Population Briefs Vol. 21 no. 2
Transcription
Population Briefs Vol. 21 no. 2
REPORTS ON POPULATION COUNCIL RESEARCH Volume 21, Number 2 New Population Council analysis details HIV risks faced by adolescents in Tanzania. See page 2. INSIDE Understanding the Adolescent Experience in Tanzania.........................2 New Program Demonstrates Success in Reducing Gender-Based Violence in Bangladesh............................................................................4 Effects of the New One-Year Reusable Nestorone®/Ethinyl Estradiol Contraceptive Vaginal Ring on Risks of Vaginal Infection......................6 Estimating Population-Based Characteristics of People Who Inject Drugs in Kenya ......................................................................8 September 2015 poverty, gender, and youth Understanding the Adolescent Experience in Tanzania In 2014, UNICEF and UNAIDS announced an initiative to reduce the high levels of HIV infection among adolescents in Tanzania. Although adolescent girls and boys (ages 10–19) in Tanzania make up nearly a quarter (23 percent) of the country’s population, there was a lack of evidence about adolescents, especially younger girls. The Tanzania Commission for AIDS (TACAIDS) and UNICEF-Tanzania commissioned the Population Council to analyze multiple sources of data in order to better understand the situation faced by adolescents. The Council’s comprehensive analysis found that while young people’s vulnerability to HIV is widely acknowledged, programs to address the risks they face are lacking. “Reducing HIV among young people in Tanzania requires bold action,” explains says Kelly Hallman, Population Council Senior Associate and primary investigator on the analysis. “But in order to create effective programs, we need evidence.” Population Council researchers conducted a secondary analysis of data drawn from the 2010 Tanzania Demographic and Health Survey, the 2011–12 Tanzania HIV and Malaria Indicator Survey, and the 2009 Violence against Children in Tanzania Survey. To determine specific vulnerabilities at national and regional levels and in urban and rural areas, the researchers analyzed approximately 40 key indicators related to knowledge, attitudes and behaviors, and outcomes (including living arrangements, school attendance, illiteracy, marriage, pregnancy, violence, and HIV) among females and males ages 10–14, 15–19, and 20–24 years. “Our objective was to provide fine-grained details on what it means to be a young female or male in Tanzania,” says Hallman. “We are thrilled that program managers and policymakers are using this valuable information to inform policy formulation, planning, monitoring, and evaluation of HIV and AIDS, child marriage, education, child protection, and social protection programs.” 2 “Reducing HIV among young people in Tanzania requires bold action. But in order to create effective programs, we need evidence.” —Kelly Hallman Senior Associate, Population Council Living locations and arrangements The analysis revealed that the migration of young people is substantial: while 80 percent of adolescents ages 10–14 live in rural areas, that proportion declines to 70 percent among young adults ages 20–24. Rural–urban differences are also seen in living arrangements: while 25 percent of girls and 20 percent of boys nationally live with neither parent, this is true for 50 percent of girls and 35 percent of boys ages 15–17 in urban areas. There are a number of possible explanations for this difference. Girls may migrate to urban areas to attend school or seek employment (including domestic labor), or they may move as a result of child marriage. School attendance, literacy rates, and child marriage School attendance rates for young adolescents are similar for boys and girls ages 10–12 (over 90 percent of young boys and girls attend school), but girls, particularly in rural areas, start to drop out at age 12, and the gender gap in attendance widens as children age. By age 14, only 66 percent of girls nationally attend school, compared with 76 percent of boys. In urban areas, girls are more than twice as likely as boys ages 10–14 to be out of school and not living with either parent (8 percent versus 3 percent). Around 5–6 percent of girls are married by age 15, and 31–37 percent by age 18. About 25 percent of married or cohabiting young women P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 ages 15–24 are living with partners at least 10 years older. Girls ages 15–17 from the poorest households are more than twice as likely as girls of the same age from the wealthiest households to have ever been married. Married girls are much less likely to continue their education: 58 percent of young women ages 15–24 who had been married by age 15 were unable to read a sentence, compared with 12 percent of their unmarried peers. Sexual activity and pregnancy rates Approximately 50 percent of girls ages 20–24 had their first sexual encounter before the age of 18; boys reported initiating sexual activity later in life. Researchers found that girls from the wealthiest households were less likely to report early pregnancy than girls from poorer households. Overall, 5 percent of girls age 15 have been pregnant, while nearly all young women aged 24 (91 percent) have been pregnant. Violence against girls and women Rates of physical and sexual violence, and the acceptance of violence toward women and girls, vary considerably by region in Tanzania. Thirty percent of girls and 20 percent of boys ages 15–24 report that their first sexual experience was forced. Ten percent of girls report that they were hit or slapped during pregnancy. Furthermore, more than half (55 percent) of young women ages 15–24 agree with at least popcouncil.org/popbriefs The Government of Tanzania and several organizations are using the Council’s new report to shape programs for young people. one justification for wife beating, although this rate is slightly lower among males of the same age (50 percent). This is significant, because acceptance of violence toward girls and women early on can result in future violent physical and sexual relationships. Knowledge of HIV prevention and use of modern contraception The majority of adolescents in Tanzania have basic knowledge of HIV-prevention methods. Most young people are aware that using condoms and limiting the number of concurrent sexual partners can reduce the risk of HIV transmission. However, less than half of young people have comprehensive HIV knowledge (for example, knowing that a healthy-looking person can have HIV), and more girls than boys know about preventing mother-to-child HIV transmission. In general, adolescents are aware of HIV testing locations, but they may not have access to testing. Older adolescents and those living in urban areas are more likely to have been tested. Although a relatively small proportion of adolescents report having multiple sexual partnerships, these partnerships are more typical among older adolescents and those living in rural areas. Young people report low use of condoms in both paid and unpaid premarital sex. More girls than boys ages 15–17 reported using a condom during premarital sex, but by ages 20–24, men report greater condom use than women. Additionally, 15 percent of males ages 15–24 report paying for sex in the past 12 months, although less than half reported using a condom when they last paid for sex. Modern contraception use among girls, especially in urban areas, is low; only 20 percent of married girls and 30 percent of unmarried, sexually active girls report using contraception. More than half (60 percent) of young women ages 15–24 who have ever been pregnant were assisted by a health professional during their most recent delivery. Policy implications The significant findings that have emerged from this research can help guide government policies and programs focused on adolescents in Tanzania. The study authors point specifically to findings related to child marriage, school reentry after dropout, pregnancy, and HIV testing and counseling as areas where change is needed in the government’s approach. Overall, there is an urgent need to improve coordination in existing adolescent sexual and reproductive health programs, and to create policies to address critical gaps in such programs. popcouncil.org/popbriefs The Government of Tanzania and several organizations are using these rich data to shape programs for young people. The findings and policy recommendations are being used by: the Government of Tanzania, to design a national cash-transfer program to keep children in school and facilitate their re-entry if they drop out; TACAIDS, for national and regional planning and to identify topics for high-impact interventions for adolescents; UNICEF, to form its adolescent strategy in Tanzania; and the U.S. Agency for International Development mission in Tanzania to shape its activities for young people. Tanzania is planned as a priority country for the US government’s new DREAMS (Determined, Resilient, AIDS-free, Mentored, and Safe) initiative and the report is also being used to inform decisionmaking for that program. SOURCE Population Council, Tanzania Commission for AIDS (TACAIDS), Zanzibar AIDS Commission (ZAC), and UNICEF-Tanzania. 2015. The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People, Tanzania 2009–2012. Dar es Salaam: Population Council, TACAIDS, ZAC, and UNICEF-Tanzania. FUNDING UNICEF Tanzania P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 3 poverty, gender, and youth New Program Demonstrates Success in Reducing Gender-Based Violence in Bangladesh A new study by the Population Council and the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) found that an innovative program in Bangladesh has demonstrated a reduction in violence against women and girls. The “Growing Up Safe and Healthy” project, also known as SAFE, sought to improve sexual and reproductive health and reduce gender-based violence among women living in urban slums in Dhaka. The project ran from March 2012 to October 2013. While it is illegal in Bangladesh for girls under age 18 to marry, more than 60 percent of Bangladeshi girls marry before they reach this age. Girls married early are particularly vulnerable to domestic violence, and legal and policy reforms to address gender-based violence have had limited impact. Research shows that less than 2 percent of married women in Bangladesh who have experienced physical violence seek any kind of remedy or service. Young women and girls living in urban slums experience the highest rates of violence and poor sexual and reproductive health. This is of particular concern in Dhaka, where the slum population is growing rapidly as young men and women migrate in search of employment. These young people face poverty, insecure living arrangements, frequent squatter evictions, weak social networks, the absence of civic society institutions, the lack of public services, and poor coordination among services. SAFE was created to address some of the problems faced by young women and girls living in slums. The project provided access to health and legal services, interactive sessions with men, young women, and girls, and community-based awareness-raising campaigns to determine what combination of 4 “Most notably, spousal violence against women and girls dropped. Group sessions that included both men and women seem to have been the key intervention.” —Sajeda Amin Senior Associate, Population Council strategies, if any, would reduce violence faced by women and girls in urban slums. SAFE evaluation methods The SAFE program’s rigorous evaluation explored sexual and reproductive health, gender-based violence, and marriage and childbearing outcomes. Participating communities were randomly divided into three intervention arms. Community campaign activities and health and legal services were present in all three arms. The difference was the presence or absence of group sessions, and the goal of the evaluation was to determine the impact—if any—of including group sessions as part of the program. Arm A included sessions with men and women; Arm B included sessions only with women; Arm C had no group sessions. A baseline survey was conducted before SAFE was launched, and an endline survey was conducted following the conclusion of the program. Evaluation findings SAFE increased awareness about women’s sexual and reproductive health and rights, gender-based violence, and rights and laws regarding marriage and dowry. In addition, it P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 increased access to support services, including reproductive and maternal health and legal services. In communities that included group sessions with men, use of modern contraceptives increased and the proportion of marriages that involved dowry declined. “Most notably, spousal violence against women and girls dropped,” said lead Population Council researcher Sajeda Amin. “Group sessions that included both men and women seem to have been the key intervention. These proved most effective at reducing inequitable gender attitudes.” In fact, with respect to economic violence (i.e., cases where women were denied money, food, clothes, medicines, etc.), violence increased when only women participated in group sessions, but decreased when men were included in the intervention. Lessons learned and policy implications The evaluation identified several key factors that can explain SAFE’s success: •It is possible to improve sexual and reproductive health and reduce violence but, to be successful, interventions must integrate interactive group sessions, community campaigns, and services. popcouncil.org/popbriefs The findings of the SAFE project in the slums of Bangladesh demonstrated that community awareness-raising sessions about gender equity that included both men and women were most effective at reducing gender-based violence. • It is critical to target vulnerable women and girls and especially to reduce their isolation and build their confidence through group sessions and peer-support networks so that they choose to seek help when they do experience violence. • Working with men will significantly improve outcomes. • Community campaigns are critical for promoting awareness about sexual and gender-based violence and improving knowledge about laws and the availability of legal services. Future interventions that seek to improve sexual and reproductive health and reduce gender-based violence in urban slum settings can use these findings to guide program development. In particular, successful interventions should take an integrated approach, strengthen informal (such as peer networks) and formal (i.e., legal systems) support systems, and engage men in order to alter gender norms and change behaviors. popcouncil.org/popbriefs SOURCE Naved, Ruchira T. and Sajeda Amin. (Eds.). 2014. Impact of SAFE intervention on sexual and reproductive health and rights and violence against women and girls in Dhaka slums. Dhaka: icddr,b. FUNDING The Embassy of the Kingdom of the Netherlands, DANIDA, and the John D. and Catherine T. MacArthur Foundation P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 5 REPRODUCTIVE HEALTH Effects of the New One-Year Reusable Nestorone®/ Ethinyl Estradiol Contraceptive Vaginal Ring on Risks of Vaginal Infection A study by the Population Council and partners has found that use of the Council’s investigational one-year reusable contraceptive vaginal ring (CVR) does not increase the risk of vaginal infections or disrupt the balance of microbes in the vagina when it is used for up to 13 cycles. Although past studies have examined the effects of short-term contraceptive vaginal ring use on risk of vaginal infection, this is the first study of a CVR intended for a full year’s use. The one-year reusable CVR contains Nestorone® and ethinyl estradiol. Nestorone (NES) is an investigational progestin that has been shown in clinical studies to prevent ovulation and pregnancy. Ethinyl estradiol (EE) is an approved, marketed, synthetic version of the female hormone estrogen. “We are very excited about this new contraceptive ring,” said Ruth Merkatz, PhD, RN, Director of Clinical Development, Reproductive Health, at the Council’s Center for Biomedical Research and corresponding author of the study. “It can be inserted and removed by the woman herself rather than by a specially trained health care provider, it does not require daily action, and it can be reused for a full year. It has been designed so that refrigeration is not required when it is not being used, which will be important in many low-resource settings.” Study design To assess the microbiological safety of the new CVR, the researchers looked for vaginal infections and changes in the balance of microbes in the vagina during cyclic use of a single NES/ EE CVR for up to one year. This study, part of a Phase III safety and efficacy trial of the NES/ EE CVR, took place at the Magee-Womens Research Institute in Pittsburgh under the di- 6 Study findings The researchers found no substantial effects on the vaginal ecosystem of long-term repeated use of the NES/EE CVR. rection of Dr. Mitch Creinin, and was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health. The study protocol was approved by the Institutional Review Boards of the NICHD Coordinating Center, the Population Council, and the University of Pittsburgh. 120 women enrolled in the study. Participants were seen by the researchers seven times throughout the study year and were interviewed about any problems they may have encountered with the ring. At three of the visits researchers obtained vaginal swabs to measure vaginal microflora and the presence of bacteria. At the completion of the study, the ring surface was swabbed and compared with the vaginal swab sample to measure for the same organisms. The researchers assessed the occurrence of common vaginal infections, specifically bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. They also evaluated changes in vaginal microflora. It is normal for microorganisms to colonize the vagina. However, changes in the amount and type of bacteria present in the vagina may lead to infection. P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 Researchers found no significant changes in the detection rate of vaginal infections between baseline to Cycle 6 or between baseline to Cycle 13. In general, they found that the prevalence of typical vaginal infections in the study population was comparable to the overall prevalence of infections among women of reproductive age. Similarly, there were no significant changes in the prevalence or concentration of the microorganisms that were cultured at baseline and at follow-up visits, i.e. Lactobacillus, Gardnerella vaginalis, Enterococcus faecalis, Staphylococcus aureus, Escherichia coli, Candida albicans or other yeast, all of which remained at very low levels. Although the prevalence of microbes called anaerobic gram negative rods (GNRs) increased, the concentration remained very low. The researchers noted that the presence of anaerobic GNRs can be attributed to characteristics of individuals in a study population, including younger age and having a culture swab obtained within three days after vaginal intercourse. Importantly, the researchers found that the cultures they took from the surface of the vaginal rings were similar to the microbes in the vaginal fluid, suggesting that the ring surface does not promote proliferation of microorganisms that cause infections. Conclusion: The investigational CVR poses no increased risk of vaginal infections The researchers found no substantial effects on the vaginal ecosystem of long-term repeated use of the NES/EE CVR for up to 13 cycles, and no significant change in the incidence of vaginal infections. popcouncil.org/popbriefs The study findings suggest that the ring surface does not promote proliferation of microorganisms that cause infections. The researchers have confidence in their findings because the study used a prospective design to evaluate the effects of one-year use of a single CVR. It also included assessments of more microorganisms than have previously been investigated prospectively with vaginal rings. Additionally, obtaining cultures of the vaginal rings themselves had not been described previously. The researchers recommend that future studies include women from more diverse populations, specifically from countries in sub-Saharan Africa and South Asia where the unmet need for contraception remains high and vaginal infections are prevalent. “The results of this study will be valuable in our efforts to gain regulatory approval for this novel contraceptive that is under the control of women. It has the potential to be an important addition to the contraceptive method mix available to women,” said Merkatz. The Population Council has a long history of developing long-acting, reversible contraceptives to meet the growing worldwide demand for modern family planning methods. Council-developed contraceptive products include the Copper T intrauterine device (IUD), the levonorgestrel intrauterine system known as Mirena®, and the implants Jadelle® and Norplant®. Currently, 170 million women worldwide are using a Council-developed contraceptive. popcouncil.org/popbriefs SOURCE Huang, Yongmei, Ruth B. Merkatz, Sharon L. Hillier, Kevin Roberts, Diana L. Blithe, Régine Sitruk-Ware, and Mitchell D. Creinin. 2015. “Effects of a one year reusable contraceptive vaginal ring on vaginal microflora and the risk of vaginal infection: An openlabel prospective evaluation,” PLOS ONE 10(8): e0134460. doi:10.1371/journal.pone.0134460. FUNDING National Institute of Child Health and Human Development of the National Institutes of Health P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 7 HIV AND AIDS Estimating Population-Based Characteristics of People Who Inject Drugs in Kenya A study of people who inject drugs in Kenya has found a high prevalence of HIV infection and high levels of risk behavior. This study, the first to report population-based prevalence of HIV, sexually transmitted infections, and risk behaviors among people who inject drugs in Kenya, was led by the Population Council and conducted with researchers from the US Centers for Disease Control and Prevention/ Kenya (CDC), the Kenya National AIDS and STI Control Programme (NASCOP), the Kenya National AIDS Control Council (NACC), and the University of California (San Francisco). People who inject drugs are at very high risk for HIV. Of the estimated 15.9 million injection drug users globally in 2010, approximately one in five was HIV-positive. While the majority of persons who inject drugs live in Southeast and East Asia, the number of such persons in sub-Saharan Africa is growing rapidly. This is of particular concern because of African countries’ limited capacity to address HIV infection. Study methods From January to March 2011, Population Council researchers used respondent-driven sampling to recruit study participants. They selected a small group of individuals who met a specific set of characteristics—men or women aged 18 and older who reported injecting drugs in the previous 3 months, lived in or around Nairobi, and were willing to provide written informed consent. These people then recruited their peers, who in turn recruited additional peers, and so on. More than 350 individuals were recruited to the study; 269 participants were eligible. Participants were interviewed by trained nurse counselors about their HIV knowledge, sexual risk and prevention behaviors, drug use, HIV testing history, and experience with violence and discrimination. HIV counseling 8 “This study has helped firmly establish the existence of an HIV epidemic among people who inject drugs in Nairobi, and confirms an extremely high HIV prevalence rate among those who have ever shared injection syringes.” —Scott Geibel Senior Associate, Population Council and testing was offered to participants who elected to be tested, and participants were also tested for sexually transmitted infections. Characteristics of Kenya’s injection drug using population The study found that the median age of people who inject drugs in Kenya is 31 years, a majority of whom are unmarried men who earn money through informal or irregular employment. While almost half of the people who inject drugs began only recently, over 20 percent had been doing so for over five years. Most of this population also engages in high-risk injection practices at least monthly, including sharing syringes and other equipment. Over half the population was not sexually active in the last month, and the majority did not engage in casual or commercial sex. Among those who were sexually active, condom use was rare and almost one-quarter of women interviewed reported selling sex. A majority of participants had previously been tested for HIV. Among people who inject drugs, HIV prevalence was 18.7 percent, compared to approximately 5.6 percent in the general Kenyan population. Notably, the rate among women who inject drugs was much higher, at approximately 60.7 percent, a finding that is confirmed by other studies of people who inject drugs in Africa. P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 “The high HIV prevalence among women who inject drugs is very concerning. The higher prevalence in women may be a result of their having more high-risk sexual partners and practices such as transactional sex and their inability to negotiate condom use with partners. They may also be more likely to be injected by someone else with an unsterile needle and syringe,” said lead Council researcher Waimar Tun. Study findings and implications for future policies and programs Because the finding in this study of an 18.7 percent HIV prevalence rate among injection drug users matches prevalence rates found in previous studies, the researchers concluded that respondent-driven sampling is a reliable method. The authors make several recommendations based on their results. “This study has helped firmly establish the existence of an HIV epidemic among people who inject drugs in Nairobi, and confirms an extremely high HIV prevalence rate among those who have ever shared injection syringes,” said Council researcher Scott Geibel. “This evidence base has also supported and justified recent policy decisions in Kenya facilitating the development of harm-reduction interventions, including needle and syringe exchange programs.” popcouncil.org/popbriefs Recent Publications The researchers contend that these programs are particularly critical because more than half of the sexually active men who inject drugs had non-injecting female partners, meaning that there is a high likelihood of the HIV epidemic moving from the injection drug using population to the general population, potentially compromising efforts to reduce the spread of HIV more broadly. The researchers also recommend that prevention programs should specifically target drug users who recently began injecting, in order to establish safer injection practices early on and ideally to stop drug use while the habit is new. Another recommendation responds to the very high HIV prevalence rate the study found among women who inject drugs. They call for further research to better estimate the number of women who inject drugs in Nairobi and to identify their unique characteristics so prevention programs can be specifically targeted to women. The authors call for increased HIV testing among people who inject drugs, pointing out that at least one-quarter of HIV-positive individuals in this population did not know they were infected. They caution that HIV prevention programs must ensure that people who inject drugs are not denied HIV treatment because of stigma and discrimination. Finally, the authors note that further research and evaluations are needed to determine the effectiveness of harm-reduction efforts to reduce the HIV prevalence rate in this highly vulnerable population. SOURCE Tun, Waimar, Meredith Sheehy, Dita Broz, Jerry Okal, Nicholas Muraguri, H. Fisher Raymond, Helgar Musyoki, Andrea A. Kim, Mercy Muthui, and Scott Geibel. 2015. “HIV and STI Prevalence and Injection Behaviors Among People Who Inject Drugs in Nairobi: Results from a 2011 Bio-behavioral Study Using Respondent-Driven Sampling,” AIDS Behavior 19:S24–S35. DOI 10.1007/s10461-014-0936-3. FUNDING The U.S. President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention (CDC), through the Population Council’s cooperative agreement of Award No. 5U62PS224506 HIV AND AIDS Barnable, Patrick, Giulia Calenda, Thierry Bonnaire, Radhika Menon, Keith Levendosky, Agegnehu Gettie, James F. Blanchard, Michael Cooney, José FernándezRomero, Thomas Zydowsky, and Natalia Teleshova. “MIV-150/zinc acetate gel inhibits cell-associated simianhuman immunodeficiency virus reverse transcriptase infection in a macaque vaginal explant model,” Antimicrobial Agents and Chemotherapy 59(7): 3829–3837. Bhattacharjya, Chiranjeev, Damodar Sahu, Sangram Kishor Patel, Niranjan Saggurti, and Arvind Pandey. “Causes of death among HIV-infected adults registered in selected anti-retroviral therapy centers in north-eastern India,” World Journal of AIDS 5(2): 90–99. Enhancing Nigeria’s HIV/AIDS Response (ENR) Programme. 2014. “Enhancing Nigeria’s Response to HIV & AIDS (ENR) Programme: A book of abstracts (2010–2014).” Abuja: Enhancing Nigeria’s HIV and AIDS Response Programme. ———. “HIV prevalence and sexual behaviours of persons with disabilities in Nigeria.” Abuja: Enhancing Nigeria’s HIV and AIDS Response Programme. ———. “HIV and sexual behaviours of out-of-school young persons in Nigeria.” Abuja: Enhancing Nigeria’s HIV and AIDS Response Programme. Fernández-Romero, José, Carolyn Deal, Betsy C. Herold, John Schiller, Dorothy Patton, Thomas Zydowsky, Joseph W. Romano, Christopher D. Petro, and Manjulaa Narasimhan. “Multipurpose prevention technologies: The future of HIV and STI protection,” Trends in Microbiology 23(7): 429–436. Firestone, Rebecca, Jorge Rivas, Sussy Lungo, A. Cabrera, S. Ruether, Jennifer Wheeler, and Lung Vu. 2014. “Effectiveness of a combination prevention strategy for HIV risk reduction with men who have sex with men in Central America: A mid-term evaluation,” BMC Public Health 14: 1244. “Introducing antiretroviral (ARV)-based prevention products for women: A guide to strategic decisionmaking and planning.” New York: Population Council. Jha, Pravin K., Padum Narayan, Saritha Nair, Deepika Ganju, Damodar Sahu, and Arvind Pandey. “An assessment of comprehensive knowledge of HIV/AIDS among slum and non-slum populations in Delhi, India,” Open Journal of Preventive Medicine 5(6): 259–268. Kelly, Christine A., Barbara Friedland, Neetha S. Morar, Lauren L. Katzen, Gita Ramjee, Mathila Mokgatle, and Khatija Ahmed. “To tell or not to tell: Male partner engagement in a Phase 3 microbicide efficacy trial in South Africa,” Culture, Health & Sexuality 17(8): 1004–1020. Morrison, Charles S., Pai-lien Chen, Cynthia Kwok, Jared M. Baeten, Joelle Brown, Angela M. Cook, Lut Van Damme, Sinead Delany-Moretlwe, Suzanna C. Francis, Barbara Friedland, Richard J. Hayes, Renee Heffron, Saidi H. Kapiga, Quarraisha Abdool Karim, Stephanie Skoler-Karpoff, Rupert Kaul, R. Scott McClelland, Sheena McCormack, Nuala McGrath, Landon Myer, Helen Rees, Ariane van der Straten, Deborah Watson-Jones, Janneke van de Wijgert, Randy Stalter, and Nicola Low. “Hormonal contraception and the risk of HIV acquisition: An individual participant data meta-analysis,” PLoS Medicine 12(1): e1001778. Muraguri, Nicholas, Waimar Tun, Jerry Okal, Dita Broz, H. Fisher Raymond, Timothy Kellogg, Sufia Dadabhai, Helgar Musyoki, Meredith Sheehy, David Kuria, Reinhard Kaiser, and Scott Geibel. “HIV and STI prevalence and risk factors among male sex workers and other men who have sex with men in Nairobi, Kenya,” Journal of Acquired Immune Deficiency Syndromes 68(1): 91–96. Musyoki, Helgar, Timothy Kellogg, Scott Geibel, Nicholas Muraguri, Jerry Okal, Waimar Tun, H. Fisher Raymond, Sufia Dadabhai, Meredith Sheehy, and Andrea Kim. “Prevalence of HIV, sexually transmitted infections, and risk behaviors among female sex workers in Nairobi, Kenya: Results of a respondent driven sampling study,” AIDS and Behavior 19(Suppl. 1): 46–58. Parimi, Prabhakar, Sangram Kishor Patel, and Niranjan Saggurti. 2014. “Financial inclusion of marginalised key populations in southern India,” Indian Journal of Economics and Development 2(4): 98–102. Patel, Sangram Kishor. 2014. “Integration of HIV and other health programmes: Implications and challenges,” International Journal of Medical Science and Public Health 3(6): 643–648. Population Council. “ARV-based HIV prevention for women: State of the science and considerations for implementation in Zimbabwe. Report from a provider workshop.” New York: Population Council. ———. “Sexual and reproductive health and rights among young people living with HIV in Uganda: Findings from the Link Up baseline survey,” Link Up Research Brief. Washington, DC: Population Council. ———. “Sexual and reproductive health among young female sex workers in Bangladesh brothels—Baseline findings from Link Up,” Study brief. Washington, DC: Population Council. Population Council and Alliance Burundaise contre le Sida. “Burundi program implementation workshop, 3–5 June 2014: Link Up meeting report,” Activity brief. Washington, DC: Population Council. Population Council, Miz-Hasab Research Center, and Organization for Social Services for AIDS. “Experiences with pregnancy among female sex workers in Ethiopia: A Link Up exploratory study,” Study brief. Washington, DC: Population Council. Sadhu, Santhosh, Archana Rao Manukonda, Anthony Reddy Yeruva, Sangram Kishor Patel, and Niranjan Saggurti. 2014. “Role of a community-to-community learning strategy in the institutionalization of community mobilization among female sex workers in India,” PLoS ONE 9(3): e90592. Sahu, Damodar, Sowmya Ramesh, Ram Manohar Mishra, K. Srikanth Reddy, Reena Bharadwaj, Niranjan Saggurti, Arvind Pandey, Mandar Mainkar, and Bitra George. “Are truckers being over stigmatized as HIV carriers in India? Evidences from behavioral and biological cross-sectional surveys among clients of female sex workers,” Open Journal of Preventive Medicine 5(3): 85–91. Saraswati, Lopamudra, Avina Sarna, Mary Philip Sebastian, Vartika Sharma, Ira Madan, Ibou Thior, Julie Pulerwitz, and Waimar Tun. “HIV, Hepatitis B and C among people who inject drugs: High prevalence of HIV and Hepatitis C RNA positive infections observed in Delhi, India,” BMC Public Health 15(726). continued popcouncil.org/popbriefs P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 9 Recent Publications continued Sharma, Vartika, Avina Sarna, Stanley Luchters, Mary Philip Sebastian, Olivier Degomme, Lopamudra Saraswati, Ira Madan, Ibou Thior, and Waimar Tun. “‘Women at risk’: The health and social vulnerabilities of the regular female partners of men who inject drugs in Delhi, India,” Culture, Health and Sexuality 17(5): 623–637. Sharma, Varun, Niranjan Saggurti, and Shalini Bharat. “Association between general media exposure and sexual behavior among mobile female sex workers in India,” International Journal of Communication and Health 6: 60–68. ———. “Association between system reach and exposure to interventions and characteristics of mobile female sex workers in four high HIV prevalence states in India,” Global Journal of Health Science 7(4): 83–95. Tolley, Elizabeth E., Barbara Friedland, Mitzy Gafos, K. Rivet Amico, Lut Van Damme, Cynthia Woodsong, Kathleen M. MacQueen, Leila Mansoor, and Sheena McCormack. 2014. “Socioeconomic and behavioral factors influencing choice, adherence and success of microbicide formulations,” in Drug Delivery and Development of AntiHIV Microbicides, pp. 569–628. Ugaonkar, Shweta, Asa Wesenberg, Jolanta Wilk, Samantha Seidor, Olga Mizenina, Larisa Kizima, Aixa Rodriguez, Shimin Zhang, Keith Levendosky, Jessica Kenney, Meropi Aravantinou, Nina Derby, Brooke Grasperge, Agegnehu Gettie, James F. Blanchard, Narender Kumar, Kevin Roberts, Melissa Robbiani, José Fernández-Romero, and Thomas Zydowsky. “A novel intravaginal ring to prevent HIV-1, HSV-2, HPV, and unintended pregnancy,” Journal of Controlled Release 213(10 September): 57–68. POVERTY, GENDER, AND YOUTH “Adolescent Girls Empowerment Program (AGEP): Program overview,” fact sheet. Lusaka: Population Council. “Adolescent Girls Initiative—Kenya: Program overview,” fact sheet. Nairobi: Population Council. Bongaarts, John. “Fertility change: Quantum and tempo,” in International Encyclopedia of the Social & Behavioral Sciences (Second Edition), pp. 10–12. ———. “Global fertility and population trends,” Seminars in Reproductive Medicine 33(01): 005–010. Bongaarts, John and Christophe Z. Guilmoto. “How many more missing women? Excess female mortality and prenatal sex selection, 1970–2050,” Population and Development Review 41(2): 241–269. ———. “How many more missing women? [Correspondence],” The Lancet 386(9992): 427. Bruce, Judith and Annabel Erulkar. “A short history of the long struggle to identify and eliminate child marriage: Amhara, Ethiopia as a case study,” in Global Institutions, pp. 318–331. London: Routledge. Building Assets Toolkit: Developing Positive Benchmarks for Adolescent Girls. New York: Population Council. Haberland, Nicole and Debbie Rogow. “iMatter: Teaching about puberty, gender, and fairness.” New York: Population Council. Hallman, Kelly and Adam Weiner. “Participatory tools to capture qualitative aspects of adolescent girl programs: Tanzania 2015.” New York: Population Council. Hallman, Kelly, Ilan Cerna-Turoff, and Neema Matee. “Participatory research results from training with the Mabinti Tushike Hatamu out-of-school girls program: Tanzania 2015.” New York: Population Council. 10 Jejeebhoy, Shireen, Rajib Acharya, Sharmistha Basu, and A.J. Francis Zavier. “Addressing genderbiased sex selection in Haryana, India: Promising approaches.” New Delhi: Population Council. Jejeebhoy, Shireen, Sharmistha Basu, Rajib Acharya, and A.J. Francis Zavier. “Gender-biased sex selection in India: A review of the situation and interventions to counter the practice.” New Delhi: Population Council. Population Council. “Curriculum on adolescent-friendly health services and health voucher mechanisms: Facilitator’s training manual.” Lusaka: Population Council. ———. “Gender-biased sex selection in South Asia: The situation and promising approaches to restore balance,” Project Summary. New Delhi: Population Council. ———. 2014. “Nutrition education curriculum for the Adolescent Girls Empowerment Program (AGEP).” Lusaka: Population Council. Population Council and UNICEF Belize. “The adolescent experience in-depth: Using data to identify and reach the most vulnerable young people—Belize 2011.” New York: Population Council. Psaki, Stephanie. 2014. “Addressing early marriage and adolescent pregnancy as a barrier to gender parity and equality in education,” Background Paper for the 2015 UNESCO Education for All Global Monitoring Report. New York: Population Council. Puri, Mahesh and Anand Tamang. “Assessment of interventions on sex-selection in Nepal: Literature review.” Kathmandu: CREHPA. ———. “Understanding factors influencing adverse sex ratios at birth and exploring what works to achieve balance: The situation in selected districts of Nepal.” Kathmandu: CREHPA. Santhya, K.G., A.J. Francis Zavier, and Shireen Jejeebhoy. “School quality and its association with agency and academic achievements in girls and boys in secondary schools: Evidence from Bihar, India,” International Journal of Educational Development 41: 35–46. Sathar, Zeba, Gul Rashida, Sabahat Hussain, and Anushe Hassan. “Evidence of son preference and resulting demographic and health outcomes in Pakistan.” Islambad: Population Council. “Urban Adolescents’ Needs Assessment Survey in Bangladesh,” Brief. Dhaka: BIED, BRACU, and Population Council. REPRODUCTIVE HEALTH Abuya, Timothy, Charlotte E. Warren, Nora Miller, Rebecca Njuki, Charity Ndwiga, Alice Maranga, Faith Mbehero, Anne Njeru, and Benjamin Bellows. “Exploring the prevalence of disrespect and abuse during childbirth in Kenya,” PLoS ONE 10(4): e0123606. African Population and Health Research Center (APHRC). 2014. “Population and health dynamics in Nairobi’s informal settlements: Report of the Nairobi Cross-sectional Slums Survey (NCSS 2012).” Nairobi: APHRC. Ashfaq, Seemin and Maqsood Sadiq. “Engaging the missing link: Evidence from FALAH for involving men in family planning in Pakistan,” Case Study. Washington, DC: Population Council, The Evidence Project. Bellows, Benjamin, Rachel Bach, Zoe Baker, and Charlotte E. Warren. 2014. “Barriers to obstetric fistula treatment in low-income countries: A systematic review.” Nairobi: Population Council. P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 015 Bellows, Nicole M., Ian Askew, and Benjamin Bellows. “Review of performance-based incentives in community-based family planning programmes,” Journal of Family Planning and Reproductive Health Care 41(2): 146–151. Berdichevsky, Karla, Claudia Díaz, Katharine McCarthy, and Ann K. Blanc. 2014. “Validating indicators of the quality of maternal health care: Final report, Mexico.” Mexico City: Population Council. Bin Nisar, Yasir, Michael J. Dibley, and Ali M. Mir. “Factors associated with non-use of antenatal iron and folic acid supplements among Pakistani women: A cross sectional household survey,” BMC Pregnancy and Childbirth 14(305). Bintou Mbow, Fatou, Babacar Mane, and Saumya RamaRao. “L’offre des anneux vaginaux contraceptifs— La planification familiale postpartum: experience du Sénégal.” Dakar: Population Council. Birungi, Harriet, Chi-Chi Undie, Ian MacKenzie, Anne Katahoire, Francis Obare, and Patricia Machawira. “Education sector response to early and unintended pregnancy: A review of country experiences in subSaharan Africa,” Research Report, July 2015. Nairobi: Population Council. Brody, Carinne D., John M. Irige, and Benjamin Bellows. “Burnout at the frontline: The effect of a reproductive health voucher program on health workers in Uganda,” International Archives of Nursing and Health Care 1(1). Chattopadhyay, Ishita, John Townsend, and Saumya RamaRao. “An innovative financing model for the progesterone contraceptive vaginal ring through voucher programs.” Washington, DC: Population Council. ———. “Offering progesterone contraceptive vaginal rings for postpartum women through integrated family planning and immunization services.” Washington, DC: Population Council. ———. “Utilizing social marketing and social franchising models to expand access to the progesterone contraceptive vaginal ring.” Washington, DC: Population Council. “Delivering contraceptive vaginal rings,” Project brief. New York: Population Council. Diop, Nafissatou and Ibrahima Diagne. 2014. “Facteurs associés aux longs intervalles intergénésiques au Sénégal. Analyse approfondie de l’EDS-MICS 2010-2011,”African Population Studies 28(3): 1324–1331. Dixit, Anvita, M.E. Khan, and Isha Bhatnagar. “Mainstreaming of emergency contraception pill in India: Challenges and opportunities,” Indian Journal of Community Medicine 40(1): 49–55. Esantsi, Selina F., Francis Onyango, Gloria Quansah Asare, Emmanuel Kuffour, Placide Tapsoba, Harriet Birungi, and Ian Askew. “Understanding the reproductive health needs of adolescents in selected slums in Ghana: A public health assessment,” STEP UP Research Report, March 2015. Nairobi: Population Council. Gao, Ying, Dolores D. Mruk, and C. Yan Cheng. “Sertoli cells are the target of environmental toxicants in the testis—A mechanistic and therapeutic insight,” Expert Opinion on Therapeutic Targets 19(8): 1073–1090. popcouncil.org/popbriefs Hardee, Karen, Shannon Harris, Mariela Rodriguez, Jan Kumar, Lynn Bakamjian, Karen Newman, and Win Brown. 2014. “Achieving the goal of the London Summit on family planning by adhering to voluntary, rights-based family planning: What can we learn from past experiences with coercion?” International Perspectives on Sexual and Reproductive Health 40(4): 206–214. Hazra, Avishek and Sandip Chakraborty. “Reproductive health of married young women in the context of HIV/AIDS in India,” Indian Journal of Public Health Research and Development 6(2): 230–236. Hazra, Avishek, M.E. Khan, and Subrato Mondal. 2014. “Mobile phone messaging as an innovative approach to involve men to stimulate discussion and change family health behaviors,” Technical Report. FHI360: Washington, DC. Juma, Milka, Jane Alaii, Ian Askew, L. Kay Bartholomew, and Bart van den Borne. “Community perspectives on parental/caregiver communication on reproductive health and HIV with adolescent orphans and non-orphans in western Kenya,” Journal of Child and Adolescent Behaviour 3(3). Keya, Kaji T., Ubaidur Rob, Md. Moshiur Rahman, Ashish Bajracharya, and Benjamin Bellows. 2014. “Distance, transportation cost, and mode of transport in the utilization of facility-based maternity services: Evidence from rural Bangladesh,” International Quarterly of Community Health Education 35(1): 37–51. Khan, M.E., Anvita Dixit, Jaleel Ahmad, and G. Pillai. “Introduction of DMPA in public facilities of Uttar Pradesh and Rajasthan: An evaluation,” Project brief. New Delhi: Population Council. Khan, M.E., Praween Kumar Agrawal, Kumudha Aruldas, and Subrato Mondal. 2014. Training Manual on Monitoring and Evaluation of Social and Behavior Change Communication Health Programs. New Delhi: IHBP. FHI, and Population Council. Kimani, James Kelly, Remare Ettarh, Charlotte E. Warren, and Benjamin Bellows. 2014. “Determinants of health insurance ownership among women in Kenya: Evidence from the 2008–09 Kenya Demographic and Health Survey,” International Journal for Equity in Health 13(27). Li, Nan, Dolores D. Mruk, and C. Yan Cheng. “Actin binding proteins in blood–testis barrier function,” Current Opinion in Endocrinology, Diabetes and Obesity 22(3): 238–247. Li, Nan, Dolores D. Mruk, Chris K.C. Wong, Daishu Han, Will M. Lee, and C. Yan Cheng. “Formin 1 regulates ectoplasmic specialization in the rat testis through its actin nucleation and bundling activity,” Endocrinology 156(8): 2969–2983. Liambila, Wilson, Saumya RamaRao, and Heather Clark. “Delivering contraceptive vaginal rings: Review of postpartum service packages in Kenya.” Nairobi: Population Council. ———. “Delivering contraceptive vaginal rings—Task shifting and task sharing in the delivery of family planning services: Experiences from Kenya.” Nairobi: Population Council. Mane, Babacar, Nafissatou Diop, and Saumya RamaRao. “Delivering contraceptive vaginal rings—Task sharing in the delivery of family planning programs: Experiences from Senegal.” Dakar: Population Council. Manzini-Henwood, Cebile, Nokwanda Dlamini, and Francis Obare. “School-based girls’ clubs as a means of addressing sexual and gender-based violence in Swaziland,” BMC Proceedings 9(Suppl 4): A5. McCarthy, Katharine, Saumya RamaRao, and Hannah Taboada. “New dialogue for the way forward in maternal health: Addressing market inefficiencies,” Maternal and Child Health Journal 19(6): 1173–1178. Mir, Ali M., Saleem Shaikh, Siti Nurul Qomariyah, Gul Rashida, Mumraiz Khan, and Irfan Masood. “Using community informants to estimate maternal mortality in a rural district in Pakistan: A feasibility study,” Journal of Pregnancy 2015 (Article ID 267923). Mozumdar, Arupendra and Praween Kumar Agrawal. “Prevalence, trends, and determinants of menopause in India: NFHS 1992–93 to NFHS 2005–06,” American Journal of Human Biology 27(3): 421–425. Mozumdar, Arupendra, Bhubon Mohan Das, and Subrata Kumar Roy. 2014. “Life table analysis of a small sample of Santal population living in a rural locality of West Bengal, India,” Anthropological Review 77(2): 233–248. Njuki, Rebecca, Timothy Abuya, James Kelly Kimani, Lucy Kanya, Allan Korongo, Piet Bracke, Benjamin Bellows, and Charlotte E. Warren. “Does a voucher program improve reproductive health service delivery and access in Kenya?” BMC Health Services Research 15(206). Powell-Jackson, Timothy, Rajib Acharya, Veronique Filippi, and Carine Ronsmans. “Delivering medical abortion at scale: A study of the retail market for medical abortion in Madhya Pradesh, India,” PLoS ONE 10(3). “Proceedings of the 1st Washington, DC Meeting of the Africa Regional Sexual and Gender-Based Violence Network, 2013,” BMC Proceedings 9(Suppl 4). “Progesterone contraceptive vaginal ring: Prevents pregnancy,” fact sheet. New York: Population Council. “Progesterone contraceptive vaginal ring: Safe for mothers and babies,” fact sheet. New York: Population Council. “The RAISE Health initiative for workers, companies, and communities,” Activity Brief. Washington, DC: The Evidence Project. RamaRao, Saumya and Anrudh K. Jain. “Family planning initiatives must focus on people, not numbers,” RH Reality Check, 8 April. “Respectful Maternity Care Resource Package.” New York: Population Council. Sandberg, Kathryn, Jason Umans, and Georgetown Consensus Conference Work Group. “Recommendations concerning the new U.S. National Institutes of Health initiative to balance the sex of cells and animals in preclinical research,” The FASEB Journal 29(5): 1646–1652. Sitruk-Ware, Régine and Anita Nath. “Applying emerging science to contraception research: Implications for the clinic,” Expert Review of Endocrinology and Metabolism 10(1): 115–126. “Strengthening the role of patent medicine vendors in the provision of injectable contraception in Nigeria,” Activity Brief. Washington, DC: The Evidence Project. Talukder, Md. Noorunnabi, Ubaidur Rob, and Forhana Rahman Noor. 2014. “Assessment of sex selection in Bangladesh.” Dhaka: Population Council. Talukder, Md. Noorunnabi, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji T. Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, and Benjamin Bellows. 2014. “Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh,” Final Report. Dhaka: Population Council. Undie, Chi-Chi, Harriet Birungi, and Ian Askew. “’Changing the World’: The Africa Regional Sexual and Gender-Based Violence Network,” BMC Proceedings 9(Suppl 4): A1. Undie, Chi-Chi, Catherine Maternowska, Margaret Mak’anyengo, and Ian Askew. “What women think: Hypothetical notions of screening for intimate partner violence in Kenyan hospital settings,” BMC Proceedings 9(Suppl 4): A6. Unumeri, Godwin and Salisu Mohammed Ishaku. “Delivering contraceptive vaginal rings: Review of postpartum and postnatal care programs in Nigeria.” Abuja: Population Council. ———. “Delivering contraceptive vaginal rings—Task sharing policies and practices in the delivery of family planning services: Experiences from Nigeria.” Abuja: Population Council. “Utilization of national health insurance for family planning and reproductive health services by the urban poor in Uttar Pradesh, India,” Activity Brief. Washington, DC: The Evidence Project. Walugembe, David Roger, Suzanne N. Kiwanuka, Joseph K.B. Matovu, Elizeus Rutebemberwa, and Laura Reichenbach. “Utilization of research findings for health policy making and practice: Evidence from three case studies in Bangladesh,” Health Research Policy and Systems 13(1): 26. Warren, Charlotte E., Timothy Abuya, Lucy Kanya, Francis Obare, Rebecca Njuki, and Marleen Temmerman. “A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya,” BMC Pregnancy and Childbirth 15(153). Warren, Charlotte E., James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine McCarthy, and Ann K. Blanc. 2014. “Validating indicators of the quality of maternal health care: Final report, Kenya.” Nairobi: Population Council. Watt, Claire, Timothy Abuya, Charlotte E. Warren, Lucy Kanya, and Benjamin Bellows. “Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s Safe Motherhood voucher scheme,” PLoS ONE 10(4): e0122828. Yasmin, Reena, Ubaidur Rob, Ismat Ara Hena, Tapash Ranjan Das, and Farid Uddin Ahmed. “Increasing access to safe menstrual regulation services in Bangladesh by offering medical menstrual regulation,” Reproductive Health Matters 22(44, Suppl. 1): 67–74. Yavinsky, Rachel Winnik , Carolyn Lamere, Kristen P. Patterson, and Jason Bremner. “The impact of population, health, and environment projects: A synthesis of evidence.” Washington, DC: Population Council. OTHER “Biomedical research at the Population Council,” Momentum, May 2015. Fertility Transition: A Selection from Population and Development Review. New York: Population Council. “From Research into Policy and Practice: Annual Report, 2014.” New York: Population Council. Population and Development Review 41(2). Studies in Family Planning 46(2). Publications are by Population Council staff members, consultants, or staff from partner organizations. Year of publication is 2015 unless otherwise noted. Names in boldface are staff members, consultants, or those seconded from partner organizations. popcouncil.org/popbriefs P O P U L AT I O N B R I E F S 2 1 ( 2 ) S E P T E M B E R 2 01 5 11 Population Briefs is a research newsletter of the Population Council. Non-Profit Organization U.S. Postage PAID New Haven, CT Permit #350 The Population Council confronts critical health and development issues—from stopping the spread of HIV to improving reproductive health and ensuring that young people lead full and productive lives. Through biomedical, social science, and public health research in 50 countries, we work with our partners to deliver solutions that lead to more effective policies, programs, and technologies that improve lives around the world. Established in 1952 and headquartered in New York, the Council is a nongovernmental, nonprofit organization governed by an international board of trustees. Population Council One Dag Hammarskjold Plaza New York, New York 10017 popcouncil.org Editor: Gina Duclayan Writer: Nina Rabinovitch Blecker Editorial Board: Jennifer Brunet and Erin Kiernon Design and Production Manager: Mike Vosika Copyeditor: Robert Heidel Editorial Assistant and Circulation: Debra Warn Photos courtesy of Population Council staff except: (cover, p. 3) Vladimir Grigoriev. Population Briefs is distributed without charge. Information in this newsletter may be reproduced without permission, provided it is distributed without charge and the source is acknowledged. To receive updates from the Population Council, including when a new issue of Population Briefs is posted to our Web site, click “Subscribe” on our homepage: popcouncil.org ISSN 1084–6786 © 2015 The Population Council, Inc. Printed on recycled paper. The SAFE project increased awareness among people living in slums in Dhaka, Bangladesh about women’s sexual and reproductive health and rights, and reduced intimate partner violence. See page 4.