Spousal support and work performance during the COVID-19 pandemic among elected women representatives in rural Bihar, India: A cross-sectional, mixed-methods study.

Background: This study examines family support for professional work and domestic labour among Elected Women Representatives' (EWR) in rural Bihar, India, and associations of this support with EWRs' professional performance during the COVID-19 pandemic. Methods: We conducted a cross-sectional, mixed-method study, surveying 1338 EWRs and conducting in-depth interviews with 31 EWRs (Oct 14- Nov 6, 2020). Purposive sampling was used to select the participants. Our team has been working for more than a decade with EWRs across 10 districts in Bihar, providing them with capacity building and community interventions. All EWRs are part of our network, and around 2000 were reached out for the survey. Of these, 1338 consented to participate. Four survey participants from each district were randomly selected and invited for the in-depth interviews. Independent variables for our quantitative analysis included help from husband and other family members on a) EWR work and b) domestic work. Dependent variables, dichotomised as yes/no, assessed EWR workload, COVID-19 work, intervening on violence against women or child marriage, and belief EWRs can have impact. Separate multivariate logistic regression models assessed the hypothesised relationships. All models were adjusted for socio-demographic variables and indicators related to EWR's work experience and community perception or respect. Findings: Most women (76%; n = 1016 EWRs) received help from their husbands with EWR work while 39% reported husband help with domestic labour. Receipt of help from husband with domestic work was associated with increase in official work since the pandemic (aOR: 2.62; 95% CI: 1.84-3.71), arrangement of needed services during COVID-19 (aOR: 2.54; 95% CI:1.65-3.90), and self-belief regarding possibility of EWR impact (aOR: 3.49; 95% CI: 2.25-5.43). Husband's help with EWR work was related to increased odds for intervening to stop violence against women only (aOR: 2.18; 95% CI: 1.32-3.60). In-depth interviews with the selected 31 EWRs underscored an increase in their EWR work under COVID-19. The increase in EWR workload under the pandemic created time constrictions for EWR's domestic labour responsibilities, even as domestic labour responsibilities increased. Interpretation: Our study highlights the importance of husband's help and support in strengthening EWRs outcomes at work in India, with help in domestic work being related to a relatively wider range of outcomes that are indicative of EWR's performance, compared to husband's help with EWR work. These findings emphasize the need for building male responsibility for domestic labour, to improve women's professional performance and outcomes. Our study has few key limitations such as lack of causal interpretations due to reliance on cross-sectional research design, potential for social desirability bias in self-reported data, and absence of information related to changes in patterns of spousal and family support received by the EWRs as a result of the pandemic. Nonetheless, our findings are important, particularly for the context of Bihar, India, where appalling gender gaps still persist in all social and economic aspects of society. Funding: Bill & Melinda Gates Foundation: 2017, OPP1179246 and EMERGE COVID-19 (2019, OPP1163682); David & Lucile Packard Foundation: 2017- 66202.

A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know?

BACKGROUND: Repressive legal environments and widespread human rights violations act as structural impediments to efforts to engage key populations at risk of HIV infection in HIV prevention, care, and treatment efforts. The identification and scale-up of human rights programs and rights-based interventions that enable coverage of and retention in evidence-based HIV prevention and treatment approaches is crucial for halting the epidemic. METHODS: We conducted a systematic review of studies that assessed the effectiveness of human rights interventions on improving HIV-related outcomes between 1/1/2003-28/3/2015 per PRISMA guidelines. Studies of any design that sought to evaluate an intervention falling into one of the following UNAIDS' key human rights program areas were included: HIV-related legal services; monitoring and reforming laws, policies, and regulations; legal literacy programs; sensitization of lawmakers and law enforcement agents; and training for health care providers on human rights and medical ethics related to HIV. RESULTS: Of 31,861 peer-reviewed articles and reports identified, 23 were included in our review representing 15 different populations across 11 countries. Most studies (83%) reported a positive influence of human rights interventions on HIV-related outcomes. The majority incorporated two or more principles of the human rights-based approach, typically non-discrimination and accountability, and sought to influence two or more elements of the right to health, namely availability and acceptability. Outcome measures varied considerably, making comparisons between studies difficult. CONCLUSION: Our review revealed encouraging evidence of human rights interventions enabling a comprehensive HIV response, yet critical gaps remain. The development of a research framework with standardized indicators is needed to advance the field. Promising interventions should be implemented on a larger scale and rigorously evaluated. Funding for methodologically sound evaluations of human rights interventions should match the demand for human rights-based and structural approaches to protect those most vulnerable from HIV infection.

Putting women at the center: a review of Indian policy to address person-centered care in maternal and newborn health, family planning and abortion.

BACKGROUND: Person-centered care is a critical component of quality care, essential to enable treatment adherence, and maximize health outcomes. Improving the quality of health services is a key strategy to achieve the new global target of zero preventable maternal deaths by 2030. Recognizing this, the Government of India has in the last decade initiated a number of strategies to address quality of care in health and family welfare services. METHODS: We conducted a policy review of quality improvement strategies in India from 2005 to 15, covering three critical areas- maternal and newborn health, family planning, and abortion (MNHFP + A). Based on Walt and Gilson's policy triangle framework, we analyzed the extent to which policies incorporated person-centered care, while identifying unaddressed issues. Data was sourced from Government of India websites, scientific and grey literature databases. RESULTS: Twenty-two national policy documents, comprising two policy statements and 20 implementation guidelines of specific schemes were included in the review. Quality improvement strategies span infrastructure, commodities, human resources, competencies, and accountability that are driving quality assurance in MNHFP + A services. However, several implementation challenges have affected compliance with person-centered care, thereby affecting utilization and outcomes. CONCLUSION: Focus on person-centered care in Indian MNHFP + A policy has increased in recent years. Nevertheless, some aspects must still be strengthened, such as positive interpersonal behavior, information sharing and promptness of care. Implementation can be improved through better provider training, patient feedback and monitoring mechanisms. Moreover, unless persisting structural challenges are addressed implementation of person-centered care in facilities will not be effective.