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reproductive health and HIV clinic). Data were collected by two female interviewers who were not involved in the clinical management of the respondents. These data were generated in response to hypothetical questions posed to women to assess the extent to which IPV screening would be acceptable to, and useful for, them. The indepth interviews were hand-recorded verbatim and typed up in MS Word. Data were analyzed using content analysis techniques primarily, with codes developed and configured along lines of topical inquiry. Additional codes were developed based on emerging themes that seemed important for determining the utility of IPV screening. Dominant themes depicting women’s main thoughts about IPV screening are presented here. Results: what women think Qualitative analysis suggested that women’ so pinions about hypothetical IPV screening protocols in this Kenyan context are shaped by their concerns about confidentiality; the need to raise awareness around IPV and available care; gaps in the health care system that translate to unmet needs of survivors; and the need for clear-cut responses to IPV that do not promise more than can be realistically offered. While there is some overlap between these themes, each is presented separately, and verbatim quotes from respondents are labelled according to the location at which the respondent sought care. Provider distance could help facilitate screening The women in this study perceived that the involvement of health providers (particularly - but not solely - doctors) in the screening and referral process would serve to greatly enhance the chances of survivors complying with referrals for IPV care. Providers in hospital settings were seen by

The objectives of this study were to: 1) foster an understanding of the current situation and context in regard to out-of-school teenage mothers and their potential support systems for school re-entry at the household and school levels in Homa Bay County 2) clarify possible solutions for promoting school re-entry on the part of out-of-school girls their families and the education sector and 3) provide a benchmark against which changes resulting from an intervention to promote school re-entry may be measured by the endline period. Carried out in Homa Bay and Ndhiwa sub-counties of Homa Bay County Kenya the study was a baseline assessment involving the following data collection components: a household survey with out-of-school teenage girls (regardless of whether they had ever been pregnant or not) teenage mothers and their household heads; and a school survey with secondary school principals and students. This report summarizes the results of the baseline study which was conducted from August to October 2014.

The progesterone vaginal ring (PVR) is a contraceptive designed specifically for use by breastfeeding women in the first year postpartum. The PVR is inserted in the vagina 30-90 days postpartum for continuous use for up to 3 months and replaced with a new ring if breastfeeding is continued and extended contraception is desired. Women can use four rings successively for up to one year. The progesterone vaginal ring functions by diffusing a continuous flow of progesterone through the vaginal walls--approximately 10 mg per day--which then enters the bloodstream and regulates the woman’s fertility by suppressing ovulation. Clinical trials have proven the PVR to be a safe and effective contraceptive; furthermore it is currently registered in eight countries in Latin America. The PVR has also been included in the 2015 WHO Essential Medicines List and the Medical Eligibility Criteria guidance. This study was part of a series of activities that assess the feasibility of and preparation for introduction of the PVR into Kenya Nigeria and Senegal. (excerpt)

More than a third of women worldwide have experienced either physical and/or sexual intimate partner violence (IPV) or non-partner sexual violence. The short- and long-term health effects of violence can be disabling if left undetected. A recent World Health Organization (WHO) report indicates that Africa is one of the regions with the highest prevalence of physical and/or sexual IPV among ever-partnered women. Routine screening for IPV can potentially improve the care and treatment of women suffering from violence. Although routine screening is commonplace in European and American countries, health systems barriers in developing countries have deterred introduction of this practice. Results from this feasibility study indicate that providers are willing and able to incorporate IPV screening into their practice and that IPV screening in a variety of health care settings in a public hospital is feasible and welcomed by clients. Referral uptake by women suffering from IPV was low compared with provider referral rates, but ways in which referral and management services could be improved were identified.

While early sexual experiences are a key marker of the transition from childhood to adulthood, it is widely acknowledged that precocious initiation of sexual activity predisposes adolescents to negative health and psychological outcomes. Extant studies investigating adolescent sexuality in sub-Saharan Africa often rely on cross-sectional data lacking information on the social-psychological underpinnings of adolescent behavior. Through the theoretical lens of the protection-risk conceptual framework, this paper draws on two waves of longitudinal data collected from 2,134 adolescents to examine sociodemographic, psychosocial and behavioral predictors of transition to first sex among adolescents living in slum and non-slum settlements in urban Kenya. We employ logistic regression models to examine the effect of antecedent sociodemographic and risk and protective factors measured during the first wave of data collection on transition to first sex by the second wave. We observe that transition to first sex is influenced by age, slum residence, perceived parental monitoring, and peer behavior. We also find evidence for coupling of risk behaviors. Study findings underscore the need to focus on very young adolescents and those growing up in resource poor settings as these young people may be highly vulnerable to negative health outcomes stemming from precocious sexual activity.

This study examined how pregnancy prevention and management services (specifically the provision of emergency contraception pregnancy testing and counselling and termination or referral for termination of pregnancy services) feature within post-rape care (PRC) services in sub-Saharan Africa. Guidance provided by the World Health Organisation was used as a benchmark for examining these issues. The study drew on a range of sources via a desk review as well as on information provided through key informant interviews. Several key messages emerge from the study’s overall findings: 1. National PRC guidelines consistently identify pregnancy prevention as an essential element of sexual assault management and all include provisions on emergency contraception for eligible survivors. Nonetheless the study reveals a disconnect between PRC guidelines and guidelines for reproductive health/family planning with the latter less likely to address the specific needs of rape survivors although many contain general provisions on emergency contraception. 2. Pregnancy management and safe abortion for survivors do not feature prominently in national sexual violence guidelines in the region with only a few exceptions. Existing provisions for pregnancy management and abortion also tend to lack detailed guidance or country-specific information that would facilitate access to these services. Pregnancy counseling is unevenly addressed across the national protocols examined. 3. Of the eight national protocols reviewed only three treat safe abortion as an essential element of care to be provided for rape survivors with clear guidance on its provision.

Objective To evaluate whether a community engagement and service-strengthening intervention raised awareness of family planning (FP) and early pregnancy bleeding (EPB), and increased FP and postabortion care (PAC) use. Methods The intervention was carried out in 3 communities in Kenya over 18 months; 3 additional communities served as the comparison group. A pre–post, contemporaneously controlled, quasi-experimental evaluation was conducted independently from the intervention. Results Baseline characteristics were similar. Awareness of FP methods increased (P ≤ 0.001) in the intervention group. The incidence of reported EPB (before 5 months of pregnancy) in the comparison group was 13.3% at baseline and 6.0% at endline (P = 0.02); 79% at baseline and 100% at endline sought care (P > 0.05). In the intervention group, recognition and reporting of EPB increased from 9.8% to 13.1% (P > 0.05); 65% sought PAC at baseline and 80% at endline (P = 0.11). The relative increase in EPB reports after the intervention was over 3 times greater in the intervention group (P ≤ 0.01). Conclusion The intervention raised FP and EPB awareness but not FP and PAC services use. As fewer comparison group respondents reported experiencing EPB, the PAC impact of the intervention is unclear. Mechanisms to improve EPB reporting are needed to avoid this reporting bias.

Background Tuberculosis still remains a major cause of maternal and newborn morbidity and mortality. Integrating tuberculosis screening and detection into postnatal care services ensures prompt and appropriate treatment for affected mothers and their babies. This study therefore examined the feasibility and effect of screening and referral for tuberculosis within postnatal care settings from the perspective of providers. Methods This operations research study used a pre- and post-intervention design without a comparison group. The study was implemented between March 2009 and August 2010 in five health facilities located in low-income areas of Nairobi, Kenya, which were suspected to have relatively high prevalence of both tuberculosis and HIV. Descriptive statistics and significance tests were employed to determine changes in the indicators of interest between baseline and endline. Results Among the 12,604 postnatal care clients screened, 14 tuberculosis cases were diagnosed. The proportion of clients screened for at least one cardinal sign of tuberculosis rose from 4% to 66%, and 21% of clients were screened for all six tracer signs and symptoms. A comparison of 10 quality of postnatal care and tuberculosis screening components at baseline and endline showed a highly significant effect on all 10 components. Conclusions The findings demonstrate that using postnatal care services as a platform for tuberculosis screening and detection is acceptable and feasible. In addition, linking clients identified through screening to further treatment significantly improved. However, the actual number of cases detected was low. A policy debate on whether to link tuberculosis screening with reproductive health services is recommended before full scale-up of this intervention.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background: Few studies in Africa have explored in detail the ability of output-based aid (OBA) voucher programs to increase access to gender-based violence recovery (GBVR) services. Methods: A qualitative study was conducted in 2010 and involved: (i) in-depth interviews (IDIs) with health managers, service providers, voucher management agency (VMA) managers and (ii) focus group discussions (FGDs) with voucher users, voucher non-users, voucher distributors and opinion leaders drawn from five program sites in Kenya. Results: The findings showed promising prospects for the uptake of OBA GBVR services among target population. However, a number of factors affect the uptake of the services. These include lack of general awareness of the GBVR services vouchers, lack of understanding of the benefit package, immediate financial needs of survivors, as well as stigma and cultural beliefs that undermine reporting of cases or seeking essential medical services. Moreover, accreditation of only hospitals to offer GBVR services undermines access to the services in rural areas. Poor responsiveness from law enforcement agencies and fear of reprisal from perpetrators also undermine treatment options and access to medical services. Low provider knowledge on GBVR services and lack of supplies also affect effective provision and management of GBVR services. Conclusions: The above findings suggest that there is a need to build the capacity of health care providers and police officers, strengthen the community strategy component of the OBA program to promote the GBVR services voucher, and conduct widespread community education programs aimed at prevention, ensuring survivors know how and where to access services and addressing stigma and cultural barriers. The Bill and Melinda Gates Foundation

Maternal health complications including those arising from unsafe abortion and miscarriage are a leading cause of morbidity among women in Kenya. The Rift Valley Province in particular has had the highest level of abortion-related outpatient morbidity in the country since at least 2003. In response to the need for interventions to prevent unintended pregnancies and ensure quality care for women with post abortion complications the RESPOND Project replicated an existing intervention previously tested under the ACQUIRE Project. The intervention package known as the Community Mobilization for Post abortion Care (COMMPAC) intervention aimed at increasing awareness and use of post abortion care (PAC) services and improving family planning (FP) reproductive health and maternal health outcomes. RESPOND worked with districts and communities to: strengthen delivery points to provide PAC services; conduct community mobilization to improve community involvement in and knowledge the prevention and treatment of post abortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalized and affected by post abortion complications. The interventions were carried out in three communities in Naivasha District Rift Valley Province over an 18-month period from July 2010 to December 2011. This report summarizes the key results emerging from an evaluation assessing the effects of the COMMPAC interventions.

A 2001 study highlighted married adolescent girls as a particularly vulnerable population in Nyanza Province Kenya because of their elevated risk for HIV infection compared to other sexually active girls elsewhere in the country. This document reports on a study whose objectives were to 1) identify and design a set of interventions that promote the uptake of comprehensive reproductive health (RH) family planning (FP) and HIV prevention services and information among married adolescent girls; and 2) expand access to comprehensive RH / FP and HIV prevention services and information among this population.

Background Modern declarations on human rights have often proceeded without reference to the cultural content of rights, the existence of rights in African indigenous backgrounds, and the embodiment of certain key rights in the community itself. This paper is an attempt at developing an ‘inventory’ of rights in African cultures as a prelude to the generation both of a holistic theory of rights as well as a research agenda that can recognize the multifaceted nature of rights. Methods We use an interpretive ethnographic approach built on three sources of data: 1) our continuing ethnographic work among two distinct ethnic groups in southeastern Nigeria – the Ubang and the Igbo; 2) informal conversational interviews with individuals from a range of African countries; and 3) a review of relevant literature based on African cultures which provides a context for some of the issues we raise. Results An examination of selected indigenous rights, entitlements, or privileges among the Ubang and Igbo illustrates indigenous culture as a key, but often neglected, axis of rights, as a critical framework for understanding human relationships with rights, and as a resource for, and challenge to, contemporary programmatic efforts focusing on universalized notions of rights. Understanding or interpreting rights in African settings within the framework defined by contemporary human rights discourse poses steep challenges to making progress in the realization of sexual and reproductive rights. Conclusions Despite the potential dangers of privileging group rights over individual rights, when important rights are vested in the community; rights, entitlements, and privileges can also be recognized through community experiences, and realized through engagement with communities. Building on communal conceptualizations of rights in order to realize an even wider range of rights remains a largely unexplored strategy which holds promise for the achievement of sexual and reproductive health rights.

The idea for this supplement arose from discussions among a set of research partners associated with the Realising Rights Research Programme Consortium (RR RPC), an international partnership funded by the UK Department for International Development from 200510 that focused on neglected areas of sexual and reproductive health and rights (SRHR) [1]. In the Consortium, work on rights has been concerned with ways of bridging the gap between international legal human rights frameworks as applied to SRHR, and how these play out for actual people ‘on the ground’ .W e noted that there was a well-developed international language of human rights in relation to sexual and reproductive health, accompanied by significant international advocacy efforts stretching back several decades [2-4]. However, SRHR remained controversial and contested; sexual rights in particular are poorly understood by many policy actors, they are not easy to operationalise ‘downstream’ in policies and programmes, and their place and relevance in people’s day to day lives have been much less explored [5-7]. The papers in this volume are one contributi on to the task of laying out why it is important to fill this gap and what the analytical challenges are in doing so. We decided, therefore, to focus our thematic work on rights on the challenges of contextualising and operationalising the concept in different local and national domains. The aim was to start from the perspective of lived experience, rather than from an

Background: The mass media have excellent potential to promote good sexual and reproductive health outcomes, but around the world, media often fail to prioritize sexual and reproductive health and rights issues or report them in an accurate manner. In sub-Saharan Africa media coverage of reproductive health issues is poor due to the weak capacity and motivation for reporting these issues by media practitioners. This paper describes the experiences of the African Population and Health Research Center and its partners in cultivating the interest and building the capacity of the media in evidence-based reporting of reproductive health issues in sub-Saharan Africa. Methods: The paper utilizes a case study approach based primarily on the personal experiences and reflections of the authors (who played a central role in developing and implementing the Center’s communication and policy engagement strategies), a survey that the Center carried out with science journalists in Kenya, and literature review. Results: The African Population and Health Research Center’s media strategy evolved over the years, moving beyond conventional ways of communicating research through the media via news releases and newspaper stories, to varying approaches that sought to inspire and build the capacity of journalists to do evidence-based reporting of reproductive health issues. Specifically, the approach included 1) enhancing journalists’ interest in and motivation for reporting on reproductive health issues through training and competitive grants for outstanding reporting ; 2) building the capacity of journalists to report reproductive health research and the capacity of reproductive health researchers to communicate their research to media through training for both parties and providing technical assistance to journalists in obtaining and interpreting evidence; and 3) establishing and maintaining trust and mutual relationships between journalists and researchers through regular informal meetings between journalists and researchers, organizing field visits for journalists, and building formal partnerships with professional media associations and individual journalists. Conclusion: Our experiences and reflections, and the experiences of others reviewed in this paper, indicate that a sustained mix of strategies that motivate, strengthen capacity of, and build relationships between journalists and researchers can be effective in enhancing quality and quantity of media coverage of research.

This paper analyzes data from the Kenya Demographic and Health Surveys to understand the trends differentials and determinants of contraceptive use among adolescent girls ages 15–19 years in Kenya from 1998 to 2008.

Sexual and gender-based violence is a pervasive global health problem rooted primarily in the context of womens and girls subordinate status in society. Sexual violence in particular poses significant risks to womens health including physical injuries psychological trauma unwanted pregnancy and sexually transmitted infections (STIs) including HIV. With an increasingly large foundation of evidence around the intersection of SGBV and HIV what is needed now is further attention to capacity building infrastructure development expansion of services and training on services for adults and children and more effective monitoring and evaluation for integrated SGBV-HIV prevention programs. As is highlighted in this document emphasis on prevention including a range of activities around girls and womens empowerment and awareness-building for boys and men is also essential. The WHO called for action that addresses both long-term and short-term needs related to violence and HIV due to the potential to impact MDG 6 (HIV) as well as other health-related MDGs including reduction of maternal mortality and achievement of universal access to reproductive health and rights. Efforts are needed to design and implement laws policies and procedures for national regional and local levels that set minimum standards and impose penalties. In order to enforce policies on SGBV training should also be provided to equip health care providers police and key community leaders with knowledge and skills to transform gender norms and attitudes that contribute to stigma and discrimination. Continued efforts to raise awareness of the rights of women and other marginalized groups as well as policy advocacy and support for those navigating complicated judicial systems will further educate those at risk of violence about options for prevention and management. And finally ensuring funding mechanisms and sufficient budgets to support the implementation and evaluation of integrated SGBV and HIV care through service-delivery programs and legislation is also required. (Excerpts)

Unless one is particularly inattentive, it is nearly impossible not to have noticed the growth of interest in the intersection between sexuality, culture and health in the East African region over ...

Drawing on qualitative data, this paper examines narratives of sexual activity (or the lack thereof) among people living with HIV in two urban poor contexts in Kenya and the ways in which these narratives intersect with the discourse of a ubiquitous HIV-prevention strategy - the 'ABC' (Abstinence, Be Faithful, Condom Use) approach. The exploration of these narratives gives insight into the ways that the notions and meanings around sexual activity are informed and re-shaped by the experience of living with HIV in urban poor settings and into the complex ways in which the components of the ABC approach feature in the lives of PLHIV in these contexts. As the sexuality of people living with HIV in sub-Saharan Africa is an under-researched area, this paper sheds light on the realities of living with HIV in urban poor settings and illuminates the context that informs constructions of sexuality in this milieui.

The realisation of sexual rights remains a daunting challenge in most of sub-Saharan Africa despite the articulation of these rights in several international documents and national laws. In this paper, we highlight a possible but neglected reason why this is so. Current sexual rights declarations derive from the notion that the body, as a physical entity, belongs to the individual. However, our work in two southeastern Nigerian cultures, the Ngwa-Igbo and the Ubang, shows that there is at least one alternative view of the body, which constructs it as the property of the wider community, rather than that of the individual. In the two cultures in question, rights are embodied in the community, which also lays powerful claims on all its members, including the claim of body ownership. Individuals are thus more likely to seek and realise their rights within the communal space, rather than by standing alone. The assumption that individuals always hold the ultimate right to their bodies is problematic and may constrain the effectiveness of rights-based programmes and interventions in general, and of work around sexual rights in particular.

Editorial The last thirty years have been characterized by tremendous growth in the number of existing health networks world-wide; yet, little is known about why such networks emerge, what their effects are, and their roles in the governance of health [1]. The ‘Africa Regional Sexual and Gender-Based Violence (SGBV) Network’ emerged in the East and Southern African region in 2006. Led and coordinated by the Population Council, this network materialized as a consequence of the landscape of SGBV work in the region. At the time, while discourse and initiatives related to SGBV prevention were not unheard of, far less attention was being given to programmatic response to the service needs of SGBV survivors. With initial funding from the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka, Zambia, the Population Council identified a number of implementing partner organizations in East and Southern Africa to facilitate collective action around the issue of responding to the needs of SGBV survivors in the region. Since then, network partner organizations have continued to work on fostering a multisectoral response (centered on those who have already experienced SGBV) in their countries and beyond exploring what such a response means in low-resource settings, what it can mean, and what it should mean, given the constraints and realities. Each partner contributes toward the network by strengthening the capacities of the medical, legal, and/or justice sectors to care for survivors of SGBV, and by building an evidence base for SGBV programming. Partners develop, implement, and evaluate core elements of a multi-sectoral response model that incorporates the overlapping and complementary responsibilities of the health, police and justice, and social service sectors. The ethos of the Africa Regional SGBV Network centers on the conviction that survivors require access to all services, but that it may not be feasible, appropriate, or cost-effective to deliver all services in one location. Through their interventions over the years, network partners have not taken the conventional understanding of a multi-sectoral approach for granted, but have instead allowed other viewpoints and actions to emerge in regard to such an approach. Where necessary, partners have conceived programmatic response to survivors’ service needs differently, testing out innovative and, sometimes, daring approaches. On December 4, 2013, for the first time ever, the Africa Regional SGBV Network convened a meeting in Washington, DC, USA. The meeting commemorated the 16 Days of Activism Against Gender Violence and raised awareness of interventions for survivors of SGBV in low-resource contexts. The forum reflected a culmination of efforts from seven years of grounded research and practice-building in the field of SGBV, and brought together network partner organizations from Kenya, South Africa, Swaziland, and Zambia, in addition to policy, practitioner, and researcher audiences from the Washington, DC area. This volume of extended abstracts summarizes network partner presentations delivered during the meeting. The presentations centered on each partner’s interventions and main results, coupled with the effectiveness of partners’ endeavors in responding to the needs of survivors. The notion of ‘effectiveness’ as employed here draws on Shiffman’s [1] definition of the concept in regard to networks and their policy consequences. As he explains

This paper explores how young people in Malawi conceptualize sex and sexual relations through an analysis of their personal narratives about these phenomena. Eleven focus group discussions were conducted with 114 youth aged 14-19 years. Participants were asked to describe behaviors, attitudes, and motivations to reduce unplanned pregnancies and the spread of HIV/AIDS, with appropriate probes to illuminate their sexual world-views. The various metaphors that emanated from the discussions suggest that young people in this study take a utilitarian approach to sex, and conceive it as a natural and routine activity of which pleasure and passion are essential components. Future research and prevention efforts (around sexuality education in particular) would do well to incorporate adolescents\' language in programming as this can enhance understanding of the world of young people as well as the effectiveness of interventions addressing problems related to early sexual behavior. Métaphores par lesquelles nous aimons: Conceptualisations du sexe chez les jeunes gens au Malawi. Cet article explore la façon dont les jeunes gens au Malawi conceptualisent le sexe et les rapports sexuels à travers une analyse de leurs narrations personnelles sur ces phénomènes. Onze discussions en groupe cible ont été menées auprès des 114 jeunes gens âgés de 14-19 ans. On a demandé aux participants de faire des descriptions des comportements, des attitudes et des motivations pour réduire des grossesses non voulues et la diffusion du VIH/SIDA et des enquêtes appropriées pour éclairer leur vision du monde sexuel. Les métaphores diverses qui ont émané des discussions ont montré que les jeunes gens dont il s\'agit dans cette étude adoptent une approche utilitaire envers le sexe et le conçoient comme une activité naturelle et de routine dont le plaisir et la passion constituent des éléments essentiels. Les recherches pour l\'avenir et les efforts de prévention (surtout à propos de l\'éducation sexuelle) feront bien d\'incorporer le langage des adolescents dans la programmation puisque ceci pourrait améliorer la compréhension du monde des jeunes gens aussi bien que l\'efficacité des interventions qui s\'occupent des problèmes liés au comportement sexuel précoce Keywords: adolescents, sexuality, language, sexuality education, rights-based approaches, Malawi, sub-Saharan Africa African Journal of Reproductive Health Vol. 11 (3) 2007: pp. 221-235

This article explores some of the complexities of fieldwork for ethnographers conducting research in the ethnographic settings of significant 'others'. The fieldwork in question took place in the rural, geographically isolated community of Ubang, in Obudu, Nigeria, where I was following in the footsteps of my anthropologist father. Drawing on personal experience, I attempt to candidly examine the challenges inevitably faced in this situation, including acceptance by the community as a bona fide researcher, pressure to fulfill the expectations of others familiar with my father's work, and the struggle to carve out a professional identity distinct from my father's.