Poverty and Sexual and Reproductive Health: towards unravelling the vicious circle

Lead Research Organisation: University of Southampton
Department Name: School of Social Sciences


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Description The key findings from the seminars are summarised as follows:

• There are wide variations in fertility rates by socioeconomic status, rural/urban residence, and geographical location. Most African countries were unlikely to achieve Millenium Development Goal (MDG) 5b of universal access to family planning.

• There was a strong link between high fertility and high child mortality so it is important for programmes to acknowledge this link by improving reproductive, maternal, and child health outcomes together.

• Community-based family planning distribution schemes appear to be more successful in reaching the poorest than static facilities.

• Poverty makes people more vulnerable to reproductive morbidities. The cost of treating such illnesses can lead people further into poverty.

• Mental health and postnatal depression are neglected research areas.

• Cash transfers appear to be effective in delaying onset of sexual activity and marriage among African adolescents.

• The traditional methods to assess geographical variation in lower income settings do not take account of the potential differences at a very small scale, with the rich and poor living as neighbours.

The project identified the following as major gaps in research:

• Research that shows the direction of causation between poverty and high fertility. There is a paucity of longitudinal data and outside of economics, under-utilisation of methodological approaches that can demonstrate causality.

• Lack of strong evidence of a relationship between fertility and economic activity of women especially in the African context.

• Insufficient evidence from interventions. Where this exists, there is a bias in publishing towards positive findings.
Exploitation Route The research can influence sexual and reproductive health (SRH) programmes by encouraging the review of service distributional modes and tailoring these to the needs of poor marginalised communities. For example, exploring community-based distribution of family planning as an alternative to static delivery points may be needed for rural community where the nearest town is far.

Service providers also need to be aware of mental health issues including postnatal depression which is often not considered in poor settings.

Delaying the onset of childbearing among adolescents remains a challenge but it may be possible to achieve this by providing incentives to stay in education while at the same time providing SRH services to those who need them. Such solutions require multi-sector approaches combining health, education, social services, and involvement of the local community. The research is influencing government thinking in the global south and multilateral agencies. Through the engagement policy adopted by the project, government policymakers, international development partners, and agencies such as WHO and UNFPA and NGOs such as International Planned Parenthood Federation and Save the Children participated in discussions around the available research evidence and in highlighting areas where there is need for more research.

The project has also contributed to discussions around the agenda post MDGs. Ultimately, if the research is acted upon, there should be benefits for poor men and women to enable them to achieve their desired family sizes, to participate in all aspects of community life, and to enjoy sexual lives free from disease.

We expect research funding agencies to review the gaps identified by the seminars participants and to fund research which addresses these gaps. We also anticipate that the project findings will challenge and stimulate doctoral students and the wider scientific community to make original contributions that fill the gaps.
Sectors Education,Healthcare,Government, Democracy and Justice

URL http://www.southampton.ac.uk/ghp3
Description The investigators have engaged constantly with the UK Department for International Development (DFID) to raise awareness of the need for family planning services among the poor. In October 2011, Members of the network (led by Falkingham and Channon) organised a policy-science forum at DFID offices and an evening public event in central London to commemorate the world population reaching 7 billion and to highlight the need for increased funding to poor countries for family planning. Members of the network (Falkingham, Matthews, Madise) have continued to advise DFID in relation to their funding priorities. Falkingham is advising DFID and ESRC on their joint funding scheme; in 2010, Madise and Matthews were asked to review the evidence for DFID's global Business Plan for Reproductive Maternal and Newborn Health. Through these relationships, we are able to feed in some of our findings. Network members (Madise, Baschieri, Matthews) have also used the findings from the seminar to advise funders such as the William and Flora Hewlett Foundation, Bill and Melinda Gates Foundation, NORAD, and WHO on funding priorities. For example, Madise was approached by Melinda French Gates prior to her TedX talk in Berlin (April 2012) to help her understand the real issues of unmet need for family planning among poor African women. The Gates Foundation's and DFID's commitments to family planning have led to millions of pounds pledged at the London Family Planning Summit in July 2012. Madise (2012) advised Hewlett on their international funding strategy and assisted the Norwegian research council in selecting priority research areas on the links between poverty, population, and reproductive health. Prior to the London Family Planning Summit in July 2012, Coast, supported by the Poverty and SRH network, organised a public event to discuss why the London Family Planning summit was needed. The speakers included Hollywood actress Ashley Judd, UK Director of Population Services International, Dr Coast, Sara Seims (Packard Foundation and ex Director of Population at Hewlett), and a programme worker from a Nairobi slum community. The event was attended by more than 150 delegates including some participants at the London FP summit. After the Aberdeen seminar in January 2011, delegates submitted a briefing for the UN Secretary General's office highlighting the priorities for research on women's and children's health. The briefing note is specifically mentioned in the technical background note to establish a Global Network of Academic and Research Institutions to Support the United Nations Global Strategy for Women's and Children's Health. A member of our network (Matthews) will be attending the meetings.
First Year Of Impact 2011
Sector Government, Democracy and Justice
Impact Types Policy & public services