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Reproductive Health

Aborting Global Women’s Rights: The Boundaries of Women’s Representation in American Foreign Policy

Citation:

Angevine, Sara. 2020. "Aborting Global Women's Rights: The Boundaries of Women's Representation in American Foreign Policy". Politics & Gender. doi:10.1017/S1743923X20000112.

Author: Sara Angevine

Abstract:

American foreign policy has expanded in recent years to address issues that affect women and girls worldwide, global women’s rights, yet there has been minimal investigation into how these representative claims for women worldwide are formed and the substantive U.S. commitment. Is this a reflection of a growing American feminist foreign policy or symbolic rhetoric for domestic audiences? To better understand the representation of global women’s rights in American foreign policy, I analyze the political context behind three widely supported American foreign policy bills focusing on women that were introduced during the 111th Congress (2009–10). Each of these bills failed to become statute. Drawing from qualitative comparative case study analysis, I show how antiabortion politics constrain the legislative success of any American foreign policy legislation that focuses on women, regardless of relevance. This suggests that foreign women’s bodies are a terrain for U.S. legislators to advance abortion policy objectives with minimal electoral constraint. Although advancing women’s rights furthers broader U.S. foreign policy objectives, such as preventing terrorism and growing market economies, domestic abortion politics shape the boundaries of how global women’s rights are represented in American foreign policy.

Keywords: women, foreign policy, global women's rights, Congress, representation, feminist foreign policy, gender, abortion, foreign policy analysis

Topics: Feminisms, Feminist Foreign Policy, Gender, Women, Health, Reproductive Health, Rights, Women's Rights Regions: Americas, North America Countries: United States of America

Year: 2020

Women's Land Rights and Maternal Healthcare in Southwestern Uganda: Exploring the Implications of Women's Decision-Making Regarding Sale and Use of Land on Access to Maternal Healthcare

Citation:

Nyakato, Viola N., Charles Rwabukwali, and Susan Kools. 2020. "Women's Land Rights and Maternal Healthcare in Southwestern Uganda: Exploring the Implications of Women's Decision-Making Regarding Sale and Use of Land on Access to Maternal Healthcare." African Journal of Reproductive Health 24 (1): 62-80.

Authors: Viola N. Nyakato, Charles Rwabukwali, Susan Kools

Abstract:

ENGLISH ABSTRACT:
Most traditional land tenure practices among developing economies are opposed to protecting and promoting women’s land ownership rights. In Uganda, land tenure practices are largely customary and patriarchal in nature, in most communities women’s land tenure security is dependent on marriage. This paper builds a body of evidence on how gender biased land tenure negatively affects maternal healthcare decision-making for family planning, antenatal care services and skilled care during childbirth. A cross-sectional mixed methodology was used to collect household survey data. Qualitative data from individual and focus group interviews were analysed using thematic content analysis. Land was found to be an important household factor that shapes women’s maternal healthcare decision-making, not only through land ownership, but also through lands role as a source of identity, gendered land use decision-making patterns, and the allocation of resources that accrue from work on land. Most of the land-owning households are headed by men. More women than men expressed insecurity of tenure, despite the households’ land ownership status. Land use decision-making, including its sale was significantly associated with maternal healthcare decision-making. Feeling secure on land was significantly associated with maternal healthcare decisions for planned pregnancy and use of antenatal care. Land purchasing was found to significantly determine place and skill level of providers for childbirth. In conclusion, women involvement in land purchasing decisions demonstrates more control and agency in the number of children. Women’s land insecurity undermines their prospects for positive maternal health behaviours.
 
FRENCH ABSTRACT:
La plupart des pratiques foncieres traditionnelles dans les economies en développement sont opposées å la protection et å la promotion des droits de propriété fonciere des femmes. En Ouganda, les pratiques foncieres sont en grande partie coutumieres et de nature patriarcale ; dans la plupart des communautés, la sécurité fonciere des femmes dépend du mariage. Cet article établit un ensemble de preuves sur la façon dont le régime foncier sexiste affecte négativement la prise de décision en matiere de soins de santé maternels pour la planification familiale, les services de soins prénatals et les soins spécialisés pendant l'accouchement. Une méthodologie mixte transversale a été utilisée pour collecter les données des enquetes aupres des ménages. Les données qualitatives issues d'entretiens individuels et de groupes de discussion ont été analysées å l'aide d'une analyse de contenu thématique. La terre s'est avérée etre un facteur important pour les ménages qui façonne la prise de décision des femmes en matiere de soins de santé maternelle, non seulement par la propriété fonciere, mais aussi par le rôle de la terre en tant que source d'identité, les modeles de prise de décision en matiere d'utilisation des terres selon le sexe et l'allocation des ressources qui découlent du travail å terre. La plupart des ménages propriétaires fonciers sont dirigés par des hommes. Plus de femmes que dhommes ont exprimé leur insécurité doccupation, malgré le statut de propriété fonciere du ménage. La prise de décision concernant l'utilisation des terres, y compris sa vente, était significativement associée å la prise de décisions en matiere de soins de santé maternelle. Le sentiment de sécurité å terre était significativement associé aux décisions de soins de santé maternels concernant une grossesse planifiée et l'utilisation des soins prénatals. L'achat de terres a permis de déterminer de maniere significative le lieu et le niveau de compétence des prestataires pour l'accouchement. En conclusion, l'implication des femmes dans les décisions d'achat de terres démontre plus de contróle et d'agence sur le nombre d'enfants. Linsécurité fonciere des femmes compromet leurs perspectives de comportements positifs en matiere de santé maternelle.

Keywords: land ownership, decision-making, gender, maternal healthcare, Uganda

Topics: Gender, Gender Roles, Gendered Power Relations, Gender Equality/Inequality, Gender Hierarchies, Patriarchy, Health, Reproductive Health, Households, Land Tenure, Rights, Land Rights, Women's Rights Regions: Africa, East Africa Countries: Uganda

Year: 2020

Sexual Orientation and Gender Identity in Canada’s ‘Feminist’ International Assistance

Citation:

Aylward, Erin, and Stephen Brown. 2020. “Sexual Orientation and Gender Identity in Canada’s ‘Feminist’ International Assistance.” International Journal: Canada’s Journal of Global Policy Analysis 75 (3): 313–28.

Authors: Erin Aylward, Stephen Brown

Abstract:

Canada’s Feminist International Assistance Policy (FIAP), launched in June 2017, marks the first time that sexual orientation and gender identity (SOGI) have been mentioned in an overarching Canadian aid policy. The inclusion of SOGI in the policy document sent an important signal to domestic and international development partners on the need to consider these sources of discrimination and marginalization. This article asks two basic research questions. First, what is the place of SOGI in Canada’s “feminist” international assistance? Second, what additional steps does Canada’s development program need to take to protect the rights of lesbian, gay, bisexual, transgender, and intersex (LGBTI) people in the Global South? Based on an analysis of official documents and secondary sources, we argue that FIAP itself sends only a weak signal about the importance of SOGI-related concerns, but Canadian foreign aid has expanded its understanding of LGBTI issues and has begun to commit dedicated resources to addressing them. Nonetheless, the initial programming (2017–2019) was channelled in an ad hoc manner and through one, major stand-alone commitment, rather than through a broader framework that would guide SOGI’s integration into Canadian programs over the long term. If serious about addressing LGBTI rights more systematically, the Canadian government needs to expand its definition of what SOGI entails and move beyond niche programming to recognize the cross cutting dimension of LGBTI rights in foreign aid, especially in the area of sexual and reproductive health and rights.

Keywords: foreign aid, sexual orientation, gender identity, LGBTI, Canada, feminism

Topics: Development, Feminisms, Feminist Foreign Policy, Gender, Health, Reproductive Health, LGBTQ, Rights, Reproductive Rights, Sexuality Regions: Americas, North America Countries: Canada

Year: 2020

Adolescents’ Perceptions and Experiences of Pregnancy in Refugee and Migrant Communities on the Thailand-Myanmar Border: A Qualitative Study

Citation:

Asnong, Carine, Gracia Fellmeth, Emma Plugge, Nan San Wai, Mupawjay Pimanpanarak, Moo Kho Paw, Prakaykaew Charunwatthana, Nosten François, and Rose McGready. 2018. “Adolescents’ Perceptions and Experiences of Pregnancy in Refugee and Migrant Communities on the Thailand-Myanmar Border: A Qualitative Study.” Reproductive Health 15 (1): 1–13. 

Authors: Carine Asnong, Gracia Fellmeth, Emma Plugge, Nan San Wai, Mupawjay Pimanpanarak, Moo Kho Paw, Prakaykaew Charunwatthana, Nosten François, Rose McGready

Abstract:

Background: Adolescent pregnancy remains a global health concern, contributing to 11% of all births worldwide and 23% of the overall burden of disease in girls aged 15–19 years. Premature motherhood can create a negative cycle of adverse health, economic and social outcomes for young women, their babies and families. Refugee and migrant adolescent girls might be particularly at risk due to poverty, poor education and health infrastructure, early marriage, limited access to contraception and traditional beliefs. This study aims to explore adolescents’ perceptions and experiences of pregnancy in refugee and migrant communities on the Thailand-Myanmar border.

Methods: In June 2016 qualitative data were collected in one refugee camp and one migrant clinic along the Thailand-Myanmar border by conducting 20 individual interviews with pregnant refugee and migrant adolescents and 4 focus group discussions with husbands, adolescent boys and non-pregnant girls and antenatal clinic staff. Inductive thematic analysis was used to identify codes and themes emerging from the data.

Results: Study participants perceived adolescent pregnancy as a premature life event that could jeopardise their future. Important themes were premarital sex, forced marriage, lack of contraception, school dropout, fear of childbirth, financial insecurity, support structures and domestic violence. Supportive relationships with mothers, husbands and friends could turn this largely negative experience into a more positive one. The main underlying reasons for adolescent pregnancy were associated with traditional views and stigma on sexual and reproductive health issues, resulting in a knowledge gap on contraception and life skills necessary to negotiate sexual and reproductive choices, in particular for unmarried adolescents.

Conclusions: Adolescents perceive pregnancy as a challenging life event that can be addressed by developing comprehensive adolescent-friendly sexual and reproductive health services and education in refugee and migrant communities on the Thailand-Myanmar border. Creating a more tolerant and less stigmatising environment in these communities and their governing bodies will help to achieve this goal.

Keywords: adolescent pregnancy, Myanmar, migrant, Qualitative, refugee, sexual and reproductive health, contraception, Stigma, forced marriage, domestic violence

Topics: Age, Youth, Armed Conflict, Displacement & Migration, Migration, Refugees, Domestic Violence, Gender, Women, Girls, Health, Reproductive Health Regions: Asia, Southeast Asia Countries: Myanmar, Thailand

Year: 2018

Empowering Women Through Land Rights: Connecting Economic Empowerment, Control Over Assets, and Sexual Negotiation Within Kisumu County, Kenya

Citation:

Shaffer, Madison. 2019. “Empowering Women Through Land Rights: Connecting Economic Empowerment, Control Over Assets, and Sexual Negotiation Within Kisumu County, Kenya.” Paper presented at APHA's 2019 Annual Meeting and Expo, Burlington, VT, November 2-6.

Author: Madison Shaffer

Abstract:

This project aims to gain a greater understanding of the current state of women’s land rights in Kisumu County, Kenya. It will discuss how current interventions are impacting women’s empowerment and their ability to negotiate safe sex. Property rights can provide women with a secure place to live, a place of economic activity and reduces dependence on men. Property ownership can also serve to empower women and “give them greater bargaining power at the household, individual, and community level...increasing agency” (Dworkin,2009). Unfortunately, men have almost always been favored in land rights in traditional land allocation and in customary law. In 2010, Kenya’s new constitution, article 60, eliminates gender discrimination in law, customs, and practices related to land. Since this, little research has evaluated the relationship between land rights and female empowerment in a Kenyan context. Through the Kenya Demographic Health survey data I was able to formulate semi-constructed interviews, and a questionnaire to analyze the impact land rights has on women’s empowerment. Empowerment was measured on a 0-1 scale based off a set of indicators drawn from the World Bank (Malhotra et al., 2002). Regardless of the clear legal standards now in place, gender-biased public attitude and limited utilization of legal services still lead to women systematically being denied their rights to land. This project utilizes Fundamental Cause Theory to describe how interventions that involve the community through legal training and education on human rights can help support women’s land claims and lead to empowering women in their own sexual, and nonsexual, health going forward.

Topics: Gender, Gendered Power Relations, Gender Equality/Inequality, Health, Reproductive Health, Rights, Reproductive Rights, Land Rights, Property Rights Regions: Africa, East Africa Countries: Kenya

Year: 2019

Prevalence of Anxiety and Depression among Women with Polycystic Ovary Syndrome Living in War versus Non-war Zone Countries: A Randomized Controlled Trial Assessing a Pharmacist Intervention

Citation:

Alkoudsi, Kinda T., and Iman A. Basheti. 2020. "Prevalence of Anxiety and Depression among Women with Polycystic Ovary Syndrome Living in War versus Non-war Zone Countries: A Randomized Controlled Trial Assessing a Pharmacist Intervention.Research in Social and Administrative Pharmacy 16 (5): 689-98.

Authors: Kinda T. Alkoudsi, Iman A. Basheti

Abstract:

Background: Polycystic ovary syndrome (PCOS) is a serious health problem. In women experiencing PCOS, there are myriad physical and mental health consequences; anxiety/depression are commonly associated with this condition. Community pharmacists are in a pivotal position to identify and help women diagnosed with PCOS. Objectives: To investigate the prevalence/severity of anxiety/depression among females diagnosed with PCOS living in Syria (a war-zone country) and Jordan (a non-war zone country). Secondly, to evaluate the impact of a pharmaceutical care service delivered by a clinical pharmacist on participants’ anxiety/depression severity. 
 
Methods: Females, diagnosed with PCOS above the age of 16, were recruited into the study and randomly allocated into either the active or the control group. The active group participants received a PCOS pharmaceutical care service. This service involved the provision of verbal and written educational materials, with a special focus on diet and exercise. The control group participants received only standard counseling. Both groups were followed up for four months. All participants completed the Beck Anxiety Inventory and the Beck Depression Inventory at baseline and follow-up. 
 
Results: Data from study participants (n = 118) from both Syria (n = 60) and Jordan (n = 58) highlighted a high prevalence of anxiety (Syria = 95% vs. Jordan = 98%) and depression (Syria = 83% vs. Jordan = 65%). At follow-up, active group participants, from both countries, showed significant improvements in anxiety and depression mean scores (anxiety: Syria = 34.97 ± 14.8 vs. 30.47 ± 14.3, p < 0.001; Jordan = 26.93 ± 13.7 vs. 23.37 ± 15.2, p < 0.001; depression: Syria = 26.53 ± 12.6 vs. 22.93 ± 12.2, p < 0.001; Jordan = 17.70 ± 11.0 vs. 15.76 ± 11.1, p = 0.049). No significant improvements were evident for control group participants from either countries. 
 
Conclusion: Prevalence of anxiety/depression for females with PCOS living in Syria and in Jordan is high and calls for special attention by healthcare specialists and policymakers in both countries. Females, who received the PCOS pharmaceutical care service, showed significant improvements in anxiety/depression scores. Improvements were similar in both countries.

Keywords: polycystic ovary syndrome, war, anxiety, depression

Topics: Armed Conflict, Civil Wars, Gender, Women, Health, Mental Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Jordan, Syria

Year: 2020

Intimate Partner Violence in Pregnancy: A Cross-Sectional Study from Post-Conflict Northern Uganda

Citation:

Clarke, Susan, Robyn Richmond, Eleanor Black, Helen Fry, James Henry Obol, and Heather Worth. 2019. "Intimate Partner Violence in Pregnancy: A Cross-Sectional Study from Post-Conflict Northern Uganda." BMJ Open 9 (11).

Authors: Susan Clarke, Robyn Richmond, Eleanor Black, Helen Fry, James Henry Obol, Heather Worth

Abstract:

Objectives: To determine the prevalence of intimate partner violence (IPV) in pregnancy and to understand associations and determinants. 
 
Design: Cross-sectional survey. 
 
Setting: Two rural health clinics in post-conflict northern Uganda. 
 
Participants: Women attending two rural health clinics for a new service providing cervical cancer screening, who had experienced pregnancy. 
 
Primary and secondary outcome measures: Data were collected by a questionnaire using validated questions from the demographic health survey women’s questionnaire and the domestic violence module. Data were entered into tablets using Questionnaire Development System software. Bivariate and multivariate logistic regression was performed, using experience of IPV in pregnancy as the dependent variable. SPSS V.25 was used for all analysis. 
 
Results: Of 409 participant women, 26.7% (95% CI 18.6% to 35.9%) reported having been slapped, hit or beaten by a partner while pregnant. For 32.3% (95% CI 20.2% to 37.9%) of the women the violence became worse during pregnancy. Women who had ever experienced IPV in pregnancy were more likely to have experienced violence in the previous 12 months (OR 4.45, 95%CI 2.80 to 7.09). In multivariate logistic regression, the strongest independent associations with IPV in pregnancy were partner’s daily drinking of alcohol (OR 2.02, 95%CI 1.19 to 3.43) and controlling behaviours (OR 1.17, 95%CI 1.03 to 1.33). 
 
Conclusions: The women in this study had more exposure to IPV in pregnancy than previously reported for this region. Women’s previous experience of intimate partner violence, partner’s daily use of alcohol and his controlling behaviours were strong associations with IPV in pregnancy. This study highlights the uneven distribution of risk and the importance of research among the most vulnerable population in rural and disadvantaged settings. More research is needed in local rural and urban settings to illuminate this result and inform intervention and policy.

Topics: Domestic Violence, Gender, Women, Health, Reproductive Health, Post-Conflict Regions: Africa, East Africa Countries: Uganda

Year: 2019

Factors Associated with the Use of Maternal Health Services by Mothers in a Post-Conflict Area of Western Côte d'Ivoire in 2016

Citation:

Samba, Mamadou, Akissi Régine Attia-Konan, Abou Dramane Sangaré, Gotré Jules Youan, Luc Philippe Kouadio, and Ramata Bakayoko-Ly. 2020. "Factors Associated with the Use of Maternal Health Services by Mothers in a Post-Conflict Area of Western Côte d'Ivoire in 2016." BMC Health Services Research 20.

Authors: Mamadou Samba, Akissi Régine Attia-Konan, Abou Dramane Sangaré, Gotré Jules Youan, Luc Philippe Kouadio, Ramata Bakayoko-Ly

Abstract:

Background: In Côte d’Ivoire, maternal health service utilization indicators remain low despite improvements in health coverage and the availability of free health care for pregnant women. The objective of the study was to identify the determinants associated with the use of maternal health services in the department of Bloléquin, in western Côte d’Ivoire. 
 
Methods: We conducted a cross-sectional study with an analytical focus. The study sample size was 400 women. Study participants were selected through a two-stage cluster survey. The data were collected using a standardized questionnaire whose items concerned socio-demographic data, the different uses of maternal health services, namely childbirth assisted by a health professional, use of family planning, prenatal consultation and postnatal consultation. Logistic regression was used to investigate factors associated with the use of maternal health services. The significance of the statistical tests was set at 5%. The odds ratios and 95% confidence intervals were calculated and interpreted. 
 
Results: The results showed that women made less use of family planning services (OR = 0.4), prenatal consultation (OR = 0.2) and assisted childbirth (OR = 0.2) when they provided the funding for care themselves. Women with monthly incomes above $26.8 used family planning services 4 times more than those with lower incomes. Married women used prenatal consultations 3 times more often than unmarried women (CI95% = 1.4–7.3). Desiring pregnancy increased the use of post-natal consultations by 3 times (CI95% = 1.5–6.1). 
 
Conclusion: Improving the use of maternal health services in western Côte d’Ivoire requires taking into account women’s socio-cultural and economic challenges. In initiatives related to the financial empowerment of women, efforts must be made at the level of emotional considerations related to pregnancy.

Keywords: determinants, Côte d'Ivoire, maternal health services, accessibility

Topics: Gender, Women, Health, Reproductive Health, Post-Conflict Regions: Africa, West Africa Countries: Côte D'Ivoire

Year: 2020

Health in Conflict and Post-Conflict Settings: Reproductive, Maternal and Child Health in Colombia

Citation:

Jaraba, Sara Milena Ramos, Natalia Quiceno Toro, María Ochoa Sierra, Laura Ruiz Sánchez, Marlly Andrea García Jiménez, Mary Y. Salazar-Barrientos, Edison Bedoya Bedoya, Gladis Adriana Vélez Álvarez, Ana Langer, Jewel Gausman, and Isabel C. Garcés-Palacio. 2020. "Health in Conflict and Post-Conflict Settings: Reproductive, Maternal and Child Health in Colombia." Conflict and Health 14.

Authors: Sara Milena Ramos Jaraba, Natalia Quiceno Toro, María Ochoa Sierra, Laura Ruiz Sánchez, Marlly Andrea García Jiménez, Mary Y. Salazar-Barrientos, Edison Bedoya Bedoya, Gladis Adriana Vélez Álvarez, Ana Langer, Jewel Gausman, Isabel C. Garcés-Palacio

Abstract:

Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. 
 
Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. 
 
Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998–2004, 2005–2011 and 2012–2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998–2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. 
 
Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

Topics: Armed Conflict, Conflict, Gender, Women, Health, Reproductive Health, International Organizations, NGOs, Post-Conflict Regions: Americas, South America Countries: Colombia

Year: 2020

Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo

Citation:

Altare, Chiara, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, and Paul Spiegel. 2020. "Health Services for Women, Children and Adolescents in Conflict Affected Settings: Experience from North and South Kivu, Democratic Republic of Congo." Conflict and Health 14.

Authors: Chiara Altare, Espoir Bwenge Malembaka, Maphie Tosha, Christopher Hook, Hamady Ba, Stéphane Muzindusi Bikoro, Thea Scognamiglio, Hannah Tappis, Jerome Pfaffmann, Ghislain Bisimwa Balaluka, Ties Boerma, Paul Spiegel

Abstract:

Background: Insecurity has characterized the Eastern regions of the Democratic Republic of Congo for decades. Providing health services to sustain women’s and children’s health during protracted conflict is challenging. This mixed-methods case study aimed to describe how reproductive, maternal, newborn, child, adolescent health and nutrition (RMNCAH+N) services have been offered in North and South Kivu since 2000 and how successful they were. 
 
Methods: We conducted a case study using a desk review of publicly available literature, secondary analysis of survey and health information system data, and primary qualitative interviews. The qualitative component provides insights on factors shaping RMNCAH+N design and implementation. We conducted 49 interviews with government officials, humanitarian agency staff and facility-based healthcare providers, and focus group discussions with community health workers in four health zones (Minova, Walungu, Ruanguba, Mweso). We applied framework analysis to investigate key themes across informants. The quantitative component used secondary data from nationwide surveys and the national health facility information system to estimate coverage of RMNCAH+N interventions at provincial and sub-provincial level. The association between insecurity on service provision was examined with random effects generalized least square models using health facility data from South Kivu. 
 
Results: Coverage of selected preventive RMNCAH+N interventions seems high in North and South Kivu, often higher than the national level. Health facility data show a small negative association of insecurity and preventive service coverage within provinces. However, health outcomes are poorer in conflict-affected territories than in stable ones. The main challenges to service provisions identified by study respondents are the availability and retention of skilled personnel, the lack of basic materials and equipment as well as the insufficient financial resources to ensure health workers’ regular payment, medicaments’ availability and facilities’ running costs. Insecurity exacerbates pre-existing challenges, but do not seem to represent the main barrier to service provision in North and South Kivu. 
 
Conclusions: Provision of preventive schedulable RMNCAH+N services has continued during intermittent conflict in North and South Kivu. The prolonged effort by non-governmental organizations and UN agencies to respond to humanitarian needs was likely key in maintaining intervention coverage despite conflict. Health actors and communities appear to have adapted to changing levels and nature of insecurity and developed strategies to ensure preventive services are provided and accessed. However, emergency non-schedulable RMNCAH+N interventions do not appear to be readily accessible. Achieving the Sustainable Development Goals will require increased access to life-saving interventions, especially for newborn and pregnant women.

Keywords: health services, health system, conflict, population displacement, North Kivu, South Kivu, Democratic Republic of Congo, maternal, newborn, child, reproductive health

Topics: Age, Youth, Conflict, Gender, Women, Girls, Boys, Health, Reproductive Health, International Organizations, NGOs, Sustainable Development Goals (SDGs) Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2020

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