Download

Violence committed by men against women in intimate relationships is a pervasive problem around the world. Patriarchal norms that place men as the head of household are often to blame. Previous research suggests that trusted authorities can shift perceptions of norms and create behavior change. In many settings, a compelling authority on behavior in relationships is religious leaders, who are influential sources of information about proper conduct in relationships and gatekeepers ofmarriage, but may also uphold traditional gender roles. One way leaders exert their influence is through premarital or couples counseling courses. In this study, we test whether, if given an opportunity to offer a more progressive religious interpretation of gender roles during these courses, religious leaders could motivate men to share power and thereby reduce violence. Building on existing faith networks of Christian religious leaders in western Uganda, we conducted a large pair-matched, randomized controlled trial among 1,680 heterosexual couples in which participants were randomized to attend a 12-session group counseling course or wait-listed. We find that the program shifted power from men to women and reduced intimate partner violence by five percentage points, comparable with more intensive secular programs. These improvements were largest among couples counseled by religious leaders who held the most progressive views at baseline and who critically engaged with the material. Our findings suggest that religious leaders can be effective agents of change for reducing violence.

Country:
Program area:
Type:
Published Paper
Date:
August 11, 2022
DOWNLOAD

In Liberia, we have continued our global tradition of rigorous, applicable research by building foundational research capacity and generating evidence to reduce poverty and achieve the Sustainable Development Goals (SDGs).

Country:
Type:
Brief
Date:
April 11, 2022
Download

We study the impact of cognitive behavioral therapy (CBT) for individuals selected from the general population of poor households in rural Ghana. Results from 2-3 months after a randomized intervention show strong impacts on mental and physical health, cognitive and socioemotional skills, and downstream economic outcomes. We find no evidence of heterogeneity by baseline mental distress; we argue that this is because CBT can improve human capital for a general population of poor individuals through two pathways. First, CBT reduces vulnerability to deteriorating mental health; and second, CBT directly improves bandwidth, increasing cognitive and socioemotional skills and hence economic outcomes.

Country:
Program area:
Type:
Working Paper
Date:
March 21, 2022
Download

Almost half of all deaths of children under five years of age are attributable to malnutrition, and despite the decline in numbers, progress continues to be very slow. Malnutrition and under-nutrition, in particular, affect mainly households living in poverty. Recent research has shown that holistic livelihood programs can have a wide range of benefits for these poor families, from increasing household consumption and income to improving food security and mental health. This evaluation measured the impact of a multifaceted program on nutritional status, productive assets, and income. The program adapts the graduation approach, which combines a comprehensive set of interventions to enable ultra-poor households to develop sustainable livelihoods and resilience. It features a cash unconditional transfer, a productive investment (livestock or seeds), and a nutrition component (distribution of fortified flour), and nutrition education. 

Country:
Program area:
Type:
Brief
Date:
March 21, 2022
DOWNLOAD

In mid-2020, IPA partnered with researchers from Yale University, Stanford University, and other organizations like Green Voice in Bangladesh to research different strategies to increase mask-wearing and measure its impact on COVID-19. They found that the now called NORM model, consisting of No-cost free masks distribution, offering information on mask-wearing, Reinforcement in-person and in public, and Modeling and endorsement by trusted leaders tripled mask-wearing, increased physical distancing and reduced COVID-19. IPA partnered with Shakti Foundation to tweak this rural model into an urban context for Dhaka North City Corporation (DNCC) and replicate the NORM program for an urban population. Overall, the intervention seemed to increase mask-wearing among middle-aged (30 to 50 years old) and men more. It has also been learning to understand the implementation impacts and challenges of the NORM module in urban areas, which has been designed in the rural setting.

Country:
Program area:
Topics:
Type:
Brief
Date:
February 28, 2022
Spanish

Los retrasos en el crecimiento en la infancia pueden tener efectos en el largo plazo para el desarrollo cognitivo, el rendimiento escolar, la productividad económica en la edad adulta, entre otros. Abordar esto en los primeros años de vida ha demostrado ser la mejor manera de combatir la desnutrición, sin embargo, las familias a menudo carecen de información adecuada sobre las buenas prácticas de alimentación en los primeros años de vida. En Ecuador, nuestro equipo de investigadores están evaluando si enviar información a los cuidadores a través de mensajes de texto aumenta el conocimiento en las familias sobre el desarrollo de la primera infancia, la nutrición y los comportamientos saludables.

Country:
Program area:
Type:
Brief
Date:
February 08, 2022
Download

We implemented a randomised controlled trial study to measure the impact of one-on-one engagement with local religious leadership on the compliance of protocols at their mosque. Our messaging was a combination of religious appeal and public health guidelines that were interactive, involving frequent elicitation of the respondents’ reactions and agreement, as well as asking them to commit to action. Our study is different from previous strategies of COVID-19 containment as it does not rely on mass messaging but rather focuses on one-on-one engagement with focal community leaders. It aims to improve the implementation and communication of the 20-point plan that was agreed between the government and religious clergy to contain the spread of COVID-19. However, it is not novel in its approach as it is similar to previous interventions like the polio vaccination drive that disseminates knowledge and engages at the community level. Thus, the results from our study can provide valuable insights for strategies used by other public health campaigns to engage the public and build trust, such as polio vaccination and eventually the COVID-19 vaccination.

Authors:
Country:
Program area:
Type:
Brief
Date:
January 01, 2022
Download

In Rwanda, we have continued our global tradition of rigorous, applicable research by building foundational research capacity and conducting evaluations in areas of pressing national concern. Examples of our work covered in this brief offer promising insights into everyday issues that affect the lives of the Rwandan poor.

Country:
Topics:
Type:
Brief
Date:
November 12, 2021
Download

Women who become pregnant less than 24 months after giving birth face numerous risks to their own health and the health of their child. As such, postpartum family planning services can help women to better space pregnancies and mitigate health risks. However, little is known about how postpartum family planning impacts women’s contraceptive use, fertility choices and birth spacing. 

In a new policy brief, Mahesh Karra, Associate Director of the Human Capital Initiative (HCI) at Boston University's Global Development Policy Center, and four coauthors analyze their results from a randomized controlled trial that provided new and expecting mothers in Lilongwe, Malawi with access to a range of postpartum family planning services between September 2016 and February 2019. The services consisted of a combination of home visits from a family planning counselor, free transportation to a family planning clinic and financial reimbursement for purchasing services from the clinic. 

Key Findings:
  • Postpartum family planning services encourage contraceptive uptake. 
  • Women with greater access to postpartum family planning services are at lower risk of short birth spacing.

Drawing on the trial results, the researchers propose two key policy recommendations aimed at encouraging healthy birth spacing.

Key Recommendations:
  • Improving access to high quality postpartum family planning services would enable women and couples to more effectively time and space their next births.
  • In practice, the effective provision of postpartum family planning and maternal health services face multiple barriers. The study shows though, that a comprehensive postpartum intervention can help overcome some of these barriers.

The researchers note that the positive effects of family planning services extend beyond health outcomes. When women live longer and healthier lives, they are more likely to achieve higher levels of education and participate in the labor force. Policies that increase access to both pre- and postpartum family planning can empower women and girls and bring a range of economic benefits to communities as a whole.

This policy brief was jointly published by the Boston University Global Development Policy (GDP) Center and Innovations for Policy Action. View a full list of GDP Center publications and view a full list of IPA publications.

Country:
Program area:
Type:
Brief
Date:
October 25, 2021
Download

The area of family planning is unique in that the patient, rather than the provider, is seen as the key decision-maker in determining the best course of treatment. As such, family planning programs strive to afford women and couples the greatest degree of choice over contraceptive methods, and consequently invest significant resources into providing patients with complete and accurate information. Counselors often consult with patients about their options, but little is known about how the information and contraceptive methods that are presented during counseling sessions shape the way women make informed choices about their preferred contraceptive methods. 

In a new policy brief, Mahesh Karra, Associate Director of the Human Capital Initiative (HCI) at Boston University's Global Development Policy Center, and Kexin Zhang assess the results of a 2019 study conducted with 785 married women from Lilongwe, Malawi. The study aimed to evaluate how user-centered counseling approaches to family planning would affect women’s preferences for contraceptive methods and how these preferences were realized over time. Participants received a family planning counseling session with a trained counselor at their homes and were provided with free transportation to a family planning clinic for one month. 

Key Findings:
  • The contraceptive prevalence rate in urban Malawi is high, with 87.4 percent of the women in the sample using a contraceptive method as of their consultation.
  • Injectables are the most commonly used method (44.7 percent), followed by implants (30.2 percent) and pills (7.2 percent).
  • In urban Malawi, women’s preferences for contraceptive methods are often not concordant with their actual method use. If given the choice, 36.7 percent would want to switch from their current method to another method.
  • The reasons cited by those who wanted to switch methods, but had not yet done so were: “does not know enough about the method” (32.5 percent); “costs too much” (10 percent); “fear of side effects” (9.6 percent); and “preferred method not available” (9.2 percent).
  • Notably, at the initial counseling session, 42 percent of women were using a contraceptive method that differed from their perceived ideal method, whereas at the final interview, 55 percent of women were using a method that was different from their ideal stated method. 

Based on these findings, Karra and Zhang draw several lessons to inform future policies, programs and interventions aimed at improving family planning and reproductive health services for women in Malawi and elsewhere.

Policy Lessons:
  • Women’s stated and realized preferences for family planning are malleable and sensitive to a range of factors.
  • Service providers need to be responsive to changes in women’s choice of contraceptive method, and particularly women’s desires to switch methods, even if it may come at a greater cost to them. 
  • To minimize costs associated with switching methods, service providers would benefit from conducting a more comprehensive initial counseling session with women.

This policy brief was jointly published by the Boston University Global Development Policy (GDP) Center and Innovations for Policy Action. View a full list of GDP Center publications and view a full list of IPA publications.

Country:
Program area:
Type:
Brief
Date:
October 25, 2021
Download

Objectives: Disrespectful and poor treatment of newborns such as unnecessary separation from parents or failure to obtain parental consent for medical procedures occurs at health facilities across contexts, but little research has investigated the prevalence, risk factors, or associated outcomes. This study examined these experiences and associations with healthcare satisfaction, use, and breastfeeding.

Design: Prospective cohort study

Setting: Health facilities in Nairobi and Kiambu counties in Kenya

Participants: Data were collected from women who delivered in health facilities between September 2019 and January 2020. The sample included 1,014 women surveyed at baseline and at least one follow-up at 2-4 or 10 weeks postpartum.

Primary and secondary outcome measures: 1) Outcomes related to satisfaction with care and care utilization, 2) Continuation of post-discharge newborn care practices such as breastfeeding.

Results: 17.6% of women reported being separated from their newborns at the facility after delivery, of whom 71.9% were separated over 10 minutes. 44.9% felt separation was unnecessary and 8.4% reported not knowing the reason for separation. 59.9% reported consent was not obtained for procedures on their newborn. Women separated from their newborn (>10 minutes) were 44% less likely to be exclusively breastfeeding at 2-4 weeks (aOR=0.56, 95%CI: 0.40, 0.76). Obtaining consent for newborn procedures corresponded with 2.7 times greater likelihood of satisfaction with care (aOR=2.71, 95%CI: 1.67, 4.41), 27% greater likelihood of postpartum visit attendance for self or newborn (aOR=1.27, 95%CI: 1.05, 4.41), and 33% greater likelihood of exclusive breastfeeding at 10 weeks (aOR=1.33, 95%CI: 1.10, 1.62).

Conclusions: Newborns, mothers, and families have a right to high quality, respectful care, including the ability to stay together, be informed and have proper consent for care. The implications of these practices on health outcomes a month or more after discharge illustrate the importance of a positive experience of postnatal care.

Country:
Program area:
Type:
Published Paper
Date:
September 05, 2021
Download

A randomized-trial of community-level mask promotion in rural Bangladesh during COVID-19 shows that the intervention increased mask-use and reduced symptomatic SARS-CoV-2 infections.

Country:
Program area:
Topics:
Type:
Working Paper
Date:
September 01, 2021
Download

The COVID-19 pandemic disproportionately threatens vulnerable populations, including women and especially pregnant and post-partum women. Early estimates suggest that maternal and child deaths could increase by 8.7-38.6% and 9.8-44.7%, respectively, across low and middle-income countries (LMIC) due to disruptions in healthcare access and food insecurity. A global systematic review of impacts on maternal health found evidence of disruptions to healthcare services, reduced use of antenatal care, decreased access to family planning, and increased stress, anxiety, and depression related in part to isolation and fear of COVID-19 infection.3 Approximately one year into the COVID-19 pandemic, there continues to be a lack of information on the social, economic, and health impacts of the pandemic on pregnant and post-partum women and their infants, particularly from LMICs. Prior to the pandemic, Kenya, in particular, reported one of the highest rates of maternal and neonatal mortality in the world. Action-oriented research is needed to identify solutions and strategies for national and local government and communities. This policy brief provides information on the experiences of pregnant and post-partum women during COVID-19, with particular attention to healthcare access, maternal and newborn healthcare utilization, and maternal and newborn health. 

Country:
Program area:
Type:
Brief
Date:
August 02, 2021
Download

In a collective effort bringing together 15 studies, researchers from over 30 institutions surveyed over 20,000 individuals between June 2020 and January 2021 on questions regarding respondents’ vaccine acceptance and hesitancy and their most trusted sources for vaccination advice. During some surveys, results from COVID-19 vaccine clinical trials had yet to be announced, and during later surveys, governments had started approving vaccines for use. The fast-moving nature of COVID-19 information may change people’s perceptions about vaccines by the time they are widely available in low- and middle-income countries (LMICs). Over the past six months, the body of evidence demonstrating the safety and efficacy of available COVID-19 vaccines, which have been given to millions of people, has become clearer. At the same time, severe, but rare, side effects may have undermined public confidence.

Program area:
Topics:
Type:
Brief
Date:
July 19, 2021
Download

Widespread acceptance of COVID-19 vaccines is crucial for achieving sufficient immunization coverage to end the global pandemic, yet few studies have investigated COVID-19 vaccination attitudes in lower-income countries, where large-scale vaccination is just beginning. We analyze COVID-19 vaccine acceptance across 15 survey samples covering 10 low- and middle-income countries (LMICs) in Asia, Africa and South America, Russia (an upper-middle-income country) and the United States, including a total of 44,260 individuals. We find considerably higher willingness to take a COVID-19 vaccine in our LMIC samples (mean 80.3%; median 78%; range 30.1 percentage points) compared with the United States (mean 64.6%) and Russia (mean 30.4%). Vaccine acceptance in LMICs is primarily explained by an interest in personal protection against COVID-19, while concern about side effects is the most common reason for hesitancy. Health workers are the most trusted sources of guidance about COVID-19 vaccines. Evidence from this sample of LMICs suggests that prioritizing vaccine distribution to the Global South should yield high returns in advancing global immunization coverage. Vaccination campaigns should focus on translating the high levels of stated acceptance into actual uptake. Messages highlighting vaccine efficacy and safety, delivered by healthcare workers, could be effective for addressing any remaining hesitancy in the analyzed LMICs.

Program area:
Topics:
Type:
Published Paper
Date:
July 16, 2021

Pages