Center for Reproductive Health

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Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017

Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017
Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017

Nurmala Selly Saputri, Belinda Rina Marie Spagnoletti, Alison Morgan, Siswanto Agus Wilopo, Ankur Singh, Barbara McPake, Rifat Atun, Rika Kumala Dewi, John Tayu Lee

Progress towards reducing sociodemographic disparities in breastfeeding outcomes in Indonesia: a trend analysis from 2002 to 2017

Background: Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups. Methods: Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups. Results: The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05)

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Early Adolescents in Adversity: A Latent Class Approach to Understanding Patterns of Emotional and Behavioral Problems Across Low-Resource Urban Settings Worldwide

Early Adolescents in Adversity: A Latent Class Approach to Understanding Patterns of Emotional and Behavioral Problems Across Low-Resource Urban Settings Worldwide
Early Adolescents in Adversity: A Latent Class Approach to Understanding Patterns of Emotional and Behavioral Problems Across Low-Resource Urban Settings Worldwide

Shoshanna L Fine, Robert W Blum, Judith K Bass, Aimée M Lulebo, William Stones, Anggriyani Wahyu Pinandari, Siswanto Agus Wilopo, Xiayun Zuo, Rashelle J Musci

Early Adolescents in Adversity: A Latent Class Approach to Understanding Patterns of Emotional and Behavioral Problems Across Low-Resource Urban Settings Worldwide

Early adolescence (ages 10-14) is a critical period for psychosocial development. With a substantial proportion of lifetime mental health problems manifesting by age 14, poor psychosocial adjustment in early adolescence can set the stage for impairment throughout the life course. Youth living in low- and middle-income countries (LMICs) are at particular risk of experiencing emotional and behavioral problems, but little research on adolescent psychosocial development has been conducted in these settings. The aim of this study was to characterize prototypical patterns of emotional and behavioral problems among early adolescents living in four LMICs, and to explore the extent to which these patterns varied by country and sex.

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Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia

Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia
Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia

Anna E Kågesten, Anggriyani Wahyu Pinandari, Anna Page, Siswanto Agus Wilopo, Miranda van Reeuwijk

Sexual Wellbeing in Early Adolescence: A Cross-sectional Assessment Among Girls and Boys in Urban Indonesia

Background: Early adolescence (ages 10-14) is a critical period of physical, cognitive, social and emotional development, which affect sexual and reproductive health and rights. Yet, little is known about positive or healthy aspects of sexuality development during this period of life, especially in South East Asia where sexual norms remain restrictive. The objective of this study is to assess the prevalence and correlates of sexual wellbeing among early adolescent girls and boys ages in Indonesia. Methods: Data for this cross-sectional study were collected as part of the Global Early Adolescent Study via a school-based survey in three Indonesian urban sites in 2018 (N=4309). We assessed the prevalence of multiple indicators of sexual wellbeing (e.g. sexual and reproductive health knowledge and communication, gender attitudes, body satisfaction, self-efficacy, freedom from violence) and tested for differences by gender using Chi-square, Student t-test, and Wilcoxon rank-sum test. Multivariable logistic regression models were used to assess the adjusted odds ratio of selected indicators in relation to sociodemographic factors, romantic and sexual experiences.

Results: The mean age of students was 12 years (53% girls); 90% had started puberty. Sexual and reproductive health knowledge and communication was low overall, but higher among boys than girls. Boys were more likely than girls to report high body satisfaction, less feelings of sexual guilt, but also to experience physical peer violence. In contrast, girls were more likely to hold gender equal attitudes, greater self-efficacy to say no, and to report being bullied by boys. In multivariable models, romantic experiences, perceived voice (boys and girls) and decision-making (girls) were associated with three or more indicators of sexual wellbeing.

Conclusions: While young adolescents in Indonesia score high on some aspects of sexual wellbeing, misconceptions, feelings of guilt and uncertainties related to sexuality are common, with clear gender differences. These findings confirm the need for comprehensive sexuality education that begins early in adolescence.

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Gender and Health in Very Young Adolescents

Gender and Health in Very Young Adolescents
Gender and Health in Very Young Adolescents

Caroline Moreau, Robert Blum, Kristin Mmari, Kara Hunersen, Eric Mafuta, Aimée Lulebi, Siswanto Agus Wilopo, William Stones, Denese Shervington, Kristien Michielsen, Chaohua Lou, Ana Luiza Borges, Matilde Maddaleno

Gender and Health in Very Young Adolescents

In 2005, the World Health Organization recognized gender as a structural driver of inequalities in health. While health patterns unfold throughout the life course, it is during the transitional period of early adolescence, 10e14 years of age, that a gender divide in health begins to emerge with consequences that exacerbate across adolescence and through adulthood. While the original understanding of this divide was mostly rooted in a biomedical conceptualization of gender (often conflated with sex), we have moved toward a biosocial understanding of gender as a sociocultural process that interacts with and regulates the bodies through differential patterns of exposures and practices. However, there are limited data outside of the United States and other Western societies that contribute to our understanding of the ways in which gender shapes health and well-being among early adolescents across diverse cultural settings. Understanding the extent to which this social process is fluid and consequential for health during this transitional period can also provide us with necessary insights into improving the design of effective early interventions to promote health and reduce inequities over the life course.

The Global Early Adolescent Study (GEAS) is the first international multisite study to focus on gender socialization and health in early adolescence. As such, it offers a unique perspective to support theory and practice in the realm of gender and health, using nuanced and validated measures to shed light on young people’s perceptions of gender, how these perceptions evolve across adolescence, and their relevance in shaping their health and well-being.

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Measuring the Prevalence of Mental Disorders in Adolescents in Kenya, Indonesia, and Vietnam: Study Protocol for the NationalAdolescent Mental Health Surveys

Measuring the Prevalence of Mental Disorders in Adolescents inKenya, Indonesia, and Vietnam: Study Protocol for the NationalAdolescent Mental Health Surveys
Measuring the Prevalence of Mental Disorders in Adolescents inKenya, Indonesia, and Vietnam: Study Protocol for the NationalAdolescent Mental Health Surveys

Holly E Erskine, Sarah J Blondell, Meaghan E Enright, Jamileh Shadid, Yohannes Dibaba Wado, Frederick Murunga Wekesah, Amirah Ellyza Wahdi, Siswanto Agus Wilopo, Loi Manh Vu, Hoa Thi Khanh Dao, Vinh Duc Nguyen, Mark R Emerson, Shoshanna L Fine, Mengmeng Li, Robert W Blum, Harvey A Whiteford, James G Scott.

Measuring the Prevalence of Mental Disorders in Adolescents inKenya, Indonesia, and Vietnam: Study Protocol for the NationalAdolescent Mental Health Surveys

Purpose: In low- and middle-income countries, there are limited data on mental disorders among adolescents. To address this gap, the National Adolescent Mental Health Surveys (NAMHS) will provide nationally representative prevalence data of mental disorders among adolescents in Kenya, Indonesia, and Vietnam. This paper details the NAMHS study protocol.

Methods: In each country, a multistage stratified cluster sampling design will be used. Participants will be eligible pairs of adolescents aged 10–17 years and their primary caregiver. Adolescents will be assessed for social phobia, generalized anxiety disorder, major depressive disorder, attention-deficit/hyperactivity disorder, conduct disorder, and post-traumatic stress disorder using the Diagnostic Interview Schedule for Children, version 5. Demographics, risk and protective factors, and service use information will also be collected. In the parallel clinical calibration study, diagnoses of major depressive disorder, social phobia, and generalized anxiety disorder made using the Diagnostic Interview Schedule for Children, version 5 will be calibrated against a diagnostic assessment by in-country clinicians in a separate sample.

Results: Data collection for the national survey and clinical calibration study will commence in 2021, with dissemination of findings and methodology due to occur in 2022.

Conclusions: Accurately quantifying the prevalence of mental disorders in adolescents is essential for service planning. NAMHS will address this lack of prevalence data, both within the NAMHS countries and within their respective regions, while establishing a gold-standard methodology for data collection on adolescent mental health in low- and middle-income countries. More broadly, NAMHS will encourage capacity building within each country by establishing linkages between researcher, clinician, government, and other networks

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Are We Passing on Violence to the Next Generation?: Gender Norms and Gender-based Violence Attitudes among Early Adolescents in Indonesia

I Gusti A A Mahendra, Anggriyani Wahyu Pinandari, Ifta Choiriyah, Siswanto Agus Wilopo

Are We Passing on Violence to the Next Generation?: Gender Norms and Gender-based Violence Attitudes among Early Adolescents in Indonesia

Intensification of gender norms during puberty affects adolescents’ perceptions and behavior related to violence. This study examined the association between gender norms and gender-based violence (GBV) among early adolescents considering socio-ecological variables using cross-sectional data from 3,618 Indonesian Global Early Adolescent Study pupils. Chi-square tests with simple and multiple logistic regression analyses examined how different factors' levels predict GBV.

Among boys, GBV attitudes were found high (53%). Furthermore, they also had high heteronormative expectations, threatened feelings, experiences of violence, porn access, and 5+ adverse childhood experiences (ACEs). Logistic regression results revealed that adolescent boys having one or two scores of gender norms at the above-median are 1.3 times more likely to commit GBV and even 2.2 times higher if all were above median [AOR (CI) = 1.3 (1.1-1.6); 2.2 (1.7-2.8)], respectively. Boys, having 5+ ACEs, and stronger endorsement on heteronormative relationships were also more likely to commit GBV [AOR (CI) = 1.5 (1.3-1.7); 1.5 (1.2-1.9); 1.5 (1.3-1.7)], respectively.

This research concluded that unequal gender norms intensified during puberty strongly correlate to attitudes towards GBV among early adolescents. Strengthening the individual aspects by providing a more conducive environment, such as comprehensive sexual education at school, is essential to prevent GBV

This research concluded that unequal gender norms intensified during puberty strongly correlate to attitudes towards GBV among early adolescents. Strengthening the individual aspects by providing a more conducive environment, such as comprehensive sexual education at school, is essential to prevent GBV

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