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Background

Reducing maternal deaths is a critical public health concern. The Sustainable Development Goals (SDGs) aim to reduce maternal mortality globally to less than 70/100,000 live births by 2030. Mozambique has one of the highest maternal mortality rates in the world, at 233/100,000 live births. Of all maternal deaths, 11% are attributed to abortion. Mozambique decriminalized abortion in 2014 under certain conditions and approved clinical guidelines for service provision in 2016, aiming to reduce maternal deaths from unsafe abortion. This study assesses the availability, coverage, and utilization of facility-based voluntary termination of pregnancy (VTP) during the period 2016-2021 in Nampula province, northern Mozambique.

Methods

A descriptive quantitative study was performed, using secondary data analysis extracted from the national health monitoring information system (SIS-MA). Trends in the availability and utilization of VTP services were calculated from 2016 to 2021. The results were analysed while considering the geospatial distribution, coverage, and level of care of health facilities providing such services.

Results

Utilization of VTP services significantly increased by 77% (p < 0.001) and complications related to unsafe abortion decreased by 23.5% (p = 0.018) during 2016-2021.

Conclusions

Despite the significant improvement in service availability and utilization, the geographic distribution and population coverage of public health facilities providing services remains uneven and limited to semi-urban and urban areas, leaving unsafe abortion as the only option for women in rural areas. Despite these challenges, the results of this study reinforce scientific evidence that decriminalization of VTP and expansion of services may significantly improve access to and utilization of facility-based VTP, holding great potential for decreasing unsafe abortion-related complications and deaths.

Objective

This study aimed to explore young people’s perceptions and experiences on access to voluntary termination of pregnancy (VTP) in northern Mozambique.

Methods

A qualitative study of twelve focus group discussions was conducted from June to September 2021 in Nampula province, northern Mozambique. A total of 94 purposively selected 15–24-year-old males and females participated in the study. Data was inductively coded and reflexive thematic analysis inspired by Braun and Clarke was applied. Socio-Ecological theory was used to frame the discussion.

Results

Despite VTP being decriminalized and by law to be provided free of charge, unsafe abortion remains a common choice among young people towards unintended pregnancy. Barriers to help-seeking access to safe VTP include: 1) fear, 2) sociocultural gendered norms and power dynamics, 3) lack of VTP service provision at nearest health facilities, and 4) unaffordable services where available. Fear associated with early forced marriage, a parental corrective action towards premarital pregnancy coupled with lack of male financial autonomy to afford illicit charges, remain the most important factors preventing young people seeking for help at family and safe VTP services at facility level.

Conclusions

Amidst multiple barriers in accessing health services, unsafe abortion is viewed by young people as a better option than facing a lifetime punishment of early forced marriage, a common parental corrective action towards premarital pregnancy.

Ragging in Sri Lanka is a longstanding initiation ritual, similar to hazing and bullying. The severe harassment of new students by seniors has led to adverse consequences including depression, university dropouts and suicide. Although, a significant problem, research on ragging is scarce. This research aimed to explore how staff and work-affiliated individuals at Jaffna University resonate around the phenomenon of ragging. Seven focus group discussions and eleven semi-structured interviews were conducted. Foucauldian Discourse Analysis and Bandura’s Moral Disengagement theory were used to interpret the data. Three main discourses reflected the context: ragging as normal and necessary, insecurity and fear of reprisal, and voices of resistance. Participants often felt unsupported and therefore adapted their moral compasses to survive in this insecure environment. These findings demonstrate a fragmented approach to ragging that not only diminished any efforts towards elimination but affected how staff were forced to adjust their behavior to work in this environment. To address ragging, there is a need to adhere to a consistent strategy focusing on increasing awareness and supporting staff by holding accountable those at all levels of the administrative hierarchy in promoting a safe working environment for all.

Background

The prevalence of mental health disorders is known to be high among university students globally. Currently there are only a few studies on depression among university students in Sri Lanka. The aim of this study was to screen for the prevalence of Major Depressive Disorder (MDD) and other forms of depression, and to evaluate the factors associated with MDD.

Methods

A cross sectional survey using the Patient Health Questionnaire (PHQ-9) was conducted among 637, second-year students from the faculties of Management Studies & Commerce, Science and Medicine at the University of Jaffna, during the Coronavirus (COVID-19) pandemic. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging.

Results

MDD was considered to have been experienced by 31% of the students. From all three faculties, 70% of the students claimed to have experienced some form of depression ranging from mild to severe. The factor associated with MDD was the students’ ethnicity.

Conclusion

Due to the high MDD risk among university students, it is imperative to develop psychosocial interventions to ensure early detection of mental health disorders and provide adequate support to safeguard this vulnerable population.

Ragging is an initiation ritual practiced in Sri Lankan universities for generations, although research is scarce. This practice has several adverse consequences such as physical, psychological, and behavioral effects and increased university dropouts. The aim of this study was to investigate the prevalence of different types of ragging: emotional/verbal, physical and sexual ragging, self-perceived health consequences, help-seeking behavior, and factors associated with the experience of ragging. A cross-sectional study was conducted among 623, second- and third-year students from the medical, and technology faculties in Jaffna University. Bivariate associations were assessed using chi-squared tests. Logistic regression was used to evaluate factors associated with any type of ragging. Ragging was experienced by 59% of the students, emotional/verbal ragging being the most common. A total of 54% of students suffered one or more health consequences and mainly sought help from friends and family, with few seeking formal help. Factors associated with any type of ragging were faculty and year of study. This study emphasizes the urgent need to address this public health problem. It is important that there are adequate student support services, planning and implementation of effective interventions, as well as ensuring that existing policies are strengthened, to reduce or eliminate ragging in Sri Lanka.

Initiation rituals such as hazing, bullying, and ragging, as it is referred to in Sri Lanka, is a global phenomenon and has become a serious public health problem. Students are bullied and harassed by senior students causing them to suffer severe adverse consequences including depression, increased university dropouts and suicide. Although this has led to a significant burden on the country, research on ragging is scarce. The aim of this study was to explore the perceptions of students concerning the phenomenon of ragging and to understand how ragging affects student life and culture at the University of Jaffna, Sri Lanka. This paper is based on 17 focus group discussions with male and female students of Sinhalese, Tamil, and Muslim ethnicity. Thematic analysis was employed to navigate through the theoretical lenses of structural violence, intersectionality, and social dominance. The findings revealed how students perceived ragging differently; as an expression of power to initiate order and as a way to express dissatisfaction towards social inequalities occurring within the larger society or to facilitate bonds between university students. Students trivialized violence related to ragging and accepted it as a part of the university subculture despite being aware of the dire consequences. There was a described cyclical nature to ragging whereby victims become perpetrators. The student’s perspective appeared to be a missed opportunity in finding feasible solutions to a societal problem that must take all parties involved, into consideration.

In all societies, violence is a social problem and violation of human rights. Changing attitudes and behaviors, which accept violence atindividual and societal levels are key components in prevention strategies.

The aim of this study was to produce educational material on Gender Based Violence (GBV). A participatory study design including educators and university students was used to create four teaching modules. The teaching was evaluated by descriptive surveys before andafter the training and focus group discussions followed the training session. The questionnaire covered attitudes to gender, violence and laws. One hundred eleven teachers and 25 students representing different faculties and universities participated in separate workshops in three Sri Lankan universities. The students lacked knowledge of the meaning of GBV, consequences and existing laws. Women held more gender-equitable attitudes. Both women and men favoured equal participation of work and decision in the households. Male undergraduates showed less accepting attitudes toward rape or blaming women for rape Three categories emerged after the FGDs; Maketraining module compulsory and teacher led; Mind your own business; What can be done.

The newly prepared and context specific material was well-received by educators and students and they provided valuable inputs, which improved the educational modules.

Background: Distinct gender roles influence gender inequality and build the foundation for gender-based violence. Violence against women is a major public health problem in all societies, and a violation of human rights. Prevalence surveys on gender-based violence have been published from Sri Lanka, but qualitative studies on men's perceptions are lacking. Objectives: The aim of this study was to explore young educated Sri Lankan men's perceptions of violence against women. Methods: Seven focus-group discussions were held. Men at the end of their university studies were purposefully selected. A topic guide was used, covering various scenarios of violence against women. Qualitative content analysis was carried out. Results: Four categories were developed through the analytic process: fixed gender roles patriarchal values are accepted in society, female mobility control, and slowly changing attitudes; violence not accepted but still exists - sexual harassment exists everywhere, different laws for different people, female tolerance of violence, and men's right to punish; multiple factors cause violence - alcohol, violent behavior is inherited, violence culturally accepted, low education, and lack of communication; and prevention of violence against women - both parents must engage and socialize girls and boys equally, life skills education, premarital counselling, working places value clarification, and more women in politics and boards are suggested. Conclusions: Medical and management students, possible future male leaders of the country, have suggestions of prevention strategies in life skills to reduce gender-based violence and to increase knowledge of health consequences with the aim of changing attitudes.

BACKGROUND:

Male involvement in maternal health is recommended as one of the interventions to improve maternal and newborn health. There have been challenges in realising this action, partly due to the position of men in society and partly due to health system challenges in accommodating men. The aim of this study was therefore to evaluate the effect of Home Based Life Saving Skills training by community health workers on improving male involvement in maternal health in terms of knowledge of danger signs, joint decision-making, birth preparedness, and escorting wives to antenatal and delivery care in a rural community in Tanzania.

DESIGN:

A community-based intervention consisting of educating the community in Home Based Life Saving Skills by community health workers was implemented using one district as the intervention district and another as comparison district. A pre-/post-intervention using quasi-experimental design was used to evaluate the effect of Home Based Life Saving Skills training on male involvement and place of delivery for their partners. The effect of the intervention was determined using difference in differences analysis between the intervention and comparison data at baseline and end line.

RESULTS:

The results show there was improvement in male involvement (39.2% vs. 80.9%) with a net intervention effect of 41.1% (confidence interval [CI]: 28.5-53.8; p <0.0001). There was improvement in the knowledge of danger signs during pregnancy, childbirth, and postpartum periods. The proportion of men accompanying their wives to antenatal and delivery also improved. Shared decision-making for place of delivery improved markedly (46.8% vs. 86.7%), showing a net effect of 38.5% (CI: 28.0-49.1; p <0.0001). Although facility delivery for spouses of the participants improved in the intervention district, this did not show statistical significance when compared to the comparison district with a net intervention effect of 12.2% (95% CI: -2.8-27.1: p=0.103).

CONCLUSION:

This community-based intervention employing community health workers to educate the community in the Home Based Life Saving Skills programme is both feasible and effective in improving male involvement in maternal healthcare.