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Sanitation change continues to be on the forefront of the global development agenda, even as it is becoming clear that the targets established in the Sustainable Development Goals will not be met. But since improving access to safely managed sanitation facilities remains a cost-effective and impactful measure to improve people's lives, it is still important to assess currently implemented policies to be able to learn from best practices and to understand how different approaches work under different contexts. This paper provides comparative analysis of country-level policies in India and Ethiopia, two countries that achieved notable progress in eliminating open defecation through distinct sanitation strategies, with the aim of confronting the advantages and disadvantages of both approaches. While in India the primary emphasis has been on the supply-side, i.e., provision of subsidized sanitation infrastructure, Ethiopian strategy prioritized the demand-side by addressing change in sanitation behavior through Community Total Led Sanitation. The analysis shows that neither of the strategies can fully achieve the sanitation change and a combination of both seems to be the most impactful approach in combating open defecation. It also argues that policymakers must consider not only local socioeconomic and budgetary constraints but also historical, institutional, sociocultural, and geographical specifics in deciding what type of subsidies would be the most fitting. At the same time, they also need to address the appropriate social norms to achieve the desirable change in sanitation behavior. [ABSTRACT FROM AUTHOR]

During the post-Green Revolution era, numerous improved wheat varieties were released and disseminated to enhance tolerance to biotic and abiotic stresses and increase productivity. Still, in the wheat-based farming systems of the Global South, gender-based and other social inequalities continue to undermine equitable access to improved varieties, especially for women, poor, and marginalized farmers. Here, we present a case for gender-sensitive technology development, dissemination, and evaluation as part of wheat varietal improvement programs. We take stock of the various challenges that persist in the uptake of modern wheat varieties by male and female smallholders. We focus on Ethiopia and India, two geographies with substantive wheat economies, widespread poverty, and gender inequalities. The socio-economic literature on wheat is relatively thin with limited and dated gender-sensitive evaluation studies on varietal technologies in these countries. Varietal technology evaluations could ideally cover gender differences in relation to wheat varietal trait preferences, technology adoption, and associated decision-making and labor-use changes related to new varieties and complementary technologies, as well as nutritional and economic benefits. The paper calls for a need to change the institutional arrangements in wheat research-and-development (R&D) programs to understand and pursue better paths for wheat improvement to proactively contribute toward gender equity and inclusivity. [ABSTRACT FROM AUTHOR]

Integrating nutrition interventions into antenatal care (ANC) requires adapting global recommendations to fit existing health systems and local contexts, but the evidence is limited on the process of tailoring nutrition interventions for health programmes. We developed and integrated maternal nutrition interventions into ANC programmes in Bangladesh, Burkina Faso, Ethiopia and India by conducting studies and assessments, developing new tools and processes and field testing integrated programme models. This paper elucidates how we used information and data to contextualize a package of globally recommended maternal nutrition interventions (micronutrient supplementation, weight gain monitoring, dietary counselling and counselling on breastfeeding) and describes four country‐specific health service delivery models. We developed a Theory of Change to illustrate common barriers and strategies for strengthening nutrition interventions during ANC. We used multiple information sources including situational assessments, formative research, piloting and pretesting results, supply assessments, stakeholder meetings, household and service provider surveys and monitoring data to design models of maternal nutrition interventions. We developed detailed protocols for implementing maternal nutrition interventions; reinforced staff capacity, nutrition counselling, monitoring systems and community engagement processes; and addressed micronutrient supplement supply bottlenecks. Community‐level activities were essential for complementing facility‐based services. Routine monitoring data, rapid assessments and information from intensified supervision were important during the early stages of implementation to improve the feasibility and scalability of models. The lessons from addressing maternal nutrition in ANC may serve as a guide for tackling missed opportunities for nutrition within health services in other contexts. Key messages: Integrating evidence‐based nutrition interventions into ANC to reach PW at scale is urgently needed for improving maternal and newborn health and nutrition.The Theory of Change and steps for strengthening nutrition interventions based on four‐country experiences provide practical guidance on addressing missed opportunities for nutrition in ANC.Strategic use of data can contextualize global maternal nutrition guidelines, protocols, capacity building and supervision approaches, and improve micronutrient supply chains and record‐keeping as part of health services strengthening.Engaging family and community members to support PW and improving the knowledge and self‐confidence of PW are important elements of all country programme models. [ABSTRACT FROM AUTHOR]

Antenatal care (ANC) is the largest health platform globally for delivering maternal nutrition interventions (MNIs) to pregnant women. Yet, large missed opportunities remain in nutrition service delivery. This paper examines how well evidence‐based MNIs were incorporated in national policies and programs in Bangladesh, Burkina Faso, Ethiopia and India. We compared the nutrition content of ANC protocols against global recommendations. We used survey data to elucidate the coverage of micronutrient supplementation, weight gain monitoring, dietary and breastfeeding counselling. We reviewed literature, formative research and program assessments to identify barriers and enabling factors of service provision and maternal nutrition practices. Nutrition information in national policies and protocols was often fragmented, incomplete and did not consistently follow global recommendations. Nationally representative data on MNIs in ANC was inadequate, except for iron and folic acid supplementation. Coverage data from subnational surveys showed similar patterns of strengths and weaknesses. MNI coverage was consistently lower than ANC coverage with the lowest coverage of weight gain monitoring and variable coverage of dietary and breastfeeding counselling. Key common factors associated with coverage were micronutrient supply disruptions; suboptimal counselling on maternal diet, weight gain, and breastfeeding; and limited or no record keeping. Adherence of women to micronutrient supplementation and dietary recommendations was low and associated with late and too few ANC contacts, poor maternal knowledge and self‐efficacy, and insufficient family and community support. Models of comprehensive nutrition protocols and health systems that deliver maternal nutrition services in ANC are urgently needed along with national data systems to track progress. Key points: Delivering nutrition services to all pregnant women is essential for maternal and child health outcomes but remains a challenge.Nutrition gaps in antenatal care (ANC) include lack of specificity in national guidelines and protocols, bottlenecks in micronutrient supplies, low ANC provider knowledge and skills, inadequate supervision to reinforce counseling, and not engaging families to encourage key practices.National protocols for ANC should be more specific for the four nutrition interventions (micronutrient supplements, weight gain monitoring, counseling on diets and counseling on breastfeeding) and assign accountability for coverage and quality.Country models are needed for improving provision and utilisation of nutrition interventions through ANC that are based on comprehensive policy frameworks. [ABSTRACT FROM AUTHOR]

The papers making up this Special Section reveal important findings and begin to fill gaps in existing literature about children's and young people's understanding and developing beliefs about socioeconomic inequality and poverty. We draw on our research experience with children growing up in poverty in Ethiopia, India, Peru, and Vietnam (Young Lives) from the perspective of sociology of childhood and social anthropology. The commentary discusses the papers in the Special Section and calls for policies and practices that argue for social justice for children and young people in political and economic terms and emphasizes the importance of including children's views and descriptions of their experiences in research about poverty and inequality. [ABSTRACT FROM AUTHOR]

Increasing participation in family decision making is an integral part of adolescent development. This paper uses longitudinal data from four low and middle income countries—Ethiopia, India, Peru and Vietnam—to assess the relationship between young people's involvement in schooling decision making and schooling outcomes. In the pooled sample, compared to young adults who indicate to have no say in educational choices at age 19, adolescents who make these decisions unilaterally or jointly with parents are on average 17%–23% more likely to drop out by age 22. The effects are, however, heterogenous across countries. [ABSTRACT FROM AUTHOR]

This paper examines the way in which learning quality has been conceptualised and measured in school effectiveness surveys conducted by Young Lives, a longitudinal study of child poverty. Primary school surveys were conducted in Vietnam in 2010–11 and Ethiopia in 2012–13, and surveys at upper-primary and secondary level were conducted in Ethiopia, India and Vietnam in 2016–17. The paper discusses the design of cognitive tests to assess Maths and reading at primary level, and then focuses on the development of cognitive tests to assess Maths, functional English and transferable skills at upper-primary and secondary level. In particular, the paper explores how learning quality can be conceptualised and measured in relation to ‘twenty-first century skills’, which are increasingly seen as an important outcome of secondary education. The challenges of designing cognitive tests to measure and compare learning quality across three diverse country contexts are also explored. [ABSTRACT FROM PUBLISHER]

Ethiopia is witnessing new twists and turns both in its domestic and foreign policy domain of late with the incumbent government in power adopting political and economic reforms aimed at fostering changes to bring about development. This has invariably provided an opportunity for India to consolidate its relationship with Ethiopia further. The new domestic political and economic reforms and the friendly gestures that the present government under Abiy Ahmed has made with its neighbors has drawn the attention of the international community to the extent of awarding him with Nobel Peace Prize. Such reform measures of Ethiopia have given India with wide scope to engage itself constructively and extend political and economic support in areas where both countries stand to gain. India's active engagement with Africa in general and Ethiopia in particular is all the more important given the China factor that has been competing with other countries of the region. This paper describes the domestic political developments in Ethiopia during the post Cold War era and its struggle to maintain the intricate ethnic balance that has characterized its nation-building process by tracing it from the days of King Haile Selassie I. It further analyzes the steps taken by the government to remove obstacles to peace and development through adopting economic liberalization measures and foreign policy changes. These are discussed in a chronological manner starting with a conceptual framework and using predominantly secondary sources and relying on personal observations. [ABSTRACT FROM AUTHOR]

Background: Maternal mental health is becoming recognized as a global health priority. Mental distress among mothers of young children may be exacerbated by exposure to adversity. Social capital may buffer the impact of adversity on mental distress during the postnatal period and beyond. This paper examines the relationship between adversity, cognitive social capital and mental distress among mothers of young children in three low and middle-income countries. Methods: This study uses data from the Young Lives study on 5,485 women from Ethiopia, India, and Vietnam. Logistic regression was used to examine the association between exposure to stressful life events (SLEs) and mental distress in women between 6 months and 1.5 years post-partum. Logistic and linear regression was used to examine the potential for effect modification by social capital. Results: The proportion of women with mental distress during the period between 6–18 months following the birth of a child in the sample was 32.6% in Ethiopia, 30.5% in India and 21.1% in Vietnam. For each additional SLE to which a woman was exposed, the odds of MMD increased by 1.28 (95% CI: 1.22, 1.36; p<0.001) in Ethiopia, 1.17 (1.11, 1.25; p<0.001) in India, and 1.98 (1.75, 2.25; p<0.001) in Vietnam. Exposure to family SLEs was significantly associated with MMD in all three countries with odds ratios of 1.76 (95% CI: 1.30, 2.38; p<0.001), 1.62 (95% CI: 1.12, 2.33; p<0.01 in India), 1.93 (95% CI: 1.27, 2.92; p<0.01), respectively. In Ethiopia and India, economic SLEs were also significantly associated with MMD after adjustment (Ethiopia OR: 1.68; 95% CI: 1.12, 2.52; p<0.01 and India OR: 1.44; 95% CI: 1.01, 2.05; p<0.05), while in India, crime SLEs (OR: 1.93; 95% CI: 1.27, 2.92; p<0.01) were associated with MMD. Cognitive social capital was found to modify the association between SLEs and symptomology of mental distress in Ethiopia, India and Vietnam. Conclusions: This study suggests that adversity may increase the risk of maternal mental distress in three LMICs, while social capital may buffer its effect. [ABSTRACT FROM AUTHOR]

Background: From conception to 6 months of age, an infant is entirely dependent for its nutrition on the mother: via the placenta and then ideally via exclusive breastfeeding. This period of 15 months - about 500 days - is the most important and vulnerable in a child's life: it must be protected through policies supporting maternal nutrition and health. Those addressing nutritional status are discussed here. Objective and design: This paper aims to summarize research on policies and programs to protect women's nutrition in order to improve birth outcomes in low- and middle-income countries, based on studies of efficacy from the literature, and on effectiveness, globally and in selected countries involving in-depth data collection in communities in Ethiopia, India and Northern Nigeria. Results of this research have been published in the academic literature (more than 30 papers). The conclusions now need to be advocated to policy-makers. Results: The priority problems addressed are: intrauterine growth restriction (IUGR), women's anemia, thinness, and stunting. The priority interventions that need to be widely expanded for women before and during pregnancy, are: supplementation with iron-folic acid or multiple micronutrients; expanding coverage of iodine fortification of salt particularly to remote areas and the poorest populations; targeted provision of balanced protein energy supplements when significant resources are available; reducing teenage pregnancies; increasing interpregnancy intervals through family planning programs; and building on conditional cash transfer programs, both to provide resources and as a platform for public education. All these have known efficacy but are of inadequate coverage and resourcing. The next steps are to overcome barriers to wide implementation, without which targets for maternal and child health and nutrition (e.g. by WHO) are unlikely to be met, especially in the poorest countries. Conclusions: This agenda requires policy decisions both at Ministry and donor levels, and throughout the administrative system. Evidence-based interventions are established as a basis for these decisions, there are clear advocacy messages, and there are no scientific reasons for delay. [ABSTRACT FROM AUTHOR]

Increasing rates of school enrolment have changed childhoods in the global South, so that it is now the norm for children to attend at least some years of primary school. This paper explores the extent to which valuing of children as educational projects and outcomes may be displacing previous valuations of children as contributors to the domestic economy. The paper draws on qualitative interview data from Young Lives, a longitudinal study of children growing up in four developing countries, using a case study approach to explore the experiences of four children in rural Andhra Pradesh, India. The paper suggests that children are balancing expectations for the future with responsibilities to their families in the present, and concludes that the over-valuing of formal qualifications and the under-valuing of forms of work such as agriculture risk being internalised by children, leaving those who do not succeed feeling they are 'a waste'. [ABSTRACT FROM AUTHOR]

Livestock provides an important source of income and nourishment for around one billion rural households worldwide. Demand for livestock food products is increasing, especially in developing countries, and there are opportunities to increase production to meet local demand and increase farm incomes. Estimating the scale of livestock yield gaps and better understanding factors limiting current production will help to define the technological and investment needs in each livestock sector. The aim of this paper is to quantify livestock yield gaps and evaluate opportunities to increase dairy production in Sub-Saharan Africa and South Asia, using case studies from Ethiopia and India. We combined three different methods in our approach. Benchmarking and a frontier analysis were used to estimate attainable milk yields based on survey data. Household modelling was then used to simulate the effects of various interventions on dairy production and income. We tested interventions based on improved livestock nutrition and genetics in the extensive lowland grazing zone and highland mixed crop-livestock zones of Ethiopia, and the intensive irrigated and rainfed zones of India. Our analyses indicate that there are considerable yield gaps for dairy production in both countries, and opportunities to increase production using the interventions tested. In some cases, combined interventions could increase production past currently attainable livestock yields. [ABSTRACT FROM AUTHOR]

Learning is a fundamental human right, the basis of developing human capital and the foundation of human development. Basic skills provide individuals, their families and communities with the foundations needed to participate in society and to achieve better life chances. The shift in focus from mass access to mass learning has drawn attention to the question of who is and is not attaining these skills, and why. Opportunities to learn depend on access to schooling, but also the effectiveness of that schooling. There is considerable evidence of learning inequalities, both across and within countries. However, less is known about whether these patterns of inequality are rooted in variations in school effectiveness. In this paper we use evidence from Young Lives school surveys in Ethiopia, India and Vietnam to consider differences in girls' and boys' learning outcomes and progress and investigate how these patterns relate to school effectiveness. We explore whether girls or boys are 'sorted' into more or less effective schools and whether the same schools are differentially effective for boys and girls. Findings from India are perhaps closest to the 'typical' story that is often heard, in which girls, particularly those in rural areas, have lower attainment and attend less effective schools. In comparison, in Vietnam, girls have higher test scores and attend more effective schools on average, with this pattern driven by the higher performance of girls in rural areas. In Ethiopia, the divide between urban and rural areas is predominant in this context, over and above other areas of inequality including gender. Comparing results from these different areas of analysis and from three very different countries reveals the complexities of understanding how gender relates to educational outcomes. It demonstrates the importance of understanding gendered outcomes and school effectiveness in context. • Educational outcomes depend on access to education and the quality of that education. • Cross-country analysis reveals the complexities of how gender and school effectiveness relate to educational outcomes. • In India, where there is greatest school choice, girls have lower attainment and attend less effective schools than boys. • In Vietnam, the opposite is true - girls perform better and attend more effective schools. • In Ethiopia, the divide between urban and rural areas is predominant, over other axes of inequality including gender. [ABSTRACT FROM AUTHOR]

The paper examines the impact of genetic research on the religious identity of the Bene Israel Indian Jewish community and the Lemba Judaising group of southern Africa. It demonstrates how DNA tests which happened to support the possibility of the communities' legends of origin affected their self-perception, the way they are viewed by their neighbors, and their image in the West. It is argued that in both cases what accounted most for the Bene Israel and Lemba responses to the tests was the way the results were portrayed in the mass media, the history of the development of Judaism in their communities, and the local realities. [ABSTRACT FROM AUTHOR]

Background: Donors often fund projects that develop innovative practices in low and middle-income countries, hoping recipient governments will adopt and scale them within existing systems and programmes. Such innovations frequently end when project funding ends, limiting longer term potential in countries with weak health systems and pressing health needs. This paper aims to identify critical actions for externally funded project implementers to enable scale-up of maternal and newborn child health innovations originally funded by the Bill & Melinda Gates Foundation ('the foundation'), or influenced by innovations that were originally funded by the foundation in three low-income settings: Ethiopia, the state of Uttar Pradesh in India and northeast Nigeria. We define scale-up as the adoption of donor-funded innovations beyond their original project settings and time periods.Methods: We conducted 71 in-depth, semi-structured interviews with representatives from government, donors and other development partner agencies, donor-funded implementers including frontline providers, research organisations and professional associations. We explored three case study maternal and newborn innovations. Selection criteria were: a) innovations originally funded by the Bill & Melinda Gates Foundation ('the foundation'), or influenced by innovations that were originally funded by the foundation; b) innovations for which a decision to scale-up had been made, allowing us to reflect on the factors influencing those decisions; c) innovations with increased geographical reach, benefitting a greater number of people, beyond districts where foundation-funded implementers were active. Our data were analysed based on a common analytic framework to aid cross-country comparisons.Results: Based on study respondents' accounts, we identified six critical steps that donor-funded implementers had taken to enable the adoption of maternal and newborn health innovations at scale: designing innovations for scale; generating evidence to influence and inform scale-up; harnessing the support of powerful individuals; being prepared for scale-up and responsive to change; ensuring continuity by being part of the transition to scale; and embracing the aid effectiveness principles of country ownership, alignment and harmonisation.Conclusions: Six critical actions identified in this study were associated with adopting and scaling maternal and newborn health innovations. However, scale-up is unpredictable and depends on factors outside implementers' control. [ABSTRACT FROM AUTHOR]

Background: Understanding the context of a health programme is important in interpreting evaluation findings and in considering the external validity for other settings. Public health researchers can be imprecise and inconsistent in their usage of the word “context” and its application to their work. This paper presents an approach to defining context, to capturing relevant contextual information and to using such information to help interpret findings from the perspective of a research group evaluating the effect of diverse innovations on coverage of evidence-based, life-saving interventions for maternal and newborn health in Ethiopia, Nigeria, and India. Methods: We define “context” as the background environment or setting of any program, and “contextual factors” as those elements of context that could affect implementation of a programme. Through a structured, consultative process, contextual factors were identified while trying to strike a balance between comprehensiveness and feasibility. Thematic areas included demographics and socio-economics, epidemiological profile, health systems and service uptake, infrastructure, education, environment, politics, policy and governance. We outline an approach for capturing and using contextual factors while maximizing use of existing data. Methods include desk reviews, secondary data extraction and key informant interviews. Outputs include databases of contextual factors and summaries of existing maternal and newborn health policies and their implementation. Use of contextual data will be qualitative in nature and may assist in interpreting findings in both quantitative and qualitative aspects of programme evaluation. Discussion: Applying this approach was more resource intensive than expected, in part because routinely available information was not consistently available across settings and more primary data collection was required than anticipated. Data was used only minimally, partly due to a lack of evaluation results that needed further explanation, but also because contextual data was not available for the precise units of analysis or time periods of interest. We would advise others to consider integrating contextual factors within other data collection activities, and to conduct regular reviews of maternal and newborn health policies. This approach and the learnings from its application could help inform the development of guidelines for the collection and use of contextual factors in public health evaluation. [ABSTRACT FROM AUTHOR]