Background In a historic move to ensure comprehensive abortion care, India amended the 1971 Medical Termination of Pregnancy (MTP) Act in 2021, creating an unprecedented opportunity for accelerating safe, respectful, and rights-based abortion services. The Federation of Obstetric and Gynecological Societies of India (FOGSI), together with World Health Organization (WHO) India and the Ministry of Health and Family Welfare, set up a flagship initiative "Respectful Abortion Care" (RAC) to provide training to obstetricians and gynecologists on the new Act, and also address their values and biases. Methods Virtual training sessions were organized during the COVID-19 pandemic to disseminate the amendments made under the MTP Act and address provider values and biases. The primary focus was on private providers as they account for more than half of all abortion services in India (52.9%). The RAC modules were systematically designed and delivered by 690 Master Trainers, trained by FOGSI and WHO. Results A total of 9051 FOGSI members (22%, with 50% from private clinics) completed the RAC trainings. Pretests and post-tests were conducted for impact assessment. Significant improvement was seen on knowledge of criteria for termination of pregnancy for significant birth defects (52%-83%). The post-training survey showed a high level of commitment to promote RAC: >95% were strongly motivated to perform or assist in abortion; 89% reported that the WHO value clarification exercises were helpful in facilitating open discussions on sensitive topics in a comfortable manner; 96% expressed a strong commitment to addressing the issue of respect and confidentiality in abortion care. Conclusion RAC was a unique initiative around the MTP Act amendment 2021 in India, which demonstrated that collaboration and leadership by professional associations can help motivate providers and lead to improved knowledge and commitment from public and private sector providers.

PurposeTo explore data availability, perceived relevance, acceptability and feasibility of implementing 52 draft indicators for adolescent health measurement in different countries globally.MethodsA mixed-methods, sequential explanatory study was conducted in 12 countries. An online spreadsheet was used to assess data availability and a stakeholder survey to assess perceived relevance, acceptability, and feasibility of implementing each draft indicator proposed by the Global Action for Measurement of Adolescent health (GAMA). The assessments were discussed in virtual meetings with all countries and in deep dives with three countries. Findings were synthesized using descriptive statistics and qualitative thematic analysis.ResultsData availability varied across the 52 draft GAMA indicators and across countries. Nine countries reported measuring over half of the indicators. Most indicators were rated relevant by stakeholders, while some were considered less acceptable and feasible. The ten lowest-ranking indicators were related to mental health, sexual health and substance use; the highest-ranking indicators centered on broader adolescent health issues, like use of health services. Indicators with higher data availability and alignment with national priorities were generally considered most relevant, acceptable and feasible. Barriers to measurement included legal, ethical and sensitivity issues, challenges with multi-sectoral coordination and data systems flexibility.DiscussionMost of the draft GAMA indicators were deemed relevant and feasible, but contextual priorities and perceived acceptability influenced their implementation in countries. To increase their use for a more comprehensive understanding of adolescent health, better multi-sectoral coordination and tailored capacity building to accommodate the diverse data systems in countries will be required.

BACKGROUND:Medical abortion with mifepristone and misoprostol can be provided up to 63 days' gestation in India. This accounts for 67.5 percent of all abortions in the country. We conducted an assessment to determine the availability of medical abortion medicines, specifically the combi-pack, in India.METHODS:We applied the World Health Organization landscape assessment protocol at the national level. The assessment protocol included a five-step adaptation of an existing availability framework, including online data collection, desk review, country-level key informant interviews, and an analysis to identify barriers and opportunities to improve medical abortion availability. The assessment was conducted between August and March 2021.RESULTS:Medicines for medical abortion are included in the national essential drug list and available with prescription in India. The assessment identified 42 combi-pack products developed by 35 manufacturers. The quality of medical abortion medicines is regulated by national authorities; but as health is devolved to states, there are significant inter-state variations. This is seen across financing, procurement, manufacturing, and monitoring mechanisms for quality assurance of medical abortion medicines prior to distribution. There is a need to strengthen supply chain systems, ensure consistent availability of trained providers and build community awareness on use of medical abortion medicines for early abortions, at the time of the assessment.CONCLUSION:Opportunities to improve availability and quality of medical abortion medicines exist. For example, uniform implementation of regulatory standards, greater emphasis on quality-assurance during manufacturing, and standardizing of procurement and supply chain systems across states. Regular in-service training of providers on medical abortion is required. Finally, innovations in evidence dissemination and community engagement about the recently amended abortion law are needed.

IntroductionA significant gap exists in the availability of indicators and tools to monitor health system capacity for quality abortion care at input and process levels. In this paper, we describe the process and results of developing and assessing indicators to monitor health system capacity strengthening for quality abortion care.MethodsAs part of a 4-year (2019–2022) multicountry project focused on preventing unsafe abortion using a health system strengthening approach in 10 countries, we developed a monitoring framework with indicators and metadata. Through an internal consultative process, we identified a structured list of operational health system capacity indicators for abortion. After implementing the indicators for baseline and annual project monitoring, project staff from 10 teams assessed each indicator using 4 criteria: validity, feasibility, usefulness and importance.ResultsWe identified 30 indicators aligning with 5 of the 6 WHO health system building blocks (excluding service delivery): 6 indicators in leadership and governance, 5 in health workforce, 6 in health information, 8 in access to medicines and health products and 5 in health financing. In our assessment of indicators, average scores against the predetermined criteria were lowest for feasibility (7.7 out of 10) compared with importance (8.5), usefulness (8.9) and validity (9.3). Assessors highlighted the need for fewer and less complex indicators, simplified language, clearer benchmarks, for indicators to be abortion-specific, less subjective and for future frameworks to also include service delivery and research and innovation.ConclusionWe used 30 indicators to monitor health system capacity for quality abortion care in 10 countries and gathered critical feedback that can be used to further strengthen the set of indicators in future work. Establishing core input and process indicators will be critical to inform and support evidence-based policy and programme improvements for quality abortion care.

Introduction Comprehensive local data on adolescent health are often lacking, particularly in lower resource settings. Furthermore, there are knowledge gaps around which interventions are effective to support healthy behaviours. This study generates health information for students from cities in four middle-income countries to plan, implement and subsequently evaluate a package of interventions to improve health outcomes. Methods and analysis We will conduct a cluster randomised controlled trial in schools in Fez, Morocco; Jaipur, India; Saint Catherine Parish, Jamaica; and Sekondi-Takoradi, Ghana. In each city, approximately 30 schools will be randomly selected and assigned to the control or intervention arm. Baseline data collection includes three components. First, a Global School Health Policies and Practices Survey (G-SHPPS) to be completed by principals of all selected schools. Second, a Global School-based Student Health Survey (GSHS) to be administered to a target sample of n=3153 13–17 years old students of randomly selected classes of these schools, including questions on alcohol, tobacco and drug use, diet, hygiene, mental health, physical activity, protective factors, sexual behaviours, violence and injury. Third, a study validating the GSHS physical activity questions against wrist-worn accelerometry in one randomly selected class in each control school (n approximately 300 students per city). Intervention schools will develop a suite of interventions using a participatory approach driven by students and involving parents/guardians, teachers and community stakeholders. Interventions will aim to change existing structures and policies at schools to positively influence students’ behaviour, using the collected data and guided by the framework for Making Every School a Health Promoting School. Outcomes will be assessed for differential change after a 2-year follow-up. Ethics and dissemination The study was approved by WHO’s Research Ethics Review Committee; by the Jodhpur School of Public Health’s Institutional Review Board for Jaipur, India; by the Noguchi Memorial Institute for Medical Research Institutional Review Board for Sekondi-Takoradi, Ghana; by the Ministry of Health and Wellness’ Advisory Panel on Ethics and Medico-Legal Affairs for St Catherine Parish, Jamaica, and by the Comité d’éthique pour la recherche biomédicale of the Université Mohammed V of Rabat for Fez, Morocco. Findings will be shared through open access publications and conferences. Trial registration number NCT04963426.

OBJECTIVE:To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group.DESIGN:Multicentric case-control study.DATA SOURCES:Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020.STUDY POPULATION:All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls.DATA QUALITY:Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy.STATISTICAL ANALYSIS:Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression.RESULTS:A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%).CONCLUSION:Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Research shows that risk factors for noncommunicable diseases (NCDs) are associated with behaviors that either begin or are reinforced during adolescence. Yet, focus on this age group in national NCDs policies globally or regionally in South-East Asia Region (SEAR) has not been adequately addressed. This overview of strategies to prevent NCDs among adolescents in SEAR countries provides a benchmark against which policy response can be assessed and strengthened. We reviewed all publically available documented strategies issued by governments in the 11 SEAR member countries of the World Health Organization on NCDs, published between January 1, 2002, and December 31, 2015. NCDs are currently a policy priority in many of the countries with school-based campaigns on healthy lifestyles; alcohol and tobacco-free environment and public ban on advertisements glamorizing unhealthy food among others. However, major challenges such as lack of specific focus on adolescents, lack of recognition of all major risk factors in national policies/programs, weak surveillance, unavailability of age disintegrated data, inefficient program management, low community awareness, and absence of multistakeholder policies persist. Of the countries reviewed, only 54.5% (6/11) proposed a policy that addressed all four of the main NCD risk factors - alcohol and tobacco use, physical inactivity, and obesity. This review demonstrates the disconnection between NCDs, adolescent health, and national policies.