Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health

George, Asha; Amin, Avni; Lopes, Cláudia Abreu; Ravindran, T.K. Sundari

doi:10.1136/bmj.l6985

Cited by 64 publications

(68 citation statements)

References 24 publications

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“…On the other hand, it is evidenced in the current study and other studies, that access to media increases HIV-related knowledge. Studies have shown that females are more economically disadvantaged and have less access to media than males in many countries [48,49]. Therefore, gender disparities in HIV-related knowledge between males and females may also be due to differences in accessing media.…”

Section: Discussionmentioning

confidence: 99%

HIV knowledge and associated factors among young Ethiopians: application of multilevel order logistic regression using the 2016 EDHS

2020

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Background Human Immunodeficiency virus continues to be a major global health problem infecting 75 million and killing 32 million people since the beginning of the epidemic. It badly hit Sub Saharan Africa than any country in the world and youths are sharing the greatest burden. The study aims to assess the level of HIV-knowledge and its determinants among Ethiopian youths using the 2016 Ethiopia Demographic and Health Survey data. Methods A nationally representative 2016 Ethiopian Demographic and Health Survey data were used. A total of 10,903 youths comprising 6401 females and 4502 males were included in the study. Descriptive statistics and multilevel order logistic regression were used and confidence interval was used to declare statistical significance in the final model. Results The mean age and SD of youths included in this study was 19.10 (±2.82). Among Ethiopian youths, 20.92% (95% CI: 18.91, 23.09%) had low knowledge of HIV whereas, 48.76% (95% CI: 47.12, 50.41%) and 30.31% (95% CI: 28.51, 32.18%) of them had moderate and comprehensive HIV knowledge respectively. Being male, access to TV and radio, ever tested for HIV/AIDS, owning a mobile telephone, and attending primary school and above compared to non-attendants were associated with having higher HIV knowledge. But, dwelling in rural Ethiopia, being in the Protestant and Muslim religious groups as compared to those of Orthodox followers and being in married groups were associated with having lower HIV knowledge. Approximately, 12% of the variation in knowledge of HIV was due to regions. Conclusion Only one-third of Ethiopian youths have deep insight into the disease, whereas, nearly one-fifth of them have lower HIV-knowledge. There is a significant disparity in HIV-related knowledge among Ethiopian youths living in different regions. Rural residents, less educated, female, and married youths have less knowledge of HIV as compared to their counterparts. Youths who do not have a mobile phone, who lack health insurance coverage, and who have limited access to media have less knowledge about HIV. Therefore, the due focus should be given to the aforementioned factors to minimize the disparities between regions and to enhance Ethiopian youths’ HIV-knowledge.

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Section: Discussionmentioning

confidence: 99%

HIV knowledge and associated factors among young Ethiopians: application of multilevel order logistic regression using the 2016 EDHS

2020

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“…From a societal lens, gender inequality as an intersectional and structural driver of adolescent health [23] must be further addressed for the GFF investments to be socially relevant, transformative and effective. It is the key social determinant underlying adolescent pregnancy, vulnerability to HIV and STIs, violence against adolescent girls and women, female genital mutilation and stigma related to menstruation [24] [25].…”

Section: Discussionmentioning

confidence: 99%

Is the Glass Half-Full or Half-Empty? A Content Analysis of Adolescent Sexual and Reproductive Health in Global Financing Facility Country Plans

George¹,

Jacobs²,

Kinney³

et al. 2020

Preprint

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Abstract Background: The Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health is recognised as a key priority by the GFF leadership. However, very little work exists examining GFF practice. As momentum builds for the GFF, we examine the initial efforts of the GFF in addressing adolescent health.Methods: We undertook a content analysis of the first 10 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda. Results: While several country documents signal understanding and investment in adolescent health as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement. Conclusion: There are important examples of how the GFF supports adolescent health as a priority area. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

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“…We discuss three cross-cutting issues in more detail: early discharge from hospital against medical advice; post-discharge treatment-seeking behavior and recovery; and concerns about inappropriate use of antibiotics. In a separate paper, we explore the gender issues and in uences in more depth, given that contextually relevant gender analyses are needed to improve health-related interventions, programs and policies [35,36].…”

Section: Discussionmentioning

confidence: 99%

Parent and Provider Perspectives on Factors Influencing Treatment-Seeking and Recovery After Hospital Discharge Among Undernourished Children Aged 2-23 Months in Bangladesh

Uddin

Molyneux

Muraya

et al. 2020

Preprint

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Background: Post-hospital discharge mortality is high among undernourished children in many low and middle-income countries; often exceeding in-patient mortality rates. Although a number of studies have highlighted a range of potential socio-cultural, economic and health system factors influencing paediatric post-discharge treatment-seeking and recovery, including in Bangladesh, few studies have explored parent and provider perspectives.Methods: As part of a large, multi-country prospective cohort study - the Childhood Acute Illness and Nutrition (CHAIN) Network - we conducted a qualitative study to understand the post-discharge treatment-seeking and recovery experiences of families of undernourished children aged 2-23 months admitted in two icddr,b (International Centre for Diarrhoeal Disease Research, Bangladesh) hospitals. To gather parent perspectives, we gathered in-depth qualitative data from family members of 17 purposively selected undernourished children from a rural and urban hospital. These data were supplemented by observations in hospitals and homes and from health worker interviews. We interviewed family members on discharge and again in their homes after discharge over several visits. Results: 13 of the 17 purposively selected children were reported by family members to have fully recovered by the time we completed our interviews; four had died. Important perceived drivers of treatment-seeking and recovery included advice provided while in hospital, media campaigns on hygiene practice, positive social and financial support from family members, relatives and neighbours, and the availability of free treatment. Key challenges included low household incomes, mothers having to juggle multiple responsibilities in addition to caring for the child, lack of support - and in some cases violence - from the child’s father, and family members’ preference for relatively accessible drug shops, physicians or healers over (re)admission to hospital. For most families, a range of challenges interplayed to contribute to early discharge from hospital against medical advice and to non-adherence to follow-up advice. Providers were primarily concerned about an inappropriately high use of antibiotics among families.Conclusion: Development of interventions that address the range of vulnerabilities that many families face is essential to support post-discharge adherence to medical advice and ensure recovery. These data suggest that potential interventions could include strengthening information giving during hospitalization on what post-discharge care is needed and why, reducing direct and indirect costs associated with hospital visits, engaging fathers and other ‘significant others’ in post-discharge advice, and building mobile phone-based support for follow-up care.

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Structural determinants of gender inequality: why they matter for adolescent girls’ sexual and reproductive health

Abstract: More comprehensive understanding of gender inequality is required, particularly the broader structural drivers that underpin the political economy of gender power relations, say Asha George and colleagues

Cited by 64 publications

References 24 publications

HIV knowledge and associated factors among young Ethiopians: application of multilevel order logistic regression using the 2016 EDHS

HIV knowledge and associated factors among young Ethiopians: application of multilevel order logistic regression using the 2016 EDHS

Is the Glass Half-Full or Half-Empty? A Content Analysis of Adolescent Sexual and Reproductive Health in Global Financing Facility Country Plans

Parent and Provider Perspectives on Factors Influencing Treatment-Seeking and Recovery After Hospital Discharge Among Undernourished Children Aged 2-23 Months in Bangladesh

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