Trends in child marriage, sexual violence, early sexual intercourse and the challenges for policy interventions to meet the sustainable development goals.

INTRODUCTION: Child marriage remains a prevalent issue in low- and middle-income countries (LMIC) despite global declines. Girls are disproportionately affected, facing health risks, limited education, and restricted decision-making power. We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. METHODS: This study used World Bank datasets to assess progress in addressing child marriage in LMIC countries. Statistical analyses, including trend analysis and compound annual growth rate (CAGR), were conducted to evaluate indicators of first marriage, sexual violence, and sexual intercourse. Countries with sufficient data were categorized based on prevalence rates and trends, and detailed analysis focused on significant indicators. RESULTS: While significant reductions were observed in the prevalence of child marriage before the age of 15 and 18 and early sexual intercourse in most countries, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. Overall, many countries showed a decline in sexual violence and early sexual intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibited an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone for women, and Namibia, Zambia, and Kenya for men, experienced substantial decline in early sexual intercourse. CONCLUSION: There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent from the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at the societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Child marriage remains a prevalent issue despite global declines, particularly affecting girls who suffer from health risks, lower education, and restricted decision-making power. However, little is known about boys in this context. This study aims to examine We aim to provide insights for child marriage prevalence across LMIC from 1990 to 2020, with a focus on sexual violence and early sexual intercourse for public health policy interventions. To achieve this, we assessed progress in addressing child marriage in LMIC countries using World Bank datasets. Through statistical analyses, including trend analysis and linear regression, we evaluated various indicators. Countries with sufficient data were categorized based on prevalence and trends. The results revealed significant reductions in all indicators, few countries show increasing trends, and others could not demonstrate statistical trends due to data limitations, such as scarcity of data for boys. The Central African Republic experienced an increase in child marriage prevalence. Overall, many countries showed a decline in sexual violence and intercourse before the age of 15, but some exhibited increasing trends. For instance, Zambia and Senegal showed a decreasing trend of sexual violence, while Nigeria exhibits an increasing trend. Notably, Uganda, Cameroon, and Sierra Leone experienced substantial declines in early sexual intercourse for women, and Namibia, Zambia, and Kenya for men. There is a decline in child marriage, sexual violence, and early sexual intercourse in most countries independent of the income group. Only a few countries show slight increasing trends. The improvements confirm that policies that address education, employment, and deep-rooted gender inequality at societal level seem to be effective and help reach the SDG. However, better data are needed to enhance the understanding of the development of child marriage in these countries to improve the effectiveness of policy intervention. Therefore, we recommend that policymakers not only include existing evidence that continues progress but also increase and improve the monitoring of relevant indicators.

Using Systems Dynamics for Capturing the Multicausality of Factors Affecting Health System Capacity in Latin America while Responding to the COVID-19 Pandemic.

Similar interventions to stop the spread of COVID-19 led to different outcomes in Latin American countries. This study aimed to capture the multicausality of factors affecting HS-capacity that could help plan a more effective response, considering health as well as social aspects. A facilitated GMB was constructed by experts and validated with a survey from a wider population. Statistical analyses estimated the impact of the main factors to the HS-capacity and revealed the differences in its mechanisms. The results show a similar four-factor structure in all countries that includes public administration, preparedness, information, and collective self-efficacy. The factors are correlated and have mediating effects with HS-capacity; this is the base for differences among countries. HS-capacity has a strong relation with public administration in Bolivia, while in Nicaragua and Uruguay it is related through preparedness. Nicaragua lacks information as a mediation effect with HS-capacity whereas Bolivia and Uruguay have, respectively, small and large mediation effects with it. These outcomes increase the understanding of the pandemic based on country-specific context and can aid policymaking in low-and middle-income countries by including these factors in future pandemic response models.

Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos

[RESUMEN]. Objetivo. Realizar una comparación entre las Directrices de la Organización Mundial de la Salud (OMS) para la anticoncepción en el marco de los derechos humanos (DDHH) con el marco normativo existente en Bolivia, Colombia y Uruguay y evaluar los aspectos que son necesarios desarrollar en la normativa. Métodos. Se realizó un análisis sistemático con base al marco analítico de la OMS ¨Respeto de los DDHH cuando se proporciona información y servicios de anticoncepción: orientación y recomendaciones¨ para determinar si la legislación de Bolivia, Colombia y Uruguay contienen referencias generales a la población, referencias específicas para los adolescentes o no hacen referencia. Para este fin, se analizó un total de 36 documentos relacionados con la anticoncepción: 9 de Bolivia, 15 de Colombia y 12 de Uruguay. Resultados. Se verificó que la legislación de cada país cumple con varias recomendaciones de la OMS. Los tres países tienen fortalezas en la no discriminación y el espacio para las decisiones informadas; sus debilidades están en la accesibilidad, la calidad y la rendición de cuentas. La aceptabilidad es una fortaleza para Colombia y Bolivia; la confidencialidad es para Bolivia y Uruguay. Colombia tiene como debilidad la disponibilidad, la confidencialidad y la participación. Conclusiones. La comparación de la legislación nacional con la guía de la OMS ayuda a ver las fortalezas y las debilidades en el marco normativo nacional y ver oportunidades para mejorar la normativa.

[ABSTRACT]. Objective. Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. Methods. A systematic analysis was based on the WHO analytical framework “Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations” to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. Results. It was confirmed that each country’s legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation. Conclusions. Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.

[RESUMO]. Objetivo. Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados. Métodos. Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai. Resultados. Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia. Conclusão. A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no

[Sexual and reproductive rights regarding contraception in a human rights framework in Bolivia, Colombia, and UruguayDireitos sexuais e reprodutivos de contracepção na Bolívia, Colômbia e Uruguai como parte dos princípios dos direitos humanos]. / Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos.

OBJECTIVE: Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. METHODS: A systematic analysis was based on the WHO analytical framework "Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations" to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. RESULTS: It was confirmed that each country's legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation. CONCLUSIONS: Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.

OBJETIVO: Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados. MÉTODOS: Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai. RESULTADOS: Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia. CONCLUSÃO: A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no enquadramento regulamentar nacional e encontrar oportunidades para melhorar.

Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos / Sexual and reproductive rights regarding contraception in a human rights framework in Bolivia, Colombia, and Uruguay / Direitos sexuais e reprodutivos de contracepção na Bolívia, Colômbia e Uruguai como parte dos princípios dos direitos humanos

RESUMEN Objetivo Realizar una comparación entre las Directrices de la Organización Mundial de la Salud (OMS) para la anticoncepción en el marco de los derechos humanos (DDHH) con el marco normativo existente en Bolivia, Colombia y Uruguay y evaluar los aspectos que son necesarios desarrollar en la normativa. Métodos Se realizó un análisis sistemático con base al marco analítico de la OMS ¨Respeto de los DDHH cuando se proporciona información y servicios de anticoncepción: orientación y recomendaciones¨ para determinar si la legislación de Bolivia, Colombia y Uruguay contienen referencias generales a la población, referencias específicas para los adolescentes o no hacen referencia. Para este fin, se analizó un total de 36 documentos relacionados con la anticoncepción: 9 de Bolivia, 15 de Colombia y 12 de Uruguay. Resultados Se verificó que la legislación de cada país cumple con varias recomendaciones de la OMS. Los tres países tienen fortalezas en la no discriminación y el espacio para las decisiones informadas; sus debilidades están en la accesibilidad, la calidad y la rendición de cuentas. La aceptabilidad es una fortaleza para Colombia y Bolivia; la confidencialidad es para Bolivia y Uruguay. Colombia tiene como debilidad la disponibilidad, la confidencialidad y la participación. Conclusiones La comparación de la legislación nacional con la guía de la OMS ayuda a ver las fortalezas y las debilidades en el marco normativo nacional y ver oportunidades para mejorar la normativa.

ABSTRACT Objective Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. Methods A systematic analysis was based on the WHO analytical framework "Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations" to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific references to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. Results It was confirmed that each country's legislation complies with several WHO recommendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in availability, confidentiality, and participation. Conclusions Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportunities to improve regulations.

RESUMO Objetivo Comparar as diretrizes da Organização Mundial da Saúde (OMS) para contracepção como parte dos princípios dos direitos humanos com os enquadramentos regulamentares existentes na Bolívia, Colômbia e Uruguai e avaliar os elementos destes enquadramentos que precisam ser melhorados. Métodos Realizou-se uma análise sistemática segundo a metodologia analítica descrita no documento da OMS ¨Respeito aos direitos humanos ao prestar informações e serviços sobre contracepção: orientação e recomendações com o propósito de verificar se as legislações da Bolívia, Colômbia e Uruguai fazem referências gerais à população, referências específicas aos adolescentes ou não fazem referências. Ao todo, 36 documentos sobre contracepção foram analisados: 9 provenientes da Bolívia, 15 da Colômbia e 12 do Uruguai. Resultados Verificou-se que as legislações dos três países cumprem com diversas recomendações da OMS. Não discriminação e oportunidade para decidir de forma esclarecida são os pontos fortes e acessibilidade, qualidade e prestação de contas são os pontos fracos. A aceitabilidade é um ponto forte na Colômbia e Bolívia e a confidencialidade, na Bolívia e Uruguai. Disponibilidade, confidencialidade e participação são os pontos fracos na Colômbia. Conclusão A comparação das legislações nacionais com o guia da OMS possibilita identificar os pontos fortes e fracos no enquadramento regulamentar nacional e encontrar oportunidades para melhorar.