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Rapid global urbanisation has seen a growing number of urban poor who lack natural endowments to cope with food shortages. Broadening their safety nets merits urgent political attention but requires understanding their profiles. A survey among 88 urban poor in Benin found that they had low educational and income levels, overcrowded and unsanitary housing conditions, and limited access to social services and health facilities; 76 per cent of them were food insecure, influenced by city, gender, ownership of a motorbike, and access to health facilities. Engaging them in allotment gardens requires farming skills, financial capital, and safety issues.

Despite a surge of literature on migration and climate change, evidence on the impact of climate change and variability on migration is inconclusive and the roles of in-situ adaptation strategies i...

In previous studies mainly focusing on determinants of adaptation, evidence of the dynamic process of adaptation decision-making is negligible. The objective of this study was to investigate the effects of socio-cultural factors, changes in household characteristics, and climate variables on the transition from non-use to use of adaptation strategies. The study integrated primary data collected from households with secondary rainfall and temperature data. The quantitative and qualitative data were analysed using a dynamic random-effects probit model and a thematic approach, respectively. The result shows strong evidence of path dependence in which use of a strategy during the previous year significantly increases its current use. Climate-related risk perception and factual knowledge may not necessarily prompt adaptation action, whereas access to financial resources and farming-related trainings were consistent positive predictors of farmers&rsquo, adaptation decisions. The findings entail that economic capacity and the associated intrinsic motivation help few farmers to utilise robust and contesting adaptation strategies. For most households, economic problems and the consequent fatalistic attitude and risk-avoidance behaviour induce either non-use or use of responsive and accommodating strategies aimed at ensuring survival. Path dependence in non-use of adaptation strategies and sub-optimal adaptation actions demand effective institutional supports to address the behavioural and economic barriers of these households in order to build overall community resilience.

Objectives: Because medical, midwifery and law students in Ghana constitute the next generation of health care and legal practitioners, this study aimed to evaluate their attitudes towards abortion and their perceptions of the decision-making capacity of pregnant adolescents. Methods: We conducted a cross-sectional survey among 340 medical, midwifery and law students. A pretested and validated questionnaire was used to collect relevant data on respondents’ sociodemographic characteristics, attitudes towards abortion and the perceived capacity and rationality of pregnant adolescents’ decisions. The χ2 test of independency and Fischer’s exact test were used where appropriate. Results: We retained 331 completed questionnaires for analysis. Respondents’ mean age was 21.0 ± 2.9 years and the majority (95.5%) were of the Christian faith. Women made up 77.9% (n = 258) of the sample. Most students (70.1%) were strongly in favour of abortion if it was for health reasons. More than three-quarters (78.0%) of the students strongly disagreed on the use of abortion for the purposes of sex selection. Most respondents (89.0%) were not in favour of legislation to make abortion available on request for pregnant adolescents, with medical students expressing a more negative attitude compared with law and midwifery students (p < 0.001). Over half of the midwifery students (52.6%) believed that adolescents should have full decision-making capacity regarding their pregnancy outcome, compared with law and medical students (p < 0.001). Conclusion: Tensions between adolescent reproductive autonomy, the accepted culture of third party involvement (parents and partners), and the current abortion law may require keen reflection if an improvement in access to safe abortion services is envisioned.

Over forty percent of pregnancies worldwide are unintended, with a quarter of these from Africa. There is a growing body of evidence regarding the adverse health, economic, societal, and developmental consequences of unintended pregnancies. The main aim of this systematic review is to report on the current prevalence and determinants of unintended pregnancies in sub-Saharan Africa. A literature search (in PubMed, Embase, PsycINFO and Scopus) was performed up to 29 May 2019. The Joanna Briggs Institute Reviewers' Manual guidelines to assess the quality of peer-reviewed quantitative articles were used to select articles that met our inclusion criteria. A total of 29 articles from 9 countries were included in the final review. The mean unintended pregnancy rate was 33.9%. The mean unwanted pregnancy rate was 11.2%, while the mean mistimed pregnancy rate was 22.1%. Mistimed pregnancies were more frequent across the 13 studies that classified unintended pregnancies into the unwanted and mistimed pregnancy sub-groups. Being an adolescent (19 years old or less), single, and having 5 children or more were consistent risk factors for unintended pregnancy. Awareness and use of modern contraception, level of education, socio-economic status, religion, and area of residence as independent variables were either protective or associated with an increased risk of reporting a pregnancy as being unintended. The unintended pregnancy rate in sub-Saharan Africa remains high, especially among singles, adolescents, and women with 5 or more children. There was no uniform tool used across studies to capture pregnancy intention. The studies did not capture pregnancy intention among women whose pregnancies ended up as stillbirths or abortions. More research is required to ascertain when it is best to capture pregnancy intention, and how exclusion or inclusion of pregnancies ending up as stillbirths or abortions impact reported unintended pregnancy rates.

Although most micro-level studies show the positive impact of adaptation on food security and household income, these are only a few of the outcomes adaptation is intended to achieve. Farmers’ livelihoods function in complex ways such that an understanding the multidimensional outcome of adaptation is important. These necessitate the use of multiple indicators in the evaluation of the impact of adaptation. Based on data collected from 810 randomly selected households in central Ethiopia, this study investigates the impacts of adaptation strategies on the sustainability of the livelihoods of farmers. The economic, social, and environmental outcomes were integrated to construct the Livelihood Sustainability Index. The endogenous switching regression model, which accounts for unobserved heterogeneity and possible endogeneity, was used to examine the impact of using adaptation strategies. With a mean score of 41, the farmers had lower levels of livelihood sustainability. Farmers switching crop type, diversifying crops, planting improved seeds, engaging in land management activities, and using irrigation had a higher livelihood sustainability index compared to the counterfactual case in which they did not use them. Non-farm employment and migration significantly increased livelihood sustainability for the using households. However, had these factors been used by the non-users, it would have resulted in reduced livelihood sustainability. Farmers using more than four adaptation strategies had more sustainable livelihoods than using fewer strategies. The findings affirm that adaptation contributes to livelihood improvement. However, since the farmers are far from achieving a higher level of sustainable livelihoods, policies shall focus on maximizing the returns to be obtained from using adaptation strategies. This includes improving access to ecosystem services through environmental protection measures, increasing production efficiency through improved access to and proper utilization of farm inputs, expanding irrigation facilities, creating decent employment opportunities, and enhancing farmers’ skills through entrepreneurial training.

Background: Social accountability or citizen-led accountability has been promoted in many low- and middle-income countries to improve the quality, access to and use of maternal health services. Experiences with social accountability in maternal health services in Nepal have not yet been documented. This study identifies existing social accountability structures and activities in maternal health services in two districts of Far-Western Nepal and explores their functions, implementation and gaps/challenges. Methods: An exploratory study was conducted that included in-depth interviews with purposively selected policy advisors (8), healthcare officials (11), healthcare providers (12) and non-governmental staff (3); and focus group discussions (FGDs) with 54 women. Data analysis was conducted using thematic content analysis based on George’s information, dialogue and negotiation framework. Results: Social accountability in maternal health existed in terms of structures such as mothers’ groups (MGs), female community health volunteers (FCHVs) and Health Facility Operation and Management Committees (HFOMCs); and activities such as social audits and community health score board (CHSB). MGs and FCHVs were perceived as trusted intermediaries, but their functioning was limited to information. HFOMCs were not fully functional. Social audits and CHSBs were implemented in limited sites and with poor participation by women. Health-sector responses were mainly found at the local level. Factors contributing to these challenges were the absence of a mandate and limited capacity, including resources. Conclusion: Formal structures and activities existed for social accountability in maternal health services in the Far-Western Development Region of Nepal, but there were limitations pertaining to their implementation. The main recommendations are: for clear policy mandates on the social accountability roles of MGs and FCHVs; wider implementation of social audits and CHSBs, with emphasis on the participation of women from disadvantaged groups; improved capacity of HFOMCs; and improved engagement of the health sector at all levels to listen and respond to women’s concerns.

This chapter provides an example of how an animal welfare project can move from monodisciplinary to transdisciplinary research, and the potential hurdles that can occur in this process. It provides suggestions on how to set up interdisciplinary projects and how communication within such teams can be made more effective.

There is a dearth of evidence on the socio-cultural aspects of climate change risk perception in developing countries. This study investigates the variation in farmers’ perception of the risks of climate change and variability by their socio-cultural characteristics. Data were collected from 810 randomly selected households in central Ethiopia using a structured questionnaire. Polling, a maximum likelihood prediction method of multivariate analysis that jointly evaluates the combined roles of different variables, allowing for non-parametric interactions, was used to analyse the data. The results show that households with a high risk perception have high accurate knowledge about climate change, experience of climatic events, value both societal and individual responsibilities to reduce the impact of climate change, and reside in the midland agro-ecological settings. On the other hand, a low descriptive norm, low social capital, lack of access to media, low level of education, and valuing autonomy characterize households with a low risk perception. The findings entail that communication strategies focusing on evidence-based knowledge about causes and consequences of and responses to climate change, past experience of climatic events, as well as fostering self-transcendence and openness-to-change values raise risk perception to engage farmers in adaptation actions.

The objective of this study is to examine the effectiveness of adaptation. We reviewed and thematically synthesized 42 household-level studies published from 2000–2019 to explain how multiple processes interact to affect the effectiveness of adaptation. The findings show the positive impacts of adaptation in increasing crop yields and income, improving food security, and enhancing environmental protection. Not all adaptation strategies are effective, due partly to differences in sensitivity to climate problems, access to livelihood assets, diversification of adaptation strategies, and flexibility and cultural relevance of institutional support. For households with lower adaptive capacity, limited adaptation choices and reliance on climate-sensitive strategies fail to unshackle them from cyclical vulnerability. Improving adaptive capacity and facilitating diversified adaptation strategies are important to address the livelihood challenges of smallholder farmers. Understanding the complexities underlying the effectiveness of adaptation necessitates evaluation focusing on multidimensional livelihood outcomes to disentangle implications for sustainable livelihoods and socio-ecological resilience.

Background This paper aims to identify factors that influence the capacity of women to voice their concerns regarding maternal health services at the local level. Methods A secondary analysis was conducted of the data from three studies carried out between 2013 and 2015 in the Democratic Republic of the Congo (DRC) in the context of a WOTRO initiative to improve maternal health services through social accountability mechanisms in the DRC. The data processing and analysis focused on data related to factors that influence the capacity of women to voice their concerns and on the characteristics of women that influence their ability to identify, and address specific problems. Data from 21 interviews and 12 focus group discussions (n = 92) were analysed using an inductive content analysis, and those from one household survey (n = 517) were summarized. Results The women living in the rural setting were mostly farmers/fisher-women (39.7%) or worked at odd jobs (20.3%). They had not completed secondary school (94.6%). Around one-fifth was younger than 20 years old (21.9%). The majority of women could describe the health service they received but were not able to describe what they should receive as care. They had insufficient knowledge of the health services before their first visit. They were not able to explain the mandate of the health providers. The information they received concerned the types of healthcare they could receive but not the real content of those services, nor their rights and entitlements. They were unaware of their entitlements and rights. They believed that they were laypersons and therefore unable to judge health providers, but when provided with some tools such as a checklist, they reported some abusive and disrespectful treatments. However, community members asserted that the reported actions were not reprehensible acts but actions to encourage a woman and to make her understand the risk of delivery. Conclusions Factors influencing the capacity of women to voice their concerns in DRC rural settings are mainly associated with insufficient knowledge and socio-cultural context. These findings suggest that initiatives to implement social accountability have to address community capacity-building, health providers’ responsiveness and the socio-cultural norms issues. Electronic supplementary material The online version of this article (10.1186/s12913-018-2842-2) contains supplementary material, which is available to authorized users.

Urban gardening offers a viable option to improve diet diversity for the urban poor. Yet, its success rate is particularly dependent on the managerial capacities of urban gardeners to coordinate and organize collective actions for the successful exploitation of the gardens. The calls from governments to organize cooperative structures among farmers seem justified and merits a high priority on agricultural policy agendas. Although principles of cooperative structures exist, there is no blueprint available that indicates how to start a gardeners&rsquo, cooperation. Moreover, these collaborations need to ally with and build on existing social structures of the urban gardeners involved. Our research can contribute to this alignment process by exploring and comparing international standards of prevailing organizations and their functioning among 261 gardeners in two cities in Benin. We found that a vast majority of urban gardeners are members of a cooperation. Nevertheless, their membership is largely titular because gardeners mostly behave semi-autonomously and few decisions are taken collectively. The obvious economic advantages of leveraging bargaining power, reducing transaction costs, and increasing possibilities for loans are seriously underutilized. We suggest that capacity building can help to develop cooperation among urban gardeners to reach their full potential which, congruently, should also improve the livelihoods of the urban poor.

Using gridded daily temperature and rainfall data covering 30 years (1988&ndash, 2017), this study investigates trends in rainfall, temperature, and extreme events in three agro-ecological settings in central Ethiopia. The Mann Kendall test and Sen&rsquo, s slope estimator were used to examine the trends and slope of changes in climate indices. The profile of farmers whose perception converges with or diverges from meteorological data was characterized using polling. The average annual temperature has increased by 0.4 and 0.3 &deg, C per decade in the lowland and midland areas, respectively. Average annual rainfall has increased only in the midland areas by 178 mm per decade. Farmers&rsquo, perception of increasing temperature fairly aligns with meteorological data. However, there is a noticeable difference between farmers&rsquo, perception of rainfall and meteorological data. The perception of farmers with poor economic status, access to media, and higher social capital aligns with measured trends. Conversely, the perception of economically better-off and uneducated farmers diverges from meteorological data. Accurate perception is constrained by the failure of the traditional forecast methods to describe complex weather variabilities and lack of access to down-scaled weather information. The findings highlight the importance of availing specific and agro-ecologically relevant weather forecasts to overcome perceptual problems and to support effective adaptation.

International audience; BACKGROUND: The epidemic of non-communicable diseases (NCDs) in slums has pushed its residents to heightened vulnerability. The Social Determinants of Health (SDH) framework has been used to understand the social dynamics and impact of NCDs, especially in poorly resourced communities. Whilst the SDH has helped to discredit the characterisation of NCDs as diseases of affluence, its impact on policy has been less definite. Given the multitude of factors that interact in the presentation of NCDs, operationalising the SDH for policies and programmes that account for the contextual complexity of slums has stalled. OBJECTIVE: To organise the complex networks of relations between SDH in slums so as to identify options for Indian municipal policy that are feasible to implement in the short term. METHODS: The study reviews the literature describing SDH in Indian slums, specifically those that establish causal relations between SDH and NCDs. Root cause analysis was then used to organise the identified relations of SDH and NCDs. RESULTS: Although poverty remains the largest structural determinant of health in slums, the multi-dimensional relations between SDH and NCDs are structured around four themes that describe the dynamics of slums, namely scarce clean water, low education, physical (in)activity and transportation. From the reviewed literature, four logic trees visualising the relations between SDH in slums and NCDs were constructed. The logic trees separate symptomatic problems from their more distal causes, and recommendations were formulated based on features of these relationships that are amenable to policy intervention. CONCLUSION: Root cause analysis provides a means to focus the lens of examination of SDH, as evidenced here for Indian slums. It provides a guide for the development of policies that are grounded in the actual health concerns of people in slums, and takes account of the complex pathways through which diseases are socially constituted.

Background: There are several studies from different geographical settings and levels on maternal health, but none analyzes how accountability problems may contribute to the maternal health outcomes. This study aimed to analyze how accountability problems in public health system lead to maternal deaths and inequities in India. Methods: A conceptual framework was developed bringing together accountability process (in terms of standard setting, performance assessment, accountability (or answerability, and enforceability) -an ongoing cyclical feedback process at different levels of health system) and determinants of maternal health to analyze the influence of the process on the determinant leading to maternal health outcomes. A scoping review of qualitative and mixed-methods studies from public health sector in India was conducted. A narrative and interpretive synthesis approach was applied to analyze data. Results: An overarching influence of health system-related factors over non-health system-related factors leading to maternal deaths and inequities was observed. A potential link among such factors was identified with gaps in accountability functions at all levels of health system pertaining to policy gaps or conflicting/discriminatory policies and political commitment. A large number of gaps were also observed concerning performance or implementation of existing standards. Inherent to these issues was potentially a lack of proper monitoring and accountability functions. A critical role of power was observed influencing the accountability functions. Conclusion: The narrative and interpretive synthesis approach allowed to integrate and reframe the relevant comparable information from the limited empirical studies to identify the hot spots of systemic flaws from an accountability perspective. The framework highlighted problems in health system beyond health service delivery to wider areas such as policy or politics justifying their relevance and importance in such analysis. A crucial message from the study pertains to a need to move away from the traditional concept of viewing accountability as a blame-game approach and a concern of limited frontline health workers towards a constructive and systemic approach.

Background Social accountability (SA) comprises a set of mechanisms aiming to, on the one hand, enable users to raise their concerns about the health services provided to them (voice), and to hold health providers (HPs) accountable for actions and decisions related to the health service provision. On the other hand, they aim to facilitate HPs to take into account users’ needs and expectations in providing care. This article describes the development of a SA intervention that aims to improve health services responsiveness in two health zones in the Democratic Republic of the Congo. Methods Beneficiaries including men, women, community health workers (CHWs), representatives of the health sector and local authorities were purposively selected and involved in an advisory process using the Dialogue Model in the two health zones: (1) Eight focus group discussions (FGDs) were organized separately during consultation aimed at sharing and discussing results from the situation analysis, and collecting suggestions for improvement, (2) Representatives of participants in previous FGDs were involved in dialogue meetings for prioritizing and integrating suggestions from FGDs, and (3) the integrated suggestions were discussed by research partners and set as intervention components. All the processes were audio-taped, transcribed and analysed using inductive content analysis. Results Overall there were 121 participants involved in the process, 51 were female. They provided 48 suggestions. Their suggestions were integrated into six intervention components during dialogue meetings: (1) use CHWs and a health committee for collecting and transmitting community concerns about health services, (2) build the capacity of the community in terms of knowledge and information, (3) involve community leaders through dialogue meetings, (4) improve the attitude of HPs towards voice and the management of voice at health facility level, (5) involve the health service supervisors in community participation and; (6) use other existing interventions. These components were then articulated into three intervention components during programming to: create a formal voice system, introduce dialogue meetings improving enforceability and answerability, and enhance the health providers’ responsiveness. Conclusions The use of the Dialogue Model, a participatory process, allowed beneficiaries to be involved with other community stakeholders having different perspectives and types of knowledge in an advisory process and to articulate their suggestions on a combination of SA intervention components, specific for the two health zones contexts. Electronic supplementary material The online version of this article (doi:10.1186/s41256-017-0024-0) contains supplementary material, which is available to authorized users.

Jamestown, an urban coastal slum in Accra, Ghana, has one of the highest adolescent pregnancy rates in the country. We sought to understand the decision (to keep or terminate) factors and experiences surrounding adolescent pregnancies.Thirty semi-structured indepth interviews were carried out among adolescents (aged 13-19 years) who had been pregnant at least once. Half of these were adolescent mothers and the other half had at least one past experience of induced abortion. A pretested and validated questionnaire to assess the awareness and use of contraception in adolescent participants was also administered. To aid social contextualization, semi-structured in depth interviews were carried out among 23 purposively selected stakeholders.The main role players in decision making included family, friends, school teachers and the partner, with pregnant adolescents playing the most prominent role. Adolescents showed a high degree of certainty in deciding to either abort or carry pregnancies to term. Interestingly, religious considerations were rarely taken into account. Although almost all adolescents (96.1%) were aware of contraception, none was using any prior to getting pregnant. Of the 15 adolescents who had had abortion experiences, 13 (87.0%) were carried out under unsafe circumstances. The main barriers to accessing safe abortion services included poor awareness of the fairly liberal nature of the Ghanaian abortion law, stigma, high cost and non-harmonization of safe abortion service fees, negative abortion experiences (death and bleeding), and distrust in the health care providers. Adolescents who chose to continue their pregnancies to term were motivated by personal and sociocultural factors.Decision-making in adolescent pregnancies is influenced by multiple external factors, many of which are modifiable. Despite legal access to services, options for the safe termination of pregnancy or its prevention are not predominantly taken, resulting in a high number of negative experiences and outcomes. Including safe abortion care within the sexual and reproductive health package, could diminish barriers to safe abortion services. Given the vulnerability of the Jamestown setting, a comprehensive sexual education package that addresses the main decision factors is recommended. Interventions aiming to reduce adolescent pregnancy rates should also recognize that adolescent pregnancies are culturally acceptable in some settings, and under certain circumstances, are desired by the adolescents themselves.

The Dutch pig husbandry has become a topic of public debate. One underlying cause is that pig farmers and urban-citizens have different perspectives and underlying norms, values and truths on pig husbandry and animal welfare. One way of dealing with such conflicts involves a learning process in which a shared vision is developed. A prerequisite for this process is that both parties become aware of their own fixed patterns of thoughts, actions, and blind spots. Therefore, we conducted five homogeneous focus groups consisting of either urban-citizens or pig farmers. The first part of the sessions aimed to make the participants aware of their own perspectives and underlying norms and values concerning animal welfare, farm practices or consumer behavior. Then, by the use of role-play and film fragments showing the perspectives of the other party, we aimed to stimulate frame reflection. The farmers maintained their own perspective and defended their practices. They denied the perspective of the urban-citizens by portraying them as ignorant of the "factual" farm practices. They proposed the use of one-way information, but our results indicate that this is likely to fail as a strategy to support or restore public acceptance. Our case shows hardy any consensus regarding the relevance of the facts at stake and a very limited amount of shared values. However, the shared love for animals together with the recognition by the urban-citizens of the inescapable dilemma for farmers to adopt a use-framing towards animals might provide an opening for further learning strategies. © 2013 Springer Science+Business Media Dordrecht.

Insight into public perceptions provides opportunities to take public desires and concerns into account in an early phase of innovation development in order to maximise the potential benefits for users of the future. Public perceptions of neuroimaging in health care are presented in this article, based on research undertaken in the Netherlands. In six focus groups, 46 citizens articulated benefits, disadvantages and specific concerns regarding future medical neuroimaging applications. Six technological frames of neuroimaging and three frames of the socio-technical system surrounding neuroimaging were found to underlie the arguments used to articulate the degree of desirability of future applications. Depending on the context, individuals use different frames and related lines of arguments. New and improved options for the prevention, diagnosis and treatment of brain disorders are considered conditionally desirable by almost all citizens consulted. The desirability of neuroimaging applications becomes controversial when specific applications embody conflicting values and desires. Depending on the weight given to these different values and desires, the application is perceived as desirable or undesirable. It appears that concerns regarding the endorsed values of certainty and naturalness are preferred to desired states as control over life and risk avoidance. As a consequence, enhancement options and options to determine a predisposition and to diagnose mental disorders might be considered controversial. The identified different perspectives and concerns are a suitable starting point for processes aiming at the identification of more responsible future directions and related applications of medical neuroimaging.

Background Social accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social accountability initiatives. Methods Data on local socio-cultural characteristics, the governance context, and socio-economic conditions related to social accountability enabling factors were collected in the two health zones using semi-structured interviews and document reviews, and were analyzed using thematic analysis. Results The contexts of the two health zones were similar and characterized by the existence of several community groups, similarly structured and using similar decision-making processes. They were not involved in the health sector’s activities and had no link with the health committee, even though they acknowledged its existence. They were not networked as they focused on their own activities and did not have enough capacity in terms of social mobilization or exerting pressure on public authorities or providers. Women were not perceived as marginalized as they often occupied other positions in the community besides carrying out domestic tasks and participated in community groups. However, they were still subject to the local male dominance culture, which restrains their involvement in decision-making, as they tend to be less educated, unemployed and suffer from a lack of resources or specific skills. The socio-economic context is characterized by subsistence activities and a low employment rate, which limits the community members’ incomes and increases their dependence on external support. The governance context was characterized by imperfect implementation of political decentralization. Community groups advocating community rights are identified as “political” and are not welcomed. The community groups seemed not to be interested in the health center’s information and had no access to media as it is non-existent. Conclusions The local contexts in the two health zones seemed not to be supportive of the operation of social accountability initiatives. However, they offer starting points for social accountability initiatives if better use is made of existing contextual factors, for instance by making community groups work together and improving their capacities in terms of knowledge and information. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1895-3) contains supplementary material, which is available to authorized users.

The debate on genetic modification (GM) is persistent, polarized and mainly involves organized groups at the national level. With the European Union’s new policy of coexistence, commercial cultivation of GM crops is expected by the Dutch Ministry of Agriculture, Nature and Food Quality within the next few years, especially maize (BT) and potato (Phytophthera resistance and starch production). This makes the debate relevant for those directly confronted with this cultivation: the inhabitants of local rural communities. In The Netherlands, stakeholders formulated coexistence rules to prevent problems between conventional, organic and GM farmers that grow their crops in the same limited land area. Little is known, however, regarding the perceptions of the non-farming inhabitants of rural communities (“the neighbours”) in the debate. This paper presents the results of a focus group-based argumentative analysis of whether (and how) the GM issues play a decisive role among non-farming inhabitants of four rural communities in the Netherlands. We analysed the arguments in relation to a conceptual model that describes the potential rise and dynamics from a pre-Nimby ambivalence towards an outspoken Nimby position. We observed that the GM debate was given very little priority relative to other national issues on the political agenda and that more social cohesion correlates with fewer arguments in the national debate. It is argued that this mechanism keeps the Nimby ambivalence in an undetermined mode, which in turn diminishes the chances of radical rural-based protest against local GM cultivation of crops.

Debates in animal ethics are largely characterized by ethical monism, the search for a single, timeless, and essential trait in which the moral standing of animals can be grounded. In this paper, we argue that a monistic approach towards animal ethics hampers and oversimplifies the moral debate. The value pluralism present in our contemporary societies requires a more open and flexible approach to moral inquiry. This paper advocates the turn to a pragmatic, pluralistic approach to animal ethics. It contributes to the development of such an approach in two ways. It offers a pragmatist critique of ethical monism in animal ethics and presents the results of a qualitative study into the value diversity present in the different ways of thinking about animals in the Netherlands. Carefully arranged group discussions resulted in the reconstruction of four distinctive moral value frameworks that may serve as instruments in the future process of moral inquiry and deliberation in the reflection on animal use. © 2010 The Author(s).

The behaviour of a group of female domestic cats (n = 10) under laboratory conditions is described. Behavioural observations were made on a total of 20 days during a 3-month period; only frequencies were recorded. Analysis of the winner/loser matrix revealed a linear rank order. This rank order correlated with several variables. The higher the rank, the more offensive threats a cat emitted overall, and the more defensive threats it received overall; within a pair, the higher-ranking cat displayed more offensive threats, whereas the lower-ranking cat displayed more defensive threats. The higher a rank, the more bouts of social licking a cat emitted overall, and the more bouts of social sniffing and social rubbing it received overall; within a pair, the higher-ranking cat tended to show more social licking, whereas the lower-ranking cat showed more social sniffing. The higher the rank, the more time a cat tended to spend on the floor, and the less time it spent in a 16-compartment complex; the further animals were apart in rank, the smaller were the proximity scores between them. Finally, higher-ranking cats tended to gain weight, whereas lower-ranking cats tended to lose weight. These data suggest that the concept of dominance may be applied to this group of cats. It is discussed whether the observed rank order is specific for indoor conditions under which the cats were living. The role of social licking is also discussed.

Public engagement is increasingly advocated and applied in the development and implementation of technological innovations. However, initiatives so far are rarely considered effective. There is a need for more methodological rigor and insight into conducive conditions. The authors developed an evaluative framework and assessed accordingly the effectiveness of a project of the Dutch Ministry of Health, Welfare and Sport in which the application of interactive policy making was piloted in medical biotechnology, among others, to increase the legitimacy and quality of the policy agenda. Relevant societal actors, including citizens, were actively involved in an open-exchange, action and reflection process, integrating relevant knowledge. Although the project was overall evaluated as effective, some difficulties were faced. These were mostly related to the novel roles public engagement requires of principal actors. The article concludes that more research is needed on the position of the executing team and on overcoming tensions existing between different governance modes.

In early 2002, the Dutch Ministry of Public Health, Welfare and Sport piloted the application of an interactive process to policy development in the field of medical biotechnology. In such an approach, relevant societal actors, including the public at large, are actively involved in an open exchange, planning, action and reflection process. This paper reports on the findings of one of the activities of the ministry within this initiative, the consultation of the public on dilemmas with respect to prenatal genetic testing by means of citizen panels. Participants were asked to reflect on questions with respect to whether and under which conditions pregnant women may have freedom of choice to use prenatal genetic testing. In a structured way, arguments in favour and against various positions were identified and prioritized. The paper closes with a discussion on the implications of the use of citizen panels and summarizes the 2 actual policy changes of the ministry that resulted from this process.

The development of animal biotechnology is accompanied by factual uncertainty and value pluralism. The arising policy controversy demands a frame-reflective approach to policy-making. A first step in such an approach is the articulation of existing value frames to provide constructive options for moral deliberation. The value lab method interactively makes an in-depth reconstruction of the qualitative diversity of moral value frameworks. This article describes the methodological steps taken to engage participants in the exploration and co-construction of their ideas, using their own concepts and language. Eventually, we discuss how this contributes to the development of new methodologies to handle value conflicts in complex public policy issues. Copyright , Beech Tree Publishing.

Every ethical review process presupposes a set of ethical criteria, proper procedures and a consistent legal framework. The Netherlands became unique in 1996, by the decision of the Parliament to start a national ethical review procedure regarding the ethical aspects of genetic modification of animals ( Animal and Biotechnology Decree). Due to the policy of public disclosure of all relevant documents and providing a legal trajectory for public objections, extensive ethical arguments pro and con are well documented. This paper lists and analyses the misconceptions when one tries to apply the “classical” ethical framework of harms and benefits to the new designs of animal experiments in the context of biotechnology. For instance, what is the object? The foster mothers, the manipulated egg cell, the malformed embryo, the pups dying before weaning or the adult mice in the experiments? The public considers the whole methodology ethically relevant. Most researchers tend to check out only “consciously” experienced harm, which implies only autonomously living mice and not a cell or an embryo. And, what is the domain of benefits? An exciting construct to be incorporated in the genome, the healthy birth of a surviving knock out, or a successful experiment with adult genetically modified mice? In the same way, the question for relevant alternatives in the “classic” sense of the Three Rs seems to shift completely to a discussion about goals in the far future. Is this modification absolutely necessary, or are the goals also reached by research strategies without genetic modification?

To the Editors: Would it be beneficial to actively involve people with a respiratory condition in identifying and setting respiratory research priorities? Research priorities are traditionally set by medical and scientific experts, and it is often argued that this should remain unchanged since it gave rise to the development of high-quality knowledge, medical innovations and the improvement of quality of life [1]. Patients are often considered subjective, knowing little about health research. Furthermore, patient involvement would cost additional time and money [1]. So why would one consider giving patients a voice in setting research priorities? Different arguments are described in a growing body of literature addressing patient participation. First, there are indications that research priorities from experts differ from those of patients [2–4]. To become more responsive to patients’ needs, it would be vital to involve patients in identifying priorities. Patients’ “experiential knowledge”, can complement scientific or medical knowledge [3, 5, 6]. Secondly, the process itself becomes more democratic [2, 5]. Furthermore, patient involvement in decision making can lead to better acceptance of these decisions and outcomes. These arguments have inspired a growing number of funding agencies, including the European Union, to involve patients in research. A pioneer in involving patients research is the Netherlands Asthma Foundation (NAF). To be more democratic, responsive to patients’ needs and to improve societal relevance of their research agenda, NAF involved in 2004, besides scientific and medical experts, people with asthma and/or COPD in setting their research agenda [7, 8]. In a facilitated process, patients articulated needs and prioritised research topics in a well-argued way. Patients did not, as was expected by some experts, just prioritise care research, social research or focus only on their …

Background: Low-income countries face many contextual challenges to manage healthcare technologies effectively, as the majority are imported and resources are constrained to a greater extent. Previous healthcare technology management (HTM) policies in Benin have failed to produce better quality of care for the population and costeffectiveness for the government. This study aims to identify and assess the main problems facing HTM in Benin’s public health sector, as well as the ability of key actors within the sector to address these problems.Methods: We conducted 2 surveys in 117 selected health facilities. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at health facilities. The Temple-Bird Healthcare Technology Package System (TBHTPS), tailored to the context of Benin’s health system, was used as a conceptual framework.Results: The findings of the first survey show that 85% of key actors in Benin’s HTM sector characterized the system as failing in components of the TBHTPS framework. Biomedical, clinical, healthcare technology engineers and technicians perceived problems most severely, followed by users of equipment, managers and hospital directors, international organization officers, local and foreign suppliers, and finally policy-makers, planners and administrators at the Ministry of Health (MoH). The 5 most important challenges to be addressed are policy, strategic management and planning, and technology needs assessment and selection – categorized as major enabling inputs (MEI) in HTM by the TBHTPS framework – and installation and commissioning, training and skill development and procurement, which are import and use activities (IUA). The ability of each key actor to address these problems (the degree of political or administrative power they possess) was inversely proportional to their perception of the severity of the problems. Observational data gathered during site visits described a different set of challenges including maintenance and repair, distribution, installation and commissioning, use and training and personnel skill development.Conclusion: The lack of experiential and technical knowledge in policy development processes could underpin many of the continuing problems in Benin’s HTM system. Before solutions can be devised to these problems, it is necessary to investigate their root causes, and which problems are most amenable to policy development.

This study aims to identify the root causes and solutions of main problems facing Healthcare Technology Management in Benin׳s public health sector. Conducted in Benin from 2008 to 2010, two surveys were used with key actors in Healthcare Technology Management. The first survey was based on 377 questionnaires and 259 interviews, and the second involved observation and group interviews at selected health facilitiesThe findings of the two surveys show that the problems are based on both high- and low-level corruption, characterized by self-interest and unwillingness of the policy makers to solve healthcare care equipment and maintenance problems. Appropriate solutions include: (i) development of policy and management tools to guide distribution, (ii) the use of reference price lists for procuring equipment, (iii) development of policy and management tools to guide financial resource allocation on the life cycle cost of the equipment, (iv) creation of a healthcare equipment and maintenance directorate, (v) development of policy and management tools for obsolete equipment, and (iv) the development of a new healthcare technology management policy with a budgeted action plan.We suggest that much can be improved by the strict development and implementation of policy and management tools, as well as regulations at each level of the Healthcare Technology Management process. A key role has to be attributed to the technical specialists, and the end users of equipment in healthcare facilities. Furthermore, there is a need for capacity building in Healthcare Technology Management institutions.

To develop responsible innovations, the potential impacts on society, both positive and negative, should be identified and incorporated into research, development and design of new technologies. In this research, neuroimaging applications in health care are subject to a constructive technology assessment (CTA) process which is combined with vision assessment that acknowledges the mechanisms and dynamics surrounding innovations. The “guiding visions” of scientists and technology developers which are currently shaping the future of neuroimaging are presented. Results show that these experts expect that future advances in neuroimaging technologies will make it possible to obtain more insight into both the healthy brain and brain disorders. They consider that these advances will lead to improved prevention, diagnosis and treatment options. The barriers that need to be overcome to realize these guiding visions are identified. In addition, findings show which aspects need further exploration and follow-up activities in order to ensure that medical neuroimaging develops in a more responsible direction.

Transdisciplinary research aims to integrate scientific knowledge and societal perspectives. Although transdisciplinarity increasingly plays a role in science, practical implications remain largely unreported in literature. A dialogue is common strategy in this type of research to stimulate mutual learning between scientists and societal stakeholders. This paper presents a four-year dialogue, using tailor-made interventions, between scientists in an interdisciplinary animal welfare research program and societal stakeholders. The dialogue aimed to encourage the scientists to move from a monodisciplinary approach to a more transdisciplinary one. Three learning phases were identified and described along with elements that worked as either barriers or facilitators of learning. We argue that this learning process can be shortened by starting with team building and the design of a shared research project after which individual experiments can be planned. Additional practical strategies are discussed.

New biotechnological inventions demand a different way of monitoring experiments for possible nonhuman animal welfare problems. Only with such a monitoring system in place will review committees be able to render good judgments on new experiments. Nuclear transfer cloning serves as a clear example. In February 1997, the Roslin Institute, situated in Edinburgh, United Kingdom, amazed the world with the birth of Dolly, the healthy, cloned sheep generated from the cell nucleus of the udder of an adult sheep. Although Dolly seems to be in good condition, cloned lambs and calves produced by nuclear transfer have generally been characterized as having a high birth weight, various anatomical and physiological abnormalities, and a low survival rate. Although these symptoms have been observed only in part of the clones, their severity shows a considerable risk of compromised animal welfare following a cloning experiment.