Academic Research

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Women’s household decision making autonomy and safer sex negotiation in Nigeria

Yuji Sano, Alice Sedziafa, Siera Vercillo, Roger Antabe & Isaac Luginaah
Published here in AIDS Care

Abstract
Although married women’s safer sex negotiation with their husbands is critical in reducing new HIV infections in Nigeria, its linkage to women’s household decision-making autonomy is less explored in Nigeria. Drawing data from the 2013 Nigeria Demographic and Health Survey and using the logistic regression technique, we examined the associations between women’s household decision-making autonomy and two indicators of the ability to engage in safer sex including whether married women 1) can refuse sex and 2) ask for condom use during sexual intercourse with husbands. Findings indicate that 64% and 41% of married women can refuse sex and ask for condom use, respectively. While the impact of women’s household decision-making autonomy on the ability to refuse sex remained statistically significant after controlling for theoretically relevant variables (OR = 1.15; p < 0.001), its impact on the ability to ask for condom use became weakly significant once socioeconomic variables were controlled (OR = 1.03; p < 0.1). Based on these results, we have two suggestions. First, it may be important that marital-based policies and counselling promote environments in which married women can establish equal power relations with their husbands. Second, it is also important to eliminate structural barriers that hinder married women’s economic opportunities in Nigeria.


Debated agronomy: public discourse and the future of biotechnology policy in Ghana

Joseph A. Braimah, Kilian N. Atuoye, Siera Vercillo, Carrie Warring & Isaac Luginaah
Published here in Global Bioethics Journal

Abstract
This paper examines the highly contested and ongoing biotechnology (Bt) policy-making process in Ghana. We analyse media content on how Bt is viewed in the context of Ghana’s parliamentary debate on the Plant Breeders Bill and within the broader public policy-making literature. This paper does not seek to take a position on Bt or the Bill, but to understand how policy actors influence the debate with political and scientific rhetoric in Ghana. The study reveals that in the midst of scientific uncertainties of Bt’s potential for sustainable agriculture production and food security, policy decisions that encourage its future adoption are heavily influenced by health, scientific, economic, environmental and political factors dictated by different ideologies, values and norms. While locally pioneered plant breeding is visible and common in the Ghanaian food chain, plant breeding/GMOs/Bt from international corporations is strongly resisted by anti-GMO coalitions. Understanding the complex and messy nature of Bt policy-making is critical for future development of agricultural technology in Ghana and elsewhere.



Does the New Alliance for Food Security and Nutrition impose biotechnology on smallholder farmers in Africa?

Siera Vercillo, Vincent Z. Kuuire, Frederick Ato Armah & Isaac Luginaah
Published here in Global Bioethics Journal

Abstract
Almost one in three people who live in sub-Saharan Africa (SSA) are hungry, higher than anywhere else. This magnitude of food insecurity coupled with slow progress in regional integration, disease and epidemics, poor access to markets, gender disparities, lack of land tenure rights, and governance and institutional shortcomings on the continent have been used to justify a narrative for the inclusion of biotechnology in smallholder agriculture in SSA. The fact, however, suggests that even in the face of these challenges, smallholder farmers in SSA still produce 70% of the food on the continent. We critically examine the introduction of biotechnology in smallholder farming within the context of the New Alliance for Food Security and Nutrition and public–private partnerships in SSA. We explicitly address the bioethical concerns and implications for technology adoption goals in line with a neoliberal economic model that is encouraging smallholder farmers to adopt biotechnology as a way to secure more food for communities. This paper is not meant to pose a simplistic pro or anti stance on genetically modified (GM) crops or biotechnology, but rather to situate the debate about GM technology within issues of power, control in the global food agriculture systems, and point to the bioethical concerns that affect the lives of smallholder farmers and their families on a daily basis.


Utilisation of skilled birth attendants over time in Nigeria and Malawi

Kilian N. Atuoye, Jonathan A. Amoyaw, Vincent Z. Kuuire, Joseph Kangmennaang, Sheila A. Boamah, Siera VercilloRoger Antabe, Meghan McMorris & Isaac Luginaah
Published here in Global Public Health

Abstract
Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery – one of the indictors of MDG 5 – has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made – based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.


Timing and utilisation of antenatal care service in Nigeria and Malawi

Vincent Z. Kuure, Joseph Kangmennaang, Kilian N. Atuoye, Roger Antabe, Sheila A. Boamah, Siera Vercillo, Jonathan A. Amoyaw & Isaac Luginaah
Published here in Global Public Health

Abstract
As the world draws curtains on the implementation of Millennium Development Goals (MDGs), there is increasing interest in evaluating the performance of countries on the goals and assessing related challenges and opportunities to inform the upcoming Sustainable Development Goals (SDGs). This study examined changes in the timing and utilisation of maternal health care services in Nigeria and Malawi; using multivariate negative log–log and logistic regression models fitted to demographic and health survey data sets. Predicted probabilities were also computed to observe the net differences in the likelihood of both the first and the required number of antenatal care (ANC) visits for each of the three analysis years. Women in Nigeria were 7% less likely in 2008 compared to 2003, and in Malawi, 32% more likely in 2013 compared to 2000, to utilise ANC in the first trimester of pregnancy. Timing of first ANC visit was strongly influenced by wealth in Nigeria but not in Malawi. The findings in our case studies show how various contextual factors may enable or inhibit policy performance. Maternal and child health, SDGs should incorporate both wealth and degrees of urbanicity into country level implementation strategies.


Financial sustainability versus access and quality in a challenged health system: an examination of the capitation policy debate in Ghana

Kilian Nasung Atuoye, Siera VercilloRoger Antabe, Sylvester Zackaria Galaa & Isaac Luginaah
Published here in Health Policy and Planning

Abstract
Policy makers in low and middle-income countries are frequently confronted with challenges of increasing health access for poor populations in a sustainable manner. After several years of trying out different health financing mechanisms, health insurance has recently emerged as a pro-poor health financing policy. Capitation, a fixed fee periodically paid to health service providers for anticipated services, is one of the payment policies in health insurance. This article examines claims and counter-claims made by coalitions and individual stakeholders in a capitation payment policy debate within Ghana’s National Health Insurance Scheme. Using content analysis of public and parliamentary proceedings, we situate the debate within policy making and health insurance literature. We found that the ongoing capitation payment debate stems from challenges in implementation of earlier health insurance claims payment systems, which reflect broader systemic challenges facing the health insurance scheme in Ghana. The study illustrates the extent to which various sub-systems in the policy debate advance arguments to legitimize their claims about the contested capitation payment system. In addition, we found that the health of poor communities, women and children are being used as surrogates for political and individual arguments in the policy debate. The article recommends a more holistic and participatory approach through persuasion and negotiation to join interests and core evidence together in the capitation policy making in Ghana and elsewhere with similar contexts.


Sustainable livelihoods and rural development

Siera Vercillo
Published here in Canadian Journal of African Studies

Book Review of Ian Scoones’ new book, Sustainable Livelihoods and Rural Development, provides a concise yet comprehensive review of the sustainable rural livelihoods approach, which is a convincing appeal for related development practice and research to take politics seriously. This balance of depth with concision is a hallmark of the Initiatives in Critical Agrarian Studies series, which aims to provide short and accessible books on important theoretical and political aspects of agrarian change and peasant studies in ways that centre attention on the structural forces affecting poor and dispossessed agrarian populations along with the complex class dynamics and varied forms of struggle.


Ethical trade, gender and sustainable livelihoods: women smallholders and ethicality in Kenya

Siera Vercillo
Published here in Canadian Journal of Development Studies

Book Review of Kiah Smith’s book Ethical Trade, Gender and Sustainable Livelihoods is a distinctive book amidst the growing literature on ethical and fair trade because it is entirely dedicated to a gendered analysis of their impacts. Smith draws on women’s voices and experiences from Kenya working in smallholder production of horticulture exports (for example, French beans) that move through ethical trade networks to Europe, to assess whether these standards can transform the inequitable socio-economic and political conditions that global trade typically reinforce.

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