REPORTS ON POPULATION COUNCIL RESEARCH

I N S I D E

Preclinical Study Shows Microbicide Gel’s Effectiveness Against HIV and Other Viruses ................................................................2

Ensuring that Family Planning Programs Respect, Protect, and Fulfill Women’s Rights......................................................................3

The Influence of Rural Women’s Autonomy on Marital Violence in Four Indian States ...............................................................................4

Meeting the Needs of Adolescent Girls: Using Research to Develop and Implement Programs that Improve Girls’ Lives ................5

A proprietary microbicide gel developed by the Population Council has been found in animal studies to prevent the transmission of HIV, herpes simplex virus 2, and human papillomavirus.

Volume 20, Number 2 August 2014

2 P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 p o p c o u n c i l . o r g / p o p b r i e f s

Results of a recent animal study offer new optimism for microbicides, biomedical products being developed to protect people against sexually transmitted infections (STIs), including HIV. Population Council scientists and their partners have found that a propri-etary microbicide gel developed by the Council is safe, stable, and can prevent the transmis-sion of HIV, herpes simplex virus 2 (HSV-2), and human papillomavirus (HPV), in both the vagina and rectum in animals. It has a window of efficacy in the vagina against all three viruses of at least eight hours prior to exposure. An in vitro study also provides the first data that the gel is effective against mul-tiple strains of HIV.

The gel, known as MZC, contains MIV-150, zinc acetate, and carrageenan. MIV-150 and zinc acetate are potent antiviral agents that inhibit HIV via different mechanisms of action. MIV-150 is an enzyme inhibitor that blocks an early step of HIV replication in target cells, and zinc acetate is an antiviral agent with demonstrated activity against HIV and HSV-2. These compounds are mixed in a water-based solution of carrageenan, a compound derived from seaweed that has been shown to have po-tent activity against HPV. Infection with HSV-2 or HPV is associated with increased risk of HIV infection. Researchers believe that microbicides that target HIV, HSV-2, and HPV may more ef-fectively limit HIV transmission than those that target HIV alone.

In this study, Council scientists and their partners used macaque and mouse models to examine whether MZC gel could prevent vaginal and rectal transmission of SHIV-RT (a virus combining genes from HIV and SIV, the monkey version of HIV), HSV-2, and HPV. They found that MZC:

• protected macaques against vaginal SHIV-RT infection when applied up to 8 hours prior to challenge

• protected macaques against rectal SHIV-RT infection when used close to the time of viral challenge

• protected mice against HSV-2 infection when applied vaginally or anally/rectally just before a high dose of virus

• protected mice against HSV-2 when applied between 8 hours before and 4 hours after vaginal challenge with a low dose of HSV-2

• protected mice against HPV when applied up to 24 hours before and 2 hours after vaginal challenge and also if applied 2 hours before or after HPV inoculation of the anus/rectum.

Researchers involved in developing MZC described the results of the preclinical study as particularly encouraging because of the product’s broad spectrum of activity. According to José A. Fernández-Romero, a scientist at the Population Council and corresponding author

of the paper, “It is the versatility of MZC that makes it a desirable microbicide candidate. It is effective against multiple viruses, can be used in both the vagina and the rectum, and retains its efficacy in the vagina over an extended period of time.”

Some microbicides are being designed as vaginal products for women, and others as rectal products for either men or women. Several candidate microbicides have been developed and tested over the past two decades. Turning the concept into reality has proved difficult, however. To date, no product has advanced beyond clinical trials in humans to regulatory approval.

The study was designed to establish proof of concept in monkeys and mice before taking steps to test in humans. Preclinical testing in animals is required by the FDA and is impor-tant to ensure the highest level of safety and to build the evidence base for potential efficacy in humans. Phase 1 safety trials of the gel in humans are now underway.

“In addition to the gel,” said Fernández-Romero, “we are exploring sustained-release intravaginal rings and on-demand nanofiber-based delivery systems for MZC.” He stressed that developing different delivery systems for effective medications is an important step in ensuring the ultimate success of any microbi-cide, adding, “There is a growing demand for microbicides that prevent multiple STIs, and we are committed to ensuring that women and men have options when choosing what works most effectively for their own protection.”

SOURCEKizima, Larisa, Aixa Rodríguez, Jessica Kenney, Nina Derby, Olfa Mizenina, et al. 2014. “A potent combination microbicide that targets SHIV-RT, HSV-2 and HPV”. PLoS ONE 9(4): e94547. doi:10.1371/ journal.pone.0094547

FUNDINGUS Agency for International Development (USAID)

HIV AND AIDS

Preclinical Study Shows Microbicide Gel’s Effectiveness Against HIV and Other Viruses

“There is a growing

demand for microbicides

that prevent multiple

STIs, and we are

committed to ensuring

that women and men

have options when

choosing what works

most effectively for their

own protection.”

p o p c o u n c i l . o r g / p o p b r i e f s P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 3

In the developing world, 222 million women would like to delay or avoid pregnancy but are not using modern contraceptives. At the 2012 London Summit on Family Planning, the international community made a commitment to reduce this unmet need by reaching 120 mil-lion women and girls from the world’s poorest countries with voluntary access to family plan-ning information, contraceptives, and services by 2020, an agreement known as FP2020.

The goals of the London Summit and FP2020 have been greeted positively by most organizations and individuals involved in family planning. However, concerns have been raised about certain aspects of the agreement, particularly the numeric goal setting. For example, some observers have said that setting such goals would lead to efforts focusing on the populations who are easiest to reach, in particular women and girls in urban areas who already have access to some services, rather than those who are harder and more costly to reach. These individuals, such as women and girls who are illiterate, undereducated, or live in rural areas, could be largely ignored.

Such concerns were cited by several leading family planning experts who devel-oped a new “Framework for Voluntary Family Planning Programs that Respect, Protect, and Fulfill Human Rights.” This framework, featured in the Population Council’s journal Studies in Family Planning in March 2014, is predicated on the notion that all women and girls, regardless of where they live or how difficult they are to reach and support, have the right to comprehensive family planning information and services.

The framework offers a practical approach to incorporating human rights into the develop-ment, implementation, monitoring, and evalu-ation of voluntary family planning programs. The approach is based on research and analysis indicating that transparent, accountable family planning programs that are grounded in hu-

man rights are the most successful in meeting the needs of women and girls.

The framework defines a human rights-based approach to voluntary family planning as requiring the following:

• Carefully analyzing and considering existing inequities in family planning and reproductive health programs, and in the laws and policies that govern these programs

• Ensuring that policies and programs are anchored in a system of rights by integrat-ing core principles such as accountability, empowerment, equitable service delivery, and non-discrimination

• Focusing on availability, accessibility, acceptability, and quality when defining service standards

• Empowering all individuals—especially those in the most marginalized popula-tions—to play a central role in the devel-opment of policies and hold stakeholders accountable for demonstrating meaningful change

Programs that are grounded in human rights will help women and adolescent girls access the information and services they need, when they need them. A renewed global commitment to provide support for family planning provides an opportunity to transform family planning programs and reach those most vulnerable and in need of these life-changing services.

The framework was developed by re-searchers at The Futures Group and Engender-Health, with support from the Bill & Melinda Gates Foundation. The lead author, Karen Hardee, is now a Population Council senior associate and director of the Council’s USAID-funded Evidence Project.

“Human rights treaties and conventions that uphold reproductive rights have the status of international law. Countries throughout the

world are signatories to these human rights treaties and conventions,” said Hardee. “Family planning programming to meet FP2020 goals must have human rights values and norms at their core. The global commitment to provide support for family planning that was galvanized at the 2012 London FP Summit offers the oppor-tunity to transform family planning programs and reach all of those in need of services.”

SOURCEHardee, Karen, Jan Kumar, Karen Newman, Lynn Bakamjian, Shannon Harris, Mariela Rodríguez, and Win Brown. 2014. “Voluntary, human rights–based family planning: A conceptual framework”. Studies in Family Planning 45[1]: 1–18. www.popcouncil.org/ research/voluntary-human-rights-based-family- planning-a-conceptual-framework

FUNDINGThe Bill & Melinda Gates Foundation

FAMILY PLANNING

Ensuring that Family Planning Programs Respect, Protect, and Fulfill Women’s Rights

Family planning programs need to ensure access for all women, including women who are harder and more costly to reach, such as those who live in rural areas.

4 P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 p o p c o u n c i l . o r g / p o p b r i e f s

There is evidence that women in India who have more education than their husbands, who earn more, or who are the sole earners in their families have a higher likelihood of experienc-ing intimate partner violence (IPV) than women who are not employed or who are less educated than their spouse. However, recent Population Council research found women’s autonomy to be correlated with less IPV in some regions.

Three researchers at the Population Council in India, Shagun Sabarwal, K. G. San-thya, and Shireen J. Jejeebhoy, investigated the relationship between rural women’s autonomy and their experience of IPV in four Indian states (Bihar and Jharkhand in the north and Maharashtra and Tamil Nadu in the south). The study is believed to be the first to prospec-tively examine this relationship in regions characterized by varying levels of gender equity. Bihar and Jharkhand are more conservative and patriarchal; Maharashtra and Tamil Nadu are more egalitarian. The study also examined the relationship between changes in women’s autonomy over time and their experiences of IPV. (Past studies have used cross-sectional data, which cannot evaluate such changes over time.)

For this study, Council researchers reviewed data from two linked studies: the National Family Health Survey-2 (NFHS-2), a nationally representative population-based survey conducted during 1998-1999, and a follow-up study of women interviewed in NFHS-2 in Bihar, Jharkhand, Maharashtra, and Tamil Nadu carried out during 2002-2003.

The researchers focused on three dimen-sions of autonomy: financial autonomy, freedom of movement, and household decision-making among a sample of 4,904 rural women. A similar set of questions was used to assess the extent of women’s autonomy at baseline and at follow-up, including the following:

•For financial autonomy, one item was measured: whether women were allowed to have money set aside for them to use as they wished.

•For freedom of movement, two items were measured: whether women needed permis-sion to (a) go to the market and (b) visit friends or relatives.

•For household decision-making autonomy, three items were considered: whether women made decisions on the following (a) seeking health care for themselves, (b) the purchase of jewelry, and (c) visiting relatives/friends. Women who reported independent say in decisions related to at least one of the three topics were considered to have decision-making autonomy.

The researchers controlled for a number of background variables, including religion, educational level, wealth status at baseline, and change in wealth status from baseline to follow-up—as well as variables specific to the Indian context, such as caste.

Key FindingsThe researchers’ analysis revealed that the effects of women’s autonomy on their experience of violence varied according to region of residence. For example, for respondents residing in Maharahstra and Tamil Nadu, in the southern region of India, where gender relations are less hierarchical and more egalitarian, researchers found a strong protective relationship between women’s financial autonomy and marital violence. No such effects were seen among sample subjects residing in Bihar and Jharkand, in the northern part of the country, which is characterized by greater gender inequality.

The study’s authors posit that in compari-son with the southern states, even financially autonomous women in those northern states have limited capacity to (a) challenge the acceptability of partner violence, (b) expect or receive better treatment from partners, or (c) find social support that can potentially prevent violence from their partner.

The authors strongly recommend implementing strategies and interventions to protect women, such as providing shelters and support groups and making legal and psycho-logical counseling more widely available. They recognize and support the importance of further enhancing the conditions for women to attain greater autonomy and to change norms and laws that keep them at risk for violence at the hands of their partners.

“More focused efforts are needed to enhance married women’s agency, mitigate their social disadvantage, and encourage sav-ings among women,” said Santhya. “Equally important are efforts to raise awareness among women about their rights and enhance their ability to challenge existing gender norms.”

SOURCEShagun Sabarwal, K. G. Santhya, and Shireen J. Jejeebhoy. 2013. “Women’s autonomy and experience of physical violence within marriage in rural India: Evidence from a prospective study,” Journal of Inter-personal Violence. doi: 10.1177/0886260513505144

The Influence of Rural Women’s Autonomy on Marital Violence in Four Indian States

POVERTY, GENDER, AND YOUTH

Whether a woman in India with financial autonomy is at increased risk of marital violence might depend upon the level of gender equality where she lives.

p o p c o u n c i l . o r g / p o p b r i e f s P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 5

In Zambia, Population Council researchers are implementing and evaluating the Ado-lescent Girls Empowerment Program (AGEP) using a randomized control trial, in order to provide strong evidence of the intervention’s impact. AGEP will enroll 10,000 poor adoles-cent girls and address their social isolation, economic vulnerability, and lack of access to vital health services.

Three Components

AGEP has three main components: safe spaces meetings, health vouchers, and savings accounts:

• Safe spaces: During weekly meetings, 20-30 girls gather with a local mentor in a safe place, such as a community center. There, they develop supportive social networks and receive training on health, life skills, and money management.

• Health vouchers: Girls are given vouchers for health services that they can redeem at partner public and private health providers.

• Savings accounts: Girls can open a “Girls Dream” savings account at a nearby bank that has partnered with the program.

The randomized control trial has three arms, so that researchers can assess the added effect of each component. In group 1, girls will attend safe spaces meetings. In group 2, girls will attend safe spaces meetings and receive a health voucher. In group 3, girls will attend safe spaces meetings, receive a health voucher, and have access to a savings account.

The study will document how each activity affects the participants and whether there are added benefits of a health voucher and a sav-ings account. Researchers will focus on primary impact indicators of school attainment, HIV prevalence, HSV-2 prevalence, age at mar-riage, age of sexual initiation, age of first birth, and experience of sexual violence. The data

will also reveal effects on self-esteem, agency, gender norms, savings activity, income genera-tion, health service seeking, and nutritional status. Finally, the study will determine the cost of delivering each program component and the cost of achieving each additional benefit. Such information is crucial in places where resources are scarce.

Pilot Phase

This research started with a pilot phase during which the researchers collected evidence to help them fine-tune the three program components. This assessment suggested a number of specific adjustments to each component to allow suc-cessful program scale-up. Some examples include:

• outlining attendance requirements for mentors in their contracts to make clear that the monthly stipend is dependent upon attendance;

• bringing the girls to the bank as a group to open their savings accounts; and

• ensuring that materials about the health voucher are available for girls with low or no literacy.

These and other important lessons will help guide the program as it expands to sites across rural and urban Zambia, ultimately reaching more than 10,000 girls aged 10 to 19. The evaluation of the program’s randomized control trial will take place in 2017.

SOURCESAustrian, K., N. Jackson Hachonda, and P. Hewett. 2013. “The Adolescent Girls Empowerment Program: Lessons learned from the pilot test program.” Lusaka: Population Council.

Population Council. 2013. Financial education curricu-lum for the Adolescent Girls Empowerment Program (AGEP). Lusaka: Population Council.

———. 2013. Health and life skills curriculum for the Adolescent Girls Empowerment Program (AGEP). Lusaka: Population Council.

DONORUK Department for International Development

Meeting the Needs of Adolescent Girls: Using Research to Develop and Implement Programs that Improve Girls’ Lives

POVERTY, GENDER, AND YOUTH

As part of the Adolescent Girls Empowerment Program (AGEP), girls participate in financial literacy and life skills activities.

6 P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 p o p c o u n c i l . o r g / p o p b r i e f s

Recent Publications

Publications are by Population Council staff members, consultants, or staff from partner organizations. Year of publication is 2014 unless otherwise noted. Names in boldface are staff members, consultants, or those seconded from partner organizations.

HIV AND AIDS

Ahonsi, Babatunde, Nahla Abdel-Tawab, Scott Geibel, Sam Kalibala, Jerry Okal, Babacar Mane, Nathi Sohaba, Julialynne Walker, and Eric P. Green. “HIV/AIDS vulnerabilities, discrimination, and service accessibility among Africa’s youth: Insights from a multi-country study.” Abuja: Population Council.

Catalani, Caricia, Eric P. Green, Lameck Diero, Jane Carter, Martin Were, Dennis Israelski, Adrian Gardner, Charity Ndwiga, and Paul Biondich. “Provider alerts and reminders to improve tuberculosis care among people living with HIV in Kenya: TB Tech formative report.” Washington, DC: Population Council.

“Evidence for action: News from the Population Council in Nigeria,” Issue no. 5, April. Abuja: Population Council.

Gloyd, Stephen S., Julia Robinson, Serge A. Dali, S. Adam Granato, Rebecca Bartlein, Seydou Kouyaté, David Aka, Doroux A. Billy, Irma Ahoba, and Ahoua Koné. “PMTCT cascade analysis in Côte d’Ivoire: Results from a national representative sample.” Washington, DC: Population Council.

Hardee, Karen, Jill Gay, Melanie Croce-Galis, and Nana A. Afari-Dwamena. “What HIV programs work for adolescent girls?” Journal of Acquired Immune Deficiency Syndromes 66(suppl 2): S176–S185.

Jani, Nrupa and Katie D. Schenk. “Formative research to develop an intervention for addressing mental health/psychosocial issues and HIV vulnerability of marginalized adolescents in Addis Ababa, Ethiopia.” Washington, DC: Population Council.

Kalibala, Sam. 2013. “The diagonal approach: Programming to combat HIV while strengthening primary health care systems in Africa,” in Global HIV/AIDS Politics, Policy and Activism: Persistent Challenges and Emerging Issues (Volume 1: Politics and Government). Santa Barbara, CA: Praeger, pp. 169–196.

Kalibala, Sam, Waimar Tun, Peter Cherutich, Anne Nganga, Erick Oweya, and Patricia Oluoch. “Factors associated with acceptability of HIV self-testing among health care workers in Kenya,” AIDS and Behavior 18(suppl 4): 405–414.

Kizima, Larisa, Aixa Rodriguez, Jessica Kenney, Nina R. Derby, Olga Mizenina, Radhika Menon, Samantha Seidor, Shimin Zhang, Keith Levendosky, Ninochka Jean-Pierre, Pavel Pugach, Guillermo Villegas, Brian E. Ford, Agegnehu Gettie, James F. Blanchard, Michael Piatak Jr., Jeffrey D. Lifson, Gabriela Paglini, Natalia Teleshova, Thomas M. Zydowsky, Melissa Robbiani, and Jose A. Fernandez-Romero. “A potent combination microbicide that targets SHIV-RT, HSV-2 and HPV,” PLoS ONE 9(4): e94547.

Mburu, Gitau, Ian Hodgson, Sam Kalibala, Choolwe Haamujompa, Fabian Cataldo, Elizabeth D. Lowenthal, and David Ross. “Adolescent HIV disclosure in Zambia: Barriers, facilitators and outcomes,” Journal of the International AIDS Society 17: 18866.

Population Council. “Baseline survey of Nigerian media coverage of youth sexual and reproductive health and HIV and AIDS related issues, January 1st - December 31st, 2012.” Abuja: Population Council.

———. “An overview of the HIV prevention landscape in Zimbabwe: Implications for tenofovir gel,” Landscaping report. New York and Johannesburg: Population Council.

Pulerwitz, Julie and John Bongaarts. “Tackling stigma: Fundamental to an AIDS-free future,” The Lancet Global Health 2(6): e311–e312.

Ramirez, Catalina B., Natasha Mack, and Barbara A. Friedland. 2013. “A toolkit for developing bilingual lexicons for international HIV prevention clinical trials.” New York: Population Council and FHI 360.

Sarna, Avina, Sowmya Ramesh, and Eileen A. Yam. 2013. “Operations research methodology options: Assessing integration of sexual and reproductive health and HIV services for key affected populations.” Bangkok: UNFPA and Population Council.

Sarna, Avina, Lopamudra Saraswati, Mary Philip Sebastian, Vartika Sharma, Ira Madan, Dean Lewis, Julie Pulerwitz, Ibou Thior, and Waimar Tun. “High HIV incidence in a cohort of male injection drug users in Delhi, India,” Drug and Alcohol Dependence 139: 106–114.

Sarna, Avina, Mary Philip Sebastian, Damodar Bachani, Ruchi Sogarwal, and Madhusudana Battala. “Pretreatment loss-to-follow-up after HIV diagnosis from 27 counseling and testing centers across India: Findings from a cohort study,” Journal of the International Association of Providers of AIDS Care 13(3): 223–231.

Schenk, Katie D., Barbara A. Friedland, Michelle Chau, Marie Stoner, Marlena Gehret Plagianos, Stephanie Skoler-Karpoff, Thesla Palanee, Khatija Ahmed, Mary-Jane Malebo Ratlhagana, Pamela Nombali Mthembu, and Nomampondomise Ngcozela. “Enrollment of adolescents aged 16–17 years old in microbicide trials: An evidence-based approach,” Journal of Adolescent Health 54(6): 654–662.

Tun, Waimar, Jerry Okal, Katie D. Schenk, Meredith Sheehy, Emmanuel Kuffour, Selina Esantsi, Hilary Asiah, Grimond Moono, Felix Mutale, Rita Kyeremaa, Edson Ngirabakunzi, and Atwijukire Justus. 2013. “Situation analysis of programs to meet the HIV prevention, care, and treatment needs of persons with disabilities in Ghana, Uganda, and Zambia,” HIVCore Final Report. Washington, DC: USAID | Project Search: HIVCore.

POVERTY, GENDER, AND YOUTH

Abdel-Tawab, Nahla, Khaled El-Sayed, and Sarah Ismail. “Transition from community education to formal schooling: Ishraq program experience [Arabic].” Cairo: Population Council.

Abdel-Tawab, Nahla, Sally Saher, and Nora El Nawawi. 2013. “Breaking the silence: Learning about youth sexual and reproductive health in Egypt,” report. Cairo: Population Council.

“The adolescent experience in-depth: Using data to identify and reach the most vulnerable young people—Rwanda 2010.” New York: Population Council, 2013.

Blanc, Ann K. “Excess risk of maternal mortality in adolescent mothers,” The Lancet Global Health 2(4): e201.

Bongaarts, John. “Demographic aspects of population policies,” in Bruce Jennings (ed.), Bioethics, 4th Edition. Farmington Hills, MI: Macmillan Reference USA.

———. “How exceptional is the pattern of fertility decline in sub-Saharan Africa?” United Nations Population Division Expert Paper No. 2013/4. New York: United Nations.

“Building evidence on effective programs to delay marriage and support married girls in Africa,” Brief, July. Addis Ababa: Population Council.

Engebretsen, Sarah. 2013. “Étude de suivi des adolescentes migrantes employées de maison ayant participé à la première cohorte du programme Filles éveillées,” Rapport technique. New York: Population Council.

———. 2013. “Évaluation de Filles éveillées : Programme pilote pour adolescentes migrantes employées de maison,” Rapport évaluation. New York: Population Council.

Jejeebhoy, Shireen J., P.M. Kulkarni, K.G. Santhya, and Firoza Mehrotra. Population and Reproductive Health in India: An Assessment of the Current Situation and Future Needs. New Delhi: Oxford University Press.

Jejeebhoy, Shireen J., K.G. Santhya, and Rajib Acharya. “Violence against women in South Asia: The need for the active engagement of the health sector,” Global Public Health 9(6): 678–690.

McDonald, Robert I., Katherine Weber, Julie Padowski, Mark R. Montgomery, et al. “Water on an urban planet: Urbanization and the reach of urban water infrastructure,” Global Environmental Change 27: 96–105.

Mmari, Kristin, Robert W. Blum, Freya Sonenstein, Beth Marshall, Heena Brahmbhatt, Emily Venables, Sinead Delany-Moretlwe, Chaohua Lou, Ershang Gao, Rajib Acharya, Shireen J. Jejeebhoy, and Adesola Sangowawa. “Adolescents’ perceptions of health from disadvantaged urban communities: Findings from the WAVE study,” Social Science and Medicine 104: 124–132.

Mmari, Kristin, Hannah Lantos, Heena Brahmbhatt, Sinead Delany-Moretlwe, Chaohua Lou, Rajib Acharya, and Adesola Sangowawa. “How adolescents perceive their communities: A qualitative study that explored the relationship between health and the physical environment,” BMC Public Health 14: 349.

Psaki, Stephanie. “Population Council and girls’ education: Stronger evidence for better outcomes,” Brief, July. New York: Population Council.

Rashed, Ali and Maia Sieverding. “Micro and small household enterprises in Egypt: Potential for growth and employment generation,” Working Paper no. 831. Giza, Egypt: Economic Research Forum.

Roushdy, Rania and Irene Selwaness. “Duration to coverage: Dynamics of access to social security in the Egyptian labor market in the 1998–2012 period,” Working Paper no. 836. Giza, Egypt: Economic Research Forum.

Selim, Mona, Nahla Abdel-Tawab, Khaled El-Sayed, Asmaa Elbadawy, and Heba El Kalaawy. 2013. “The Ishraq Program for out-of-school girls: From pilot to scale-up [Arabic].” Cairo: Population Council.

REPRODUCTIVE HEALTH

Adongo, Philip Baba, Placide Tapsoba, James F. Phillips, Philip Teg-Nefaah Tabong, Allison Stone, Emmanuel Kuffour, Selina Esantsi, and Patricia Akweongo. “’If you do vasectomy and come back here weak, I will divorce you’: A qualitative study of community perceptions about vasectomy in southern Ghana,” BMC International Health and Human Rights 14: 16.

Agrawal, Praween Kumar, Kumudha Aruldas, and M.E. Khan. “Training manual on basic monitoring and evaluation of social and behavior change communication health programs,” toolkit. New Delhi: Population Council.

p o p c o u n c i l . o r g / p o p b r i e f s P O P U L A T I O N B R I E F S 2 0 ( 2 ) A U G U S T 2 0 1 4 7

Recent Publications

Akhter Huda, Fauzia, Sabiha Chowdhuri, Yolande Robertson, Noushin Islam, Bidhan Krishna Sarker, Ashrafi Jahan Azmi, and Laura Reichenbach. 2013. “Understanding unintended pregnancy in Bangladesh: Country profile report,” Research report, December. Dhaka: icddr,b.

“Améliorer l’accès à la planification familiale au ghana par un changement ‘orientation: Partage des taches pour permettre aux aides-soignants d’offrir des services d’implants contraceptifs,” Note d’orientation. Accra: Population Council.

“BCS+: The Balanced Counseling Strategy Plus,” fact sheet. Washington, DC: Population Council.

Beguy, Donatien, Joyce Mumah, Salome Wawire, Kanyiva Muindi, Lindsey Gottschalk, and Caroline W. Kabiru. 2013. “Status report on the sexual and reproductive health of adolescents living in urban slums in Kenya,” STEP UP Technical Working Paper. Nairobi: African Population and Health Research Center.

Beguy, Donatien, Robert Ndugwa, and Caroline W. Kabiru. 2013. “Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya,” Journal of Biosocial Science 45(6): 721–742.

Clarke, Kaila, Mohamadou Sall, Babacar Mane, Nafissatou Diop, and Bocar Mamadou Daff. 2013. “Comprendre les grossesses non désirées au Sénégal: Rapport du Profil Pays,” Rapport de Recherche STEP UP. Dakar: Population Council.

“Confronting disrespect and abuse during childbirth in Kenya: The Heshima Project,” Project Brief. Nairobi: Population Council.

Daniele, Marina. “Postpartum family planning in Burkina Faso,” STEP UP Research Report. London: London School of Hygiene and Tropical Medicine.

Dibaba Wado, Yohannes, Mesganaw Fantahun Afework, and Michelle J. Hindin. 2013. “The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: Evidence from rural southwestern Ethiopia,” BMC Pregnancy and Childbirth 13: 135.

———. “Childhood vaccination in rural southwestern Ethiopia: The nexus with demographic factors and women’s autonomy,” Pan African Medical Journal 17(Suppl 1): 9.

“Final report: Emergency contraception in crisis settings consultation.” Arlington, VA: International Consortium for Emergency Contraception, JSI, Population Council, and Women’s Refugee Commission.

Hossain, Sharif Mohammed Ismail, Saumya RamaRao, Ismat Ara Hena, and Ubaidur Rob. “Maternal health commodity landscaping exercise: A snapshot of the Bangladesh program.” Dhaka: Population Council.

Ikamari, Lawrence, Chimaraoke O. Izugbara, and Rhoune Ochako. 2013. “Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya,” BMC Pregnancy and Childbirth 13(69).

“Increasing access to family planning in Ghana through policy change: Task-sharing to enable auxiliary nurses to provide contraceptive implant services,” Policy brief. Accra: Population Council.

“International seminar on ‘Is access enough? Understanding and addressing unmet need for family planning’,” STEP UP Seminar Report. Nairobi: STEP UP, 2013.

Izugbara, Chimaraoke O. and Carolyne Egesa. “The management of unwanted pregnancy among women in Nairobi, Kenya,” International Journal of Sexual Health 26(2): 100–112.

Kabiru, Caroline W., Chimaraoke O. Izugbara, and Donatien Beguy. 2013. “The health and wellbeing of young people in sub-Saharan Africa: An under-researched area?” BMC International Health and Human Rights 13(11).

Kabiru, Caroline W., Chimaraoke O. Izugbara, Donatien Beguy, and Estelle M. Sidze. 2013. “Transitions to adulthood in a high fertility context: The case of sub-Saharan Africa,” United Nations Population Division Expert Paper 2013/3. New York: United Nations.

Kanya, Lucy, Francis Obare, Charlotte Warren, Timothy Abuya, Ian Askew, and Benjamin Bellows. 2013. “Safe motherhood voucher programme coverage of health facility deliveries among poor women in South-western Uganda,” Health Policy and Planning 29(suppl 1): i4–i11.

Khan, M.E., Anvita Dixit, Isha Bhatnagar, and Martha Brady. “Medical barriers to emergency contraception: A cross-sectional survey of doctors in North India,” Global Health: Science and Practice 2(2): 210–218.

Machiyama, Kazuyo and John C. Cleland. 2013. “Analyse des besoins non satisfaits au Sénégal,” Rapport de Recherche STEP UP. London: London School of Hygiene and Tropical Medicine.

———. 2013. “Unmet need for family planning in Ghana: Trends and determinants,” IUSSP Working Paper. Paris: IUSSP.

Marston, Milly, Donatien Beguy, Caroline W. Kabiru, and John C. Cleland. 2013. “Predictors of sexual debut among young adolescents in Nairobi’s informal settlements,” International Perspectives on Sexual and Reproductive Health 39(1): 22–31.

“Measuring the impact of contraceptive use on unintended pregnancy and other health outcomes,” STEP UP Brief, April. New York: Population Council.

Mir, Ali Mohammad and Gul Rashida Shaikh. 2013. “Islam and family planning: Changing perceptions of health care providers and medical faculty in Pakistan,” Global Health: Science and Practice 1(2): 228–236.

Mir, Ali Mohammad, Abdul Wajid, Steve Pearson, Mumraiz Khan, and Irfan Masood. 2013. “Exploring urban male non-marital sexual behaviours in Pakistan,” Reproductive Health 10(1): 22.

Mruk, Dolores D., Xiang Xiao, Marta Lydka, Michelle W.M. Li, Barbara Bilinska, and Chuen-yan Cheng. “Intercellular adhesion molecule 1: Recent findings and new concepts involved in mammalian spermatogenesis,” Seminars in Cell & Developmental Biology 29: 43–54.

Mukiira, Carol, Joyce Mumah, Caroline W. Kabiru, and Chimaraoke O. Izugbara. “Unintended pregnancy by the numbers: A look at Kenya,” STEP UP Fact Sheet. Nairobi: African Population and Health Research Center.

Mumah, Joyce, Caroline W. Kabiru, Chimaraoke O. Izugbara, and Carol Mukiira. “Coping with unintended pregnancies: Narratives from adolescents in Nairobi’s slums,” STEP UP Research Report. Nairobi: African Population and Health Research Center.

Mumah, Joyce, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, and Ian Askew. “Unintended pregnancies in Kenya: A country profile,” STEP UP Research Report. Nairobi: African Population and Health Research Center.

Ngo, Thoai D., Min Hae Park, and Caroline Free. 2013. “Safety and effectiveness of termination services performed by doctors versus midlevel providers: A systematic review and analysis,” International Journal of Women’s Health 5: 9–17.

“La planification familiale postpartum au Burkina Faso—résumé en français,” STEP UP Research Report summary. London: London School of Hygiene and Tropical Medicine.

Raifman, Sarah, Sisay Mellese, Kelemua Hailemariam, Ian Askew, and Annabel S. Erulkar. 2013. “Assessment of the availability and use of maternal health supplies in the primary health care system in Amhara Region, Ethiopia,” Final report. Addis Ababa: Population Council.

Sathar, Zeba A. 2013. “Family planning: A missing priority in Pakistan’s health sector?” The Lancet 381(9884): 2140–2141.

Sebastian, Mary Philip, M.E. Khan, and Daliya Sebastian. “Unintended pregnancy and abortion in India: Country profile report,” STEP UP Research Report. New Delhi: Population Council.

STEP UP Research Programme Consortium. “Second consultation on developing standards for identifying evidence-based practices in reproductive health,” STEP UP Report. New York: Population Council.

Undie, Chi-Chi, Harriet Birungi, Francis Obare, Wilson Liambila, and Ian Askew. “Community-based interventions can expand access to comprehensive RH and HIV information and services for married adolescent girl,” International Journal of Child and Adolescent Health 7(1).

Undie, Chi-Chi, Lynn Van Lith, Mercy Wahome, Francis Obare, Esther Oloo, and Carolyn Curtis. “Community mobilization and service-strengthening to increase awareness and use of post-abortion care and family planning in Kenya,” International Journal of Gynecology and Obstetrics 126(1): 8–13.

Yam, Eileen A., Zandile Mnisi, S. Maziya, Caitlin E. Kennedy, and Stefan Baral. “Use of emergency contraceptive pills among female sex workers in Swaziland,” Journal of Family Planning and Reproductive Health Care 40(2): 102–107.

Zama, Mary, Mardieh Dennis, Jessica Price, Stephanie M. Topp, Jonathan K. Mwansa, and Jill Keesbury. 2013. “Mitigating the consequences of sexual violence in Zambia by decentralizing emergency medical responses to police victim support units: Report on the feasibility of police provision of post-exposure prophylaxis for HIV (PEP) in Zambia.” Lusaka: Population Council.

OTHER

“Achieving an AIDS-free future,” Momentum, May.

Population and Development Review 40(2).

Studies in Family Planning 45(2).

Population Briefs is a research newsletter of the Population Council.

The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees.

Population Council One Dag Hammarskjold Plaza New York, New York 10017 popcouncil.org

Editor: Gina Duclayan

Writer: Jeff Hoover

Editorial Board: Sasha Gruber and Erin Kiernon

Design and Production Manager: Mike Vosika

Copyeditor: Robert Heidel

Editorial Assistant and Circulation: Debra Warn

Photos: Population Council staff.

Population Briefs is distributed without charge. Information in this newsletter may be reproduced without permission, provided it is distrib-uted without charge and the source is acknowledged.

To receive updates from the Population Council, including when a new issue of Population Briefs is posted to our Web site, click “Subscribe” on our homepage: popcouncil.org

ISSN 1084–6786

© 2014 The Population Council, Inc. Printed on recycled paper.

Non-Profit OrganizationU.S. Postage

PAIDNew Haven, CT

Permit #350

A new framework aims to help voluntary family planning programs respect, protect, and fulfill human rights.