Globally, abortion has emerged as a critical determinant of maternal morbidity and mortality. The Ghana government amended the country's abortion law in 1985 to promote safe abortion. This article discusses the findings of a qualitative study that explored the decision-making experiences of 28 female abortion seekers aged between 15 and 30 years in Ghana. Key findings from the study are that individuals claimed autonomy in their abortion decisions; underlying the abortion decisions were pragmatic concerns such as economic difficulties, child spacing, and fear of parental reaction. In conclusion, we examine the health implications of Ghanaian women's abortion decisions.
Using a social ecological approach (Bronfenbrenner) to violence and including Hobsbawm's historical analysis of the collective uses of violence, this article shows how gender-based violence is experienced and used. Drawing on three distinct studies in Ghana, Kenya and South Africa, it shows the commonalities and divergence of young people's experiences of violence. It links the microsystems of school, community, street and family with the larger macrosystems of poverty, government policies, power relations and structural violence. This approach highlights the relationship between the forms of gender-based violence, youth experience, and the marginalized and deprived habitats in which our research was conducted. Violence experienced by young women is shown to be linked to the ways in which young men use violence as vehicles of revenge and retribution, a desire for respect, expression of love of a mother, control over female sexuality and, ultimately, assertion of collective notions of masculinity on the street and in sprawling urban settlements. We conclude by attempting to identify what is needed to challenge the violence inflicted by poverty on young people, especially young women, the denial of their rights, and the violence they inflict on themselves and others.
Population health surveys are rarely comprehensive in addressing sexual health, and population-representative surveys often lack standardised measures for collecting comparable data across countries. We present a sexual health survey instrument and implementation considerations for population-level sexual health research. The brief, comprehensive sexual health survey and consensus statement was developed via a multi-step process (an open call, a hackathon, and a modified Delphi process). The survey items, domains, entire instruments, and implementation considerations to develop a sexual health survey were solicited via a global crowdsourcing open call. The open call received 175 contributions from 49 countries. Following review of submissions from the open call, 18 finalists and eight facilitators with expertise in sexual health research, especially in low- and middle-income countries (LMICs), were invited to a 3-day hackathon to harmonise a survey instrument. Consensus was achieved through an iterative, modified Delphi process that included three rounds of online surveys. The entire process resulted in a 19-item consensus statement and a brief sexual health survey instrument. This is the first global consensus on a sexual and reproductive health survey instrument that can be used to generate cross-national comparative data in both high-income and LMICs. The inclusive process identified priority domains for improvement and can inform the design of sexual and reproductive health programs and contextually relevant data for comparable research across countries.
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