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.

Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria.

BACKGROUND: Armed conflict and insecurity have been linked to deteriorations in reproductive health and rights globally. In Nigeria, armed violence has taken a significant toll on women's and girls' health and safety. However, knowledge is limited about how conflict shapes attitudes surrounding their ability to make autonomous decisions on relationships and childbearing. Drawing on a socioecological framework and terror management theory, we aimed to investigate the association between conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria. METHODS: We conducted a cross-sectional study using data from two sources: the World Values Survey (WVS) and the Uppsala Conflict Data Program-Georeferenced Event Dataset (UCDP-GED). Nationally representative data on attitudes of 559 men and 534 women was collected by WVS in 2017-2018. Linear probability models estimated the association between attitudes toward five dimensions of women and girl's reproductive autonomy (contraception, safe abortion, marital decision-making, delayed childbearing, early marriage), respondents' perceptions of neighborhood insecurity using WVS data, and geospatial measures of conflict exposure drawn from UCDP-GED. RESULTS: Exposure to armed conflict and perceived neighborhood insecurity were associated with more supportive attitudes toward access to safe abortion among both men and women. Among women, conflict exposure was associated with higher support for contraception and the perception that early marriage can provide girls with security. Conflict-affected men were more likely to support a delay in girls' childbearing. CONCLUSION: Our findings suggest that conflict and insecurity pose a threat to, but also facilitate opportunities for, women's and girls' reproductive autonomy. Contraception, abortion, early marriage, and postponement or childbearing may be perceived as risk-aversion strategies in response to mortality threats, livelihood losses, and conflict-driven sexual violence. Our findings foreshadow changes in fertility and relationship patterns in conflict-affected Nigeria and highlight the need for health programming to ensure access to contraception and safe abortion services.

Reproductive justice in the Colombian armed conflict.

This study explores the impacts of armed conflict on women's sexual and reproductive health in Colombia, building on a reproductive justice perspective to analyse original interviews with stakeholders in healthcare, women's rights, and peacebuilding. The analysis reveals that war affects women's sexual and reproductive health in three ways, through violent politicisation, collateral damage, and intersectional dimensions. First, multiple armed actors have used women's health as an instrument in politically motivated strategies to increase their power, assigning political meaning to sexuality and reproduction within the context of war. Second, women's health has also suffered from secondary damage of conflict resulting from a decay in healthcare service provision and an unmet need for healthcare services among those affected by sexual and reproductive violence. Third, marginalised women have been particularly affected by a discriminatory nexus of poverty, ethnicity, and geographic inequality. The paper concludes with a reflection on the opportunities for reproductive justice in Colombia.

COVID-19 vaccine hesitancy among first-generation immigrants living in Sweden.

BACKGROUND: In many countries, immigrants face higher risks of contracting and dying from COVID-19 compared with the native-born population. Moreover, their COVID-19 vaccination uptake tends to be lower. This study aimed to investigate COVID-19 vaccine hesitancy in relation to sociodemographic characteristics, COVID-19-related exposures and social values, norms and perceptions among first-generation immigrants in Sweden. Vaccine hesitancy is an important public health issue to ensure protection against vaccine-preventable mortality and morbidity. METHODS: Nation-wide representative data were collected by the Migrant World Values Survey. Descriptive and multinomial multivariate analyses were performed to analyze vaccine hesitancy among 2612 men and women aged ≥16 years. RESULTS: One-quarter of the respondents expressed some degree of vaccine hesitancy; 5% said they would definitely not vaccinate, 7% probably not, 4% did not know and 7% did not want to answer. Young age, arriving to Sweden during the large migration wave in 2015, Eastern European origin, female gender, lower education and low trust in authorities, and less perceived benefits of vaccination were all significant determinants of vaccine hesitancy. CONCLUSIONS: The results underscore the importance of trust in healthcare providers and government authorities. Additionally, the importance of providing adequate and targeted information about vaccination to groups who face the largest barriers to care, enabling informed decision-making about the benefits and risks of vaccination in relation to health risks. Given these health risks, it is crucial that government agencies and the health sector address the multiple social dimensions that shape the low vaccine uptake and, in turn, health equity.

Contraceptive choice as risk reduction? The relevance of local violence for women's uptake of sterilization in Colombia.

Altered childbearing behaviour has been observed in many settings of violent conflict, but few studies have addressed fertility control. This is the first study to investigate empirically the relationship between local conflict and uptake of sterilization, the only contraceptive method that reflects a definitive stop to childbearing. The study is based on Colombia, a middle-income, low-fertility, and long-term conflict setting. It builds on a mixed methods approach, combining survey and conflict data with expert interviews. Fixed effects regressions show that local conflict is generally associated with an increased sterilization uptake. The interviews suggest that women may opt for sterilization when reversible methods become less accessible because of ongoing violence. Since sterilization is a relatively available contraceptive option in Colombia, it may represent a risk-aversion strategy for women who have completed their fertility goals. These findings can enlighten research and programmes on fertility and family planning in humanitarian contexts.

Conflict and Contraception in Colombia.

This study explores how armed conflict relates to contraceptive use in Colombia, combining data from the Uppsala Conflict Data Program and Demographic and Health Surveys 1990-2016. Our study is the first systematic effort to investigate whether and how violent conflict influences women's contraceptive use, using nationally representative data across all stages of women's reproductive careers. With fixed effects linear probability models, we adjust for location-specific cultural, social, and economic differences. The results show that although modern contraceptive use increased over time, it declined according to conflict intensity across location and time. We find no evidence that this relationship varied across socioeconomic groups. Increased fertility demand appears to explain a small portion of this relationship, potentially reflecting uncertainty about losing a partner, but conflict may also result in lack of access to contraceptive goods and services.