abortions and other laws concerning SRHR.

"Not just the consequences, but also the pleasurable sex": a review of the content of comprehensive sexuality education for early adolescents in Rwanda.

BACKGROUND: Responding to adolescents' educational needs in sexual and reproductive health and rights (SRHR) is central to their sexual health and achieved through school-based comprehensive sexuality education (CSE). In 2016, Rwanda introduced CSE through the competence-based curriculum in schools to enhance learners' knowledge about sexuality, gender, and reproductive health issues, including HIV/AIDS. However, globally, the content of CSE is sometimes dissimilar, and little evidence surrounds its scope in many settings, including Rwanda. In addition, the extent to which CSE aligns with international guidelines has yet to be well known. This study assesses major areas of CSE for early adolescents in Rwanda, analyses how CSE correlates with international guidelines and makes recommendations accordingly. METHODS: We reviewed the Rwandan competence-based curriculum to map CSE competences for early adolescents and conducted semi-structured interviews with key informants (N = 16). Eleven of the 23 curriculum documents met the selection criteria and were included in the final review. We manually extracted data using a standard form in Microsoft Excel and analysed data using frequency tables and charts. Interviews were thematically analysed in NVivo 11 for Windows. FINDINGS: We found 58 CSE competences for early adolescents across various subjects, increasing with school grades. All recommended CSE areas were addressed but to a variable extent. Most competences fall under four recommended areas: sexual and reproductive health; human body and development; values, rights, and sexuality; and understanding gender. The least represented area is violence and staying safe. Of the 27 expected topics, there are two to six CSE competences for 13 topics, one CSE competence for each of the six others, and none for the eight remaining ones. Qualitative findings support these findings and suggest additional content on locally controversial but recommended areas of sexual pleasure, orientation, desire and modern contraceptive methods. CONCLUSION: This study explores the CSE content for early adolescents in Rwanda and how they align with sexuality education standards. Ensuring equal coverage of CSE areas and addressing missing topics may improve CSE content for this age group and foster their SRHR.

Fighting female genital mutilation/cutting (FGM/C): towards the endgame and beyond.

Despite the criminalization of the practice by numerous laws and international treaties in most countries concerned, female genital mutilation/cutting (FGM/C), although on the decline overall, is stagnating or tending to increase in some parts Africa. This relative failure in the fight against FGM/C could be explained from an institutional perspective. Although these struggles affect the regulatory mechanisms, which include laws, they hardly touch the normative mechanisms, which constitute the set of values deemed socially acceptable by a society, and the cultural and cognitive mechanisms, which are the manifestations of the ideologies or beliefs of a group. The naming of FGM/C among certain ethnic groups, which is part of the normative character of the social institution, rather valorizes them and makes uncut girls/women feel "dirty" or "unfit". In these communities, women who have undergone FGM/C are viewed by society as women of honour while uncut girls are perceived as promiscuous and victims of mockery, rejection, or exclusion by the community. In addition, since excision ceremonies and rituals are exclusively reserved for women, many see them as a way of freeing themselves from the rules of patriarchy and male domination that are omnipresent in the societies concerned. Informal mechanisms such as the use of witchcraft, gossip, and beliefs related to the supernatural power of the excisors underpin the cultural-cognitive nature of FGM/C practice. As a result, many families are reluctant to challenge the cutters. The fight against FGM/C can be more effective by addressing the normative and cultural-cognitive roots that form the basis for its perpetuation. This can be achieved by avoiding moralizing the practice, involving those who resist the practice in a context of high prevalence, known as "positive deviants," and using productive methods from the societies concerned. This will create a social environment in which FGM/C is increasingly perceived as less favourable and will ultimately allow for a gradual reform of the normative and cultural-cognitive character of societies that practice FGM/C. Education of women and social mobilisation are critical tools which can act as powerful levers in shifting attitudes about FGM/C.

Sexual and reproductive health services awareness and utilisation among young people in a semi-Urban community in Cross River State, Nigeria.

Young people's unawareness and poor utilisation of sexual and reproductive health and rights (SRHR) services is one of the contributing variables that increase the susceptibility of youths to many challenges in SRHR. This study sought to assess young people's level of awareness and utilisation of available sexual and reproductive health and rights services in Calabar South Local Government Area of Cross River State, Nigeria. The available SRHR services in the study area were identified. A community-based cross-sectional descriptive design was adopted for the study, whereby a sample of 325 youths aged 15-24 years were recruited from households within the 6 selected out of 12 political wards of Calabar Local Government Area, using a multistage sampling technique. A validated self-developed questionnaire was used for data collection which were analysed using SPSS version 22.0. Findings revealed low awareness (94.8%) of young people to available SRHR services, and the proportion of SRHR services utilisation by youths was also low (21.5%). There was a statistically significant influence of SRHR services awareness on youth's utilisation (P <0.05). Also, in the logistic regression, the P-value for all the variables showed that there is no significant influence of the predictor variables (age, religion, marital status, educational qualification, means of livelihood, mother's, and father's educational background) on the outcome variable (awareness and utilization). Limited awareness on SRHR services was a rationale for low utilisation of such services among young people. The study recommended training of health care providers on SRHR services with periodic monitoring to ensure that providers are maintaining standards of care. More community enlightenment through government-community partnership is required to strengthen the concept of SRHR, increase awareness for service utilisation and sustainable development.

At the interface between the formal and informal, the actual and the real: a realist study protocol for governance and accountability practices in urban settings focusing on adolescent sexual and reproductive health and rights.

BACKGROUND: This paper presents the protocol of a study that aims at exploring how different multi-level governance arrangements impact on sexual and reproductive health of adolescents living in informal settlements. The overall objective of this study is to contribute to a better understanding of the causal chains underlying accountability in sexual and reproductive health for adolescent girls and young women living in urban informal settlements in low-and middle-income countries. METHODS: The overarching methodology is realist evaluation. The study adopts a case study design, through which governance and accountability practices in Mumbai, Delhi, Cotonou and Kampala will be examined. Different social science methods to develop and test a programme theory will be used. Heuristic tools for the analysis of the accountability ecosystem and mapping of governance arrangements, drawing from contextual political analysis and critical realism, will be developed in order to identify the intervention-context-actor-mechanism-outcome configurations. DISCUSSION: The methodological approach is geared towards building robust case-based explanation with due attention to context and the roles of different actors. The combination of different social science methods will lead us to a better grasp of the inherently political nature of social accountability.

A Realist-Informed Review of Digital Empowerment Strategies for Adolescents to Improve Their Sexual and Reproductive Health and Well-being.

The use of digital technologies for health has been rapidly gaining ground in the last decade, including as a strategy to empower adolescents living in urban resource-constrained settings. Nevertheless, unclarity and incoherence remain regarding which programme strategies generate which outcomes, as well as regarding the importance of context. We set out to answer the question "How do digital empowerment strategies work to improve adolescent health and well-being?". We conducted a realist-informed review, the first on this subject matter to our knowledge. The realist methodology is geared towards the understanding of socially complex interventions, such as digital empowerment. We synthesized the data into a programme theory uncovering social mechanisms and context conditions underlying specific programme strategies. We found that digital technologies enlarge the space for adolescents to access information to health services on their own terms and provide anonymity, which leads to a sense of safety if access is not curbed by gatekeepers. If adolescents have access to information adapted to their needs, they will be able to make informed decisions, and this will contribute to improved health outcomes because their better understanding enlarges their sense of individual agency. We identified two main gaps in the literature on digital interventions for adolescents. Both are related to an under-theoretisation of the concepts the programmes rely on in implementation: (1) the urban environment the programme has to operate in and its meaning for the adolescents; (2) the socio-developmental stage of the adolescents the programmes work in.