Head porterage, popularly known in Ghana as Kayayei, has been an old economic venture for young girls and women who migrate from the northern to the southern part of the country. Even though Head Porters view Kayayei as a source of livelihood, conditions such as the outbreak of the 2019 coronavirus disease (COVID-19) further worsened their sexual vulnerabilities, as well as their autonomy to make decisions on contraceptive use. Head Porters, as a term defined in this study, refers to women aged 15 years or older who carry loads from one point of the town to another for a fee. The study is qualitative and used both purposive and simple random sampling in recruiting 120 Head Porters for focus group discussions. The study was planned and implemented in three zones in Kumasi, the Ashanti Regional capital of Ghana, during the lockdown period (between March and April 2020). Factors such as access to contraceptives, self-reported sexual desire, and partner desire to use condoms, sexual demands, and the impact of the COVID-19 pandemic on contraceptive access were assessed. Sexual demands increased during the COVID-19 period, with most Head Porters indicating they used fewer condoms and contraceptives during the same period. The desire to use a condom was limited among both Head Porters and their partners, and access to contraceptives was hampered by fear of getting infected by COVID-19 from a health worker at family planning clinics. The COVID-19 pandemic significantly increased the sexual and economic vulnerabilities of Head Porters in Ghana and impacted their access to family planning services. Governmental and international organizations need to start developing intervention programs for vulnerable populations such as Head Porters before future disease outbreaks.

Despite the growing literature on the impact of Covid-19 on antenatal care (ANC) and maternal/neonatal and child health outcomes globally, substantial knowledge gaps remain about the population-level impact in sub-Saharan Africa (SSA). Existing evidence on the ANC impact of Covid-19 in SSA is largely based on health facility or small-scale qualitative research, which are limited in providing population-level understanding. This paper examines the extent to which Covid-19 impacted ANC service utilisation and identifies what population sub-groups were most adversely impacted. It is based on a secondary analysis of the Madagascar Demographic and Health Survey (DHS), the first DHS in SSA released following the Covid-19 pandemic. Multilevel logistic regression analysis was used to estimate the net effect of Covid-19 on ANC and identify the most at-risk population sub-groups. The findings show that all ANC measures considered (no ANC, early ANC, adequate ANC visits) were significantly affected by Covid-19 (p<0.05). On average, Covid-19 was associated with a 42% increase in the odds of having no ANC, a 22% reduction in the odds of starting early ANC during the first trimester, and a 22% reduction in the odds of receiving adequate ANC (at least four visits, starting during the first trimester). Births to older mothers and to mothers with no education were disproportionately affected during Covid-19. Although youth aged 15–24 had poorer ANC compared to older women before the pandemic, the pattern was reversed during the pandemic. Also, the protective effect of education was stronger during than before the pandemic. These findings underscore the importance of Covid-19 impact mitigation strategies targeting the most at-risk groups (e.g. older mothers). Furthermore, essential information/education during pandemics should be in formats accessible to non-literate women. This paper advances understanding of the population-level impact of Covid-19 on ANC and emphasises the need for further research to better understand the population-level impact of Covid-19 across countries of SSA.

As COVID-19 spread rapidly during the early months of the pandemic, many communities around the globe anxiously waited for a vaccine. At the start of the pandemic, it was widely believed that Africa would be a significant source of infection, and thus, vaccinating African communities became a primary goal among local and global health authorities. However, when the COVID-19 vaccine became available in March 2021 in Sierra Leone, many people viewed it with scepticism and hesitation. While much literature has focused on access and distribution-related challenges for vaccination in the region, a growing number of studies discuss vaccine hesitancy as driving low vaccine uptake. Shifting attention to understanding the determinants of vaccine hesitancy remains fundamental to increasing vaccination rates, as negative vaccine perceptions tend to delay or prevent vaccination. This study sought to do this by assessing, through semi-structured qualitative interviews, vaccine-related attitudes and experiences of residents of Sierra Leone’s Kono District. In contrast to studies that utilise “knowledge-deficit” models of belief, however, this study drew upon the vaccine anxieties framework (Leach and Fairhead, 2007), which views vaccines as being imbued with personal, historical, and political meaning. Findings suggest that important bodily, social, and political factors, including fear of side effects, the spread of misinformation prompted by poor messaging strategies, and distrust of government and international actors, influenced people’s COVID-19 vaccine attitudes and behaviours. It is hoped that the study’s findings will inform future policies and interventions related to vaccine uptake in Africa and globally.

A minority of ultra-Orthodox (Charedi) Jews choose not to be vaccinated, and their refusal has assumed significant importance from a variety of perspectives. Clinicians often encounter patients whose beliefs are different from their own. Vaccine hesitancy within the US Charedi Jewish community is a factor contributing to outbreaks of disease, reflecting a growing mistrust between communities and arms of the State played out on the terrain of bodies and societies. Clinicians need to be aware of and understand this broader context as a foundation of empathetic listening and epistemic humility that might lead to improved health for the Charedi community based on reinforced trust.

The Garo tribe, one of a major indigenous communities of Meghalaya, India, relies heavily on their traditional health practices. This research investigates the healthcare-seeking behaviour of Garo women, their health concerns, their indigenous medical knowledge, and their reasons for preferring traditional over modern medicines. Conducted in East Garo Hills, Meghalaya, quantitative data (N = 96) were randomly collected from Garo women aged 15–49 through interviews to understand their health-seeking behaviour. Following a preliminary analysis, qualitative data (N = 12) were gathered through in-depth interviews to identify common illnesses, dimensions of traditional medicines, and reasons for dependency on them. Thematic analysis was performed using Atlas Ti. The result shows that almost 84% of Garo women (N = 86) seek treatment from Ojha (traditional healer) for achik (traditional) medicine, with only 6% using modern health facilities and 10% relying on herbal home remedies. Garo women rely on their age-old traditional remedies for health issues, irrespective of their educational or economic status. From the qualitative findings, this study explores the Garo tribe’s unique traditional medicine, known as ‘achik medicine’, prepared through local herbs and plants, and is disseminated by traditional healers, or ‘ojhas’, whose knowledge is generational. Moreover, every Garo household possesses medicinal plants, and all are knowledgeable about their use. Major health issues faced by Garo women are menstrual disorders, post-delivery weakness, fever with severe headache and jaundice. Reasons for using achik medicines are more effectiveness than modern medicines, cultural identity, preference for natural remedies, efficiency of Ojhas, availability, accessibility, and affordability of Ojhas. Meanwhile, the reasons for using limited use of modern healthcare facilities are poor quality of service and remote location. This study underscores the importance of preserving indigenous knowledge systems and respecting cultural heritage while ensuring the well-being of marginalised communities. Additionally, it highlights the need to improve modern healthcare quality and public transportation in the region.

Reproductive health indicators in many developing countries including Nigeria are poor, and this is due to the less-than-optimum utilization of reproductive healthcare that has been linked to numerous factors including the educational attainment of women and their partners. In societies like Nigeria, marriage is nearly universal and upheld by patriarchal practices, while education is one of the determining factors for the choice of partner in the marriage market, as it also influences household power dynamics. Despite the plethora of studies investigating the link between education and utilization of these services, there is a paucity of research examining educational assortative mating (EAM) and its link to reproductive healthcare utilization. Hence, this study investigated EAM and explored its association with reproductive healthcare utilization from the perspective of family systems theory. Data from the 2018 Nigeria Demographic and Health Survey (n = 19,950) was analysed with frequencies presented and binary logistic regression models fitted. The result showed that high-education (34%) and low-education (46%) homogamy are the most prevalent types of EAM, while 40% of the partnered women reported facility delivery, 11% used modern contraceptives and 20% reported 8+ antenatal care visits. The multivariate analysis showed that compared to women in hypergamy, women in both high-education homogamy and hypogamy are more likely to deliver at a health facility but women in low-education are less likely. Women in both high-education homogamy and hypogamy are more likely, but those in low-education homogamy are less likely to use modern contraceptives. For antenatal care, only women in high-education homogamy are more likely to have 8 or more visits during pregnancy compared to women in hypergamy, while women in low-education homogamy and hypogamy are less likely. These findings provide evidence of the importance of an indicator of social stratification for important family decisions like healthcare utilization.

Covert contraceptive use is a strategy to avoid unintended pregnancy. However, evidence regarding the multilevel factors linking past experiences of unintended pregnancy with covert contraceptive use is limited. The objective of this study was to identify the compositional and contextual factors associated with covert contraceptive use among women with a prior unintended pregnancy. Framed by the socio-ecological model, a cross-sectional study was conducted using data from Round 5 of the Performance Monitoring and Accountability 2020 project in Nigeria. Non-pregnant women aged 15–49 years who reported a previous mistimed or unwanted pregnancy were included (N = 1631). Multilevel logistic regression models with random intercepts were specified to investigate the relationship between covert contraceptive use and compositional and contextual factors. Approximately 4.54% (95% CI = 3.28–6.25) of women reported covert contraceptive use. At the individual level, having less than secondary education (aOR = 5.88, 95% CI = 1.20–28.72) and being single (aOR = 11.29, 95% CI = 2.93–43.56) were associated with higher odds of covert contraceptive use. There was no significant association between covert contraceptive use and the type of unintended pregnancy (mistimed: aOR = 3.13, 95% CI = 0.88–11.13). At the community level, living in a community with average poverty levels (aOR = 6.18, 95% CI = 1.18–32.55) and high exposure to family planning mass media (aOR = 6.84, 95% CI = 1.62–29.11) were associated with higher odds of covert contraceptive use. Measures of variation showed significant variation in covert contraceptive use across communities. Further research is warranted to better understand the underlying mechanisms in these observed associations and variations in covert contraceptive use among women following the experience of an unintended pregnancy. Additionally, there is a need to design family planning strategies that integrate community-level structures.

This reflection explores the transformative power of critical theory through a quality improvement (QI) project creating culturally relevant dietary resources for Pacific Islander communities in Washington State, USA. Food injustice and lack of food sovereignty are examined as manifestations of modern-day colonialism perpetuated by capitalist-driven social structures. The methodology employed critical reflection, defined as the process of examining assumptions and power relations that shape practice, central to critical theory. Iterative group discussions aimed to understand the impact of individual and collective assumptions, power dynamics, and oppression on the project’s conceptualization, implementation, and evaluation.

Specific recommendations are integrated into the discussion to aid those replicating similar protocols, emphasizing actionable steps such as engaging with the community at all project stages. The research team, composed of osteopathic medical students and a critical theory expert, engaged in reflexivity to understand how social locations and lived experiences influenced perceptions. Despite the goal of fostering cultural inclusivity, limitations in engaging the Pacific Islander community throughout the project lifecycle highlighted the need for cultural humility and participatory action methodology.

This study underscores the importance of understanding the history and socio-political context of marginalized communities to avoid perpetuating colonial practices and trauma. It emphasizes the necessity for medical schools to incorporate sociological theories into curricula to promote compassionate, culturally appropriate care and research. By critically examining positionality and engaging in transformative learning, the group advocates for systemic changes towards a more equitable global healthcare system.

Through critical reflection, the group has come to understand how lived experiences have shaped perceptions of oppression, which are entrenched within and perpetuated by social institutions. Actionable items from these reflections are presented to help future practitioners and educators apply cultural humility, community empowerment, and critical theory in QI projects.

Quality of care during childbirth is crucial to maternal health outcomes. Studies from India that report on women’s experiences of disrespect and abuse by healthcare providers during facility-based childbirth are limited to high-fertility states and predominantly focus on public hospitals. However, the quality of maternal care in states with low fertility rates like West Bengal needs further examination. This study aimed to understand women’s experiences of disrespect and abuse and their perceptions of facility-based childbirth. The study focused on public, private, and charitable hospitals in Kolkata district of West Bengal that presents a higher institutional birth rate than the national average. The findings derive from a qualitative study using in-depth interviews with 17 postpartum women who had facility-based births within one year before data collection in May 2019. Grounded theory approach was used to iteratively code the interview transcripts, identify reappearing categories, and generate themes through abstraction. The participants’ narratives revealed experiences of verbal abuse, neglect and abandonment, poor rapport between providers and women, improper conduct of procedures, health facility conditions and constraints, and instances of overlapping forms of disrespect and abuse. The findings demonstrate the nature of disrespect and abuse across different hospital types in a major metropolis of India. Normalisation of poor-quality care manifested in women’s lack of expectations of patient education and attention from providers. Health system conditions and constraints can impact the quality of care that problematise the push for institutional deliveries as a panacea for poor maternal health outcomes. The findings add to long-standing calls for improving maternal experiences of birth with an emphasis on promoting autonomy. National and state guidelines related to maternal health need to be aligned with accepted standards of care. West Bengal must establish ways to assess the implementation of such guidelines on the ground.

Millions of young girls in Nigeria have continued to suffer the negative consequences of early marriage such as discontinuation of education and restricting them from achieving their full potential. Successive Nigerian governments have therefore deployed different strategies over the years to mitigate the practice, particularly in the northern part of the country. This study analysed the changes in the pattern of child marriage across space-time in Nigeria using a dataset obtained from the Nigeria Demographic and Health Survey conducted between 2003 and 2018 at a consecutive interval of 5 years. A Bayesian spatio-temporal random effect model with inference based on integrated nested laplace approximation was considered. Whereas the findings demonstrate a reduction in the practice of child marriage over time everywhere in the country, the prevalence remains highest in States such as Kogi, Niger, Federal Capital Territory Abuja, Taraba, and Kaduna, all in the northern part of the country despite the policies, program and interventions by international organisations, Child Right Acts, and Non-governmental organisations. Over the fifteen years, only slight changes were recorded in the Southwest region. Furthermore, higher levels of education, urban residency, household wealth, being a Yoruba, or belonging to a Christian religious group were found to lower the chances of child marriage. State-specific strategic planning would be useful in deploying suitable local solutions to reduce child marriage in Nigeria.

Economic uncertainties have become the focus of many recent fertility studies. Embedded in and shaping people’s forecasts of the future, economic uncertainties refer to the lack of predictability and stability in the economic conditions, such as employment status and labour market situations. It is believed that economic uncertainties can impact fertility outcomes and the timing of family transitions through people’s perceptions of varying futures, but much is unexplored in Asian countries, particularly when an economic downturn has been observed and is underway recently. This study’s objective was to examine the perceptions of economic uncertainties among young people in China and the influence these had on the value attached to the experience of having children. For this, a national sample of young individuals aged 17 to 33 was recruited online through the Credamo platform. Demographic and individual economic factors were controlled, and multinomial logistic regression was used to analyse the association between economic uncertainties and young people’s views on having children. The study found a clear association between economic uncertainties and the necessity and planning for having children. More optimistic expectations for the future economy and labour market were associated with higher likelihood of approving of the necessity of childbearing and childrearing, as well as higher fertility intention. The findings also highlighted associations of other demographic and socioeconomic characteristics, such as sex, marital status, and house ownership. The respondents’ expectations of an uncertain future shaped their decisions regarding life events, including future fertility. Thus, assisting young people in gaining a sense of security in the face of social uncertainty is critical in future government policy plans if a fertility rebound in China is to be achieved.

Despite significant public health investments, rural India’s sanitation challenges persist, raising questions about effective intervention strategies. This study investigates the influence of participation in social schemes on household sanitation behaviours, specifically toilet adoption and soap usage. Using panel data from the India Human Development Survey (2004–05 and 2011–12), a Linear Probability Model with Propensity Score Matching is employed to address potential selection bias. Results indicate that scheme participation increases toilet adoption by 45.5% and soap usage by 13.8%, with effects varying by socio-economic status, demographic characteristics, and local infrastructure. Particularly strong impacts are observed among historically disadvantaged communities, suggesting that social schemes can effectively reduce sanitation inequities. The spillover effect on soap usage indicates these interventions may catalyse broader hygiene behaviour changes. The findings highlight the value of social schemes in improving rural sanitation practices and offer insights for future programme design.