Interventions to reduce the prevalence of female genital mutilation/cutting in African countries
This review, prepared by the International Initiative for Impact Evaluation (3ie), adopts a realist synthesis approach that integrates the effectiveness data of interventions to reduce the prevalence of female genital mutilation/cutting (FGM/C) when compared with either no or another active intervention with context data on how factors related to the continuation or discontinuation of FGM/C help to explain the effectiveness of FGM/C interventions. The data were derived from a rigorously conducted systematic review of the available literature.
Overall the study looked at 7042 participants from nine African countries. Eight effectiveness and 27 context studies were idenitfied for the review. FGM/C is reported to be practiced in around 28 African countries. The prevalence of FGM/C in certain countries is around 70%, although there is considerable variation both within and between countries. The interventions assessed include training and education (including the Tostan education programme), outreach and advocacy and multimedia communication. The synthesis of context studies showed that the factors related to the continuance and discontinuance of FGM/C varied across contexts, but the main factors that supported FGM/C were tradition, religion and reduction of women's sexual desire. The main factors that hindered FGM/C were medical complications and prevention of sexual satisfaction. The extent to which a conclusion could be drawn, on how the factors related to the continuance and discontinuance of FGM/C can help to explain the effectiveness of interventions, was limited. However, the effectiveness of any intervention was dependent on the successful dissemination of information about FGM/C, and a range of contextual factors. For example, where FGM/C and Islam were closely related, failure to involve religious leaders and ensuring that the programme had considered the benefits for the community tended to correlate with a lower attendance and higher programme drop-out rate. Recommendations include: the need to establish community-approved, nonsectarian, politically and culturally acceptable organisations to work towards the abandonment of FGM/C; programme managers must gain the support of local community decision makers and ensure that interventions are culturally responsive; the need to conduct well-designed and methodologically sound evaluations of interventions, ensure long-term measurement of outcomes and in particular address local community enforcement systems that support FGM/C and be based upon key behaviour change theories.
Toolkit on how to protect and promote the nutrition of mothers and children
This web-based toolkit published by the World Bank has been specifically designed to help countries in Latin America and the Caribbean—which tend to be affected recurrently by a range of crises, including social and economic upheavals, periods of major food price volatility and devastating natural disasters—devise and introduce policies to address the nutritional needs of mothers and young children in response to both stable and unstable circumstances. Aimed at non-specialists in nutrition such as crisis response teams, programme managers and policy makers, the toolkit comprises three main sections: policy guidance; country benchmarking; and case studies. The policy guidance section includes comprehensive information on prioritising nutrition interventions and cross-cutting approaches to address the issue. Specific advice is provided for maternal and infant nutrition. The benchmarking section provides data from 12 countries from the Latin American and Caribbean region and includes information on infant feeding practices, micronutrient deficiencies, and the availability of complementary food products. The case studies section provides valuable information about how four different countries have, in practice, responded to different unstable situations and successfully implemented the recommended interventions. A comprehensive list of links to additional resources for individual countries is also provided.
Comprehensive cervical cancer prevention and control: a healthier future for girls and women
This World Health Organization (WHO) guidance, aimed at programme managers and senior policy makers, provides a vision of what comprehensive cervical cancer control and prevention is, how complementary strategies might work in the primary, secondary and tertiary prevention of cervical cancer and discusses the need for collaborative working between partners, programmes and organisations. On a worldwide basis, cervical cancer is the second most common cancer and of the 270 000 women that die every year from it, 85% of these deaths are from low-income and middle-income countries. Primary prevention involves the employment of human papillomavirus (HPV) vaccination targeted at girls aged between 9 and 13 years, who are generally not yet sexually active. For both girls and boys, as appropriate, health information and warnings about tobacco use, sexuality education tailored to age and culture, condom promotion/provision for those engaged in sexual activity and male circumcision are the other recommended primary preventive measures. Secondary prevention aims at the early detection and treatment of precancerous lesions using conventional (Papanicolaou smear) and liquid-based cytology, visual inspection with acetic acid and HPV testing for women aged between 30 and 49 years old. At a minimum, screening is recommended for every woman within this age group at least once in a life time. Tertiary prevention addresses the treatment and palliative care for cervical cancer. The challenges here are the establishment and maintenance of treatment referral networks, compliance with treatment, and effective palliative care. A helpful checklist is included for establishing a comprehensive cervical cancer prevention and control programme.
WHO Global Health Equity Monitor
The WHO Global Health Observatory Health Equity Monitor has recently been published online. The Health Equity Monitor database currently includes around 30 reproductive, maternal, neonatal and child health indicators covering 91 different countries with data gathered from around 200 Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) conducted between the years 1993 and 2011. Data are available for at least two time points during these years for around half of the included countries and the data, arranged by place of residence, educational level or wealth quintile, include contraceptive prevalence, family planning needs, antenatal care coverage, births attended by skilled health professional, births by caesarean section, pregnant women sleeping under insecticide-treated nets and postnatal care visit. Additional filters can also be applied when accessing the database such as data source, year and WHO region. Detailed country profiles and interactive visualisations showing inequalities in selected health outcomes and services are also provided. The Health Equity Monitor database aims to provide an evidence database for equity-oriented interventions and contribute towards the goal of universally equitable health coverage.