IntroductionAdolescent girls and young women (AGYW) disproportionately experience gender-based violence (GBV), which can increase during emergencies like the COVID-19 pandemic.MethodsA cohort of youth ages 15–24 in Nairobi, Kenya was surveyed at three time points over an 18-month period prior to and during the COVID-19 pandemic: June–August 2019 (prepandemic), August–October 2020 (12-month follow-up) and May 2021 (18-month follow-up). We characterise (1) prevalence, relative timing and help-seeking for leading forms of GBV, (2) GBV trajectories over 18 months and (3) associations of individual, dyad and COVID-related factors on GBV trajectories among AGYW (n=612) in Nairobi, Kenya. Virtual focus group discussions (n=12) and interviews (n=40) contextualise quantitative results.ResultsIntimate partner violence (IPV) prevalence hovered at 17% across time points (ever at pre-pandemic; past 12 months at 12-month follow-up (2020); past 6 months at 18-month follow-up (2021)); non-partner sexual violence (SV) was 3% at 12-month and 18-month follow-up. Overall, 27.6% of AGYW experienced IPV during the pandemic. IPV during the pandemic was associated with work as the primary pre-COVID activity, low social support and partner age difference >4 years. Among AGYW partnered at all three time points, 66.2% stayed IPV-free (no IPV), 9.2% saw IPV resolve by 18-month follow-up, while 11.1% had IPV start and 13.6% experienced intermittent IPV. Help-seeking for IPV and SV in 2020 (11.1% and 4.6%, respectively) increased to 21.7% and 15.1%, respectively, by 2021. Qualitative results speak to impacts of curfews, and pandemic-related financial stress in prompting conflict and threatening traditional gender roles, and underlying conditions that enable IPV.ConclusionThe persistence of IPV against AGYW in Nairobi prior to and during the COVID-19 pandemic reflects endemic conditions and pandemic-specific stressors. Youth, including unmarried youth, remain a priority population for GBV prevention and survivor-centred response.
BackgroundOxytocin for postpartum hemorrhage (PPH) prophylaxis is commonly administered by either intramuscular (IM) injection or intravenous (IV) infusion with both routes recommended equally and little discussion of potential differences between the two. This trial assesses the effectiveness and safety of 10 IU oxytocin administered as IM injection versus IV infusion and IV bolus during the third stage of labor for PPH prophylaxis.MethodsIn two tertiary level Egyptian maternity hospitals, women delivering vaginally without exposure to pre-delivery uterotonics were randomized to one of three prophylactic oxytocin administration groups after delivery of the baby. Blood loss was measured 1 h after delivery, and side effects were recorded. Primary outcomes were mean postpartum blood loss and proportion of women with postpartum blood loss ≥500 ml in this open-label, three-arm, parallel, randomized controlled trial.ResultsFour thousand nine hundred thirteen eligible, consenting women were randomized. Compared to IM injection, mean blood loss was 5.9% less in the IV infusion arm (95% CI: -8.5, − 3.3) and 11.1% less in the IV bolus arm (95% CI: -14.7, − 7.8). Risk of postpartum blood loss ≥500 ml in the IV infusion arm was significantly less compared to IM injection (0.8% vs. 1.5%, RR = 0.50, 95% CI: 0.27, 0.91). No side effects were reported in any arm.ConclusionsIntravenous oxytocin is more effective than intramuscular injection for the prevention of PPH in the third stage of labor. Oxytocin delivered by IV bolus presents no safety concerns after vaginal delivery and should be considered a safe option for PPH prophylaxis.Trial registrationclinicaltrials.gov #NCT01914419, posted August 2, 2013.
Background Infectious disease outbreaks like COVID-19 and their mitigation measures can exacerbate underlying gender disparities, particularly among adolescents and young adults in densely populated urban settings. Methods An existing cohort of youth ages 16–26 in Nairobi, Kenya completed a phone-based survey in August-October 2020 (n = 1217), supplemented by virtual focus group discussions and interviews with youth and stakeholders, to examine economic, health, social, and safety experiences during COVID-19, and gender disparities therein. Results COVID-19 risk perception was high with a gender differential favoring young women (95.5% vs. 84.2%; p<0.001); youth described mixed concern and challenges to prevention. During COVID-19, gender symmetry was observed in constrained access to contraception among contraceptive users (40.4% men; 34.6% women) and depressive symptoms (21.8% men; 24.3% women). Gender disparities rendered young women disproportionately unable to meet basic economic needs (adjusted odds ratio [aOR] = 1.21; p<0.05) and in need of healthcare during the pandemic (aOR = 1.59; p<0.001). At a bivariate level, women had lower full decisional control to leave the house (40.0% vs. 53.2%) and less consistent access to safe, private internet (26.1% vs. 40.2%), while men disproportionately experienced police interactions (60.1%, 55.2% of which included extortion). Gender-specific concerns for women included menstrual hygiene access challenges (52.0%), increased reliance on transactional partnerships, and gender-based violence, with 17.3% reporting past-year partner violence and 3.0% non-partner sexual violence. Qualitative results contextualize the mental health impact of economic disruption and isolation, and, among young women, privacy constraints. Implications Youth and young adults face gendered impacts of COVID-19, reflecting both underlying disparities and the pandemic’s economic and social shock. Economic, health and technology-based supports must ensure equitable access for young women. Gender-responsive recovery efforts are necessary and must address the unique needs of youth.
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