Frustrated student

More Sleep Could Improve Many U.S. Teenagers’ Mental Health

California now requires most high schools to start no earlier than 8:30 a.m. to support students’ well-being and safety.

Most American teenagers are sleep deprived: Fewer than one in four U.S. high school students gets the recommended eight hours of sleep per night.1

Researchers who study the relationship between sleep and depression are unanimous: Adequate sleep could greatly improve many U.S. teenagers’ mental health.

“Perpetually fatigued adolescents look and feel depressed,” says Rachel Widome of the University of Minnesota. Her research links adequate sleep to fewer symptoms of depression among teenagers.2

“Poor sleep and depression are reinforcing—depression interferes with sleep, and not enough sleep leaves someone feeling like they don’t have energy to engage in life, which is a symptom of depression.”

The notion that anyone “can push through on little sleep with little cost to mental health is a myth,” says Andrew Fuligni of the University California, Los Angeles. His research demonstrates that despite some individual variation, most teenagers need about 8.5 hours of sleep to function at their best.3

“Mental health is very sensitive to sleep,” he explains. “To operate at peak levels—emotionally and intellectually—most teens should sleep between eight and 10 hours each night. Less than seven and more than 11 hours is unhealthy.”

Mounting Evidence Shows Later High Schools Start Times Are Key to Better Sleep

Telling teenagers to go to bed earlier is not the answer. The entire circadian-driven sleep cycle—both sleep and wake times—is temporarily pushed later in adolescence because of hormonal changes, Fuligni explains. Child health advocates have been calling for later school start times since the 1980s and 1990s, he notes.

Growing scientific evidence on the benefits of later school start times is behind a new California law, which goes into effect July 1, 2022, that will bar most high schools from starting classes before 8:30 a.m.

The key findings spurring school districts to consider later school start times come from Widome and colleagues, who tracked students at five public Minnesota high schools using wrist monitors (actigraphy) that accurately measured the students’ sleep.4 They showed that when schools instituted later start times, students slept longer and their need for catch-up sleep on the weekends shrank. Students’ bedtimes did not move with the later start time, and they continued to get better sleep over two years.

Additional evidence comes from analysis of a multi-year study conducted by Kayla Wahlstrom and colleagues at the University of Minnesota.5 They examined data on more than 9,000 students attending eight high schools in three states that switched to later start times and documented improved sleep. When schools started after 8:30 a.m., attendance, standardized test scores, and academic performance in math, English, science, and social studies increased, while tardiness declined. One school that shifted start times from 7:35 a.m. to 8:55 a.m. saw a 70% decline in the number of local car accidents among drivers ages 16 to 18.

Despite the documented benefits of later school start times, only about 15% of U.S. high schools start at 8:30 a.m. or later, while 42% start before 8:00 a.m., Widome reports. “Early high school start times are strictly a United States phenomenon,” she notes. “Europe and Australia do not start school so early.”

Some parents and school officials have voiced opposition to changing school start times because the current timing facilitates after-school sports and allows the same school buses to transport high schoolers early in the morning and young children afterward. Family schedules are also often built around early start times that enable “the older kids to get home first to watch the younger ones,” she says.

“It’s appalling that our nation is willing to accept that teens are extremely fatigued during their adolescent years,” says Widome, “when there is a straightforward evidence-based solution—starting school later.”

Teenagers’ Mental Health Problems Rose as Adequate Sleep Declined

The mental health crisis among American youth began growing long before the coronavirus pandemic: In 2019, more than one in three high school students reported “persistent feelings of sadness or hopelessness,” representing a 40% increase from 2009, according to the U.S. Centers for Disease Control and Prevention (CDC).6

During that same period, teenagers’ nightly sleep dropped sharply: The share of high school students getting the recommended minimum of eight hours of sleep declined from nearly 31% in 2009 to around 22% in 2019.7

Research shows a strong connection between sleep and symptoms of depression. In a 2019 study, Widome and colleagues showed that about one in three students who slept less than six hours per night had a high number of depression symptoms compared with about one in 10 students who got adequate sleep.8 But inadequate sleep is one of many factors affecting teenagers’ mental health.

The rise in sleep-deprived teenagers is a long-term trend, reports Widome. “A lot in our society has changed in the last decade, including more time spent using screens—phones, games, computers—and marketing caffeine drinks to adolescents.” In her 2019 study, teenagers who had inadequate sleep tended to spend twice as much time on devices with screens than their peers and were more likely to use those devices after they went to bed.

“We know people feel better when they get enough sleep,” notes Widome. “If we improved sleep, how much of that is addressing the tiredness that looks like depression? It is easy to forget how critically important sleep is to our lives.”

What Biology Tells Us About the Connections Among Sleep, Stress, Depression, and Disease

One way that poor sleep appears to heighten the risk of depression is by activating the body’s stress response system. Fuligni and colleagues identified altered levels of cortisol—the stress hormone—in the saliva of teenagers with consistently inadequate sleep.9 In a related study, the researchers showed that inadequate sleep exacerbated the connection between daily stress and inflammation-triggering genes, another biological sign of stress.10

Poor sleep can keep the body’s stress response system on high alert long term, which can have a profound impact on many of the body’s systems—not just increasing the risk of depression but laying a foundation for chronic conditions such as heart disease later in life, according to Fuligni.

The researchers found that students in 10th and 11th graes who consistently reported inadequate sleep were more vulnerable to depression several years later.11 Interventions designed to improve sleep during the high-school years may prevent depression among young people in their early 20s, when an individual’s risk of depression is highest, the researchers suggest.

Additional Strategies for Improving Teenagers’ Sleep

Starting high schools later in the morning is the number one way to improve teenagers’ sleep, both Fuligni and Widome say. They express concerns over legislation to make Daylight Saving Time permanent because more high school students would go to school in the dark and wouldn’t see the sun rise until after their first period classes.

Widome favors permanent Standard Time, which would set sunrise earlier—helpful to teenagers’ waking—despite earlier evening sunsets. Both Fuligni and Widome agree that the current switch from Daylight Saving Time that moves clocks ahead in spring is a challenging adjustment for teenagers.

Along with later school start times, Fuligni would like to see school administrators and teachers assess whether students are sacrificing sleep for homework and adjust their expectations. If Widome were making school policy, she also would eliminate online assignments that have midnight due dates and ban high school clubs from meeting before 8:00 a.m.

“We need to really value sleep,” she says, “not see it as something extraneous that is only for the weak.”


This article was produced under a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). The work of researchers from the following NICHD-funded Population Dynamics Research Centers was highlighted: University of Minnesota (5P2CHD041023-19) and University of California, Los Angeles (5P2CHD041022-19).

References

[1] Centers for Disease Control and Prevention (CDC), High School Students Who Got 8 or More Hours of Sleep, YRBS Explorer.

[2] Aaron T.  Berger, Kyla L. Wahlstrom, Rachel Widome, “Relationships Between Sleep Duration and Adolescent Depression: A Conceptual Replication,” Sleep Health 5, no. 2 (2019): 175-9, doi:10.1016/j.sleh.2018.12.003.

[3] Andrew J. Fuligni et al., “Individual Differences in Optimum Sleep for Daily Mood During Adolescence,” Journal of Clinical Child and Adolescent Psychology 48, no. 3 (2019): 469-79.

[4] Rachel Widome et al., “Association of Delaying School Start Time With Sleep Duration, Timing, and Quality Among Adolescents,” JAMA Pediatrics 174, no. 7 (2020): 697-704, doi:10.1001/jamapediatrics.2020.0344.

[5] Kayla L. Wahlstrom et al, Examining the Impact of Later School Start Times on the Health and Academic Performance of High School Students: A Multi-Site Study (Center for Applied Research and Educational Improvement, University of Minnesota, St. Paul, MN: 2014).

[6] CDC, “Adolescent and School Health: Mental Health,” n.d.

[7] CDC, High School Students Who Got 8 or More Hours of Sleep.

[8] Rachel Widome et al., “Correlates of Short Sleep Duration Among Adolescents,” Journal of Adolescence 77 (2019): 163-7.

[9] Kate Ryan Kuhlman et al., “Sleep Problems in Adolescence Are Prospectively Linked to Later Depressive Symptoms Via the Cortisol Awakening Response,” Developmental Psychopathology 32, no. 3 (2020): 997-1006.

[10] Jessica J. Chiang et al., “Daily Interpersonal Stress, Sleep Duration, and Gene Regulation During Late Adolescence,” Psychoneuroendocrinology 103 (2019): 147-55, doi: 10.1016/j.psyneuen.2018.11.026.

[11] Kate Ryan Kuhlman et al., “Persistent Low Positive Affect and Sleep Disturbance Across Adolescence Moderate Link Between Stress and Depressive Symptoms in Early Adulthood,” Journal of Abnormal Child Psychology 48, no. 1 (2020): 109-21, doi: 10.1007/s10802-019-00581-y.

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Abortion: A Global Overview

Abortion's legal status does not significantly affect the rate at which the procedure occurs but does affect the conditions under which it occurs. Unsafe abortions claim the lives of tens of thousands of women around the world every year.

Abortion is a public health concern. It is also a sensitive and contentious issue with religious, moral, cultural, and political dimensions.

 

More than one-quarter of the world’s people live in countries where the procedure is prohibited or permitted only in cases of rape, incest, or fetal abnormalities, or to save the pregnant person’s life. Yet, regardless of legal status, abortions still occur, and nearly half of them are unsafe—performed by unskilled practitioners or in less than hygienic conditions, or both.

Abortions performed under unsafe conditions claim the lives of tens of thousands of women around the world every year, leave many times that number with chronic and often irreversible physical and mental health problems, and drain the resources of public health systems. Controversy, however, often overshadows the public health impact.1

An estimated 73 million abortions occur globally each year.

Nearly half of them—45%—are unsafe.2

Globally, unsafe abortion accounts for up to 13% of deaths related to pregnancy and childbirth.3

Abortions are considered unsafe when they are performed by people who lack the necessary skills and information or in an environment that doesn’t meet minimum medical standards, or both.4

Worldwide, at least 7 million women are treated for complications from unsafe abortion each year.5

When abortion is performed by qualified people using correct techniques in hygienic conditions, it is very safe. In the United States—where abortion has been legal since 1973, with restrictions that vary by state—the death rate from induced abortion is less than one per 100,000 procedures.6

Unsafe abortions occur more often where abortion is restricted by law.7

The legal status of abortion is one factor that determines the extent to which the procedure is safe, affordable, and accessible.8

 

In countries that…
Allow abortion for any reason, nearly 90% of abortions are safe.
Have broad restrictions, about 41% of abortions are safe.
Prohibit abortion or allow it only to save the life of the woman or protect her physical health, only 25% of abortions are safe.

Source: Bela Ganatra et al., “Global, Regional, and Subregional Classification of Abortions by Safety, 2010-14: Estimates From a Bayesian Hierarchical Model,” The Lancet 390, no. 10110 (2017).

 

While abortion is more common in some countries than others, it occurs in every country. Where the procedure is broadly legal, abortions are more likely to be performed by trained health professionals, be more available, and cost less—and maternal deaths and injuries tend to be lower.9

In the United States, banning abortion could raise pregnancy-related death rates.10

A nationwide ban on abortion in the United States would lead to an estimated 21% increase in the number of pregnancy-related deaths for all women and a 33% increase among Black women compared with rates for 2017, as calculated by Amanda Stevenson of the CU Population Center at the University of Colorado Boulder.11 These estimates consider only increased deaths from a ban due to pregnancy complications and delivery—both of which are more risky than abortion; they do not include increases due to unsafe abortion.

 

Increased Lifetime Risk of Pregnancy-Related Death Following a U.S. Ban on Abortion

Lifetime Risk (2017) Estimated Increased Risk
White women 1 in 4,500 1 in 3,900
Black women 1 in 1,300 1 in 1,000

Source: Amanda Jean Stevenson, “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant,” Demography (2021).

Abortion’s legal status does not significantly affect the rate at which the procedure occurs.

 

Countries that prohibit abortion for any reason 39 abortions per 1,000 women
Countries that allow abortion only to save the woman’s life 36 abortions per 1,000 women
Countries that permit abortion without restriction 41 abortions per 1,000 women

Source: Guttmacher Institute, “Unintended Pregnancy and Abortion Worldwide” (2022).

For More Information

These PRB resources provide context on the state of abortion worldwide and identify links between access to safe abortion and maternal health outcomes.

References

[1] PRB, Abortion Facts and Figures 2021 (Washington, DC: PRB, 2021).

[2] World Health Organization (WHO), “Abortion,” Nov. 25, 2021.

[3] WHO, “Preventing Unsafe Abortion” (2019).

[4] WHO, “Preventing Unsafe Abortion.

[5] WHO, “Abortion.”

[6] Katherine Korsmit et al., “Abortion Surveillance—United States, 2019,” Surveillance Summaries 70, no. 93 (2021): 1-29.

[7] Bela Ganatra et al., “Global, Regional, and Subregional Classification of Abortions by Safety, 2010-14: Estimates From a Bayesian Hierarchical Model,” The Lancet 390, no. 10110 (2017).

[8] WHO, “Abortion.”

[9] Susheela Singh et al., Abortion Worldwide 2017: Uneven Progress and Unequal Access (New York: Guttmacher Institute, 2018).

[10] PRB, “Black Women Over Three Times More Likely to Die in Pregnancy, Postpartum Than White Women, New Research Finds,” Dec. 6, 2021.

[11] Amanda Jean Stevenson, “The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant,” Demography (2021).

PRB-Mental-Health-Background

The Mental Health Crisis Among American Youth

Understanding the pandemic’s role in an ongoing decline in the emotional well-being of U.S. children and young adults

May is Mental Health Awareness Month in the United States. As the COVID-19 pandemic enters its third year, many countries—including the United States—are experiencing a surge in mental health issues, especially among vulnerable populations.1

While children and young adults are less likely to become severely ill or die from the disease, their lives have been turned upside down by other effects of the pandemic, such as shuttered schools; increased economic insecurity; and increased family distress, including deaths of parents and other family members.2 These stresses have further exacerbated a youth mental health crisis in the United States that was apparent even before the pandemic.3

The following PRB resources shine a light on the mental health issues facing American youth, illuminating statistics, contributing factors, effects, and possible policy solutions for a looming national emergency.

PRB-ELM-swings-Featured

Sociologist Richard G. Rogers and coauthors examine why Americans ages 15 to 24 are twice as likely to die as their peers in other wealthy nations and recommend policy changes, including improving treatment for and prevention of mental illness and substance abuse among youth.

PRB-1 million deaths-Featured

Beth Jarosz, PRB program director and expert in child well-being, discusses the pandemic’s potential long-term impacts on American livelihood, with particular attention to the effects on infants, children, and young adults.

PRB---Family-Experience-COVID---Featured

For 18 years, the KidsData program has gathered and analyzed data on the health and well-being of children in California, home to more people under age 18 than any other U.S. state. Here, KidsData explores results from the national questionnaire Family Experiences During the COVID-19 Pandemic.

Teen boy puts head in hand as mother lectures

From KidsData: The pandemic's effects on young people are of particular concern, as adverse childhood experiences (especially in early childhood) can have negative, long-term impacts on health and well-being.

Mother playing with her children at home

From KidsData: Reports from caregivers provide mounting evidence that they are highly concerned for their children’s well-being during the COVID-19 pandemic, and the need for intervention may be great.

Young students running up stairs at the school

From KidsData: The suicide rate for youth in California and the United States was increasing even before COVID-19 entered the picture in 2020, and the pandemic’s extended social isolation and other stressors have presented newly compounding risk factors for suicide.

Doctor visits patient in hospital ward

From KidsData: Positive emotional health is critical to equipping young people for the challenges of growing up and living as healthy adults, yet the pandemic led to many new stressors for children, including disruptions and socioeconomic shifts.

Shadow of a girl with a bag

From KidsData: Youth who feel more connected to school are more likely to have a stronger sense of well-being. Data on suicidal ideation among California students before the COVID-19 pandemic suggest a relationship to school connectedness.

Group of Students with Backpacks Walking to School

From KidsData: Children often rely on schools to provide mental health services, but school closures during the pandemic made it difficult to access and preserve the quality of these services. Current analyses on the impact of COVID-19 can help inform best practices for promoting resilience.

References

[1] World Health Organization, “COVID-19 Pandemic Triggers 25% Increase in Prevalence of Anxiety and Depression Worldwide,” March 2, 2022.

[2] Harvard Health Publishing, “Coronavirus Outbreak and Kids: Advice on Playdates, Social Distancing, and Healthy Behaviors to Help Prevent Infection,” May 20, 2022.

[3] Matt Richtel, “Surgeon General Warns of Youth Mental Health Crisis,” The New York Times, Dec. 7, 2021; and Children’s Hospital Association, “Sound the Alarm for Kids Raises Awareness of National Mental Health Emergency,” Nov. 2, 2021.

05-22-FP Review-b

The Future of Family Planning in Africa

As policymakers, advocates, and program implementers consider the future of family planning programs in sub-Saharan Africa, we identify emerging opportunities to drive equitable, data-based, and client-centered programs through 2030 and beyond.

This report examines the status of family planning programs in 22 countries in sub-Saharan Africa since the 2016 release of Fostering Economic Growth, Equity, and Resilience in Sub-Saharan Africa: The Role of Family Planning. We build and expand on themes explored in the 2016 report to better understand progress and challenges that may shape the trajectory of rights-based family planning programs and inclusive development in the region.

Where has modern contraceptive use increased? What are the implications for fertility trends? How are trends in family planning use related to trends in poverty and economic inequality? What impact has the COVID-19 pandemic had on access to and use of family planning services? We explore the existing evidence to gain a better understanding of the progress that’s been made and the challenges that will influence family planning and inclusive development in sub-Saharan Africa over the next decade.

The report, available in English and French, is broken into six sections.

  • Section 1 introduces the report and summarizes the key takeaways.
  • Section 2 explores family planning program progress, particularly increases in mCPR, in SSA since the 2016 report.
  • Section 3 explores how trends in mCPR may influence trends in fertility, highlighting patterns unique to SSA.
  • Section 4 examines the extent to which family planning programs have reached women regardless of economic status, enriching our understanding of whether poverty is affecting family planning use.
  • Section 5 complements the analysis of poverty by examining the relationship between family planning, fertility trends, and socioeconomic inequality both between and within countries in SSA.
  • Section 6 proposes future directions for family planning decisionmakers to prioritize during the next decade.

Explore the report

Explorer le rapport

Polygamy in West Africa: Impacts on Fertility, Fertility Intentions, and Family Planning

en français

Many women in West Africa are in polygamous marriages, but the unique needs and preferences of this group are not well understood.

West Africa has one of the highest fertility rates in Africa and in the world.1 Several factors, including the persistence of subsistence farming and cultural and social norms that place a premium on having children, have contributed to a higher desire for children and higher fertility rates.2 However, different forms of marriage, including polygamy, have also contributed to the current landscape of fertility intentions in West Africa.

Recent Demographic and Health Surveys (DHS) data reveal that polygamy rates are high in most countries in the region (Figure 1), with the proportion of women in polygamous unions at or above 30% in eight countries and below 30%in two countries (Côte d’Ivoire and Ghana).

Figure 1: Proportion of Married Women in Polygamous Unions by Country

Sources: Data from DHS for various years: Benin (2017-18), Burkina Faso (2010), Côte d’Ivoire (2011-12), Ghana (2014), Guinea (2018), Mali (2018), Niger (2012), Nigeria (2018), Senegal (2019), and Togo (2013-14), https://dhsprogram.com/.

Several socioeconomic and cultural factors promote the practice of polygamy in West Africa, including:

  • The large age gap between spouses at the time of marriage and the age structure of the larger population.3
  • The security and respect that come with polygamy.4
  • The opportunity for remarriage after widowhood.5

While several studies have highlighted the decline in entry into marriage in West Africa and its impact on fertility decline, little attention has been given to the role of polygamy in maintaining high fertility and family planning use.6 To better understand the role of polygamy in fertility and to ensure that the needs of women in polygamous unions are addressed, it is therefore important to assess the impact of polygamy on fertility intentions and family planning use. This study addresses the topic of polygamy through three main questions:

  1. Do women in polygamous unions have higher fertility than other women?
  2. Do women in polygamous unions have a higher desire for children than other women?
  3. What is the effect of union type on contraceptive use?

To provide scientific answers to these questions, data from recent DHS in 10 West African countries were used as a framework for analysis: Benin (DHS 2017-18), Burkina Faso (2010), Côte d’Ivoire (2011-12), Ghana (2014), Guinea (2018), Mali (2018), Niger (2012), Nigeria (2018), Senegal (2019), and Togo (2013-14). We used this data to construct descriptive statistics and implement multivariate regressions to estimate the impact of polygamy on fertility, the average ideal number of children, and the proportion of women using family planning. Control variables included age, area of residence, household wealth quintile, level of education, occupation, number of co-wives, and ranking of wives. For additional information on our methodologies, please refer to Annex 1.

Women in polygamous unions do not have higher fertility rates than women in monogamous unions.

The figure below shows the descriptive analysis of the total fertility rate (TFR) for women in monogamous unions and women in polygamous unions. This represents the average number of children a woman would have during her reproductive life if current fertility rates held steady. The data shows no significant difference in fertility rates between women in polygamous unions and those in monogamous households in almost all countries.

Figure 2: Total Fertility Rate (TFR) Among Married Women by Country and Type of Union

Source: DHS.

Regarding the socioeconomic characteristics of women, women in polygamous unions living in rural areas have significantly more children than those in urban areas. In addition, the TFR of women in polygamous and monogamous unions decreases as their standard of living and level of education increases. Our analysis also shows that women in the labor force have a significantly lower fertility rates than unemployed women, regardless of type of union (Annex 2).

Considering the rank of wife and the number of co-wives, the descriptive results show that in polygamous unions, the level of fertility decreases as the rank of wife decreases (for example, third wife compared to second wife) and as the number of co-wives increases.

Figure 3: Total Fertility Rate (TFR) by Rank of Wife Among Married Women in Polygamous Unions

Source : EDS.

 

Women in polygamous unions desire more children than women in monogamous unions.

Estimating the average ideal number of children per woman (Figure 4) reveals that, in most countries, women in polygamous unions have a higher average ideal number of children than women in monogamous unions. The results of our analysis of the average ideal number of children by type of union reveal that women in polygamous unions are 28 percent more likely to want an additional child than women in monogamous households (Annex 3). Also, the results show that married women with primary or secondary and higher education, as well as those living in middle-income or wealthy households, have lower fertility intentions than those with no education (Annex 3).

Figure 4: Average Ideal Number of Children Among Married Women by Country and Type of Union

Source: DHS.

 

Women in polygamous unions are less likely to use family planning than women in monogamous unions.

Descriptive analysis of family planning use by type of union reveals that the proportion of women using a contraceptive method is lower among women in polygamous unions than among women in monogamous unions (Figure 5). In addition, multivariate analysis reveals that, other things being equal, women in polygamous unions are 14% less likely to use a family planning method than women in monogamous unions. Considering other factors associated with family planning use, a higher ideal number of children per woman, older partner age, and rural residence reduce the likelihood of using family planning; if the woman is employed, the likelihood increases. The probability of using family planning also increases with the standard of living and the level of education of women in union. (Annex 4).

                                                                            

Figure 5: Proportion of Married Women Currently Using Family Planning by Country and Type of Union

Source: DHS.

 

Women in polygamous unions are also found to have lower percentages of demand for family planning satisfied by modern methods than those in monogamous unions (Figure 6). However, in Niger and Senegal, the results show little difference between women in polygamous unions and those in monogamous unions. Other findings indicate that the percentage of current family planning users who make decisions with their husbands is lower among women in polygamous unions than those in monogamous unions.

Figure 6: Proportion of Married Women With Demand for Family Planning Satisfied by Modern Methods and Proportion of Current Married Female Family Planning Users Who Make the Decision With Their Husbands (%), by Country and Type of Union

Source: DHS.

Analyzing the impact of polygamy on fertility intentions and family planning helps us better understand women’s fertility intentions in West African countries.

This analysis deepens our understanding of the role of polygamy in fertility, fertility intentions, and family planning use in West Africa. While fertility rates do not vary significantly between women in polygamous and monogamous unions, those in polygamous unions have a higher desire for children and are less likely to use family planning compared to women in monogamous unions. These findings build on previous population-specific analyses of the impact of polygamy on fertility, fertility intentions, and family planning and apply them more broadly to the West African region.

The results indicate no significant difference in current fertility rates between women in polygamous and monogamous unions in most countries, which is similar to the results of previous studies in Nigeria.7 Our analysis validates these results for other countries in West Africa.

In addition, other studies similarly indicate that fertility intentions are higher among women in polygamous unions than among those in monogamous unions. This finding may be related to competition for fertility among co-wives. For example, studies of the Yoruba people in western Nigeria have shown that in polygamous couples, younger wives with lower status have a greater desire to improve their status by having a male child or by giving birth to more children than older wives.8 Other research has shown that competition between wives intensifies when women are more directly dependent on their husbands for emotional fulfillment or access to resources.9

In most of the countries in this study, women in polygamous unions are less likely to use contraception than women in monogamous unions. While an earlier study in Nigeria found a different result10, our result could be explained in part by the fact that women in polygamous unions may be reluctant to use contraceptive methods because a high desire to have more children. In addition, the low autonomy of women in polygamous unions, which makes it difficult for couples to negotiate access to family planning, could help explain this difference.11

Future research could build on this analysis by addressing some of the existing limitations. The first limitation relates to the lack of qualitative anthropological data that could help us understand certain behaviors in society that might have an impact on fertility rates. For example, in a society where there is a preference for boys, co-wives who do not yet have a boy might tend to compete for the birth of the husband’s “heir.” Another limitation of our analysis is the endogeneity between polygamy, fertility, and fertility intentions. Indeed, low fertility could encourage a man to take new co-wives. Finally, our study is limited by the absence of some variables that are strongly correlated with fertility, such as the wife’s perception of her husband’s fertility desires.

This study does not address all the sociocultural, economic, or other factors that might add important context to differences in fertility desires, nor does it attempt to explain all contributing factors. Explorations of other factors, such as ethnicity or religiosity, may be the subject of future research in this area in order to understand the implications of fertility desires among women in polygamous unions. Another aspect not included in this study is the role of the husband in decision-making in couples or polygamous unions, and the husband’s role as family decisionmaker on fertility or contraceptive use. The role of the husband and other factors influencing fertility choices among women in polygamous unions merits further exploration for programmatic and policy implications.

Recommendations

In the West African countries in this study, there are no specific policies or programs to address the family planning needs of polygamous couples. Apart from the legal status of polygamy in each country, it is important to recognize the extent of the practice in the region and to consider polygamy as one of the factors influencing levels of access to sexual and reproductive health care and services. This study demonstrates that there are identifiable differences in fertility desires and contraceptive use between women in polygamous and monogamous unions that deserve to be incorporated into programs and awareness campaigns.

With a deeper understanding of the sociocultural, religious, and gendered elements of decision-making in polygamous unions, policymakers and program managers responsible for access to sexual and reproductive health care and services should:

  • Implement a national policy with family planning guidelines that address the unique needs of polygamous couples, including quality family planning counseling and male engagement services.
  • Implement standardized data collection systems to collect and disaggregate family planning measures by type of union.
  • Target more awareness and information-sharing programs with husbands in polygamous unions, such as the “École des maris” (Husbands’ Schools).
  • Adapt messages to include women in polygamous unions in knowledge sharing and sexual and reproductive health counseling, taking into account social norms affecting the practice of polygamy.
  • Identify entry points for initiatives targeting birth spacing and family planning use by women in polygamous unions.

References

1 Toshiko Kaneda, Charlotte Greenbaum, and Carl Hobbs, World Population Data Sheet 2021 (Washington, DC: PRB, 2021).

2 John Bongaarts, “The Measurement of Wanted Fertility,” Population and Development Review 16, no. 3 (1990): 487-506; John C. Caldwell and Pat Caldwell, “The Cultural Context of High Fertility in Sub-Saharan Africa,” Population and Development Review 13, no. 3 (1987): 409-37.

3 Sadio Ba Gning and Philippe Antoine, “Polygamy and the Elderly in Senegal,” Mondes en développement, no. 3 (2015): 31-50.

4 Solène Lardoux and Etienne Van de Walle, “Polygyny and Fertility in Rural Senegal,” Population 58, no. 6 (2003): 807-36.

5 Fatou Binetou Dial, “Divorce, remariage et polygamie à Dakar,” [Divorce, Remarriage and Polygamy in Dakar] Le mariage en Afrique. Pluralité des formes et des modèles matrimoniaux [Marriage in Africa: Plurality of Matrimonial Forms and Models] (Québec: Presses de l’Université du Québec, 2014): 250-65; Gning and Antoine, “Polygamy and the Elderly in Senegal. “

6 Shelley Clark, Alissa Koski, and Emily Smith‐Greenaway, “Recent Trends in Premarital Fertility Across Sub‐Saharan Africa,” Studies in Family Planning 48, no. 1 (2017): 3-22; Barbara S. Mensch, Monica J. Grant, and Ann K. Blanc, “The Changing Context of Sexual Initiation in Sub‐Saharan Africa,” Population and Development Review 32, no. 4 (2006): 699-727.

7 Jelaludin Ahmed, “Polygyny and Fertility Differentials Among the Yoruba of Western Nigeria,” Journal of Biosocial Science 18, no. 1 (1986): 63-74; Helen Chojnacka, “Polygyny and the Rate of Population Growth,” Population Studies, 34, no. 1 (1980): 91-107.

8 P. O. Olusanya, “The Problem of Multiple Causation in Population Analysis, With Particular Reference to the Polygamy-Fertility Hypothesis,” The Sociological Review, 19, no. 2 (1971): 165-78; Osei-Mensah Aborampah, “Plural Marriage and Fertility Differentials: A Study of the Yoruba of Western Nigeria,” Human Organization 46, no. 1 (1987): 29-38.

9 Riley Bove and Claudia Valeggia, “Polygyny and Women’s Health in Sub-Saharan Africa,” Social Science & Medicine 68, no. 1 (2009): 21-9.

10 Bala Audu et al., “Polygamy and the Use of Contraceptives,” International Journal of Gynecology & Obstetrics 101, no. 1 (2008): 88-92.

11 Abdellatif Lfarakh, “Préférences, comportements et besoins non satisfaits en matière de planification familiale,” [Unmet Family Planning Preferences, Behaviors and Needs] (2005).

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Récapitulatif de la série de webinaires : Jeunesse, religion et contraception en Afrique francophone

Introduction

En Afrique francophone, les jeunes âgés de 15 à 24 ans ont difficilement accès aux informations et services de planification familiale (PF) de qualité. De plus, ils affichent un taux d’abandon de la contraception supérieur à celui de leurs aînées et sont particulièrement sensibles aux effets indésirables.  En mars 2022, PRB a tenu une série de quatre webinaires s’inscrivant dans la suite du dialogue initié en 2021 sur l’utilisation durable des contraceptifs chez les jeunes. L’initiative est portée par le projet PACE, financé par l’Agence Américaine pour le Développement (USAID) en collaboration avec le projet Knowledge SUCCESS. La série a réuni différents représentants du Ministère de la Santé, d’organisations de jeunes, de leaders religieux, et de Partenaires Techniques et Financiers (PTF) engagés dans l’amélioration de l’accès à la contraception par les jeunes. L’accès durable des jeunes à la PF a été discuté, sur la base d’une analyse du paysage politique des pays du Partenariat de Ouagadougou (PO), réalisée par le projet PACE. Les outils de communication développés par ce même projet pour renforcer le dialogue sur la PF pour les jeunes informés par des données probantes ont été présentés pour soutenir les échanges.

Résumés des interventions

8 mars 2022 : soutenir le recours à la contraception chez les jeunes dans le contexte des engagements envers FP2030.

Le paysage politique pour l’utilisation durable de la contraception par les jeunes dans les neufs pays du PO a été analysée sur la base de sept recommandations définies dans une note de politique rédigée par PRB en 2021. Ces recommandations visent à assurer que tout jeune accède, sans discrimination, à la méthode contraceptive de son choix quand et où il le souhaite. L’examen des documents politiques et règlementaires de différents pays, notamment les engagements FP2030, les lois relatives à la Santé de la Reproduction (SR) et les Plans d’Action Nationaux Budgétisés de la Planification Familiale (PANB/PF), montre que dans l’ensemble, l’environnement politique des pays demeure peu favorable à l’utilisation durable de la contraception par les jeunes. La plupart des pays reconnaissent les jeunes comme un groupe aux besoins spécifiques, mais l’accessibilité financière, le suivi personnalisé et l’accès à toute la gamme de contraceptifs, particulièrement aux méthodes auto-administrées, sont largement insuffisants. Les panélistes ont débattu des priorités pour leurs pays respectifs.

En Guinée, l’insuffisance des ressources domestiques, le contexte socio-culturel et le manque de services adaptés aux jeunes sont les obstacles à surmonter. La disponibilité de la gamme complète des produits contraceptifs est relevée comme essentielle, problématique actuellement traitée par un engagement dans l’élargissement de l’offre de produits dans les infirmeries scolaires, le secteur privé et les garnisons militaires. Cette dynamique s’appuie également sur la collaboration avec les organisations de la société civile, les PTF et la participation active des jeunes.

Au Sénégal, la prise en compte de la diversité des besoins des jeunes est identifiée comme prioritaire, considérant leur hétérogénéité en termes d’âge, de statut marital et de milieu de vie.  Les organisations de jeunes saisiront l’opportunité du nouveau PANB/PF pour améliorer l’accès à la contraception pour les jeunes non mariés – ignorés dans les documents actuels. Enfin, la RDC (pays extérieur au PO) met la priorité sur la facilité d’accès à la contraception dans le secteur privé. Des organisations de jeunes y ont mené un plaidoyer informé par des données pour la reconnaissance des besoins spécifiques des jeunes, et obtenu la signature par le gouvernement provincial, d’un arrêté soutenant un plan quinquennal pour l’accès des jeunes à la contraception, intégrant leur diversité.

14 et 24 mars 2022 : renforcer les partenariats avec les leaders de la jeunesse et les chefs religieux afin d’améliorer l’accès des jeunes à la planification familiale grâce à des dialogues communautaires éclairés.

Le rôle des leaders religieux pour démystifier les tabous autour de la PF pour les jeunes et renforcer un dialogue informé par des données est largement démontré. Des vidéos produites par le projet PACE en collaboration avec des leaders religieux et des jeunes du Sahel ont illustré l’engagement des diverses confessions religieuses dans la promotion de l’utilisation de la contraception par les jeunes afin d’assurer le bien-être de la mère et de l’enfant. Et si leurs messages s’inscrivent dans le contexte du mariage quel que soit le pays, l’accès à la contraception pour tous les jeunes, y compris ceux non-mariés, est pris en compte dans les politiques de pays laïcs comme le Mali ou la RCA. Au Mali, des campagnes annuelles offrent les services de PF à toutes les utilisatrices sans restriction, en cohérence avec les principes de non-discrimination, particulièrement pour les jeunes, avec l’appui des PTF.

Tous les panélistes reconnaissent l’importance d’informer la communication sur la PF avec des données probantes – telles que celles des enquêtes nationales Enquête Démographique et Santé (EDS) et Enquête en grappes à multiples indicateurs (MICS) – mais constatent qu’elles restent insuffisantes pour alimenter les dialogues et le plaidoyer. Les données existantes, souvent quantitatives et informant sur un temps donné, ne permettent pas de comprendre la dynamique de l’utilisation de la contraception par les jeunes. Des analyses secondaires des données nationales peuvent aider à expliquer l’abandon de la contraception et à comprendre l’impact des effets secondaires afin d’améliorer les messages tant pour les décideurs politiques que pour la communauté. Elles sont également importantes pour démontrer, par exemple, le rôle la PF pour la réduction de la mortalité maternelle et néonatale et des grossesses précoces. La nécessité d’un cadre de gouvernance et de coordination des données produites par les EÉtats et les PTF a été également soulignée. Les PTF sont encouragés à publier sur leurs sites les données qu’ils produisent pour un meilleur suivi des engagements dans le cadre du PO et de FP2030.

29 mars 2022 : renforcer la position des dirigeants communautaires en tant qu’alliés en faveur d’une utilisation continue des méthodes contraceptives chez les jeunes.

La recommandation politique sur la reconnaissance des besoins propres aux jeunes et celle sur la disponibilité d’une gamme complète de contraceptifs ont été spécifiquement discutées. Les panélistes (Ministère de la santé, organisation des jeunes et PTF) ont relevé les progrès réalisés, tels que l’approbation du programme d’éducation aux valeurs et à la santé sexuelle au Togo, la promotion par les autorités de RDC d’espaces conviviaux “jeunes” dans les structures de santé et la communauté, ou encore que les lois SR de leurs pays (Mali, RDC, Sénégal et Togo) intègrent l’utilisation de la contraception par les jeunes.  Cependant, ce cadre légal reste insuffisant ou fait face aux pesanteurs socio-culturelles. En RDC, la loi restreint le choix des méthodes contraceptives accessibles sans l’autorisation des parents pour les 15-17 ans, et interdit l’accès sans consentement parental aux moins de 15 ans. Au Mali ou au Togo, la faible compétence des prestataires de santé en counseling adapté aux jeunes, les préjugés, leur fréquentation des centres de santé et l’influence de leaders religieux conservateurs représentent des obstacles majeurs. Malgré l’engagement croissant de la société civile et des chefs religieux, les barrières socio-culturelles demeurent. Le constat est unanime quant à l’absence d’améliorations notables pour l’accès des jeunes à la contraception et sur la nécessité impérative de renforcer leur reconnaissance et leur implication comme acteurs à part entière des processus de formulation des politiques et programmes.

Conclusion/Recommandations

Le paysage politique des pays du PO demeure peu favorable à l’utilisation durable de la contraception par les jeunes. Malgré des progrès en termes d’engagements forts et d’adoption de textes règlementaires, les jeunes font face à plusieurs défis pour accéder durablement à une méthode contraceptive moderne quand et où ils le souhaitent. Les restrictions fondées sur l’âge, le coût, les préjugés des prestataires sont autant d’obstacles qui doivent disparaître. Face à cette situation récurrente, la participation des jeunes n’est pas optionnelle. Ils représentent la majeure partie de la population et doivent être pleinement impliqués dans la formulation des politiques qui les concernent et qui construisent leur futur. Ils doivent disposer du savoir nécessaire pour être entendus et assurer la prise en compte effective de leurs besoins spécifiques. Acteurs à part entière de la communauté, ils sont les alliés des gouvernements. Dans des sociétés fondamentalement guidées par la foi, les chefs religieux sont une force pour renforcer le dialogue et démystifier les fausses croyances. Leur collaboration avec les jeunes pour provoquer des changements positifs dans la communauté doit alors être soutenue pour amplifier une communication pertinente basée sur des données probantes, utilisant des messages adaptés et partagés par tous.

Ressources clés

Les ressources suivantes du projet PACE ont été partagées au cours de la série de webinaires :

  • Note de politique – Meilleures pratiques pour l’utilisation durable des contraceptifs chez les jeunes : cette note de politique décrit les modèles d’abandon de la contraception chez les jeunes et résume les preuves sur les facteurs d’abandon, à savoir les préoccupations liées à la méthode et la qualité des soins. Il présente une nouvelle analyse des principaux éléments d’insatisfaction à l’égard des services de PF chez les jeunes qui peuvent contribuer à l’arrêt de la contraception. Elle décrit les stratégies politiques et programmatiques qui peuvent améliorer la continuation contraceptive chez les jeunes femmes qui souhaitent prévenir, retarder ou espacer les grossesses.
  • Une présentation ENGAGE – Renforcer la confiance des communautés et le dialogue avec elles sur la foi, les mutilations génitales féminines et la planification familiale (Mauritanie) : PRB a collaboré avec l’Association des Gestionnaires pour le Développement (AGD) et le Cadre des Religieux pour la Santé et le Développement (CRSD) pour réunir un groupe multidisciplinaire engagé pour l’espacement des naissances chez les couples mariés et l’abandon de la pratique des mutilations génitales féminines et l’excision en Mauritanie. Ce groupe multidisciplinaire est constitué par des représentants du Ministère de la santé, les leaders religieux, les jeunes et les PTF. Il a validé le développement et la production d’une vidéo destinée aux leaders religieux et aux jeunes de la Mauritanie et du Sahel. Le but de la vidéo est de catalyser le dialogue régional et national sur les intersections positives entre la religion islamique et les besoins de santé reproductive et du bien-être des femmes et des jeunes de la Mauritanie. Elle montre les formes de collaboration possibles entre les leaders religieux et les jeunes afin de créer un environnement favorable aux politiques et programmes de santé reproductive des jeunes.
  • Une présentation ENGAGE – Rien N’est Tabou ! (Région du Sahel) :la présentation ENGAGE montre comment les communautés religieuses et les jeunes dans le Sahel peuvent œuvrer ensemble à faire avancer l’avenir de la région en promouvant un dialogue franc et ouvert et en encourageant en priorité la tolérance sociale. Elle souligne comment les leaders religieux peuvent se servir de leur influence de manière positive pour condamner les pratiques de mariage d’enfants et de mutilations génitales féminines. La présentation renforce également le message selon lequel les leaders religieux de la région sont disposés à encourager l’usage de la planification familiale chez les jeunes couples mariés et à soutenir les programmes d’éducation à la vie familiale.
  • Une présentation ENGAGE – Le Sénégal s’Engage : la Religion et la Santé familiale : Il s’agit d’un outil de plaidoyer pour relier les questions de santé reproductive et de planification familiale aux attitudes et croyances confessionnelles. S’appuyant sur des chefs communautaires et religieux, la présentation relie les impacts de la planification familiale et de l’espacement des naissances à des résultats positifs pour les soins, la nutrition et l’éducation des enfants ainsi que pour les ressources naturelles. La présentation illustre comment la planification familiale améliore la santé des mères et des enfants et contribue au bien-être des familles sénégalaises. En décomposant des concepts complexes et en utilisant un langage non technique, la présentation montre comment les chefs religieux du Sénégal peuvent guider les familles afin qu’elles puissent mener une vie spirituelle, heureuse et saine.
  • Analyse du paysage politique – Rapide analyse de l’environnement politique de l’utilisation durable de la contraception chez les jeunes : Le document d’analyse de paysage politique présente l’état de la mise en œuvre des sept recommandations de la note de politique dans les neuf pays du PO. Chaque recommandation est déclinée en critères auxquels des indicateurs sont attribués. La revue des documents politiques et de programmes a permis d’attribuer à chaque indicateur une notation. La méthode d’analyse des indicateurs a tenu essentiellement compte de l’accessibilité immédiate ou pas d’une jeune de 15-24 ans dans le besoin des services de PF. La notation retenue pour chaque indicateur est donc : Oui ou Non. L’objectif du document est de mettre à la disposition des acteurs de plaidoyers des informations et des données issues des documents nationaux pour alimenter leurs messages et leurs dialogues avec les décideurs politiques.

Webinaire 1 : soutenir le recours à la contraception chez les jeunes dans le contexte des engagements envers FP2030

Modératrice : Madame Aissata Fall, Représentante Régionale pour l’Afrique de l’Ouest et du Centre – PRB

Panélistes :

  1. Madame Fatou Diop, membre fondatrice du Cadre Consultatif des organisations de la société civile jeune du Sénégal et point focal jeunes du Sénégal de FP2030
  2. Dr Simon Mambo, co-fondateur/directeur exécutif, Alliance des Jeunes pour la Santé de la reproduction (YARH), RDC
  3. Dr Siré Camara, Cheffe de Division PF à la Direction Nationale de la santé familiale et de la nutrition (DNSFN) au Ministère de la Santé et de l’Hygiène Publique, Guinée

Webinaire 2 : renforcer les partenariats avec les leaders de la jeunesse et les chefs religieux afin d’améliorer l’accès des jeunes à la planification familiale

Modératrice : Madame Célia d’Almeida, Consultante en communication – Directrice ODEKA Médias & Formations

Panélistes :

  1. Monsieur Aly Kébé, membre du réseau des jeunes ambassadeurs SR/PF en Mauritanie
  2. Imam Abdallah Sarr, Secrétaire Générale de l’Association Mains de la fraternité en Mauritanie
  3. Dr Ben Moulaye Idriss, Directeur Général de l’Office National de la Santé de la Reproduction (ONASR), Mali
  4. Dr Konan Jules Yao, Représentant Adjoint, UNFPA RCA

Webinaire 3 : promouvoir les programmes politiques grâce à des dialogues communautaires éclairés

Modératrice : Madame Célia d’Almeida, Consultante en communication – Directrice ODEKA Médias & Formations

Panélistes :

  1. Madame Hayathe Ayeva, Jeune leaders, Ambassadrice SR/PF, Togo
  2. Madame Marlène Quenum, Présidente de l’ONG Allô Bénin, Chargée de l’organisation de la coalition des organisations de la société civile du Bénin
  3. Cheikh Elh Oumarou Mahaman Bachir, Président de l’Alliance des Religieux de l’Afrique de l’Ouest, Niger
  4. Monsieur Aliou Diop, Président de l’Association des Gestionnaires pour le Développement, point focal PF2030 pour la société civile, Mauritanie
  5. Dr Koudaogo Ouédraogo, Représentant Résident, UNFPA RCA

Webinaire 4 : renforcer la position des dirigeants communautaires en tant qu’alliés en faveur d’une utilisation continue des méthodes contraceptives chez les jeunes

Modératrice : Madame Aïssata Fall, Représentante Régionale pour l’Afrique de l’Ouest et du Centre – PRB

Panélistes :

  1. Madame Sorofing Traoré, point focal jeunes UCPO/FP2030 Mali
  2. Dr Alice Ndjoka, Directrice Adjointe, Programme National de la Santé de la Reproduction, Ministère de la Santé Publique, Hygiène et Prévention, R.D.C
  3. Madame Aminatou Sar, Directrice du Hub Afrique de l’Ouest et du bureau Sénégal de PATH
  4. Dr Bwato N’sindi, Spécialiste Technique, MH/RHCS Chef de l’unité Santé Sexuelle et Reproduction, UNFPA Togo
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Webinar Series Recap: Youth, Faith, and Contraception in Francophone Africa

Introduction

In Francophone Africa, young people ages 15 to 24 have difficulty accessing quality family planning (FP) information and services. In addition, they have a higher contraceptive discontinuation rate than older women and are particularly sensitive to adverse effects.  In March 2022, PRB convened a series of four webinars as a follow-up to the dialogue initiated in 2021 on sustainable youth contraceptive use. This webinar series was supported by the U.S. Agency for International Development (USAID)-funded PACE project, in collaboration with Knowledge SUCCESS. The series brought together representatives from the Ministries of Health of the Democratic Republic of Congo (DRC), Guinea, and Mali, youth organizations, religious leaders, and technical and financial partners (TFPs) committed to improving FP access for youth. Panelists discussed sustainable FP access for youth based on a PACE analysis of the policy landscape in the Ouagadougou Partnership (OP) countries. Project-developed communication tools designed to strengthen the evidence-based dialogue on FP for youth supported the discussions.

Summary of Webinar Sessions

March 8, 2022: Sustaining Youth Contraceptive Use in the Context of FP2030 Commitments

The policy landscape for sustainable youth contraceptive use in the nine OP countries was analyzed based on seven recommendations outlined in a 2021 PRB policy brief. These recommendations aim to ensure that every young person has access, without discrimination, to the contraceptive method of their choice when and where they want it. A review of policy and regulatory documents from different countries, including FP2030 commitments, reproductive health laws, and National Budgeted Family Planning Action Plans, shows that overall, the policy environment in countries remains unsupportive of youth sustainable contraceptive use. Most countries recognize youth as a special needs group, but affordability, personalized follow-up, and access to the full range of contraceptives, especially self-administered methods, are largely inadequate. Panelists discussed priorities for their respective countries.

In Guinea, insufficient domestic resources, the sociocultural context, and the lack of youth-friendly services are the obstacles to overcome. The availability of a full range of contraceptive products was identified as a key issue, which is currently being addressed through a commitment to expand the supply of products in school infirmaries, the private sector, and military garrisons. This dynamic is also based on collaboration with civil society organizations, TFPs, and the active participation of young people.

In Senegal, addressing the diversity of youth needs was identified as a priority, considering their heterogeneity in terms of age, marital status, and living situation.  Youth organizations will seize the opportunity of the new National Budgeted Family Planning Action Plans to improve access to contraception for unmarried youth who are ignored in the current documents. Finally, the Democratic Republic of Congo (a country outside the OP) is prioritizing easy access to contraception in the private sector. Youth organizations there have conducted data-informed advocacy for the recognition of the specific needs of youth and obtained the signature of the provincial government on a decree supporting a five-year plan for youth access to contraception that emphasizes the importance of client-centered care.

March 14 and 24, 2022: Strengthening Partnerships With Youth and Religious Leaders to Improve Youth Access to Family Planning Through Informed Community Dialogue

The role of religious leaders in demystifying the taboos around FP for youth and reinforcing an evidence-informed dialogue is amply demonstrated. Videos produced by the PACE project in collaboration with religious leaders and youth in the Sahel illustrated the commitment of various religious denominations in promoting youth contraceptive use to ensure the well-being of the mother and child. And while their messages are framed in the context of marriage in any country, access to contraception for all youth, including unmarried youth, is included in the policies of secular countries such as Mali and the Central African Republic. In Mali, annual campaigns offer FP services to all users without restriction, in accordance with the principles of non-discrimination, particularly for young people, with the support of TFPs.

All panelists recognized the importance of informing FP communication with evidence – such as national Demographic and Health Survey (DHS) and Multiple Indicator Cluster Survey (MICS) data – but noted that it remains insufficient to inform dialogue and advocacy. Existing data, often quantitative and time-specific, do not provide insight into the dynamics of youth contraceptive use. Secondary analyses of country data can help explain contraceptive discontinuation and convey the impact of side effects to improve messaging for both policymakers and the community. They are also important to demonstrate, for example, the role of FP in reducing maternal and neonatal mortality and early pregnancy. Panelists emphasized the need for a framework for governance and coordination of data produced by states and TFPs. The TFPs were encouraged to publish the data they produce on their sites for better monitoring of commitments in the OP and FP2030 frameworks.

March 29, 2022: Reinforcing Community Leaders as Allies for Continued Youth Contraceptive Use

Policy recommendations from the brief regarding recognizing the unique needs of youth and on the availability of a full range of contraceptives were specifically discussed. The panelists (Ministry of Health, youth organizations, and TFPs) noted the progress made, such as approval of the values and sexual health education program in Togo, promotion by DRC authorities of “youth-friendly” spaces in health facilities and the community, and inclusion of the use of contraception by youth in the reproductive health laws of their respective countries (DRC, Mali, Senegal, and Togo).  However, this legal context remains insufficient or is subject to sociocultural constraints. In the DRC, the law restricts 15-to-17-year-olds’ choice of contraceptive methods that can be accessed without parental authorization and prohibits access without parental consent for those under 15. In Mali and Togo, prejudice, health care providers’ lack of youth-friendly counseling skills, and the influence of conservative religious leaders are major obstacles. Despite the growing commitment of civil society and religious leaders, sociocultural barriers remain. Agreement is unanimous that no significant improvement in youth access to contraception has been made, underscoring the need to strengthen recognition and involvement of youth as full-fledged actors in policy and program formulation processes.

Conclusion/Recommendations

The policy landscape in OP countries remains unsupportive of youth sustainable contraceptive use. Despite progress in terms of strong commitments and the adoption of regulations, young people face several challenges in gaining sustainable access to a modern contraceptive method when and where they want it. Restrictions based on age, cost, and provider bias are all obstacles that must be overcome. Given this persistent situation, meaningful youth participation cannot be considered optional. Youth represent the majority of the population and must be fully involved in the formulation of policies that affect them and build their future. They must have the necessary knowledge to be heard and to ensure that their specific needs are effectively taken into account. As full-fledged actors in the community, they are the allies of governments. In societies fundamentally guided by faith, religious leaders are a force for strengthening dialogue and debunking false beliefs. Religious leaders’ collaboration with youth to bring about positive change in the community must be supported to amplify relevant evidence-based communication, using messages that are appropriate and shared by all.

Key Resources

The following PACE project resources were shared during the webinar series:

  • Policy brief—Best Practices for Sustainable Contraceptive Use Among Youth: This policy brief describes patterns of contraceptive discontinuation among youth and summarizes the evidence on the drivers of discontinuation, namely method concerns and quality of care. It presents a new analysis of key elements of dissatisfaction with FP services among youth that may contribute to contraceptive discontinuation. It describes policy and programmatic strategies that can improve contraceptive continuation among young women who want to prevent, delay, or space pregnancies.
  • An ENGAGE presentation—Building Community Confidence and Dialogue on Faith, Female Genital Mutilation, and Family Planning (Mauritania): PRB collaborated with the Association des Gestionnaires pour le Développement (AGD) and the Cadre des Religieux pour la Santé et le Développement (CRSD) to convene a multidisciplinary group committed to birth spacing among married couples and the abandonment of the practice of female genital mutilation and cutting (FGM/C) in Mauritania. This multidisciplinary group is made up of representatives from the Ministry of Health, religious leaders, youth, and donors. The group validated the development and production of a video aimed at religious leaders and youth in Mauritania and the Sahel. The purpose of the video is to catalyze regional and national dialogue on the positive intersections between the Islamic religion and the reproductive health and wellness needs of women and youth in Mauritania. It shows possible forms of collaboration between religious leaders and youth to create an enabling environment for youth reproductive health policies and programs.
  • An ENGAGE presentation—Nothing is Taboo! (Sahel Region): The ENGAGE presentation shows how religious communities and youth in the Sahel can work together to advance the future of the region by promoting frank and open dialogue and by prioritizing social tolerance. It highlights how religious leaders can use their influence in a positive way to condemn the practices of child marriage and FGM/C. The presentation also reinforces the message that religious leaders in the region are willing to encourage the use of FP among young married couples and to support family life education programs.
  • An ENGAGE presentation—Senegal is Committed: Religion and Family Health—is an an advocacy tool to link reproductive health and family planning issues to faith-based attitudes and beliefs. Drawing on community and religious leaders, the presentation links the impacts of family planning and birth spacing to positive outcomes for childcare, nutrition, and education, as well as for natural resources. The presentation illustrates how family planning improves maternal and child health and contributes to the well-being of Senegalese families. By breaking down complex concepts and using non-technical language, the presentation shows how religious leaders in Senegal can guide families to lead spiritual, happy, and healthy lives.
  • Rapid analysis—Policy Landscape for Sustaining Youth Contraceptive Use in the Nine Ouagadougou Partnership Countries: The Policy Landscape Analysis presents the status of implementation of the seven recommendations of the policy brief in the nine OP countries. Each recommendation is broken down into criteria to which indicators are assigned. The review of policy and program documents made it possible to assign a rating to each indicator. The method of analysis of the indicators essentially took into account the immediate accessibility or lack of services for a young person ages 15 to 24 in need of FP services. The rating for each indicator was therefore: Yes or No. The objective of the document is to provide advocacy actors with information and data from national documents to inform their messages and their dialogue with policymakers.

Webinar 1: Sustaining Youth Contraceptive Use in the Context of FP2030 Commitments

Moderator: Ms. Aissata Fall, Regional Representative for West and Central Africa – PRB

Panelists:

  1. Fatou Diop, Founding member of FP2030’s consultative group of young civil society organizations, Senegal
  2. Simon Mambo, Co-Founder/Executive Director, Youth Alliance for Reproductive Health, Democratic Republic of the Congo
  3. Siré Camara, Head of the Division of Family Planning at the National Directorate of Family Health and Nutrition (DNSFN) at the Ministry of Health and Hygiene, Guinea

Webinar 2: Reinforcing Partnerships With Youth and Faith Leaders to Improve Youth’s Access to Family Planning

Moderator: Ms. Célia d’Almeida, Communication Consultant – Director at Odeka Media & Training

Panelists:

  1. Aly Kébé, Member of the network of youth SRH/FP ambassadors in Mauritania
  2. Imam Abdallah Sarr, Secretary General of the Hands of Fraternity Association in Mauritania
  3. Ben Moulaye Idriss, Director General of the National Office of Reproductive Health (ONASR), Mali
  4. Konan Jules Yao, Deputy Representative, UNFPA Central African Republic

Webinar 3: Advancing Policy Agendas Through Informed Community Dialogues

Moderator: Ms. Célia d’Almeida, Communication consultant – Director at Odeka Media & Training

Panelists:

  1. Hayathe Ayeva, Young leader and SRH/FP ambassador, Togo
  2. Marlène Quenum, President of Hello Benin NGO, Head of the coalition of civil society organizations of Benin
  3. Cheikh Elh Oumarou Mahaman Bachir, President of the Religious Alliance of West Africa, Niger
  4. Aliou Diop, President of the Association of Managers for Development, FP2030 civil society focal point, Mauritania
  5. Koudaogo Ouédraogo, Resident Representative, UNFPA Central African Republic

Webinar 4: Reinforcing Community Leaders as Allies for Continued Youth Contraceptive Use

Moderator: Ms. Aissata Fall, Regional Representative for West and Central Africa – PRB

Panelists:

  1. Sorofing Traoré, UCPO/FP2030 youth focal point, Mali
  2. Alice Ndjoka, Assistant Director, National Reproductive Health Program at the Ministry of Public Heath, Hygiene, and Prevention, Democratic Republic of the Congo
  3. Aminatou Sar, Director of West Africa Hub and Senegal Office, PATH
  4. Bwato N’sindi, Technical Specialist (MH/RHCS), Head of Sexual and Reproductive Health Unit, UNFPA Togo
Nepali little girls looking at Annapurna South

Building Resilience Through Family Planning and Adaptation Finance

Climate change adaptation has come to the forefront of the global agenda since the 2015 Paris Agreement under the United Nations Framework Convention on Climate Change, and momentum for international financing for climate change adaptation projects is growing. This growth provides the family planning/reproductive health (FP/RH) community an opportunity to engage with adaptation decisionmakers and processes to potentially access adaptation funding as part of multisectoral adaptation projects.

The Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) Project has been a leader in advancing multisectoral approaches that integrate family planning and reproductive health as solutions to complex challenges such as climate change adaptation and sustainable, equitable development. PACE has underlined how these programs contribute to increased climate adaptation and resilience, opening the door to greater investment in health and development interventions among climate adaptation solutions.

A growing evidence base links women’s met needs for family planning with reduced human vulnerability to climate change and enhanced resilience in the face of climate change impacts. Yet, thus far, population and family planning have been largely left out of adaptation proposals and projects. A PRB policy brief, available in English and French, identifies four key strategies the FP/RH community can use to promote inclusion of family planning in adaptation strategies in ways that build resilience, improve health, and enhance women’s economic empowerment.

  • Draw the connections to and build the evidence base for including family planning in multisectoral adaptation approaches.
  • Reach out to a country’s designated authority to identify main climate change adaptation decisionmakers at the national level and develop an understanding of how adaptation finance flows.
  • Engage in a country’s National Adaptation Plan process to connect with stakeholders and identify country-driven adaptation priorities.
  • Consider partnering with others in developing multisectoral proposals that include family planning and helping to implement those proposals.

The best opportunity for funding FP/RH within adaptation projects is to integrate women’s empowerment—including family planning—within multisectoral proposals. A how-to video produced in 2022 adds to the report and brief published in 2018 to illustrate strategies for family planning and reproductive health program implementers and advocates to position their programs to access climate adaptation funding. A virtual watch party and workshop in April 2022 showcased the video and provided an opportunity for implementers and advocates to explore how to apply each of the strategies to their programming with advice from key experts.

 

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Resilient Future: Climate Financing Strategies for Family Planning Programs

Resilient Future: Climate Financing Strategies for Family Planning Programs

NOT A DIFFERENT LENS, BUT A WIDER LENS

Women’s Edition Enables Big-Picture Reporting in Southeast Asia’s Remote Coastal Lands and Beyond

While women make up about half the world’s population, they are vastly underrepresented as both newsmakers and news sources. Just one in four of all people seen, mentioned, or quoted in news stories are women.1 The proportion of women featured as experts—especially on topics given prominent coverage in most media outlets, such as politics and the economy—is even smaller. And while women make up 40% of all journalists, they constitute less than one-quarter of newsroom leaders and decisionmakers.2

For nearly 30 years, PRB’s Women’s Edition has trained, connected, and championed women journalists from around the world covering news about health and population. The fellowship program has long been supported by the U.S. Agency for International Development, most recently through the Policy, Advocacy, and Communication Enhanced for Population and Reproductive Health (PACE) project. In more than six years under PACE, Women’s Edition evolved to meet changing media and public health landscapes, with an increased focus on data-driven reporting that spotlights marginalized communities facing intersecting challenges. The program transformed its recruitment practices to diversify its fellow groups, organized innovative virtual programming in response to the COVID-19 pandemic, added professional development and collaboration opportunities to its suite of activities, and broadened its thematic scope to include urgent questions around global health and security.

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Women's Edition fellow Swati Bhattacharjee at work on the Indian side of the Sundarbans region.

But the program’s animating values have remained consistent: to focus media attention on women’s perspectives and experiences, and to give women journalists resources and opportunities to help them stake a larger—and, ultimately, equal—claim in newsrooms and in newsprint. As we look forward and adapt the program to new frontiers, we also learn from the foundational elements that make Women’s Edition a unique and needed source of support for news coverage by and about women.

This feature explores those lessons through one of the program’s recent additions: a cross-border reporting grant that enabled a team of fellows to reveal linkages between women’s health and environmental degradation in the Sundarbans, a vast, isolated, and resource-rich region shared by Bangladesh and India. This case study highlights approaches that have strengthened the representation and impact of women journalists reporting on population dynamics, reproductive health, and multisectoral development across the globe.

WOMEN’S EDITION IN ACTION

Cross-Border Reporting Team Exposes Women’s Health Crises in the Sundarbans
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Swati Bhattacharjee is a senior assistant editor at Anandabazar Patrika, a Bengali-language daily newspaper that marked its 100th anniversary this year. Based in Kolkata, near India’s eastern border, Bhattacharjee writes editorials and assigns articles to contributors on a range of topics. But her passion lies in investigating “poverty alleviation and gender justice,” especially in less-covered rural areas of India, and reporting through “the eyes of the people who are living in the margins of society.” A Women’s Edition fellow since 2020, Bhattacharjee joined the program during its transition to virtual training, when its thematic focus was the gendered effects of the COVID-19 pandemic.

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Jesmin “Papri” Akter is a freelance reporter based in Dhaka, Bangladesh, where she has worked mainly in online and multimedia journalism for more than a decade. Previously a diplomatic correspondent, she prefers her current focus on migration and the environment honed under Women’s Edition, and she reports in Bengali for Radio Free Asia, among other outlets. Akter joined the fellowship during a weeklong, in-person workshop in Kathmandu, Nepal, in 2019, and has remained committed to the program during its pandemic repositioning. “My knowledge and reporting style changed a lot since being admitted to Women’s Edition,” Akter said, crediting the program with teaching her to “think big.”

In 2021, these two fellows teamed up on a reporting project called “Bitter Salt: How Rising Salinity Affects Women in the Sundarbans.” Their partnership, which culminated in a series of Bengali-language stories published in two outlets from both sides of the Bangladesh-India border, illustrates the core components of Women’s Edition in practice. It also showcases the urgency of dedicated investment in women journalists and women’s stories.

STRENGTH IN NUMBERS

Building Peer Networks Provides Material and Moral Support for Journalists

While some aspects of Women’s Edition—including its focal theme—change annually, the program’s fostering of regional peer networks is one of its central pillars, and one of the most durable benefits for fellows. Peer networks provide a safety net, a sounding board, and a source of encouragement for Women’s Edition fellows. “As working journalists, we know that cross-fertilization of ideas is helpful,” said Bhattacharjee. “That’s how you develop your networks…and you learn from each other’s experiences.”

“As working journalists, we know that cross-fertilization of ideas is helpful. That’s how you develop your networks…and you learn from each other’s experiences.”

-SWATI BHATTACHARJEE

For much of the program’s history, connections between fellows were forged organically during intensive in-person workshops. Fellows would share meals, swap stories and jokes about the hardships and rewards of their work, and press guest speakers and experts for straight answers during group Q&A sessions. Pivoting to an all-virtual training model in 2020 meant that peer learning had to be cultivated intentionally, and over a longer period. Today, dedicated monthly peer sessions on Zoom include breakout rooms where fellows can refine story ideas and exchange contacts and tips. “The peer meetings are a good time for us to discuss the issues in different countries and to share ideas and knowledge and difficulties,” said Akter.

Bhattacharjee agreed that sharing experiences with other fellows helped strengthen the journalists’ reporting and create “an enabling sphere” for improved work.

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Romesa (35), whose story is told in Jesmin Akter’s reporting, lives with her family at the mouth of the Ganges River. In the last 25 years, Romesa’s family’s home has flooded repeatedly. She had a hysterectomy a few years ago after experiencing chronic illness, which she connects to hours spent working in salt water. “Almost every female in our village is suffering from the same problem,” she said.

ASK AN EXPERT

Forging Connections With Diverse Sources Enriches Reporting and Bridges Gaps

While the media landscape across countries can differ dramatically, some challenges are common for journalists everywhere. One of these is access to sources—especially experts—who may be mistrustful of the media, unfamiliar or uncomfortable with journalistic practices, or too busy with their own deadlines to meet anyone else’s.

Women’s Edition leverages PRB’s and PACE’s rosters of experts across sectors and serves as a pipeline for data, research, and context around program themes. The virtual training model enhances this benefit: Though fellows are no longer able to engage in face-to-face dialogue with experts, the diversity of available experts has increased. Since location and travel time are no longer barriers, training sessions may now feature speakers from Germany, Pakistan, Senegal, and the United States in the same online classroom.

The program has identified the leading experts in this area, and we realize that this can only happen after a lot of research on who has intimate knowledge on the gender aspects of climate change. Hence we could get expert quotes with relative ease,” said Bhattacharjee.

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A woman pulls a shrimp net through waist-deep water on the Bangladeshi side of the Sundarbans region.

REPORTERS ACROSS BORDERS

Supporting Teamwork Expands Journalists’ Capacity and Stimulates Ambitious Coverage

To enhance collaboration among fellows and increase the impact of their news stories, Women’s Edition added a cross-border grant opportunity in 2021, allowing journalists to apply for funding to support deep coverage of topics with international importance.

Bhattacharjee and Akter were among the first fellows to apply, envisioning work in the Sundarbans, which spans 10,000 square kilometers and encompasses forests, islands, three major rivers, and four UNESCO World Heritage Sites. Known for its remarkable biodiversity, the Sundarbans is now threatened by climate change and a rapidly growing human population.3

The story presented—both literally and figuratively—too much ground to cover. And since the Sundarbans is shared by two countries, the pair knew their story would be enriched by perspectives and connections on both sides of the border. “What especially attracted us was that we need to find out how in these two countries, which of course have two different governments…how were these governments and health systems reacting to the issue?” said Bhattacharjee.

Many urgent challenges transcend geographic, socioeconomic, and political boundaries, and merit cross-border information sharing and news coverage. Tracking and health systems response for infectious disease is one example, illustrated by the ongoing COVID-19 pandemic. Conflict and security, environmental conservation, economic shifts, supply chain management, and migration are others on a growing list. Cross-border newsgathering and cooperation among journalists allow media to effectively report on complex topics and provide the public and decisionmakers with the context needed to inform constructive action.

MINDING THE GAPS

Highlighting Neglected Subjects Reveals Important Truths and Connections

Women’s Edition has, since its inception, focused on elevating women’s stories. Each year’s fellowship program is structured around a health and population theme, and the program’s evidence-based training, expert presentations, independent coaching, and storytelling grants hew to that theme. In recent years, program themes have aligned with dominant news stories or current events while still directing attention to new narratives.

In 2020, programming unpacked the effects of COVID-19 on women, including the ways in which health system shocks deepen existing inequities in health care. “[Women’s] needs were being easily overshadowed during the pandemic,” said Akter. Women’s health in particular, “which [is] always very neglected in countries like Bangladesh,” was invisible across news media, she added.

In 2021, the fellowship focused on the disproportionate effects of climate change on women and explored land and natural resource access, as well as how a dearth of women in leadership roles inhibits equitable decision-making and how climate-linked threats to women impact whole communities. Women’s Edition “has come as a huge support for many of us journalists who are writing on slightly unusual subjects and newer subjects trying to explore the crisis happening at the margins,” said Bhattacharjee.

Participation in Women’s Edition often permanently reorients fellows’ reporting: Years and even decades after their fellowships, many alumnae continue to publish stories that prominently feature women’s perspectives and challenge norms and conventions related to gender. And that shift can change minds within newsrooms. “This gender lens helped my colleagues also to change their directions and work,” said Akter. “Many of our colleagues from different media outlets have contacted me on how to write and report stories about women in the coastal areas” as well as on climate change and pandemic response.

“We don’t have enough stories on women and how they are being impacted, so there is no policy response.”

-SWATI BHATTACHARJEE

Bhattacharjee agreed. “Many people call me up to say we have been living in the Sundarbans all our lives and we don’t know that women here are suffering so frightfully from these health problems,” she said. One of the reasons gender inequities persist, according to Bhattacharjee, is that they don’t get enough attention. “We don’t have enough stories on women and how they are being impacted, so there is no policy response.”

During their reporting for the Bitter Salt series, Akter and Bhattacharjee witnessed the practical consequences of decision-making that fails to account for women’s experiences. “All this starts from a lack of gender-sensitive stories, and in our small way we trying to counteract that by putting out our stories,” Bhattacharjee said. “The gender lens is not a different lens, it is just a wider lens that allows us to capture the true picture of what is happening out there.”

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Women in the region spend hours each day in salt water to prepare nets and harvest shrimp.

LEVELING THE PLAYING FIELD

Funding Women’s Stories Makes In-Depth Reporting Possible

While the fragility of the traditional media business model—and the industry-wide cutbacks that have affected newsgathering and production—are not new or unique to any place, they compound a disadvantage already faced by women journalists. Stereotypes linked to traditional gender roles affect how women are portrayed in news stories, and women are paid less than their male colleagues for comparable newsroom jobs almost universally.4

Akter and Bhattacharjee have experienced these disparities. “In Bangladesh, the opportunities for female journalists are not the same as male journalists, and funding is the biggest problem we face while reporting,” Akter said.

Reporting grants made available through Women’s Edition help fill the resource gap that holds women journalists back.

Bhattacharjee explained that cutbacks in many news organizations are making reporting from the margins exceedingly difficult. This is where journalism grants, such as those offered by Women’s Edition, can play a critical role. The coastal areas covered in their “Bitter Salt” stories required travel by boat and across long distances, which cost time and money. Especially when reporting on a controversial or personal topic, being able to spend time with sources and visit a reporting site multiple times improves the accuracy and nuance of a story, but news organizations rarely support that process. “…You have to invest a lot in those relationships,” said Bhattacharjee. “Without good relationships there is no good journalism.”

 

BITTER SALT: THE STORIES

How Rising Salinity Affects Women in the Sundarbans

In their reporting grant pitch to Women’s Edition, Akter and Bhattacharjee proposed to explore how women in coastal communities in the Sundarbans region were affected by climate change, and how the governments of Bangladesh and India were responding to the manifold consequences of this change, including loss of livelihood, lack of access to clean water, and chronic health problems.

In preparation for their series, the fellows gathered evidence that rising salinity in the water and soil in coastal areas coincided with a high number of cases of pelvic inflammation, skin disease, and reproductive tract ailments that led to hysterectomies among coastal women. They also observed both devastation and innovation in the work traditionally done by women, including farming of water-reliant crops such as rice.

“In our stories, Jesmin [Akter] and I were looking at two systems through the gender lens,” said Bhattacharjee.  “One was how people and communities cope after huge disasters, like repeated cyclones that the Sundarbans constantly faces. The second is the response of public health systems and other governmental systems, which often ignore the needs of women. We need to get the stories of women out so we can show the reader how women are being affected deeper—their wounds are deeper…”

But commitment to their story didn’t eliminate barriers to reporting. In addition to the twin hurdles of accessing remote areas and earning the trust of local women, Akter and Bhattacharjee were exploring health effects that hadn’t been thoroughly studied, and among people who were largely ignored due to their economic and social status and location. “This story was unique in the connections it made. It linked climate change to reproductive health quite tangibly, and it argued for the need to integrate public health with reproductive health,” said Bhattacharjee. “These health problems go unnoticed; the connection to salinity is not acknowledged in West Bengal in medical research or in health policy.”

 

 

 

 

LOOKING FORWARD

Threats and Opportunities in the Modern Media Landscape

The cross-border collaboration exemplified by Akter and Bhattacharjee was a new approach for Women’s Edition, one meant to address the parallel challenges of a rapidly changing media landscape and a fluid, fast-moving set of news events that demand information sharing and cross-sectional thinking.

As newsrooms shrink and journalists increasingly work on an independent or freelance basis, media face more pressures than ever, including a flood of information published without journalistic rigor on social media and criticism from authorities that can have dangerous consequences.5 Women journalists face unparalleled threats in the course of their work, and they are more likely to be harassed and targeted with sexual violence than their male colleagues.6 The digital media landscape can be particularly daunting: Women journalists have been targeted for asking tough questions about access, rights, and equity.7 Strengthening journalist networks and elevating the roles of women journalists are important reinforcements against these hazards.

“The gender lens is not a different lens, it is just a wider lens that allows us to capture the true picture of what is happening out there.

-SWATI BHATTACHARJEE

Women’s Edition’s recent focus on complex themes, such as the interplay between gender dynamics and climate adaptation, pandemic response, and health supply chain management, promotes critical thinking about the ways in which current events—and our response to them—can alter or entrench existing inequities. A reduction in budgets for remote correspondents, travel, and in-depth newsgathering has meant some populations don’t get covered at all, Bhattacharjee noted, especially women in rural areas.

Yet PACE’s experience shows that when these stories are covered, decisionmakers take notice. Following a reporting grant to produce a three-part series on migration linked to climate change in late 2021, Women’s Edition fellow and television reporter Tahsina Sadeque learned that the Dhaka city government and city planners were using her reporting to inform a new detailed area plan that addresses the needs of climate refugees. In 2018, a Nepali fellow’s coverage of uterine prolapse resulted in expanded government-supported health services and a rural information campaign about the issue. Other fellows’ work has been cited by government ministers, U.S. ambassadors, civil-society organizations, and even other news media as an agent of change.

The convergence of factors that threaten to reduce the quality and breadth of publicly available information comes at a time when we most need accurate, real-time journalism to inform public debate and drive accountability among decisionmakers. The building blocks of Women’s Edition—peer networks, deep collaboration, multisectoral communication, and intersectional analysis of current events—exemplify the multidimensional solutions that can galvanize support for more inclusive and effective policies.

References

1 Global Media Monitoring Project, Who Makes the News? 2021.

2 Simge Andı, Meera Selva, and Rasmus Kleis Nielsen, Women and Leadership in the News Media 2020: Evidence From Ten Markets, Reuters Institute for the Study of Journalism, March 2020.

3 Janet Ranganathan, Sarah Parsons, and Jasmine Qin, “Squeezing the Sundarbans: Threats to World’s Largest Mangrove Forest Put Millions of People At Risk,” Resource Watch, May 24, 2018.

4 Prashanth Rao and Maite Taboada, “Gender Bias in the News: A Scalable Topic Modelling and Visualization Framework,” Frontiers in Artificial Intelligence, June 16, 2021; and Carolyn M. Byerly, Global Report on the Status of Women in the News Media, International Women’s Media Foundation (IWMF), 2011.

5 Arlene Getz, “Number of Journalists Behind Bars Reaches Global High,” Committee to Protect Journalists, December 9, 2021.

6 Alana Barton and Hannah Storm, Violence and Harassment Against Women in the News Media: A Global Picture, International Women’s Media Foundation (IWMF) and International News Safety Institute (INSI), 2014.

7 Julie Posetti et al., Online Violence Against Women Journalists: A Global Snapshot of Incidence and Impacts, United Nations Educational, Scientific and Cultural Organization (UNESCO), 2020.

Power and Partnership: Supporting Youth Through the PACE Project

PACE’s approach to listening to and meaningfully supporting youth partners’ goals has developed into an intentional model.

Youth leaders are increasingly calling for inclusion through meaningful engagement and more equitable partnerships in their work in the international development community. This is driven, part, by power differentials between international nongovernmental organizations (INGOs) and local partners, which can be amplified by age differences. In their collaborations with youth leaders and youth-led organizations (YLOs), non-youth-led organizations and partnerships are encouraged to adhere to principles and values of respect, inclusion, resource sharing, and mutual learning, as embodied in the Global Consensus Statement on Meaningful Adolescent and Youth Engagement and the We Trust You(th) Initiative.

In its nearly seven years supporting evidence-based policy, advocacy, and communication for population and reproductive health, PRB’s PACE project worked to foster respectful and mutually beneficial partnerships with youth leaders and youth-led organizations (YLOs) that honored their unique priorities while also exploring new approaches, reflecting on learnings, and applying lessons to collaborate with youth in more equitable, intentional ways. In response, PACE’s approach to program implementation evolved into one that prioritized questioning traditional strategies, shifting power dynamics, learning from partners and other projects, and capitalizing on the diverse skills and strengths of partners. As the project ends, PACE shares the following experiences and insights for other INGOs aiming to deepen their partnerships with youth and YLOs.

Extending Opportunities to Apply Skills and Advance Dialogue

In all of PACE’s work, strengthening the capacity of partners to effectively use data in their communication and advocacy has been a central mandate. Many of PACE’s activities with young people launched with this purpose, then grew into multi-year partnerships as PACE and youth jointly created opportunities to apply their skills to advance their priorities—whether youth-focused or not. What began as isolated activities to strengthen youth capacity were given space and trust to shift in response to the skills, needs, and priorities voiced by youth participants.

For example, PACE enlisted YLO stakeholders as key collaborators for its policy brief on youth contraceptive discontinuation, compensating them for their time. As PACE prepared to launch the brief, the youth partners requested skills-building activities to help them reach decisionmakers with the brief’s key messages. In response, PACE worked with them to create targeted training and resources to bolster their policy communication skills, including a PowerPoint-based advocacy tool and training and grant opportunities. The project hired one of these youth leaders as a consultant to help organize a policy dialogue with regional decisionmakers, and provided grants and technical support to three YLOs to use the brief to advance their advocacy goals.

PACE similarly expanded the training program for the inaugural West Africa Policy Fellows activity, supporting youth Ph.D. candidates to use the recommendations from the same policy brief to conduct a new, youth-led assessment of national policy and program contexts for sustaining youth contraceptive use in Ouagadougou Partnership countries. Following the success of these (and similar) activities, PACE’s skills-building activities with youth now consistently include financial support for participants to implement policy advocacy and communication activities using their skills while drawing support and mentorship from PACE as needed.

Co-Creating Activities and Sharing Leadership With Youth Partners

As activities blossomed into shared partnerships, PACE’s willingness to trust youth partners and share leadership was critical to success. Bridge Connect Africa Initiative (BCAI), a YLO based in northern Nigeria, co-led PACE’s Youth Multimedia Fellowship alongside PRB starting in 2019, following their standout participation in the first year of the program. Drawing on their own expertise and experience in advocacy and sharing decision-making power and financial resource management with PACE, BCAI helped adapt the fellowship training curricula and materials, supported the selection of new participants, facilitated half of the weekly training sessions, and coached new fellows on foundational concepts. Building on the success of this co-leadership model, USAID/Nigeria supported the production of a podcast and radio series through PACE, with BCAI receiving half of the award funding.

From the start of our partnership with PACE until now, we are treated as experts who bring much experience to the table and [are] trusted to lead programs with adequate and timely resources. We have played central roles in decision making throughout….This has resulted in BCAI’s exponential growth and expertise…and…built our confidence working and negotiating with other partners outside the PACE project….This proactive and forward-thinking energy by PACE to ensure BCAI succeed[s] with all the tools it will need going forward is the best definition of meaningful youth engagement you would find anywhere across the globe.” —Sani Muhammad, BCAI executive director

 

At the start of each year of the Youth Multimedia Fellows program, PACE conducted a needs assessment with incoming fellows to identify which skills they desired to build through the fellowship. Using these expressed needs, PACE and BCAI provided each fellow with targeted resources and guidance to help them meet their goals. By trusting youth in this way, PACE supported each fellow in developing a comprehensive advocacy campaign, including a targeted multimedia advocacy tool, before the end of the fellowship.

PACE’s experience working across countries and BCAI’s mentorship created space for the youth fellows to discuss solutions to common challenges across contexts. As BCAI and the multimedia fellows continued their advocacy activities, the fellowship fostered peer-to-peer learning, creating a cycle of growth that strengthened each organization’s activities. Likewise, PACE’s partnerships with BCAI and YLOs helped PACE strengthen its youth- and partner-led programming by listening to organizations’ needs and priorities and maintaining flexibility to adapt approaches in response.

Bolstering the Organizational Capacity of Youth-Led Organizations

Many young leaders who partnered with PACE identified specific organizational capacity needs that would enhance their family planning policy, advocacy, and communication efforts. In some instances, PACE finance and administration (F&A) staff mentored and supported partners directly. In others, PACE funded YLOs to hire consultants with expertise in specific areas, such as human resources. PACE’s support of organizational capacity encouraged YLOs to build and formalize their organizations. For example, PACE helped some YLOs work through the process of defining their wage structures and setting overhead rates—both as an organizational best practice and to ensure the YLOs are fairly compensated for work performed through contracts or within partnerships.

PACE also adapted standard application and contract approaches to better respond to the needs and capacity of YLOs. PACE lowered administrative barriers to application and partnership for smaller organizations and sought approval to pay out larger shares of contracts in advance, supporting YLOs with insufficient funds to cover expenses before reimbursement.

As PACE’s relationships with youth-led partner organizations expanded, the project connected organizations who could share experiences, even while working in different countries or contexts. After partnering with SERAC in Bangladesh, PACE invited the established YLO to share their approaches and experiences in formalizing organizational systems (such as F&A) with other PACE YLO partners whose organizations were more nascent. PACE’s investments in building the capacity of YLOs helped them to network and learn from each other, participate fully with INGO partners, and meet donor requirements, ultimately contributing to their policy advocacy successes.

Supporting Youth to Advance Proven Approaches Toward Greater Achievements: Lessons Learned

Over the life of the project, PACE’s approach to listening to and meaningfully supporting youth partners’ goals developed into an intentional model. The foundations of PACE’s approach included:

  • Establishing official structures during activity implementation, including subaward scopes of work, that share leadership and decision-making with YLOs.
  • Trusting youth to understand their own context and identify their own advocacy needs and goals, and working with them as partners to co-create responsive activities.
  • Meeting a commitment to shared leadership by providing financial resources at the level of need identified by partners.
  • Incorporating intentional components, such as trainings and mentorship, to strengthen partners’ organizational capacity and self-identified priorities, investing in the future and sustainability of youth as leaders in their space.

By committing to flexibility to adapt activities, investing in building trust and long-term relationships, and sharing leadership, the international development community can promote more equitable, inclusive, and meaningful—and, ultimately, impactful—partnerships with youth leaders.