Chimaraoke O. Izugbara

Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya

BackgroundThe prevalence of unintended pregnancy in Kenya continues to be high. The 2003 Kenya Demographic and Health Survey (KDHS) showed that nearly 50% of unmarried women aged 15–19 and 45% of the married women reported their current pregnancies as mistimed or unwanted. The 2008–09 KDHS showed that 43% of married women in Kenya reported their current pregnancies were unintended. Unintended pregnancy is one of the most critical factors contributing to schoolgirl drop out in Kenya. Up to 13,000 Kenyan girls drop out of school every year as a result of unintended pregnancy. Unsafe pregnancy termination contributes immensely to maternal mortality which currently estimated at 488 deaths per 100 000 live births. In Kenya, the determinants of prevalence and determinants of unintended pregnancy among women in diverse social and economic situations, particularly in urban areas, are poorly understood due to lack of data. This paper addresses the prevalence and the determinants of unintended pregnancy among women in slum and non-slum settlements of Nairobi.MethodsThis study used the data that was collected among a random sample of 1262 slum and non-slum women aged 15–49 years in Nairobi. The data was analyzed using simple percentages and logistic regression.ResultsThe study found that 24 percent of all the women had unintended pregnancy. The prevalence of unintended pregnancy was 21 per cent among women in slum settlements compared to 27 per cent among those in non-slum settlements. Marital status, employment status, ethnicity and type of settlement were significantly associated with unintended pregnancy. Logistic analysis results indicate that age, marital status and type of settlement had statistically significantly effects on unintended pregnancy. Young women aged 15–19 were significantly more likely than older women to experience unintended pregnancy. Similarly, unmarried women showed elevated risk for unintended pregnancy than ever-married women. Women in non-slum settlements were significantly more likely to experience unintended pregnancy than their counterparts in slum settlements.The determinants of unintended pregnancy differed between women in each type of settlement. Among slum women, age, parity and marital status each had significant net effect on unintended pregnancy. But for non-slum women, it was marital status and ethnicity that had significant net effects.ConclusionThe study found a high prevalence of unintended pregnancy among the study population and indicated that young and unmarried women, irrespective of their educational attainment and household wealth status, have a higher likelihood of experiencing unintended pregnancy. Except for the results on educational attainments and household wealth, these results compared well with the results reported in the literature.The results indicate the need for effective programs and strategies to increase access to contraceptive services and related education, information and communication among the study population, particularly among the young and unmarried women. Increased access to family planning services is key to reducing unintended pregnancy among the study population. This calls for concerted efforts by all the stakeholders to improve access to family planning services among the study population. Increased access should be accompanied with improvement in the quality of care and availability of information about effective utilization of family planning methods.

Building capacity for public and population health research in Africa: the consortium for advanced research training in Africa (CARTA) model.

Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the regions socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from West, East, Central, and Southern Africa, and select northern universities and training institutes. CARTAs program of activities comprises two primary, interrelated, and mutually reinforcing objectives: to strengthen research infrastructure and capacity at African universities; and to support doctoral training through the creation of a collaborative doctoral training program in population and public health. The ultimate goal of CARTA is to build local research capacity to understand the determinants of population health and effectively intervene to improve health outcomes and health systems. Conclusions: CARTAs focus on the local production of networked and high-skilled researchers committed to working in sub-Saharan Africa, and on the concomitant increase in local research and training capacity of African universities and research institutes addresses the inability of existing programs to create a critical mass of well-trained and networked researchers across the continent. The initiatives goal of strengthening human resources and university-wide systems critical to the success and sustainability of research productivity in public and population health will rejuvenate institutional teaching, research, and administrative systems.

Women, poverty and adverse maternal outcomes in Nairobi, Kenya

BackgroundThe link between poverty and adverse maternal outcomes has been studied largely by means of quantitative data. We explore poor urban Kenyan womens views and lived experiences of the relationship between economic disadvantage and unpleasant maternal outcomes.MethodSecondary analysis of focus group discussions and in-depth individual interviews data with women in two slums in Nairobi, Kenya.ResultsUrban poor women in Nairobi associate poverty with adverse maternal outcomes. However, their accounts and lived experiences of the impact of poverty on maternal outcomes underscore dynamics other than those typically stressed in the extant literature. To them, poverty primarily generates adverse maternal outcomes by exposing women to exceedingly hard and heavy workloads during pregnancy and the period surrounding it; to intimate partner violence; as well as to inhospitable and unpleasant treatment by service providers.ConclusionsPoverty has wider and more intricate implications for maternal outcomes than are acknowledged in extant research. To deliver their expected impact, current efforts to promote better maternal outcomes must be guided by a more thorough perspective of the link between womens livelihoods and their health and wellbeing.

URBAN POOR KENYAN WOMEN AND HOSPITAL-BASED DELIVERY

The increasing availability of formal obstetric care in Kenya notwithstanding the majority of births in urban areas of the country still occur at home assisted by unskilled traditional birth attendants (TBAs). To add to current knowledge on this topic we probed the views of poor women -- who form the bulk of mothers who deliver at home in urban Kenya -- on the attractions of and deterrents to hospital-based deliveries. In investigating lay views surrounding the hospital as a delivery site our aim was to illuminate the lives and plights of urban poor Kenyan women who even in the 21st century continue to experience difficulties in accessing quality obstetric care. The participants indicated availability of providers and equipment that could make birthing safer as the major appeal of hospital-based deliveries. They generally admitted to the capacity of hospital-based providers to make childbearing safer frequently noting that hospital-based delivery put women under the care of skilled providers and ensured the ready availability of equipment for managing emergencies and difficult deliveries. Informal providers (e.g. TBAs) reportedly lacked these skills and tools. While delivery could occur safely in any birth site the respondents only characterized hospitals as capable of effectively managing life-threatening complications and difficult deliveries. An important issue that dominated the narratives however was that it was unreasonable for women to seek hospital birth unless they anticipated a difficult delivery. So although respondents frequently admitted to the superiority of the hospital as a delivery site they tended to view it primarily as a delivery site for women anticipating or at risk of obstetric emergencies and difficult deliveries. The women considered the management of uncomplicated deliveries to be the traditional turf of TBAs who were depicted as naturally and divinely gifted to assist during deliveries. Respondents frequently viewed TBAs’ innate expertise and skills as more effectual and dependable than the learned practice of hospital-based providers. (Excerpts)

Gendered interests and poor spousal contraceptive communication in Islamic northern Nigeria

Relying on focus group discussions and in-depth individual interviews with men and women in Jigawa and Kano states in northern Nigeria, we investigated barriers to spousal contraceptive communication. While attitudes toward spousal contraceptive communication were generally positive, there was very little evidence that respondents engaged in it. Poor spousal contraceptive communication in northern Nigeria is, in many ways, driven by the ample incentives that husbands and wives have to keep having children. For wives, having many children stabilises their marriage. It prevents husbands from marrying additional wives and sustains their attention and investments even if they ultimately do. For husbands, having many children helps them to keep their wives from objecting to their taking other wives and to mollify them by showing their continued commitment to that relationship should they take other wives. Our findings clearly challenge conventional population, family planning and reproductive health programmes that view high fertility as disempowering for women, and contraceptive use as capable of redressing gender inequality. New norms of gender relations are key to promoting contraceptive uptake and smaller families in northern Nigeria.

Who Owns the Body? Indigenous African Discourses of the Body and Contemporary Sexual Rights Rhetoric

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. Résumé Les droits sexuels demeurent difficiles à réaliser dans la plupart de l’Afrique subsaharienne, en dépit de leur inclusion dans plusieurs documents internationaux et législations nationales. Cet article donne une explication possible, mais négligée, de ce phénomène. Les déclarations actuelles sur les droits sexuels découlent de l’idée que le corps, comme entité physique, appartient à l’individu. Néanmoins, notre travail dans deux groupes du sud-est du Nigéria, les Ngwa-Igbo et les Ubang, montre qu’il y a au moins une autre conception du corps, considéré comme la propriété de l’ensemble de la communauté, plutôt que comme celle de l’individu. Dans ces deux cultures, les droits relèvent de la communauté, qui a aussi de fortes prétentions sur tous ses membres, y compris sur la propriété du corps. Les individus ont donc plus de probabilités de chercher à réaliser leurs droits dans l’espace communautaire que dans l’isolement. Le principe qui confère toujours à l’individu le droit final sur son corps est problématique et risque de limiter l’efficacité des programmes et des interventions fondés sur les droits en général, et en particulier du travail autour des droits sexuels. Resumen El cumplimiento de los derechos sexuales continúa siendo un reto de enormes proporciones en casi toda Ãfrica subsahariana, pese a la articulación de estos derechos en varios documentos internacionales y leyes nacionales. En este artículo se proporciona una razón posible pero olvidada del porqué. Las declaraciones de los derechos sexuales se basan en la noción de que el cuerpo, como entidad física, pertenece a la persona. Sin embargo, nuestro trabajo en dos culturas del sureste de Nigeria, Ngwa-Igbo y Ubang, muestra que existe por lo menos otra visión del cuerpo como propiedad de una comunidad más amplia, y no de la persona. En las dos culturas en cuestión, los derechos son parte de la comunidad, la cual exige mucho de todos sus miembros, incluso el derecho de propiedad sobre el cuerpo. Por tanto, es más probable que cada persona busque y haga realidad sus derechos dentro del espacio comunal, y no como ser independiente. La suposición de que toda persona tiene siempre derecho a su cuerpo es problemática y podría limitar la eficacia de las intervenciones y programas basados en derechos, en general, y obrar en torno a los derechos sexuales en particular.

Male youth and Voluntary Counseling and HIV-Testing: the case of Malawi and Uganda

There is limited research addressing the beliefs of adolescents related to Voluntary Counseling and HIV-Testing (VCT). This paper analyzes qualitative data on such beliefs elicited from male youth in Uganda and Malawi. Although study participants understood the mainstream public health rhetoric on VCT, much of their narratives framed going for HIV testing in terms of danger, as a sign of lack of self-confidence, and as an acknowledgment of vulnerability. This tendency, we contend, is strongly rooted in the inclination of male youth to perform and validate their identities in gestures of self-certitude, imperviousness, invulnerability, and invincibility. Further, the idea of ‘not wanting to die alone’ from AIDS also featured prominently in the narratives, with many respondents declaring that they would deliberately infect others with HIV should they test positive. Key to freeing young people from the shackles of consternation and misconceptions about VCT and HIV is comprehensive HIV education.

'High profile health facilities can add to your trouble': Women, stigma and un/safe abortion in Kenya.

Public health discourses on safe abortion assume the term to be unambiguous. However, qualitative evidence elicited from Kenyan women treated for complications of unsafe abortion contrasted sharply with public health views of abortion safety. For these women, safe abortion implied pregnancy termination procedures and services that concealed their abortions, shielded them from the law, were cheap and identified through dependable social networks. Participants contested the notion that poor quality abortion procedures and providers are inherently dangerous, asserting them as key to womens preservation of a good self, management of stigma, and protection of their reputation, respect, social relationships, and livelihoods. Greater public health attention to the social dimensions of abortion safety is urgent.

Masculinity Scripts and the Sexual Vulnerability of Male Youth in Malawi

ABSTRACT This study investigates contextually rich talk about sex and sexual activity among Malawian male youth. While their sexual ideologies have a potential to prompt them into risky practices, a more urgent driver of their vulnerability is their sexual scripts which constitute masculinity as very fragile and in need of constant protection, making the boys wary both of female partners who refuse them sex and of sexual practices which offer little or no control and power over women, raise suspicions about their manliness, or do not clearly validate their identities as powerful, go-getting males. These were, however, inherently risky sexual partners and practices. Urgently needed are strategies to help male youth realize the ways in which defense of masculinity, which may seem like self-defense, puts them at risk.

The health and wellbeing of young people in sub-Saharan Africa: an under-researched area?

A third of sub-Saharan Africa’s (SSA) population comprises persons aged 10–24 years. These youth are growing up in a context marked by pervasive poverty, limited educational opportunities, high HIV/AIDS prevalence, widespread conflict, and weak social controls. Published research on the broad issues that affect youth health and wellbeing in SSA is limited and centers heavily on sexual and reproductive health. In this commentary, we provide a broad overview of sub-Saharan African youth, highlight research gaps with respect to youth health and wellbeing, and describe potential avenues to develop the region’s research capacity on youth health and wellbeing.