Women's economic empowerment and health related decision-making in rural Sierra Leone.

Maternal mortality rates during childbirth in Sierra Leone are amongst the highest globally, with 1360 maternal deaths per 100,000 live births. Furthermore, the country's neonatal mortality rate is estimated at 39 deaths per 1000 live births. There is growing recognition of the health consequences of gender inequality, but challenges in addressing it. Gendered power dynamics within households affect health outcomes, with men often controlling decisions about their family's health, including their family's use of health services. The Government's Free Health Care Initiative, which abolished user fees for pregnant women, lactating mothers and children under five is promising, however this reform alone is insufficient to meet health goals. Using in-depth interviews and focus group discussions with men and women, this study explores women's economic empowerment and health decision-making in rural Sierra Leone. Findings show the concept of power related to women's income generation, financial independence and being listened to in social relationships. Whilst women's economic empowerment was reported to ease marital tensions, men remained household authority figures, including regarding health decision-making. Economic interventions play an important role in supporting women's economic empowerment and in influencing gender norms, but men's roles and women's social empowerment, alongside economic empowerment, needs consideration.

Building resilience to El Niño-related drought: experiences in early warning and early action from Nicaragua and Ethiopia.

Forecast-based drought early warning/early action has been hampered by both inadequate decision-making frameworks and a lack of appropriate funding mechanisms. Rural communities in Nicaragua and Ethiopia that have participated in resilience-building interventions of varying durations demonstrate the value of community-based actions informed by early warning, forecasts and drought management advice, both before and during the agricultural season. While drought affected all crops negatively, participants were better able to mitigate impacts, were more organised in accessing relief and recovered more effectively. These results are consistent with other research on the cost/benefit of anticipatory actions, use of climate services and appropriate drought management advice. They also confirm the importance of embedding short-term early action in long-term resilience-building. Despite this, formal systems, national and local, remain essentially unimplemented. Systems being developed at global level now need to be operationalised and translated into effective local drought management standard operating procedures for the most vulnerable.