Informal settlements, Covid-19 and sex workers in Kenya.

This paper highlights the challenges faced by female sex workers living and working in the urban informal settlements in Nairobi, Kenya, during the Covid-19 outbreak and the aftermath of the pandemic. Using data collected through phone interviews during the immediate crisis, we document the experiences of urban poor sex workers, illustrating the acute problems they faced, including precarious housing with the reality of eviction and demolition. The paper highlights the ramifications of the Covid-19 crisis for the sex industry and predominantly women working within this informal, illegal economy. Through our empirical data we illustrate how the nature of selling sex has changed for sex workers in this context, increasing risks of violence including police abuses. We argue that examining the Covid-19 crisis through the lens of one the most marginalised populations graphically highlights how the pandemic has and will continue to deepen pre-existing structural urban inequalities and worsen public health outcomes among the urban poor. Sex worker communities are often located at the intersections of structural inequalities of gender, class, race and nation and the socio-spatial fragmentations of how they live make them some of the most vulnerable in society. We close with comments in relation to sexual citizenship, exclusionary state practices and the feminisation of urban poverty.

The role of partners, parents and friends in shaping young women's reproductive choices in Peri-urban Nairobi: a qualitative study.

BACKGROUND: Contraceptive use among young women in Nairobi remains low despite high general knowledge of family planning (FP) methods. This paper draws on social norms theory to explore the role of key influencers (partners, parents and friends) in women's FP use and how women anticipate normative reactions or sanctions. METHODS: A qualitative study with 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya. Interviews were conducted during the COVID-19 pandemic in 2020 by phone. A thematic analysis was conducted. RESULTS: Women identified parents, specifically mothers, aunts, partners, friends and healthcare workers as key influencers on FP. Their interactions with these key influencers varied based on trust, the information they needed about FP, and whether they perceived a key influencer to perpetuate or challenge existing social norms on FP. Mothers were perceived to understand the social risks of using FP and thus could advise on discreet FP use, and aunts were trusted and approachable sources to impartially describe the benefits and drawbacks of FP. Although women identified partners as key FP decision makers, they were cognisant of possible power imbalances affecting a final FP choice. CONCLUSIONS: FP interventions should consider the normative influence key actors have on women's FP choices. Opportunities to design and deliver network-level interventions which seek to engage with social norms surrounding FP in order to challenge misconceptions and misinformation among key influencers should be explored. Intervention design should consider dynamics of secrecy, trust and emotional closeness that mediate discussions of FP to address changing norms. Further training to change norms held by healthcare providers about why women, in particular unmarried young women, access FP should be provided to reduce barriers for FP access.

Women's decisions to use family planning (FP) are influenced by social norms, the unwritten rules of appropriate actions within social networks, and are shaped by advice and information received from key influencers­important individuals who shape what is acceptable within social networks. The aim of this study was to understand how key influencers uphold and transmit information and norms about FP, and explore who women consult as they make FP decisions and why they consult these key influencers.We interviewed 16 women, 10 partners and 14 key influencers in peri-urban Nairobi, Kenya.We found that key influencers for decisions about FP included mothers, aunts, partners, friends and healthcare providers. In making a decision about FP use, women consulted key influencers based on who they deemed trustworthy to keep their FP use secret and described less trust to speak with men about FP in their social networks. Mothers understood the social risks of using FP and so could advise on its discreet use, and aunts were approachable sources of impartial information about FP. Although women identified partners as key decision makers, they were aware that power imbalances might affect final FP choices.Our findings underscore the importance of FP interventions working with women's social networks and to address social norms influencing women's decisions in using FP. Interventions to change FP norms should consider dynamics of secrecy, trust and emotional closeness that affect FP discussions among women's networks.

Gender norms and family planning amongst pastoralists in Kenya: a qualitative study in Wajir and Mandera.

There is growing recognition among global health practitioners of the importance of rights-based family planning (FP) programming that addresses inequities. Despite Kenya achieving its national FP target, inequities in access and use of modern FP remain, especially amongst marginalised nomadic and semi-nomadic pastoralist communities. Few studies explore norms affecting FP practices amongst nomadic and semi-nomadic pastoralists and how these can influence social and behaviour change (SBC) interventions. We carried out 48 in-depth interviews and 16 focus group discussions with women and men from pastoralist communities in North Eastern Kenya in November 2018. Data were analysed thematically. Results from focus groups and interviews confirmed themes, while allowing differences between the qualitative approaches to emerge. We found that large family size was a descriptive and injunctive norm in both nomadic and semi-nomadic communities. The desire for around 10 children was sustained by religious beliefs and pastoralist ways of living. Despite a desire for large families, maintaining child spacing was encouraged and practised through breastfeeding and sexual abstinence. Most participants viewed modern FP negatively and as something used by "others". However, it was acceptable in order to prevent severe negative health outcomes. Future FP research to inform interventions should continue to consider community fertility preferences and the rationale for these, including norms, religion and power dynamics. Targeted qualitative social norms research could inform multi-component SBC interventions in this context.

Use of digital media for family planning information by women and their social networks in Kenya: A qualitative study in peri-urban Nairobi.

Access to information about family planning (FP) continues to have financial, physical and social barriers among young women living in Kenya. This paper draws on social norms theory to explore how young women and their social networks access FP information on digital media (e.g., WhatsApp, websites). Qualitative phone interviews were conducted with 40 participants - young women, their partners and key influencers - in seven peri-urban wards in Nairobi, Kenya. Data were analyzed using thematic analysis. Findings suggested that young women, their partners and key influencers predominately accessed FP information online through their informal networks, but identified healthcare workers as the most trusted sources of FP information. In digital spaces, participants described being more comfortable sharing FP information as digital spaces allowed for greater privacy and reduced stigma to talk about FP openly. Our findings highlight the importance of digital media in disseminating FP information among young women and their networks, the differences in norms governing the acceptability to talk about FP online vs. in-person and the significance of targeting misinformation about FP in digital media spaces.

'If she gets married when she is young, she will give birth to many kids': a qualitative study of child marriage practices amongst nomadic pastoralist communities in Kenya.

Child marriage is associated with adverse health and social outcomes for women and girls. Among pastoralists in Kenya, child marriage is believed to be higher compared to the national average. This paper explores how social norms and contextual factors sustain child marriage in communities living in conflict-affected North Eastern Kenya. In-depth interviews were carried out with nomadic and semi-nomadic women and men of reproductive age in Wajir and Mandera counties. Participants were purposively sampled across a range of age groups and community types. Interviews were analysed thematically and guided by a social norms approach. We found changes in the way young couples meet and evidence for negative perceptions of child marriage due to its impact on the girls' reproductive health and gender inequality. Despite this, child marriage was common amongst nomadic and semi-nomadic women. Two overarching themes explained child marriage practices: 1) gender norms, and 2) desire for large family size. Our findings complement the global literature, while contributing perspectives of pastoralist groups. Contextual factors of poverty, traditional pastoral lifestyles and limited formal education opportunities for girls, supported large family norms and gender norms that encouraged and sustained child marriage.

Improving provision of family planning among pastoralists in Kenya: Perspectives from health care providers, community and religious leaders.

There exist significant inequities in access to family planning (FP) in Kenya, particularly for nomadic and semi-nomadic pastoralists. Health care providers (HCP), are key in delivering FP services. Community leaders and religious leaders are also key influencers in women's decisions to use FP. We found limited research exploring the perspectives of both HCPs and these local leaders in this context. We conducted semi-structured interviews with HCPs (n=4) working in facilities in Wajir and Mandera, and community leaders (n=4) and religious leaders (n=4) from the nomadic and semi-nomadic populations the facilities serve. We conducted deductive and inductive thematic analysis. Three overarching themes emerged: perception of FP as a health priority, explanations for low FP use, and recommendations to improve access. Four overlapping sub-themes explained low FP use: desire for large families, tension in FP decision-making, religion and culture, and fears about FP. Providers were from different socio-demographic backgrounds to the communities they served, who faced structural marginalisation from health and other services. Programmes to improve FP access should be delivered alongside interventions targeting the immediate health concerns of pastoralist communities, incorporating structural changes. HCPs that are aware of religious and cultural reasons for non-use, play a key role in improving access.

Navigating family planning access during Covid-19: A qualitative study of young women's access to information, support and health services in peri-urban Nairobi.

The COVID-19 response has profoundly affected women's access to family planning services in Kenya. While prior studies have shown how the COVID-19 response created barriers to accessing family planning (FP) services, less is known about how the pandemic affected the normative influence that partners, peers, and health providers exert on women's FP choices. In this qualitative study, we interviewed 16 women (aged 18-25 years), 10 men in partnerships with women, and 14 people in women's social networks across 7 low-income wards in Nairobi, Kenya. Our findings suggest that COVID-19 response measures changed the contexts of normative influence on FP: financial insecurity, increased time at home with husbands or parents, and limited access to seek the support of health workers, friends, and other people in their social network affected how women negotiated FP access and use within their homes. Our study underscores the importance of ensuring FP is an essential service in a pandemic, and of developing health programs that change norms about FP to address the gendered burden of negotiating FP during COVID-19 and beyond.

Reproductive health decision making among nomadic pastoralists in North Eastern Kenya: a qualitative social network analysis.

BACKGROUND: To our knowledge, no studies exist on the influence of nomadic pastoralist women's networks on their reproductive and sexual health (RSH), including uptake of modern family planning (FP). METHODS: Using name generator questions, we carried out qualitative egocentric social network analysis (SNA) to explore the networks of four women. Networks were analyzed in R, visuals created in Visone and a framework approach used for the qualitative data. RESULTS: Women named 10-12 individuals. Husbands were key in RSH decisions and never supported modern FP use. Women were unsure who supported their use of modern FP and we found evidence for a norm against it within their networks. CONCLUSIONS: Egocentric SNA proves valuable to exploring RSH reference groups, particularly where there exists little prior research. Pastoralist women's networks likely change as a result of migration and conflict; however, husbands make RSH decisions and mothers and female neighbors provide key support in broader RSH issues. Interventions to increase awareness of modern FP should engage with women's wider networks.

Few studies have asked nomadic women in Kenya to name the important individuals in their lives when it comes to making reproductive and sexual health decisions, including their use of family planning. These important individuals are described as a woman's "network". We used a survey and open-ended interview format to identify the individuals in four nomadic women's networks ("social network analysis"). Data was analysed in R and we created a visual map of these networks. Women named 10­12 individuals. Women's husbands made reproductive health decisions and did not approve of modern family planning use. Apart from their husbands, women did not know who in their network approved of their use of family planning. Female neighbors and mothers provided important support to women. Interventions to increase awareness of modern FP should engage with everyone in a woman's network.

Access to Healthcare in a time of COVID-19: Sex Workers in Crisis in Nairobi, Kenya.

This paper uses empirical data collected from 117 female sex workers living in informal settlements in Nairobi and 15 healthcare providers to highlight specific effects of COVID-19 and related restrictions on healthcare access for the sex workers. We highlight the existing gender and health inequalities that have now been reinforced by the initial outbreak of the COVID-19 pandemic. Specifically, we focus on the most concerning healthcare needs for the sex workers including HIV prevention, care and treatment and sexual and reproductive healthcare. Our study findings reveal that the various restrictions imposed by the government to help curb the spread of COVID-19 to a large extent made it difficult for the sex workers to access their healthcare needs. The paper discusses the challenges of healthcare service delivery reflecting on some innovative and pioneering responses from health care providers to address the emergency situation.

Well-defined silica-supported rare-earth silylamides.

Rare-earth silylamides [Ln{N(SiMe3)2}3] [1a-d, Ln = Y (1a), La (1b), Nd (1c), Sm (1d)] react with partially dehydroxylated silica to generate the singly surface-bonded species [(Si-O)Ln{N(SiMe3)2}2] (2a-d). Trimethylsilylation of silanols occurs during the grafting process, affording in fine a hydroxyl-free surface. Contacting these well-defined surface species with excess triphenylphosphine oxide yields [(Si-O)Ln{N(SiMe3)2}2(OPPh3)] surface adducts 3a-d as the major (80%) species, leaving about 20% of unreacted siloxide bisamido species (20%). In addition to elemental analysis and infrared spectroscopy, solid-state NMR spectroscopy was used to characterize these new materials and proved to be a particularly efficient tool for the study of the paramagnetic Nd- and Sm-containing materials and for providing unambiguous verification of OPPh3 coordination on the rare-earth center. Silica-supported rare-earth amides 2a-d are active catalysts for 1-hexene and styrene hydrosilylation and for phenylacetylene dimerization. When compared to the molecular species 1a-d, grafting of the catalyst induces significant changes in the activity and selectivity of these systems.