In sub-Saharan Africa, women have a high unmet need for postpartum family planning (PPFP) until a year after childbirth despite the well-known benefits of PPFP: more than 30% of maternal, 21% of child and 10% of infant deaths could be prevented by effectively spacing birth-to-pregnancy intervals by at least two years. PPFP is defined by the World Health Organization as the prevention of closely spaced pregnancies and unwanted pregnancies up to 12 months after childbirth when pregnancy is the riskiest. The Yam Daabo study (i.e., "your choice" in Mooré) aimed to (i) identify barriers and enablers related to PPFP, (ii) craft interventions to address critical barriers based on participatory action research principles, and (iii) test the effectiveness of the resulting interventions on contraceptive use at 12 months postpartum, using a cluster randomized controlled trial design in predominantly rural settings in Burkina Faso and urban settings in the DRC.
Background: Worldwide more than ten million people are incarcerated at any given time. Between 5 and 60% of people experiencing incarceration report receipt of a tattoo in prison – mostly clandestine, which is associated with risks of blood-borne infections. Although safer tattooing techniques are effective in preventing the transmission of blood-borne infections and available to the general population, there is limited knowledge about the impact of safer tattooing strategies in prison settings in terms of health outcomes, changes in knowledge and behaviors, and best practice models for implementation. The objective of this research was to identify and review safer tattooing interventions in prison settings. Methods: We conducted a systematic review of the literature using search strings which combined terms related to safer tattooing with terms related to detention. Forward and backward snowballing was used to capture additional studies. Studies of all design types were included if they were published until 27 June 2018, the population was incarcerated adults, they reported quantitative outcomes, and were published in English, French, or Spanish. The authors identified during an international conference an unpublished safer tattooing project, for which in-depth interviews with key actors were conducted to capture their current practice. Results: Of 55 papers retrieved from the initial search, no peer-reviewed article was identified. One paper from the grey literature described a multi-site pilot project in Canada. Its evaluation suggested that the project was effective in enhancing knowledge of incarcerated people and prison staff on standard precautions, had the potential to reduce harm, provided vocational opportunities, and was feasible although enhancements were needed to improve implementation issues and efficiency. Conclusions: Although access to preventive services, including to safer tattooing interventions, is a human right and recommended by United Nations agencies as part of a comprehensive package of harm reduction interventions in prisons and other closed settings, this review identified only a few promising strategies for safer tattooing interventions in detention settings. We call upon governments, criminal justice authorities, non-governmental organizations, and academic institutions to implement safer tattooing projects in prisons. These interventions should adhere to the following guiding principles: i) integration of methodologically-rigorous implementation research; ii) involvement in the project design, implementation, and research of key stakeholders, including people who are incarcerated, criminal justice and prison authorities, and research partners; iii) integration into a comprehensive package of blood-borne infection prevention, treatment, and care, using a stepwise approach that considers local resources and acceptability; and iv) publication and dissemination of findings, and scaling up efforts.
La thèse aborde une question originale et d'actualité: l'extension artificielle des côtes. Afin de mieux comprendre ce phénomène dans son actualité, la thèse attache une importance à la description de la pratique des États en fournissant les informations aussi précises, aussi actuelles et aussi concrètes que possible. C'est à partir de cette pratique que la thèse répond à la question de savoir comment les règles de droit répondent aux exigences de la pratique. En ce qui concerne la pratique des États, la thèse explique, dans une première partie, que l'extension artificielle des côtes est destinée, tantôt, à protéger les côtes contre l'élévation du niveau de la mer, tantôt à gagner des terres pour diverses fins: habitat humain, agricoles, développement des ports et de leurs infrastructures pour les besoins des navires modernes et du commerce international. Mais parallèlement, cette extension entraîne des effets négatifs pour l'écosystème côtier (chapitre I). Des travaux de ce genre ont été menés, ou vont l'être, en Europe (Pays-Bas, Allemagne, Belgique, France, R.-U. etc), aux États-Unis, en Asie (Bahreïn, Malaisie, Hong Kong, Singapour, Japon), en Australie, et sur certains archipels du Pacifique (chapitre II). La seconde partie de la thèse examine le droit applicable au phénomène d'extension artificielle des côtes. Sont ainsi passées en revue: les règles relatives à la navigation (chapitre III), les règles relatives aux lignes de base (chapitre IV), les règles relatives aux hauts-fonds découvrants (chapitre V), les règles relatives aux îles et aux rochers (chapitre VI) et enfin les règles relatives à la protection de l'environnement marin (chapitre VII). ; Doctorat en droit ; info:eu-repo/semantics/nonPublished
Abstract Background Social capital is an important social determinant of women's sexual and reproductive health and rights. Little research has been conducted to understand the role of social capital in women's sexual and reproductive health and how this can be harnessed to improve health in humanitarian settings. We synthesised the evidence to examine the nexus of women's sexual and reproductive health and rights and social capital in humanitarian contexts.
Methods We undertook a systematic review of qualitative studies. The preferred reporting items for systematic review and meta-analysis guidelines were used to identify peer-reviewed, qualitative studies conducted in humanitarian settings published since 1999. We searched CINAHL, MEDLINE, ProQuest Health & Medicine, PubMed, Embase and Web of science core collection and assessed quality using the Critical Appraisal Skills Programme tool. We used a meta-ethnographic approach to synthesise and analyse the data.
Findings Of 6749 initially identified studies, we included 19 studies, of which 18 were in conflict-related humanitarian settings and one in a natural disaster setting. The analysis revealed that the main form of social capital available to women was bonding social capital or strong links between people within groups of similar characteristics. There was limited use of bridging social capital, consisting of weaker connections between people of approximately equal status and power but with different characteristics. The primary social capital mechanisms that played a role in women's sexual and reproductive health and rights were social support, informal social control and collective action. Depending on the nature of the values, norms and traditions shared by network members, these social capital mechanisms had the potential to both facilitate and hinder positive health outcomes for women.
Conclusions These findings demonstrate the importance of understanding social capital in planning sexual and reproductive health responses in humanitarian settings. The analysis highlights the need to investigate social capital from an individual perspective to expose the intra-network dynamics that shape women's experiences. Insights could help inform community-based preparedness and response programs aimed at improving the demand for and access to quality sexual and reproductive health services in humanitarian settings.
AbstractRecent crises have accelerated global interest in self-care interventions. This debate paper aims to raise the issue of sexual and reproductive health (SRH) self-care and invites members of the global community operating in crisis-affected settings to look at potential avenues in mainstreaming SRH self-care interventions. We start by exploring self-care interventions that could align with well-established humanitarian standards, such as the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises, point to the potential of digital health support for SRH self-care in crisis-affected settings, and discuss related policy, programmatic, and research considerations. These considerations underscore the importance of self-care as part of the care continuum and within a whole-system approach. Equally critical is the need for self-care in crisis-affected settings to complement other live-saving SRH interventions—it does not eliminate the need for provider-led services in health facilities. Further research on SRH self-care interventions focusing distinctively on humanitarian and fragile settings is needed to inform context-specific policies and practice guidance.
AbstractThe recent Ebola virus disease (EVD) outbreaks in 2021 exemplify how sexual and reproductive health services are too often considered unessential during health emergencies. Bleeding for reasons other than EVD, such as pregnancy complications or rape, can be construed as EVD symptoms, reinforcing fear and stigmatisation, and delaying timely access to adequate care. In this commentary, we urgently call on all humanitarian actors to integrate the Minimum Initial Services Package for Sexual and Reproductive Health in Crisis Situations into current and future EVD preparedness and response efforts.
In Organisationen spiegeln sich die ungleichen Strukturen der Gesellschaft und die vielfach verinnerlichten rassistischen Denkstrukturen vieler Menschen wider. Das betrifft auch pädagogische Institutionen und Einrichtungen Sozialer Arbeit. In dem Gespräch zwischen der Diversity-Trainerin und Autorin Nkechi Madubuko, dem Organisationsberater Toan Nguyen und der Sozialpädagogin Adelheid Schmitz geht es um die zentralen Elemente, die Institutionen und damit Fachkräfte aufgreifen sollten, um Strukturen aufzubrechen: (Erfahrungs-)Wissen ernst nehmen, Allianzen bilden, Diskriminierungssensibilität als Kompetenz begreifen und kontinuierliche Arbeits-/Lenkungsgruppen zum Thema einrichten, um effektive Maßnahmen durchzuführen.
Abstract Background Planning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product.
Methods Anchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox's Bazar, and Yemen for selected Governorates.
Results Results suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations.
Conclusion Collaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.
