ABSTRACT An alarming progression of human-centred and environmental concerns has marked the Anthropocene, including climatic changes and the inextricably linked deterioration of human mental health. Expanding on the 2015 Rockefeller Foundation-Lancet Commission on Planetary Health, we propose that mental health be explicitly included within the planetary health approach. This inclusion acknowledges the importance of population mental health as part of planetary health and addresses the symbiotic deterioration of global mental health and environmental health. As part of this approach, we conceptualise several types of interventions, including symbiocentric and transformative mental health interventions, with the latter combining active environmentalism with the aim of simultaneously improving mental health and wellbeing. We further identify several areas of opportunity in which transformative interventions could be translated to practice and implemented across a range of settings, including workplaces, educational contexts, and organised sport. Making a call to action, we highlight the urgency of shifting from individualised to collective environmental responsibility, including collective transformative reflection, with different stakeholders coming together to scale up transformative interventions and working towards true planetary (mental) health. Finally, we give recommendations to promote symbiocentric and transformative interventions in policy and reform.

ABSTRACT Bioengineering technologies are increasingly important in global health research, yet their applications beyond vaccines and diagnostics remain underexplored. Our paper examines the role of organoids – advanced stem cell technologies used to model human organs, such as lungs and brains – in the context of infectious disease research. Organoids became crucial during the Zika and COVID-19 outbreaks. These new model systems enabled rapid insights into pathogen behaviour. We analyse how the urgency of Zika and Covid-19 accelerated organoid research, tracing its rise and subsequent slowdown. Our investigation reveals that while organoid technologies experienced a burst of activity during these emergencies, their momentum has waned, with ongoing research predominantly focusing on diseases prevalent in the Global North. We argue that the uneven acceleration and subsequent deceleration of organoid research underscores a critical need for equitable integration of bioengineering in global health priorities, particularly in the context of pandemic preparedness. Our findings advocate for a balanced and inclusive strategy to enhance pandemic preparedness and address global health disparities effectively.

ABSTRACT Niger has the world's highest fertility rate, with about seven children per woman, significantly impacting maternal and child health. This study examines how fertility-related attitudes and social norms affect adolescent wives’ (AWs) fertility desires in rural Niger. Using data from 768 AWs (ages 15-19), their husbands, and mothers-in-law, the study employed multilevel linear regression models to analyse associations between birth spacing attitudes, social norms, and AWs’ fertility desires. Results show a significant link between social norms and wives’ fertility desires. Wives with pro-natalist descriptive and injunctive norms and those whose husband has pro-natalist injunctive norms have higher fertility desire. Interestingly, individual attitudes weren't directly correlated with fertility desires, suggesting social norms predominate over personal attitudes. The study further highlights that village-level descriptive norms are significantly associated with fertility desires. It underscores the need for interventions that address social contexts within communities, not just individual-level activities. The research emphasises the complexity of these norms, considering multiple perspectives, and highlights husbands’ influence on wives’ fertility intentions. Recommendations include community-based programs engaging various stakeholders and policy initiatives promoting women's agency and rights.

ABSTRACT Malaria remains a major global public health burden and is a potential priority for Chinese health cooperation. However, limited analysis exists on the reference value of China’s malaria elimination experience for other countries. While existing studies have focused on specific control strategies used in China, few have examined how Chinese malaria policy and practice have been adapted over time in response to heterogeneity across a vast country. This paper draws on literature, policy reviews, and in-depth interviews with key informants, including government officials and experts involved in malaria policy or implementation. It analyses the evolution of Chinese malaria policy from the 1950s to 2020 and presents case studies profiling specific practices through the lenses of policy experimentation and ‘policy capacity’. The findings highlight how adaptive malaria policy and practice in China responded not only to the changing distribution and burden of malaria but also to shifts in institutions and the political economy as the country developed. Experimentation facilitated adaptive, sequential problem-solving, starting from a low base with limited data availability and capacity. China’s experience offered valuable insights for other countries and for the evolution of its health cooperation initiatives.

ABSTRACT Despite being widely implemented, little information exists on the effect of Value Clarification and Attitude Transformation (VCAT) workshops on health care provider knowledge and attitudes and abortion provision. Between 2019 and 2021, we conducted a cluster-randomised controlled trial among 101 private abortion-providing healthcare facilities in Ethiopia. We surveyed 217 providers prior to a VCAT workshop and again at 2 weeks, 6 months, and one year following VCAT workshop participation to understand abortion knowledge and attitudes, examined service statistics to assess abortion client volumes, and conducted in-depth interviews with 30 providers. We found that a VCAT workshop for providers increased abortion service provision. In the year following the workshop, intervention facilities served 13% more abortion clients than expected based on the control group trend (95% CI: 6%−21%, p = .01). VCAT workshops moderately improved knowledge and supportive attitudes about abortion in the short-term. The VCAT workshop worked to change providers’ attitudes by highlighting the importance of abortion in protecting clients from potential death and harm, but providers were less comfortable providing care to patients in situations deemed to be less socially justified (e.g. for married clients). Results support implementing ongoing VCAT refreshers with additional emphasis on client autonomy, cultural norms, and person-centred care. Trial registration: ClinicalTrials.gov identifier: NCT04181021.

ABSTRACT Puerto Rico faces a significant health crisis due to the mass migration of physicians to the United States, exacerbating the challenge of achieving the World Health Organisation’s recommended physician-to-population ratio. While economic factors such as higher salaries in the US have been identified as primary drivers, the complexity of this migration wave requires a deeper exploration. This study quantitatively examines the role of push factors, pull factors, and spatial stigmatisation in physician migration from Puerto Rico. Using data from a randomly selected sample of 550 physicians (255 who had migrated to the US and 295 who lived in Puerto Rico), we analyse how perceptions of Puerto Rico’s image and reputation, combined with stigmatisation linked to practicing medicine on the Island, influence migration decisions. Findings highlight that while better economic opportunities in the US are significant, the spatial stigma associated with Puerto Rico’s healthcare system plays a crucial role in the decision to migrate. Policies aimed at curbing physician migration must address not only economic incentives but also the broader socio-cultural perceptions that contribute to the stigmatisation of practicing medicine in Puerto Rico. This study provides insights to inform comprehensive policy solutions to the healthcare crisis in Puerto Rico.

ABSTRACT This article presents the results of a mapping and analysis of key stakeholders operating in the field of Sexual, Reproductive, and Maternal Health and Rights (SRMHR) who are involved in the entitlement of health rights and access to health services for women, adolescents, LGBTQI+ individuals, migrants, indigenous people, Afro-descendants, and people with disabilities in Latin America and the Caribbean. Our study focuses on Argentina, Colombia, Guatemala, Guyana, Jamaica, Mexico, and Peru. The primary objective was to identify and comprehensively categorise the activities undertaken by them, since their actions shape, and promote or hinder the SRMHR political agenda in the region. The findings of this mapping can be useful in contributing to the development of public policy strategies.

ABSTRACT From both an academic and a policy angle, menstruation is receiving an unprecedented level of attention. Within the academic literature, there are many different normative arguments being furthered for how menstruation should be understood and framed – variously, that it should be understood as an issue of rights, justice, health or hygiene management. Yet less attention has been paid to the step preceding these normative arguments – how menstruation actually is understood at present within global health policy. In this paper, we argue that, despite this proliferation of academic and policy interest, attention to menstruation is still relatively muted at the level of global health policy. Using Carol Bacchi’s ‘what’s the problem?’ approach to critical frame analysis, we show that global health policy on menstruation remains patchy, with little cohesive understanding of it as a policy issue emerging at the international level. Instead, competing constructions of it as an issue emerge, such that there is not one clear way in which menstruation is addressed in international health policy. We sketch the implications of this, arguing that without a collective understanding of the problem, solutions are likely to remain siloed, and cross-sectoral work will be difficult.

ABSTRACT Mistreatment during institutional childbirth is multifactorial and can have a detrimental effect on women’s health and future care-seeking behaviour. Understanding its determinants is essential for improving respectful maternity care. This study aimed to explore women’s experiences of mistreatment during childbirth in Nepal. Sixteen in-depth interviews were conducted with women who had recently given birth in a tertiary health facility (between 5 and 16 weeks postpartum). Participants were selected using purposive sampling to ensure a heterogenous sample. Data were analysed using Nvivo12, following Braun and Clarke’s thematic analysis approach. Four themes were identified: (1) mistreatment and undignified care, (2) health system constraints, (3) adverse hospital culture, (4) power and territorial display. Mistreatment and undignified care included abuse, threats, neglect, inadequate communication, painful medical procedures and lack of autonomy. Health system constraints included inadequate resources and overcrowding. Adverse hospital culture was characterised by work stress among health professionals, a rigid hierarchical structure and the normalisation of mistreatment practices. Power and territoriality were evident in an atmosphere of fear for women with restricted companionship during birth. Favorable institutional strategies and tailored interventions are needed to eliminate solitary births and to provide women-centered respectful care by motivated and competent health professionals.

ABSTRACT This paper contributes to the literature on the professionalisation of NGOs in the context of the rise of ‘business-minded’ approaches whereby donors establish a market environment in which NGOs compete for funding by demonstrating their achievement of targets and implementing globally recognised management models. Theoretically, we use the distinction between ‘economies of performance’ and ‘ecologies of practice’ to explore how NGOs simultaneously ‘perform’ themselves publicly as meeting expected professional standards while simultaneously producing themselves practically through ‘unprofessional’ means. Limited global health and development literature addresses professionalisation as an empirical practice and experience. We report on an ethnography of a Bill and Melinda Gates Foundation-funded, HIV-targeted intervention NGO in western India, drawing on six months of participant observation and 17 interviews with NGO workers. The organisation meets ‘business-minded’ success criteria but does so through informal, personal, hierarchical arrangements at odds with the professionalisation model. Frontline workers are demotivated by their professionalisation experience, are suspicious of the performance of success, and find ways of achieving their vocation despite a system which they feel does not recognise the value of human relationships. Showing that ‘business-minded’ approaches do not necessarily rule out informal, potentially ‘corrupt’ ways of working, we argue against the ‘professional-unprofessional’ binary.