Browsing by Author "Kibira, Simon P. S."

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    An investigation of the impact of the Global Gag Rule on women’s sexual and reproductive health outcomes in Uganda: a difference-in-differences analysis
    (Informa UK Limited, 2022-10-19) Giorgio, Margaret; Makumbi, Fredrick; Kibira, Simon P. S.; Bell, Suzanne O.; Chiu, Doris W.; Firestein, Lauren; Sully, Elizabeth
    In 2017, the Trump administration reinstated the Global Gag Rule (GGR), making non-U.S. non-governmental organisations ineligible for US government global health assistance if they provide access to or information about abortion. Little is known about the impact of the Trump administration’s GGR on women’s outcomes. Data for this analysis come from a panel of women surveyed in 2018 and 2019 in Uganda (n = 2755). We also used data from meetings with key stakeholders to create a detailed measure of exposure to the GGR within Uganda, classifying districts as more or less exposed to the GGR. Multivariable regression models were used to assess changes in contraceptive use, all births, unplanned births, and abortion from before to during implementation of the GGR. Difference-in-differences (DID) estimates were determined by calculating predicted probabilities from interaction terms for exposure/survey round. Descriptive analyses showed long-acting reversible contraceptive use increased more rapidly among women in less exposed districts after GGR implementation. DID estimates for contraceptive use were small. We observed a DID estimate of 3.5 (95% CI −0.9, 7.9) for all births and 2.9 (95% CI −0.2, 6.0) for unplanned births for women in more exposed districts during the period the policy was in effect. Our results suggest that the GGR may have attenuated Uganda’s recent progress in improving SRHR outcomes, with women in less exposed districts continuing to benefit from this progress, while previously increasing trends for women in more exposed districts levelled off. Although the GGR was rescinded in January 2021, the impact of these disruptions may be felt for years to come.
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    Contraceptive Uptake Among Married Women in Uganda: Does Empowerment Matter?
    (African Population Studies, 2014) Kibira, Simon P. S.; Ndugga, Patricia; Nansubuga, Elizabeth; Sewannonda, Andrew; Kwagala, Betty
    Although contraceptive prevalence increased from 24% to 30% between 2006 and 2011, this uptake is still below global level of 62% and low levels of women empowerment could be a factor. Data was extracted from 2011 UDHS to examine associations between women’s empowerment and contraceptive uptake. We developed four empowerment indices symbolising economic and social empowerment, established associations between them and contraceptive use. Most women (83%) were from the rural areas and 61% were married for 10+ years. Most (59%) scored low on power over earnings and domestic violence indices. All indices independently were positively associated with contraceptive use, but only the reproductive health rights index was significant before (OR 2.13, 95% CI; 1.52-2.98) and after adjusting for background characteristics (AOR 1.72, 95% CI; 1.07-2.73). Empowered women were more likely to use contraceptives. More efforts in sensitisation of women about their sexual and reproductive health rights as well as ensuring more control over their earnings
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    Menstrual health challenges in the workplace and consequences for women’s work and wellbeing: A cross-sectional survey in Mukono, Uganda
    (PLOS Global Public Health, 2022-07-21) Hennegan, Julie; Bukenya, Justine N.; Nakamya, Petranilla; Makumbi, Fredrick E.; Kibira, Simon P. S.
    This study describes women’s menstrual health needs at work in Uganda and explores the associations between unmet needs and women’s work and wellbeing. We undertook a cross-sectional survey of women working in marketplaces, public primary schools, and health care facilities in Mukono district, central Uganda. Survey questions were designed to capture women’s experiences of managing menstrual bleeding, pain, social support, and the social environment. A total 435 women working in markets, 45 teachers and 45 health care facility workers participated. Of these, 15% missed work due to their last period, and 41% would prefer not to work during menstruation. Unmet menstrual health needs were associated with consequences for women’s work and psychological wellbeing. Experiencing menstrual pain (aPR 3.65 95%CI 1.48–9.00), along with the use of improvised menstrual materials (aPR 1.41 95%CI 1.08–1.83), not feeling comfortable to discuss menstruation at work (aPR 1.54 95%CI 1.01–2.34) and the expectation that women should stay home when menstruating (aPR 2.44 95%CI 1.30–4.60) were associated with absenteeism due to menstruation. In contrast, not having menstrual management needs met (aPR 1.45 95%CI 1.17–1.79) and the attitude that menstruating women are dirty (aPR 1.94 95%CI 1.50–2.51), along with pain (aPR 1.59 95%CI 1.12–2.24) and norms around absenteeism were associated with wanting to miss work. After adjustment for age and poverty, unmet menstrual management needs (b = -5.97, 95%CI -8.89, -2.97), pain (b = -3.89, 95%CI -7.71, -0.08) and poor social support (b = -5.40, 95%CI -9.22, -1.57) were associated with lower wellbeing measured using the WHO-5. Attitudes that menstruation should be kept secret (b = 4.48, 95%CI 0.79, 8.17) and is dirty (b = 4.59, 95%CI 0.79, 8.40) were associated with higher wellbeing. Findings suggest that supporting care for menstrual pain, addressing secrecy surrounding menstruation and the perception of menstruation as dirty, and improving access to materials and facilities for managing menstrual bleeding are avenues for programs and policies to support working women.