Research and Practice Highlights
- Bill & Melinda Gates Institute
- Center for Adolescent Health
- Early Childhood Services Research Program
- Women, Infants and Children Program
Gates Institute Continues to Implement Principles of Inclusion, Diversity, Anti-racism and Equity (IDARE)
The Gates Institute (GI) is committed to upholding the collective responsibilities outlined in the Public Health Code of Ethics while meeting the needs of the populations we serve. We will continue our work to actively uncover and address racism, oppression, and discrimination within Gates Institute and the systems, institutions, and partnerships in which we operate. This commitment requires unlearning prejudices and biases and understanding the disparities affecting the populations with which we work as well as transparency and accountability throughout these efforts.
Efforts began with a Director’s Message to the community challenging the field to acknowledge the biases within the system and address them head on. The institute then required Implicit Bias and Discrimination Trainings for all GI staff and additional courses for GI’s Leadership Team and all managers. Additionally, the Crucial Conversations series was launched allowing the entire institute to speak openly about the diversity, equity and inclusion issues that exist within our organization, community, partnerships, and institutions. Gates Institute worked in coordination with the Johns Hopkins School of Public Health historian to create a lecture series designed to dig into these areas of our history in order to help us better navigate the way forward. This series was open to the entire JHSPH community and well attended by many across the School.
Currently, the Gates Institute is undergoing a strategy refresh to ensure the elements of IDARE continue to be at the forefront of all activities within and connected to the systems, institutions, and partnerships in which the Gates Institute operates. GI remains committed to continuing to actively uncover and address racism, oppression, and discrimination.
‘My Choice My Future’ Digital Campaign Raises Awareness of AYSRH among Youth in Francophone West Africa
“I choose family planning for my future” is the motto of the “My Choice My Future” campaign recently supported by The Challenge Initiative (TCI) in Francophone West Africa. The digital media campaign promoted open communication about adolescent and youth sexual and reproductive health (AYSRH) among young people aged 15 to 24 in six cities (UCOZ, Cotonou, Abidjan, Ziguinchor, Niamey and Ouagadougou). TCI technical advisors worked with youth who had been trained as Young Transformational Leaders and youth-friendly health care providers to create WhatsApp and Facebook groups for local youth in each city.
New AFP Briefs Feature Country and Media Advocacy Achievements
Seven new briefs from Advance Family Planning (AFP) capture advocacy achievements in Bangladesh, the Democratic Republic of the Congo, Kenya, Nigeria, Tanzania, and Uganda, as well as AFP’s six-country media advocacy effort.
ICFP Community Action
Participate in the newest ICFP Community Action and add to the collective voice of the FP Community
We are inviting YOU to submit a personal, first-person experience that demonstrates the human-level benefits of access to family planning services & products. We are dedicated to ensuring our community’s perspectives, expertise, diversity and passions are captured, available, and heard.
The ICFP Voices Community Action was launched during the Not Without FP Forum. If you are an organization that is interested in partnering on highlighting a series of stories, we would love to partner with you. Contact us at firstname.lastname@example.org.
ICFP is also crowdsourcing content to populate the ICFP 2022 theme page and the new FP & UHC blog, Not Without FP, which spotlights on the key role FP plays in the success of UHC. To learn more or submit content, click here.
Reminder: The sixth ICFP will now take place November 14-17, 2022. Mark your calendars—we hope to see you there!
120 Under 40 winners play key roles in ICFP's first-ever Not Without FP Forum
Three 120 Under 40 winners played prominent roles in ICFP's first-ever virtual Not Without FP Forum, held February 2-3, 2021. The forum featured four plenaries stipulated by engaging scientific and community sessions, a virtual ICFP Exhibit Hall, and more. The sessions by community leaders and sector experts discussed the latest research and programmatic learnings while sharing solutions for addressing emerging challenges.
Dr. Tlaleng Mofokeng, United Nations Special Rapporteur, Author, and Reproductive Rights activist and 2016 120 Under 40 winner, served as the official hostess of the two-day event. She also hosted "The Wrap With Dr. T," where she is joined by six FHI 360 rapporteurs to discuss the forum's presentations, highlights, and key takeaways.
Dr. Natasha Salifyanji Kaoma, CEO, Copper Rose Zambia and 2019 120 Under 40 winner, kicked off the forum as a panelist for the Opening Plenary—UHC: Not Without FP. This session illustrated the importance of Universal Health Coverage (UHC) and demonstrated why integrating family planning is essential to its success.
Peter Ngure, Policy and Advocacy Team Lead at Pathways Policy Institute (PPI) and 2017 120 Under 40 winner, moderated the Day 2 Morning Plenary—UHC: Data, Actions, Solutions. This session unpacked the research and data behind successful universal health coverage schemes through the lens of family planning.
William Otuck, Tanzanian Sexual Reproductive Health and Rights advocate and 2019 120 Under 40 winner, moderated the Day 2 Youth Community Session, "Building Resilience in AYSRH,”, highlighting the need for increased investment in sexual and reproductive health services for youth, especially during a crisis.
The recordings and materials of these engaging sessions are available on-demand at ICFP2022.org.
COVID-19 Impact on Contraceptive Use in Sub-Saharan Africa: Evidence from PMA
Two recent studies published in The Lancet Global Health and BMJ-Sexual and Reproductive Health sought to understand how need for and use of contraception was altered in the context of the COVID-19 pandemic among women in sub-Saharan Africa.
Although sub-Saharan Africa appears to be a notable exception in the global debilitating experience of COVID-19, with total case and mortality burdens lower than the rest of the world, evidence from past emergencies suggests that the pandemic may have long-lasting, detrimental effects on women’s sexual and reproductive health (SRH).
In light of this widespread concern about women’s access to sexual and reproductive health services, Drs. Caroline Moreau, Celia Karp, Shannon Wood, and colleagues from the Johns Hopkins Bloomberg School of Public Health and partner universities in sub-Saharan Africa used longitudinal data to examine changes in the need for and use of contraception during COVID-19 in four sub-Saharan African contexts. Contrary to the authors’ initial hypothesis that the proportion of women in need of contraception—that is, women who are married/in-union, sexually active, and want to avoid pregnancy in the next year—would rise as contraceptive access and use decreased, the study found that the proportion of women in need of contraception actually increased in one site (Lagos) by about 6% (rising from 74.5% to 80.3%). When the researchers explored potential changes in contraceptive use, among women in need of contraception, they found contraceptive use also rose among women in Kenya and rural Burkina Faso since the onset of the pandemic. No significant changes in contraceptive use were observed in urban sites of Kinshasa or Lagos.
In another study, the same authorship team used individually linked data from before and during COVID-19 in Burkina Faso and Kenya and found that most women at risk of unintended pregnancy did not change their contraceptive status during COVID-19, and those who did were more likely to adopt a method (25.4% and 13.1%, respectively) than to discontinue (6.0% and 5.3%, respectively). Most women who switched methods used contraception as or more effective than the method they were using pre-pandemic. Economic instability related to COVID-19 was associated with increased contraceptive protection in Burkina Faso but not Kenya. Importantly, 14% of contraceptive non-users in Kenya and 4% in Burkina Faso reported COVID-19-related reasons for non-use. These findings underscore the resilience of women and health systems in these contexts. Safe modes of contraceptive service delivery during health emergencies, counselling that directly addresses women’s potential concerns as a result of the pandemic, especially their fears of facility-based infection and changing economic situations, are central to safeguarding continuity of quality SRH care amid public health crises.
Both manuscripts highlight that, at least within the initial months of the pandemic, COVID-19 has not brought about the anticipated detrimental effects on women’s access to contraception within these contexts in sub-Saharan Africa. However, the authors “warn against assumptions that women are protected from the future risk of unintended pregnancy, as our reported trends might not be sustainable throughout prolonged economic hardship and service disruption”. As the economic impact of the pandemic unfolds and further lockdown measures are implemented due to spiking cases, greater challenges remain in meeting women’s demand for contraception in the sub-Saharan Africa context. Such circumstances require concentrated efforts and continued research to ensure women have access to family planning services and are able to achieve their reproductive goals.
These results, as well as their contextualization within the broader family planning context, are further discussed by PMA’s Drs. Caroline Moreau and Phil Anglewicz on Johns Hopkins Bloomberg School of Public Health’s Podcast “Public Health on Call.”
PMA Ethiopia trains students and government health officials on data use
The PMA Ethiopia team held the first session of an advanced data analysis course training from December 14 to 19, 2020. The second session of this two-week course was offered in March. The pause between the first and second session allows participants to refine the topic of a course research project. The course, which was open to PhD students at Addis Ababa University (AAU) and regional universities, academic staff at AAU School of Public Health (SPH), and PMA Ethiopia central staff and regional coordinators, fills the gap in research training related to conducting advanced analysis using large-scale survey data.
The PMA Ethiopia team also held a data use workshop where invitees included the Federal Minister of Health and key staff from twelve regional health bureaus. The goal of the workshop was to familiarize regional health bureau staff with PMA data and encourage data use by reviewing the latest regional results briefs and exploring the components of PMA Ethiopia data on the website, including SOI tables, questionnaires, publications and DataLab. The workshop culminated in the regional health bureaus developing draft action plans based on PMA data. The action plans are currently being refined and updated by respective regional health bureau staff with technical guidance provided by AAU faculty and staff who work on PMA Ethiopia.
CAH Expands Vaccine Outreach with CDC Grant
Thanks to a COVID-19 Supplemental Grant from the Centers for Disease Control and Prevention (CDC), the Center for Adolescent Health and HeartSmiles are teaming up with Hip Hop Public Health to make sure Black families in Baltimore get vaccinated.
As part of the grant, CAH will also work with the Hopkins Vaccine Center, Baltimore City Public Schools, and the Baltimore City Health Department to understand the rate of COVID-19 vaccine uptake in Baltimore’s Black families – which make up 63 percent of Baltimore’s population.
“We’re thrilled to have the opportunity to work with Hip Hop Public Health, HeartSmiles, the Hopkins Vaccine Center, and our other partners on this project,” said Center for Adolescent Health Director Dr. Tamar Mendelson. “We’re excited to train young people as health ambassadors and develop a multi-generational website that families can access for accurate and engaging information about the COVID vaccine.”
The partnership will use the Youth Health Ambassadors model developed by Hip Hop Public Health as an entry point to educating Black families on the COVID-19 and encouraging them to get vaccinated. It will include a website that will expand to be a health resource for Baltimore’s families.
The grant – which CAH was eligible for as a CDC Prevention Research Center – allows the Center, HeartSmiles, and Hip Hop Public Health to expand on work they were already doing together on Hip Hop Public Health’s “Community Immunity” campaign.
The centerpiece of the “Community Immunity” campaign is a series of animated Hip Hop videos featuring Darryl “DMC” McDaniels of RUN DMC and Hip Hop Public Health founder and President Dr. Olajide Williams.
As featured on PBS News Hour last month, Hip Hop Public Health began working with HeartSmiles’ founder and President Joni Holifield and members of the CAH’s Youth Advisory Board like Young Elder to localize the “Community Immunity” videos to Baltimore.
This will include Baltimore youth adding their own lyrics to the videos that center on their communities.
Young people from Baltimore can submit their verses by May 26 for a chance to be one of three $1,000 winners who have their lyrics included in the Baltimore specific videos. The hope is to replicate this localization model in other cities around the country.
In their role as Youth Health Ambassadors, members of CAH’s Youth Advisory Board led a virtual session at the CDC Prevention Research Center conference at the end of April.
Improving the Precision of Home Visiting
Early Childhood Services Research Team has been the home for the Home Visiting Applied Research Collaborative (HARC) since 2012. Under the direction of Dr. Anne Duggan, HARC has advanced the field of research on home visiting programs. Home visiting programs serve pregnant women and families with young children and aim to address a broad array of outcomes, including improving maternal and child health, preventing child abuse and neglect, encouraging positive parenting, and promoting child development and school readiness.
In its early years of funding, HARC established a national research agenda for home visiting, built a practice-based research network of several hundred programs, networks and researchers and promoted research studies within the member network. With its most recent round of funding from the Health Resources and Services Administration, Maternal and Child Health Bureau, HARC has sharpened its focus on “precision home visiting.” It has promoted research and innovative methods to answer the question: “what works best for whom, under what conditions, why and how”.
Over the past year, HARC has developed a framework, the Precision Paradigm, that illustrates the components that must be defined in order to answer this core question. These components include outcomes of home visiting, the target behaviors that must be changed to achieve outcomes, the techniques used by home visitors to change caregiver behaviors, the mechanisms of action by which behaviors are changed, usage of services and the context in which it all sits. The HARC team has borrowed from the field of behavior change research and ontology development to create this framework. Over the next year, the HARC team will pull from the literature to fully define each component of the Precision Paradigm. They will use stakeholder-driven feedback to refine each component.
HARC recently received funding from the Pritzker Children’s Initiative to explore the use of the Precision Paradigm with prenatal home visiting to improve birth outcomes. This study had four components. First, a survey of national evidence-based home visiting models to explore the techniques that they expect home visitors to use to change behaviors to reduce risk factors for poor birth outcomes. Second, a companion survey with local home visiting programs. Third, qualitative interviews with families enrolled in prenatal home visiting to explore their perspectives of these techniques. And finally, a review of the literature to explore which techniques have been documented. Results from the first objective have been published as a preprint via Open Science.
All of this work was featured in HARC’s sixth annual and first virtual national home visiting meeting. The prenatal home visiting work was presented by members of the Population, Family and Reproductive Health Department – staff members Ciara Zagaja, MPH and Danielle Gaskin, MSPH and MSPH student Paris Lowe. All presentations from the annual meeting can be viewed on the HARC website.
News from the HPRIL Project
The Hopkins Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL) team, led by Drs. David Paige and Laura Caulfield, now has a blog! Please check it out for project updates, case studies, and other resources.
The HPRIL website also now features pages dedicated to each of the local WIC agencies funded through the grant. There, you will find details about the projects and quotes and photos from local agency team members.