Reproductive health needs to be front and centre in development

SummaryBackgroundFour methods have previously been used to track aid for reproductive, maternal, newborn, and child health (RMNCH). At a meeting of donors and stakeholders in May, 2018, a single, agreed method was requested to produce accurate, predictable, transparent, and up-to-date estimates that could be used for analyses from both donor and recipient perspectives. Muskoka2 was developed to meet these needs. We describe Muskoka2 and present estimates of levels and trends in aid for RMNCH in 2002–17, with a focus on the latest estimates for 2017.MethodsMuskoka2 is an automated algorithm that generates disaggregated estimates of aid for reproductive health, maternal and newborn health, and child health at the global, donor, and recipient-country levels. We applied Muskoka2 to the Organisation for Economic Co-operation and Development's Creditor Reporting System (CRS) aid activities database to generate estimates of RMNCH disbursements in 2002–17. The percentage of disbursements that benefit RMNCH was determined using CRS purpose codes for all donors except Gavi, the Vaccine Alliance; the UN Population Fund; and UNICEF; for which fixed percentages of aid were considered to benefit RMNCH. We analysed funding by donor for the 20 largest donors, by recipient-country income group, and by recipient for the 16 countries with the greatest RMNCH need, defined as the countries with the worst levels in 2015 on each of seven health indicators.FindingsAfter 3 years of stagnation, reported aid for RMNCH reached $15·9 billion in 2017, the highest amount ever reported. Among donors reporting in both 2016 and 2017, aid increased by 10% ($1·4 billion) to $15·4 billion between 2016 and 2017. Child health received almost half of RMNCH disbursements in 2017 (46%, $7·4 billion), followed by reproductive health (34%, $5·4 billion), and maternal and newborn health (19%, $3·1 billion). The USA ($5·8 billion) and the UK ($1·6 billion) were the largest bilateral donors, disbursing 46% of all RMNCH funding in 2017 (including shares of their core contributions to multilaterals). The Global Fund and Gavi were the largest multilateral donors, disbursing $1·7 billion and $1·5 billion, respectively, for RMNCH from their core budgets. The proportion of aid for RMNCH received by low-income countries increased from 31% in 2002 to 52% in 2017. Nigeria received 7% ($1·1 billion) of all aid for RMNCH in 2017, followed by Ethiopia (6%, $876 million), Kenya (5%, $754 million), and Tanzania (5%, $751 million).InterpretationMuskoka2 retains the speed, transparency, and donor buy-in of the G8's previous Muskoka approach and incorporates eight innovations to improve precision. Although aid for RMNCH increased in 2017, low-income and middle-income countries still experience substantial funding gaps and threats to future funding. Maternal and newborn health receives considerably less funding than reproductive health or child health, which is a persistent issue requiring urgent attention.FundingBill & Melinda Gates Foundation; Partnership for Maternal, Newborn & Child Health.

Status and drivers of maternal, newborn, child and adolescent health in the Islamic world: a comparative analysis

Indonesia makes maternal health a national priority

Roots of Iraq's maternal and child health crisis run deep

Editors' choice.

SummaryBackgroundTracking aid flows helps to hold donors accountable and to compare the allocation of resources in relation to health need. With the use of data reported by donors in 2015, we provided estimates of official development assistance and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to reproductive, maternal, newborn, and child health for 2013 and complete trends in reproductive, maternal, newborn, and child health support for the period 2003–13.MethodsWe coded and analysed financial disbursements to reproductive, maternal, newborn, and child health to all recipient countries from all donors reporting to the creditor reporting system database for the year 2013. We also revisited disbursement records for the years 2003–08 and coded disbursements relating to reproductive and sexual health activities resulting in the Countdown dataset for 2003–13. We matched this dataset to the 2015 creditor reporting system dataset and coded any unmatched creditor reporting system records. We analysed trends in ODA+ to reproductive, maternal, newborn, and child health for the period 2003–13, trends in donor contributions, disbursements to recipient countries, and targeting to need.FindingsTotal ODA+ to reproductive, maternal, newborn, and child health reached nearly US$14 billion in 2013, of which 48% supported child health ($6·8 billion), 34% supported reproductive and sexual health ($4·7 billion), and 18% maternal and newborn health ($2·5 billion). ODA+ to reproductive, maternal, newborn, and child health increased by 225% in real terms over the period 2003–13. Child health received the most substantial increase in funding since 2003 (286%), followed by reproductive and sexual health (194%), and maternal and newborn health (164%). In 2013, bilateral donors disbursed 59% of all ODA+ to reproductive, maternal, newborn, and child health, followed by global health initiatives (23%), and multilateral agencies (13%). Targeting of ODA+ to reproductive, maternal, newborn, and child health to countries with the greatest health need seems to have improved over time.InterpretationThe increase in reproductive, maternal, newborn, and child health funding over the period 2003–13 is encouraging. Further increases in funding will be needed to accelerate maternal mortality reduction while keeping a high level of investment in sexual and reproductive health and in child health.FundingSubgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.

Reproductive and sexual health rights: 15 years after the International Conference on Population and Development

Context: A faith-based NGO wanted to expand its reproductive health programmes to Northeastern Nigeria in view of its poor reproductive health indices compared to the other parts of the country. In order to make the programme more acceptable, accessible and successful, a rapid needs assessment was conducted. Objective: To assess the perception and acceptability of the various components of reproductive health among community and religious leaders in northeast Nigeria. Study Design. Setting and Subjects: A community-based qualitative study. One community leader and one Islamic religious leader each were interviewed in Ganjuwa, Dass and Shira local government areas of Bauchi state. Similarly, a community leader and a religious leader each were interviewed in Maiduguri, Konduga and Gwoza local government areas of Borno state. In Yobe state, one religious and one community leader were interviewed. Results: The community/religious leaders perceived reproductive health problems as prevalent and contributing to maternal morbidity and mortality. They believe women should seek healthcare services for preventive and curative care preferably from female providers. They suspect reproductive health programmes as Western agenda for population control. They have very strong feelings against the provision of elective abortion services. The only acceptable indications for elective abortion include death of the fetus in utero, gross congenital anomaly incompatible with life and serious maternal health risk. A committee of trusted, and preferably Muslim, Godfearing, doctors should assess and confirm these indications. They accept that women with complications of spontaneous abortion should seek care. The provision of contraceptive services to adolescents or married couples is not acceptable. In case of married couples, the only acceptable indication is on serious maternal health grounds. Even then, only harmless methods of contraception may be used specifically coitus interruptus or calendar method with prior spousal consent. The use and promotion of condoms as a barrier method or for the prevention of STIs is not acceptable. The prevention and care of those with HIV/AIDS is acceptable with emphasis on pre-marital abstinence and faithfulness among couples. Conclusion: The varied perceptions, cultural and religious barriers to reproductive health services need to be articulated in order to structure appropriate strategies that will inform and sensitize people about reproductive health programmes and services. Advocacy, monitoring and involvement in programme planning, implementation and social mobilization are useful strategies for addressing this issue. Key Words: Community Leaders, Perception, Reproductive Health. [Trop J Obstet Gynaecol, 2004; 21:83-87] Trop J Obstet Gynaecol Vol.21(2) 2004: 83-87

To evaluate the contributions of the INDEPTH Network of health and demographic surveillance system (HDSS) members to research efforts and interventions on reproductive health in low- and middle-income countries (LMICs). Review of peer-reviewed published papers on sexual and reproductive health (SRH) that use the HDSS framework through (i) an online search for publications using terminology related to HDSS, HIV, Maternal health, adolescent sexual and reproductive health, family planning/contraceptives and fertility, and (ii) asking INDEPTH member centres for information on their published papers on SRH publications that used the HDSS framework. A paper was included in the review only if it used HDSS data, dealt with SRH issues, and had been published in a peer-reviewed international journal. Most of the papers in the review focused on HIV, maternal health, family planning and adolescent sexual and reproductive health (ASRH). Generally, people are knowledgeable about HIV. School attendance considerably delays entry into motherhood and reduces the probability of entering into early marriage or sexual union. The general decline in maternal mortality over the last decade is partly due to better access to emergency obstetric services, improved education of women and reduction in fertility. Sexual and reproductive health is a significant public health need, yet little research has been published in this area to inform policy. The HDSS framework is ideal for SRH research, as it offers the advantage to track and monitor progress of relevant health and demographic indicators, especially in family planning, marriage and fertility studies.

BackgroundCOVID-19 pandemic directly or indirectly increases the burden of unintended pregnancy by limiting women’s access to family planning and other reproductive health services. COVID-19 results in extra 15 million unintended pregnancies over a year. Almost all previous studies conducted about unintended pregnancy were before COVID-19 pandemic in Ethiopia. Therefore, the purpose of this study was to assess the prevalence and associated factors of unintended pregnancy during the COVID-19 pandemic among women attending antenatal care in public hospitals of southwest Ethiopia.MethodsThis study was cross-sectional and conducted among women attending antenatal care at public hospitals of southwest Ethiopia from June 14 to July 14, 2021. Data were collected using a face-to-face interview. Factors associated with unintended pregnancy were analyzed using binary and multiple logistic regressions with an adjusted odds ratio and 95% confidence interval. Finally, the p-value was used as a graded measure of evidence to quantify the degree of significance.ResultsA total of 405 women participated in this study. The overall prevalence of unintended pregnancy was 19.5% (95% CI: 1.44–6.92) among women attending antenatal care during COVID-19 pandemic. Of which, 50.6% were mistimed and 49.4% unwanted. Urban residence (AOR: 3.1 95% CI: 1.44–6.92) and not being primary decision-maker (AOR: 2.85 95CI: 1.18–6.88) had high significance with unintended pregnancy. Not having ANC in a previous pregnancy (AOR: 3.40; 95% CI: 1.02–11.94) and not being exposed to community education about maternal health care (AOR: 2.36; 95% CI: 1.06–5.27) had medium significance with unintended pregnancy.ConclusionOne-fifth of women attending antenatal care had unintended pregnancies during the COVID-19 pandemic. Efforts to scale up women’s decision-making power on family planning services and access to community education are needed to prevent unintended pregnancy.

IntroductionDespite recent gains, Kenya did not achieve its Millennium Development Goal (MDG) target for reducing under-five mortality. To accelerate progress to 2030, we must understand what impacted mortality throughout the...

Clinician Perspectives on Ethics and COVID-19: Minding the Gap in Sexual and Reproductive Health.

Women’s health—what’s new world wide

Background: Maternal health care, and sexual and reproductive services are high priorities in the Kiribati Ministry of Health Plan and key targets areas in the Sustainable Development Goals. They are fundamental to reducing unsafe abortion, maternal and perinatal mortality, and improving social, financial and physical wellbeing. This review was conducted with three aims. Firstly to determine strengths and gaps of sexual and reproductive health services across 14 community clinics in South Tarawa, Kiribati. Secondly review alignment with other health services and actions for improvement. Thirdly, to distribute I-Kiribati resources on cervical screening, an antenatal tool, and emergency birth kits. Methods: An investigative approach using a questionnaire and an audit of basic resources, information and equipment was carried out in each of the 14 clinics over a 5 day period. An I -Kiribati nurse conducted the majority of the interviews in I - Kiribati and English with the other investigators taking notes, photos and recording observations. The information was then collated, and analyzed with a report developed on findings and recommendations. Findings: This review found specific areas for improvement are required across the 14 clinics if the key targets of the SDGs are to be met. Specifically these are access, standardisation and education Clinics are impacted by the availability of contraceptive commodities and the knowledge, confidence and skill of staff to provide the full range of contraceptive methods. There is reduced access to cervical screening which is only available in two locations as is pregnancy testing using standard pregnancy testing kits. Availability of routine blood testing in pregnancy is influenced by the current requirements to provide HIV testing as a separate process. Equipment including emergency equipment is not standard in all clinics affecting safety, services and quality of care. Leaflets for contraceptive methods and on cervical screening are not available as take home information. There is a lack of standardized care evident in differences in numbers of antenatal visits, tetanus toxoid immunisation and scanning frequency in pregnancy. Staff identify areas for education including family planning, diagnosis and treatment of sexually transmitted infections (STIs), breastfeeding updates and child health. Conclusions: Despite challenges and limitations community clinic staff demonstrate commitment in serving their communities to provide primary health care services. Recommendations include ensuring all frontline staff are knowledgeable, confident, and skilled to improve the quality of services. Limitations in resources including emergency equipment, a functioning phone service, and accessible contraceptives are also required to be addressed. Pregnancy testing at site and routine blood screening including HIV would also strengthen the quality of care to women. Developing guidelines and adherence to existing policies for antenatal care, tetanus toxoid immunisation and scanning in pregnancy to improve safety, continuity and consistency in services. These improvements to maternal, sexual and reproductive health are likely to increase access, safety, and health outcomes for women and their families.

In low-income and middle-income countries, such as those in sub-Saharan Africa and Latin America, the COVID-19 pandemic has had substantial implications for women's wellbeing. Policy responses to the COVID-19 pandemic have highlighted the gendered aspect of pandemics; however, addressing the gendered implications of the COVID-19 pandemic comprehensively and effectively requires a planetary health perspective that embraces systems thinking to inequalities. This Viewpoint is based on collective reflections from research done by the authors on COVID-19 responses by international and regional organisations, and national governments, in Latin America and sub-Saharan Africa between June, 2020, and June, 2021. A range of international and regional actors have made important policy recommendations to address the gendered implications of the COVID-19 pandemic on women's health and wellbeing since the start of the pandemic. However, national-level policy responses to the COVID-19 pandemic have been partial and inconsistent with regards to gender in both sub-Saharan Africa and Latin America, largely failing to recognise the multiple drivers of gendered health inequalities. This Viewpoint proposes that addressing the effects of the COVID-19 pandemic on women in low-income and middle-income countries should adopt a systems thinking approach and be informed by the question of who is affected as opposed to who is infected. In adopting the systems thinking approach, responses will be more able to recognise and address the direct gendered effects of the pandemic and those that emerge indirectly through a combination of long-standing structural inequalities and gendered responses to the pandemic.