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This is the sixth post in our series, “Adolescent Girls, Microbicides, and HIV Prevention Trials.” This post was written by Anna Kaale, Doreen Bangapi, and Mildred Mwanjesa, who are with Muhimbili University of Health & Allied Sciences (MUHAS) and who work with FHI 360 on the study.
As part of a study entitled “Adolescent Women and Microbicide Trials: Assessing the Opportunities and Challenges of Participation” (see blog #1), researchers sought to determine how adolescent participants would feel about, and whether they would use, a potential study microbicide product.
A total of 135 females ages 15-21 were participating in a mock clinical trial (MCT). Participants made four visits over six months: baseline, month two, month four and month six. MCT participants who made the month four visit were asked if they would be willing to participate in a smaller sub-study. Fifty-seven of the 71 eligible participants at this visit agreed, and they were asked to use a vaginal gel (over-the-counter lubricant) or take a pill (vitamin) for two months.Participants were told that they were being asked to use lubricants or vitamins, and that these were not microbicide products.Those who declined (14) completed a decliner questionnaire. Their reasons for declining included not willing to be randomized to pill or gel, being afraid of being seen by other people like parents when taking pills, being afraid of using the product because it is a new experience, fear of side effects, general dislike of taking pills and not wanting to insert any product in their vagina.
Participants were randomly assigned to the vitamin pill group (44%) or the vaginal gel group (56%).
Most participants liked the product they were given—both the pill and the vaginal gel. Reasons for liking the products included that they could use them without partner knowledge, they were easy to use, and the products did not interrupt sex. Few participants disliked the products; however, some reasons included appearance and/or smell and need to remember to use the product.
Researchers were surprised that most participants said they hoped to be randomized to the gel instead of the pill. Some participants who were randomized to the pill asked the nurse counselors if they could be switched to the gel and others wished to get the same product that their friends received. Some participants came to the study clinic to ask for more product after the sub-study had ended. For example, some asked for more gel, saying that it made sex more pleasurable; others asked for pills and said that the pills gave them more appetite and a “good feeling.” The nurses observed more participants coming in for additional gel than pills during the sub-study, and unused vitamin pills were more likely to be returned to the clinic at the end of the sub-study than unused gel. The study staff also learned that some participants were sharing the gel/pills with family members. Overall, the sub-study provided valuable information about how adolescents might feel about using a microbicide product.
Call to Action: The Sino-implant (II) Initiative was recently selected as a finalist for the Katerva Award in the Human Development Category. Click here to vote for the project for the People’s Choice Award. Deadline is January 29, 2013.
Markus Steiner is a senior epidemiologist at FHI 360 and project director for the Sino-implant (II) initiative. Heather Vahdat is an associate scientist at FHI 360, where she serves as project manager for the Sino-implant (II) initiative. Kate Rademacher is a senior technical officer at FHI 360 and serves as the strategic partnership manager for the Sino-implant (II) initiative.
All women benefit from access to longer-acting contraceptive methods. From a mother living in a rural village with limited access to health care services to a young woman living in an urban center who is focused on completing her education and starting a career. The peace of mind, independence, and continuous contraceptive protection that comes with a long-acting method is priceless.
Contraceptive implants are a vital commodity in the spectrum of contraceptive choice. They provide discrete, long-term pregnancy prevention without the need for a pelvic exam, which has been shown to be a barrier to uptake of intrauterine devices (IUDs) for many women. Contraceptive implants are a popular method in developing countries; however, until recently, the high cost of implants has been a barrier to access.
The Sino-implant (II) initiative has been at the forefront of helping to reduce the cost of implants in resource-constrained settings. Manufactured by Shanghai Dahua Pharmaceutical Co., Ltd., Sino-implant (II) is a low-cost, highly effective contraceptive implant currently labeled for four years of use that is available for approximately US $8 per unit. Through the initiative, which is led by FHI 360 with funding from the Bill & Melinda Gates Foundation, Sino-implant (II) has been registered in 22 countries in Sub-Saharan Africa, Asia, and Latin America since 2008.
Sino-implant (II) entered the international contraceptive market as a game-changing product. Through a network of dedicated distribution partners, Sino-implant (II) has been introduced through in-country programs and provided an opportunity to diversify the contraceptive commodity stock. The lower price of Sino-implant (II) has meant that cost savings could be used to support larger procurements of contraceptive implants, other health commodities, training, or other program needs.
So what is the “So What?” of the cost savings offered by Sino-implant (II)?
- More than 870,000 units of Sino-implant (II) have been distributed
- US $10.4 million in cost savings have been generated when compared to buying similar, more expensive implants
- According to the Marie Stopes International Impact Calculator, the procurement of 870,00 units of Sino-implant (II) can prevent:
- 1.2 million unintended pregnancies
- 150,000 abortions
- 3,500 maternal deaths
Recently, Sino-implant (II) (marketed in parts of Africa, Asia, and Latin America under trade names including Zarin, Femplant, Trust, and Simplant) was selected as a finalist for the Katerva Award in the Human Development Category. Click here to vote for the project for the People’s Choice Award. Voting began on January 14and runs through January 29, 2013. For more information on the Katerva award or Sino-implant (II) initiative, visit: http://katerva.org/2012-nominees/sino-implant-ii/
A Note from the IYWG: Among adolescents who have access to contraception, poor compliance, inconsistent use, and discontinuation are common and often result in unintended pregnancy. Longer-acting family planning methods—including contraceptive implants—provide more effective coverage than shorter-acting methods such as Depo-Provera and oral contraceptives (OCs). According to the World Health Organization, implants are safe and appropriate for adolescents. Implants are discreet, easy to use, and effective for 3-5 years without any need for resupply or regular action by the user. In addition, implants remove the challenge of user compliance and therefore have a very low failure rate. Researchers estimate that if 20 percent of the 17.6 million women using OCs and Depo in sub-Saharan Africa who wanted long-term protection switched to implants, more than 1.8 million unintended pregnancies could be averted over a five-year period.
Kara Perez has a degree in English from Wesleyan University and has been working for Smart Girls since September.
I don’t know about you, but I have some of my best ideas at the most unusual times- at the grocery store, taking a shower or just falling asleep. The idea for Smart Girls at the Party was conceived by Meredith Walker and Amy Poehler over a late night bottle of wine. Realizing the enormous pressures on girls and how difficult the process of growing up can be, Amy and Meredith wanted to start something where girls can go have authentic experiences as themselves and be celebrated for it. Smart Girls at the Party is a website and youtube series that serves to highlight the talents, smarts and ambition of girls around the world. Our tagline is ‘Change the world by being yourself, something we all believe in. We strive to show girls that who they are right now is enough.
We want to celebrate interests and passions that girls have and we want them to share themselves with the world. Smart Girls at the Party uses several different shows (Operation Nice, Girls of the World, Ask Amy, Meow Meow Music and Smart Girls at the Party) as a voice for girls everywhere. Our website, sgatp.net, is also a place where girls can find other amazing women and girls, like our Smart Girl of the Week. Visitors can learn how to make fun DIY projects or submit their own content. As a team, we work every day to showcase the amazing Smart Girls who have gone before us and the ones that are growing up now.
The show Amy hosts, ‘Smart Girls at the Party,’ is a show where she interviews a girl about an interest or hobby she has. We’ve done things like drag racing and glassblowing. We want to make it very clear that you are already standing out just by being who you are. Nothing else required. ‘Girls of the World’ invites girls from anywhere on the planet to show us around their hometown and introduce us to their culture and way of living. We’ve done places like New Zealand and Mali.
Smart Girls at the Party is more than a website or a youtube channel. It’s a way of viewing and valuing yourself and the world. Everyone can be a Smart Girl.
This story was originally posted on The Huffington Post and appeared on Pathfinder International’s blog.
Purnima Mane is Pathfinder’s President and Chief Executive Officer. She oversees more than 1,000 staff around the world, an annual budget exceeding $100 million, and sexual and reproductive health programs in more than 20 developing countries.
I traveled home to India over Christmas to spend time with family—a time that should be filled with cheer. Yet this trip has been overshadowed by the terrible, horrific gang rape of a young Indian woman.
At first, I could not get myself to write about it. The details are just too revolting. And as more information emerges and fills the pages of the newspapers here day in and day out, I have felt sick. It would be easy to be disheartened and pessimistic. Here’s a young woman brutally violated and beaten by six men, left on the road unaided, passed by people who did not offer help, who ultimately lost her battle to survive.
Not only is her story heartbreaking, but one feels crushed that we, as a worldwide community, have been working on improving the rights of girls and women for so long—yet these kinds of atrocities continue. Not only is her story heartbreaking, but one feels crushed that we, as a worldwide community, have been working on improving the rights of girls and women for so long—yet these kinds of atrocities continue.
However, the fact that this gang rape is raising huge attention in India, and around the world, is important to note. In many ways, it’s a sea change.
Both women and men—yes, men!—are standing up and saying, “This is unacceptable.”
Their protests are reminiscent of the 19th century when a few brave men led the fight against sati (the practice of burning a woman on her husband’s funeral pyre), against child marriage, and for girls’ education and in support of widow remarriage. That was a time when it would have been nearly impossible for women to make such demands without significant risks.
It’s inspiring to see women standing strong so publicly today. And the fact that many more men from all walks of life are standing up openly is also a significant sign of progress. A well-known Indian actor whose screen image revolves around his manifestation of machismo said, “I feel ashamed to be a man today.”
People are protesting in the streets, taking action through media, including social media, to demand justice and attention not just for this case, but for all women who continue to face sexual harassment, gender-based violence, and sexual violence. That spirit must be encouraged.
But there’s a long way to go.
The sad truth is that we are nowhere close to where we need to be on ending all forms of violence against women. Not only are there cases like these—brutal and public—there are also more devious means of harassment and bullying. Violence against women is getting more and more sophisticated and insidious. It’s verbal, it’s sexual, it’s physical, and it’s manifested in a variety of ways.
We know sexual violence is a pervasive issue, not just in India, but in countries around the world. Just look at the discussion happening in the United States right now about Steubenville, Ohio and the young girl whose sexual assault was documented via Twitter and Facebook. Society cannot say it only happens once in a while and only in some parts of the world.
Sadly, this is happening everywhere.
So what can we do?
We need to be talking not just about how we punish these actions, but about how we prevent this from happening. We must talk about changes in cultural norms, in India and around the world. We need to be talking not just about how we punish these actions, but about how we prevent this from happening. We must talk about changes in cultural norms, in India and around the world. We must talk about increasing respect for women with no tie to what time they travel, who they are with, what clothes they wear, whether they’ve been drinking, what their sexual history is.
Sexual harassment in any form, at any point in time, under any circumstances is unacceptable. Period. That should be the norm.
I hope that the tragedy of the young woman’s death in India, whom many are calling Nirbhaya, “the fearless one,” will not be in vain. But rather, inspire fearlessness for all of us—women and men—to take action.
Fearlessness to say “this has happened to me” and to speak out when one sees it happening. To hold perpetrators, communities, and leaders accountable. To stop defining masculinity through violence. And fearlessness to end violence against women for good.
“The Stories Behind the Statistics” is a series we developed for the Gates Foundation blog, “Impatient Optimists.” The following post is the first in our series on early marriage. The original post, located on “Impatient Optimists,” is available here.
Every day more than 37,000 girls get married, and if present trends continue, an estimated 15 million girls will become child brides every year beginning in 2021. Early marriage has devastating social and health impacts on adolescent girls. Girls who are married are forced to take on roles for which they are not emotionally and physically prepared. When girls marry at a young age, they often leave their homes, stop attending school, and lose contact with family and friends. Many married adolescents experience domestic and sexual violence.
For many girls, marriage marks the beginning of their sexual life. Married adolescents have sex more often than their unmarried peers; are less able to refuse sex or negotiate safe sex; and often have older, more sexually experienced partners — all factors that increase their risk of HIV infection. Young women are often expected to demonstrate their fertility by becoming pregnant. Many give birth within the first year of marriage when their bodies are not fully matured. Childbirth- and pregnancy-related complications are the number one cause of death among girls ages 15-19; of the 16 million adolescent girls who give birth each year, 90% are married. Furthermore, because adolescents’ bodies are not yet fully developed, they are at a greater risk pregnancy complications including obstructed labor, which can cause obstetric fistula. The consequences of obstetric fistula are devastating: the baby usually dies, and the woman can suffer from constant leakage of urine or feces or both. The condition can result in stigma, isolation, and abuse.
Early marriage is an egregious violation of human rights with severe consequences for girls’ sexual and reproductive health. All girls deserve to enjoy their adolescence, and the cycle of early marriage can be broken. Programs that can help include those that provide better economic opportunities for girls, that help girls stay in school, and that work to change traditional attitudes and policies about early marriage, as well as those that offer sexual and reproductive health services to married adolescents.
In the next two blog posts, two youth authors, one from Zimbabwe and one from the Philippines, will share the direct impact of early marriage on their communities.