Sexual|Reproductive Health

Gender Gaps in Vaccines November 2021

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 22 of 24 countries where CARE has data, women are less likely to be vaccinated and less likely to feel vaccines are safe.

There are massive local and global gaps in who can get vaccinated. Only 4.5% of people in low-income countries are vaccinated, and 79% of vaccinations have been in wealth countries. Tragically, wealth and geography are just two factors that skew access to vaccines. Another is gender. In many low and middle-income countries, women are less likely to get COVID-19 vaccines than men are. This compounds gender inequality women are already facing in health and decision-making Read More...

Who pays to deliver vaccines? An Analysis of World Bank Funding for COVID-19 Vaccination and Recovery

The World Bank is one key source of funding in the global push to vaccinate 70% of the world’s population against COVID-19. Many actors point to this as the funding that will cover any additional delivery needs for COVID-19 vaccines that national governments cannot meet. With $5.8 billion in funding already approved out of a $20 billion commitment, the World Bank funding is an important part of the picture, but the World Bank alone cannot cover the full gap in vaccine delivery needs.

Reviewing 60 funding agreements from the World Bank on COVID-19 vaccination and recovery shows the following insights.

• There is still a gap in delivery funding. The World Bank is currently funding $1.2 billion in vaccine delivery—10% of the total funding allocated for COVID-19 recovery. If that trend applies to the rest of the $20 billion commitment, World Bank funding will cover a between $2 and $4 billion—well below the $9 billion that ACT-A estimates as the lowest possible investment to vaccinate 70% of the world’s population. In contrast, $3.1 billion is going to purchase vaccines.
• Health workers remain underfunded. Only 15 of 60 agreements, just 25% detail provisions to pay health workers. Of those, 7 explicitly fund surge capacity, 3 provide for ongoing salaries, and 4 allow for hazard pay to health workers.
• Countries are taking on debt to rollout COVID-19 vaccinations. 86% of the funding in this analysis is in the form of loans. That gives countries debt that may weaken future pandemic preparedness rather than reinforcing health systems.
• All funders should adopt the World Bank’s commitments to investments in gender equality. 90% of the agreements in this analysis refer to gender inequality and many make corresponding investments—like requiring that 60% of vaccine leadership positions are women—to overcome these barriers. Earmarking exact funds going to advance gender equality would provide further transparency. Nevertheless, this consistent and concrete commitment is commendable, and all actors should strive to replicate it.

TAMANI (Tabora Maternal and Newborn Health Initiative) Impact Evaluation

According to the 2015-2016 DHS survey, Tabora region has the highest percentage population (45.8%) in the lowest wealth quintile in the country, which reflects high levels of structural inequality that have a direct bearing on reproductive, maternal, newborn, child, and adolescent health outcomes.(2) Polygamy is most prevalent in the Western zone with approximately one-third of marriages polygamous, contributing to high fertility rates. Tabora has a low contraceptive prevalence rate of 21.9%, and the Western Zone has the highest levels of teenage childbearing in Tanzania (38%). The latest DHS survey (2015-2016) indicated that 44.3% of women in Tabora deliver at home.

Given this context, the international aid organization CARE began reproductive health programming in Tabora in 2012 with the aim of improving maternal and reproductive health. This paper presents an impact evaluation of CARE’s second stage of reproductive, maternal and newborn health programming in Tabora, the Tabora Maternal and Newborn Health Initiative (TAMANI), which builds on the experience of CARE in the region and spans from 2017-2021. Read More...

Rapport d’évaluation finale du projet : Préserver la Dignité et Réduire les Souffrances des personnes affectées par les effets des mouvements de population dans la commune de N’guigmi II

Le projet PREDIRES II a été mis en de Septembre 2019 à Août 2020. Il est axé sur les volets sécurité alimentaire, Violence basée sur le genre et la santé sexuelle reproductive. Le projet a touché 500 ménages vulnérables issus de 9 villages de la commune de N’guigmi. Les activités réalisées vont de la mise en place et formation des structures communautaires de protection et VBG, des pairs éducateurs sur IST/VIH/SIDA à l’appui alimentaire et une mise en place, formation et appui en cash pour AGR des groupements MMD.
Pour mieux évaluer la pertinence, l’efficacité, l’efficience et l’impact du projet, une évaluation finale a été faite, objet du présent rapport. L’évaluation a été conduite en interne et le plus simplement possible par le chef de projet. L’exercice a été guidé par 05 questions d’évaluation avec un certain nombre de sous-questions. Les méthodes de collectes ont été une revue documentaire du projet et une étude qualitative (enquête des connaissances, d’attitudes et des pratiques). Pour cette dernière, des entretiens de groupe ont été menés avec des hommes (jeunes et adultes) et femmes (jeunes et adultes). Les données ont été collectées par une équipe externes dans 3 villages d’intervention du projet. Le projet est à 63% du taux de consommation en Juillet 2020. [14 pages] Read More...

A Baseline Study and Social Norms Analysis using SNAP for the project BERHAN: Sexual and Reproductive Health and Rights Initiative in Amhara Region, Ethiopia

Background: BERHAN – Sexual and Reproductive Health and Rights initiative in Amhara region of Ethiopia seeks to support women and girls in Fogera and Estie woredas to safely exercise their sexual and reproductive health rights, leading to improved wellbeing (impact).

Objective: The purpose of this study was to understand the social norms that are associated with the practices of female genital cutting (FGC) and early marriage (EM), and to establish a baseline for all project indicators.

The quantitative survey was conducted on a randomly selected sample of 375 respondents comprising of men, women, girls, and boys (adults and adolescents). Quantitative data were collected using an interviewer administered structured questionnaire. Qualitative data were collected by masters and PhD degree holders, and quantitative data were collected by trained and experienced BSC level data collectors.

Results: The results revealed that FGC and EM were common practices in the community with a prevalence of 85.0% and 64.0% respectively. The community held the practices because of various reasons among which are cultural preservation and lack of knowledge. The community members were highly influenced by the sanctions that made them change their initial positions. Generally, women could not use contraceptive methods without permission from their partners or family members and this applies to all modern contraceptive methods.Only 3.7% of girls and women in the age group of 15-49 were able to use a modern contraceptive of their choice and, only 30.5% were able to decide on their own reproductive health care use. Read More...

Gender Gaps in COVID 19 Vaccines

COVID-19 vaccinations are quickly becoming a story of inequality. Gender inequality is a critical part of this story. In 16 countries where CARE has data, women are less likely to be vaccinated, and less likely to feel vaccines are safe.
There are massive local and global gaps in who can get vaccinated Only 1 9 of people in low income countries are vaccinated, and 79 of vaccinations have been in wealth countries Tragically, wealth and geography are just two factors that skew access to vaccines Another is gender In many low and middle income countries, women are less likely to get COVID-19 vaccines than men are This compounds gender inequality women are already facing in health and decision making Read More...

Regional project FAIR III “ For Active Inclusion & Rights of Roma Women in the Western Balkans III”

This intervention builds on extensive CARE’s expertise and experience in facilitating process related to women’s empowerment and gender equality across the globe and in the Balkan region. It also intends to scale up approaches and models that have proven successful over the last six years of the FAIR projects’ implementation (FAIR and FAIR II). The project seeks to empower Roma women and girls to be free and able to exercise their rights to live a healthy, dignified life free from violence, inequality and discrimination with support from their partners, families and communities in Bosnia and Herzegovina, Serbia and Montenegro. This will be accomplished through four output level results that need to be met for the longer-term changes to happen, they are inter-connected and mutually reinforcing since only in that way the outcome can be accomplished.

The first one (Output 1) refers to the enhanced capacities of Roma CSOs, youth and key community actors to practice and promote gender equitable, healthy and non-violent lifestyle with help of tested models and approaches. Under the second expected result (Output 2) Improved access to and provision of services for Roma, Egyptian (RE) women and girls (in particular on SRMH, GBV and Education) will be ensured through strengthening of the Roma CSOs and the existing participatory accountability community mechanisms. Output 3will enable three national-level Roma women networks to be active and contribute to the effective functioning of the regional Roma Women Balkans Network and its enhanced efforts towards Post 2020 EU Roma Integration Agenda. In the last expected result (Output 4), Roma women and girls, CSOs and Networks are part of the regional and global social movement initiatives promoting and advocating for gender equality and (minority) women’s rights. The project will directly target 26,150 people in total –aiming at 85% Roma and over 60% women and girls. Data collection under this project will be disaggregated by sex, age and ethnicity, whenever possible. Over20,000 people are expected to be reached in the three target countries through a series of promotional activities. Final Beneficiaries will include about 78,000 people in the 3 target countries based on the assumption that each target group person will reach out to at least 3 persons in his/her direct environment. [13 pages] Read More...

Endline Evaluation of Haushala Initiative of LEAD Program

Care Nepal has been implementing Haushala project which was designed to strengthen girls’ agency along with education outcomes, economic empowerment and adolescent sexual and reproductive health (ASRH) practices, hence helping to build sustainable change, including through creating a safer and more secure learning environment, facilitating social networks and gradually transforming traditional social norms with a negative impact on girls. The project also aimed to improve accountability and gender responsiveness of service providers for improved learning for girls.

During the evaluation both qualitative and quantitative data were collected using questionnaires, FGD and KII checklist for girls, parents, head teachers, cooperatives and school management committee. The data collection faced few limitations arising from COVID-19 which limited the logistical flexibility of the project along with created greater ethical consideration regarding health of the enumerators.

Girls reported that they perceived high parental support in their studies but this perception decreased with age. Parents and Girls both credit UALC and its program for aiding them and their children to attend formal schools. Parents were highly motivated by UALC and its stakeholders to help their daughter(s) to join formal education. However, it was also observed that the effort put by stakeholders such as schools and social mobilisers on influencing the parents who did not enroll their daughter(s) in formal school after UALC was not enough. But, as the transition was already very high and parents who did not send their daughter(s) for the first time were not that willing to re-enroll. Hence, the project can be deemed a success to certain point. [151 pages] Read More...

ProJeunes Final Evaluation Prévenir les mariages précoces et forcés au Bénin

Prévenir les mariages précoces et forcés au Bénin (PROJEUNES) est un projet de 3 millions de dollars canadiens destiné à lutter contre les mariages précoces et forcés d'enfants au Bénin, dans 20 villages aux départements de l'Alibori et du Borgou. PROJEUNES est un partenariat entre CARE, Youth Coalition for Sexual and Reproductive Rights et le gouvernement du Bénin (Ministère de la Santé, Ministère des Affaires sociales et de la Microfinance et Ministère des enseignements secondaire, technique et de la formation professionnelle). Le projet est un partenariat de trois ans, d'avril 2018 à mars 2021, financé par le gouvernement du Canada. Ce rapport présente les progrès réalisés pour l’atteinte des résultats ultime, intermédiaires et immédiats du projet. Plusieurs collectes et analyses des données de fin du projet ont été réalisées par l’équipe de projet et un consultant externe entre mars et juin 2021. Les différentes évaluations effectuées sont les suivantes : Revue et analyse documentaires des principales lois, politiques et stratégies béninoises relatives à la SSRD/SSRAJ, aux MPFE et aux VBG; Évaluation de groupements FaFa Wa et de certaines de leurs members; Évaluation de filles à risque/vulnérables et survivantes de MPFE; Enquête auprès des ménages; Analyse qualitative contextuelle et Évaluation de 12 CS et 4 CPS. Read More...


La vaccination et les services de planification familiale sont deux composantes importantes des soins de santé primaire. La plupart des femmes en période post-partum prolongée souhaitent retarder ou éviter d’autres grossesses mais beaucoup d’entre elles n’utilisent pas de méthode moderne de contraception. Une analyse des données provenant de plusieurs pays a montré que les besoins de contraception non satisfaits chez cette population étaient très importants, allant de 45 % à plus de 80 % des femmes en post-partum (Borda and Winfrey, 2008). La planification familiale permet aux couples d’avoir le nombre d’enfants qu’ils désirent et de choisir le moment et l’espacement des grossesses, ce qui permet d’améliorer la santé de la mère et de l’enfant. Les grossesses trop rapprochées peuvent représenter un danger pour la santé de la mère et de l’enfant (OMS, 2007a). Les grossesses espacées de moins de 18 à 24 mois ont été associées à des risques plus élevés de naissance prématurée, de faible poids de naissance, de décès fœtal, néonatal ou du nourrisson, et d’effets négatifs sur la santé maternelle (Conde-Agudelo et al. 2012). La vaccination des enfants est l’un des services de santé les plus équitables et les plus utilisés dans le monde. Le calendrier de vaccination et de soins de santé primaire recommandé pendant la première année de vie de l’enfant donne lieu à de nombreux contacts pour des soins de santé. Veiller à ce que des services et conseils de planification familiale soient liés aux contacts pour la vaccination des enfants via des services de santé primaire bien gérés peut permettre de proposer aux mères des informations et des services de planification familiale pendant la période critique des 12 mois suivant l’accouchement. Une modélisation à partir de données provenant de cinq pays d’Afrique subsaharienne a montré que le fait d’entrer en contact avec les femmes en post-partum au moment de la vaccination infantile pouvait faire diminuer les besoins de planification familiale non satisfaits de 3,8 à 8,9 points de pourcentage (Gavin et al. 2011). Dans ce contexte, CARE Benin/Togo, sur financement de la Fondation GSK en collaboration avec le Ministère de la Santé et de l’Hygiène Publique du Togo, a mis en œuvre depuis Décembre 2018 une initiative de renforcement du système de santé et d'intégration des services de vaccination et de planification familiale dans 11 Formations Sanitaires du district de la Binah dans la Région de la Kara au Togo, dénommée « Promotion de la Santé de la Mère et de l’Enfant (PSME) [48 Pages]. Read More...

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