The ball has made a mess of his stumps. Shakib Al Hasan falls after trying to sweep Tim Southee over square leg. And, the ball finds Umesh. Shakib goes across the off stump, exposes all three stumps to a yorker, but paddles the ball to fine leg ropes.
Shakib scored another four too off the second ball. He tries to shuffle across and loft a delivery pitched well outside off towards backward square leg. A difficult shot to play even for Williamson. He errs and holes it to Mandeep Singh.
Kohli and the rest of the RCB are delighted. Third ball of this Umesh Yadav over, he sends a slow delivery towards extra cover. And, as always with his shots, it looks effortless. A well deserved half-century for Captain Kane. Williamson you beauty! Effortlessly shifts gears. Scores a six over midwicket off that Chahal over in the second ball floated delivery by Chahal that pitched outside off. Then takes a single to complete his fifth half-century of the tournament. Bowled a knee-high full toss on the leg side.
Williamson times it beautifully past the backward square leg fence. Before this, he bowled a length ball that Williamson glanced it to fine leg for four. Just four runs including a wide came off that Siraj over. Sunrisers would need at least 10 an over from here to get to SRH 's batting hasn't changed in the last couple of years.
Sunrisers pick eight runs off that over. The boundaries have been a problem to get for the Sunrisers. Chahal concedes just seven that over. Sunrisers need to start scoring quick. None of the lower-order batsmen have scored heavily this season. Or do they? Shakib scores two superb boundaries off that Moeen over. He falls to Yuzvendra Chahal, who picks a wicket after three games. SRH, after 8. Just five runs off it. Manish Pandey usually have slow starts.
He can afford that in this match but has to make a big score tonight. The last time that happened was in The leg-spinnner has to wait for a wicket but bowled a fine first over. Just four runs off it. Siraj dismisses Dhawan in front of his home crowd.
He bowled a short one, had some pace on it too. The ball went straight to Tim Southee at fine leg. After 5. He waits, puts his front foot forward, and with a high backlift, drives the ball through covers for four. Not a great ball, but the shot was all class, all Williamson. But Williamson is unperturbed. He seems to be always in control of things, unaffected by the frenetic pace of T20, by the hustle of RCB bowlers, by the yell of Kohli.
SRH will hope he stays on. Hales tries to play across the line of a cross-seamed delivery by Tim Southee. But the ball misses and hits his middle stump. RCB rejoice for the dangerous Hales has departed. SRH, after 2. Umesh Yadav tries to cramp Dhawan. But the fourth ball he pitches a tad short and Dhawan reads it quickly and puts it away past the rope at midwicket. Then, on the last ball pitched on good length , Hales lofts him over mid-off. Their first-over run-rate is under four.
And, they score four against Moeen Ali tonight. No boundaries. Just a few singles. Okay, no earth-shattering first ball. Hales just pushes it to long on and gets to the other end. Alright then, the teams are walking into the middle. Shikhar Dhawan and Alex Hales open for the home team. And, it might be tough for their powerful-yet-inconsistent batting line-up to face the best bowling attack this season.
So, the Sunrisers are favoured to win this game. Not just the afore-mentioned reasons, Sunrisers are also favoured because of Toss: Virat Kohli calls tails in a must-win game RCB will bowl first against Sunrisers. Captain Kane is all set for the clash ahead. Are you? Yuzvendra Chahal has gone wicket-less in the last three matches; the last time he had a stretch of three or more wicket-less matches was in A consistent Sunrisers Hyderabad unit would look to consolidate its position at the top of the points table while Royal Challengers Bangalore will fight for survival when they clash in the Indian Premier League on Monday.
Courtesy their splendid bowling attack, SRH emerged as good defenders initially but by defeating Delhi Daredevils with a seven-wicket margin on Saturday, they proved that they can pull off tight chases as well. The Virat Kohli-led RCB, though, are struggling for survival as they need to win every game and also hope that other results go in their favour to remain in contention for the play-offs.
They are placed sixth in the table with just three wins from nine games. Contribute Now. Sunrisers Hyderabad. Wrapping up. RCB need six off the last ball to take this to a super over. Just one scored Grandhomme. Mandeep tries a paddle. Just a single. Grandhomme gets it to long on. Rashid Khan into the attack Sandeep starts with a wide. Finally, the themes emerging from the data were discussed among the first three authors and subsequently elaborated in brief memos through an iterative process that required returning to the articles.
These memos were then collapsed into broader categories and developed into the discussion section. We ensured trustworthiness by triangulating among papers as we identified and elaborated themes and being attentive to discrepant findings.
Moreover, since our intent is descriptive rather than a meta-analysis of findings, threats to validity are less of a concern. Because this paper is not directly related to patient care, this research was done without patient involvement. Patients were not invited to comment on the study design and were neither consulted to develop patient-relevant outcomes or interpret the results nor invited to contribute to the writing or editing of this paper for readability or accuracy.
Given the somewhat academic nature of the research question, the public were not invited to participate. However, public participation in some form might be appropriate for future work that addresses some of the gaps and tensions identified in this paper. We present some basic attributes of the included papers, and then go on to present the programmes by level of the social ecological model.
The papers included describe programmes undertaken in diverse regions that address different elements of SRH, and for which power functions in manifold ways. Online supplemental table 1 presents a high-level overview of the results, including the countries where the programme was implemented, the levels of the social ecological framework the programme engaged, the theoretical and other bases provided for the intervention, and the primary SRH domain of intervention.
There were five programmes in Latin America and one in Eastern Europe. There were no papers regarding the Western Pacific region. None of the papers focused on comprehensive abortion care. Twenty-one papers used exclusively qualitative methods or did not report an evaluation or study but simply described a programme. On the other hand, some papers included more in-depth discussions of which organisation s implemented the programme, the context of the organisation and the implications for the programme.
As reflected in online supplemental table 1 , many of the theoretical underpinnings were from the behavioural sciences and social cognitive theories; others used the theory of gender and power or Freirean approaches, and a few relied on diffusion or other theories focused on social networks.
Moreover, many programmes referred to multiple theories. Most programmes addressed more than one level of the social ecological model. Twenty-eight programmes, just under a third of the total, addressed the organisational level. Some programmes explicitly aimed to build organisational capacity to identify and address power dynamics and how these constrain autonomy in the context of SRH.
For example, several programmes entailed health facility-led efforts to engage communities in expressing their priorities regarding quality of care; some of these had an explicit health facility accountability component. Another group of programmes addressed organisations or entities that bridge the state—society intersection meaning that they are governed by public sector and community actors , such as hospital committees or village health and sanitation committees.
Some programmes sought to build the capacity of community-based organisations to work on a particular area related to power and SRH, such as facilitating the right to a legal remedy for sex workers who experience GBV.
Programmes intervening at the organisational level intended to influence power dynamics that were manifest at the organisational level as well as other levels, such as in interpersonal interactions. Many of the health facility-focused programmes aimed to foster the provision of respectful maternity care, such as programmes aiming to improve communication between providers and patients and their families; to ensure that providers do not employ condescending, demeaning or discriminatory language; and to support community monitoring of health facilities to prevent and document disrespect.
Some of the analyses sought to compare programmes that engaged the community with those that did not. Other mobilisation efforts used community-based activities to shift community norms in ways that promote SRH equity, including through community theatre, community action groups and repeated community dialogues regarding issues such as the acceptability of IPV, gender norms and HIV stigma.
Many programmes endeavoured to change community norms by training opinion leaders, community action teams, community activists or ambassadors; these efforts often focused on shifting gender norms at the community level. Several programmes aiming to shift power relations at the community level were implemented by grassroots organisations or other types of community-based organisations.
They created and amplified demand for change by working to decrease the acceptability of domestic violence, claiming human rights for sex workers or agitating for better quality maternal healthcare. For example, Balestra and colleagues and Dasgupta and colleagues describe a programme wherein grassroots women set their own goals related to maternal health and other issues and then collected evidence to use in their advocacy vis-a-vis local health facilities, as well as district and state managers and policy-makers.
Some programmes included advocacy activities aiming to foster governmental commitment to the given SRH issue, such as by ensuring the involvement of local or national government leaders or entities in programme awareness raising activities. The papers described lessons learnt regarding programmes seeking to alter power relations in order to improve SRH.
While the focus of this paper is on what the programmes did rather than the impact they had, we report on some of the key lessons presented insofar as these shed light on fundamental issues such as the combination and types of activities that comprise a programme. Not all papers reported programme results. Of those that did, many simply presented results and noted that the programme—understood as an exposure—worked or did not work.
These focused on the viability of the programme theory without necessarily invoking power. For example, some described community resistance as a barrier and discussed how they overcame it; others simply asserted that a particular approach had helped to minimise community resistance.
This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
We elaborate further. The 93 programmes reviewed reflect a diversity of priorities and approaches to addressing power. Others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. Almost all of the programmes tried to influence individual knowledge and behaviour, as well as some of the proximal structures shaping individual ability to exercise agency, such as gender relations of power in sexual encounters.
The predominance of positivist biomedical framing and study approaches of the programmes reviewed in this study stands in contrast to the diverse and deep body of research—ranging from ethnography to political science—that analyse the ways that power shapes SRH policy, programmes and population health. Such framings are often germane to programmes that aim to shift power relations.
Time frame and methodological limitations may undermine the effectiveness and assessment of a programme, and undercut effective scale-up or adaption and replication as the influence of social and political context is not elucidated. On the other hand, there was a subset of articles that focused on bottom-up efforts to build agency and mobilise collective power, typically led by NGOs working at the national and subnational levels.
Overall, their approach was grounded in a human rights or social movements paradigm, and the focus of research included how these programmes were part of a longer process of changing both structure and agency, rather than a time-bound effort to increase quantifiable indicators. It is notable that none of the programmes described focused on abortion, although one included postabortion care in their efforts to improve respectful maternity care.
Perhaps in part because they are empirical research on programmes to address specific health concerns and behaviours, the studies reviewed are somewhat removed from the larger question of how governments can address the power-related drivers of SRH inequities. The right to health approach is based on the assumption that the government is the ultimate duty bearer mandated to respect, protect and fulfil the right to SRH. To be sure, many of these efforts were intended to produce evidence that can be diffused and used by governmental and other actors developing national strategies and scaled-up programming, and these scaled up efforts may not be documented in peer-reviewed literature.
Nonetheless, the extent to which pilot evidence is useable to policy-makers and actually informs governmental programmes remains an important priority for research, support and advocacy. Relatedly, none of the programmes explicitly address the provision of SRH care within the private sector—both for profit and non-profit private actors.
The private sector is a major provider of SRH services in many settings often responsible for over half of the services provided in a country, so programmes aiming to affect power as a determinant of SRH at the organisational level should consider the role played by the private sector. Almost all of the programmes reviewed were led by NGOs, universities or research institutions, though they typically were implemented within the public sector.
This raises questions about governmental commitment and capacity; potential for scale; and researcher commitment, ability, and incentives to study governmental efforts. In other words, there is likely both a research gap and an implementation gap.
The research gaps reflects the fact that funders typically fund NGOs and universities to study programmes, including those implemented in the public sector. On the one hand, non-governmental actors may have greater expertise to both research and provide rights-based care, particularly to marginalised groups. As a body of work, research needs to consider these questions if researchers aim to produce evidence that can influence the right to SRH over the long term and at scale.
Our review has several limitations. First, the peer-reviewed literature is not an unbiased representation of the universe of action to address the power-related determinants of SRH. This limitation holds for almost any review of academic literature describing programme approaches, but it has specific implications for our paper. As compared with external interventions, social movement efforts are likely under-represented in the peer-reviewed global health literature, particularly in a literature search that takes an interventionist frame.
At the same time, social movement efforts and grassroots advocacy on SRH are deep and long-standing, and integral to a comprehensive assessment of efforts to address power dynamics as these shape the right to SRH. Social movement and grassroots NGO action may be most significant for especially contentious SRH issues, such as abortion. Stigma relating to abortion and other issues may also contribute to their under-representation in research and, thus, in peer-reviewed literature.
It is also possible that programmes that describe themselves as being transformative may in some way reinforce power relations; our summation of the article would not have detected that. As an illustration, a programme that purportedly seeks to change gendered power relations in SRH might not refer patients to abortions, even in contexts where abortion is permitted.
In essence, the gap between the literature and reality may be especially pertinent in the case of SRH. Second, this analysis did not include programmes that may inadvertently affect power relations by perpetuating harmful power relations, 22 or the ways that power pervades SRH agenda setting, and research and evaluation itself. For example, efforts to improve morale and job security among healthcare workers could help to lessen rude treatment of clients seeking maternal healthcare but may not be labelled as an SRH intervention.
An effort to hold the government accountable for failing to deliver quality maternal health services in a national court or to change the laws related to abortion, age of consent, or the regulation sex work would address power dynamics shaping the right to SRH but would likely not be detected using search terms related to programmes. Fourth, this analysis focuses on LMICs. Indeed, the power dynamics shaping SRH may be shaped and influenced at the global level, and, even if not, have many commonalities across countries at all income levels, such as accelerating wealth inequality.
Fifth, because we addressed such a broad topic here, we were unable to zoom in on granular issues that may be of great importance to theory development. For example, the papers revealed different theories and findings regarding the creation of peer groups to foster individual empowerment, as opposed to creating peer groups to serve as a source of social capital or a mechanism for collective mobilisation.
As another example, some programmes addressed sex workers as an at-risk group that needs to be empowered with health information and prevention tools, while other programmes addressed sex workers as a group that needs health information and tools as well as avenues for rights claiming and obtaining remedies for police harassment. These approaches make different assumptions about how power dynamics shape the right to SRH.
Power and the right to SRH is a big topic. This paper looks at a significant slice of that topic—how programmes seeking to improve the right to SRH address power. Despite the limitations of our approach, we identified key trends and themes, including the prevailing focus on behaviour change strategies, and the related use of research approaches that are focused on detecting changes therein.
This should be done in a way that links research back to its purpose: producing a body of evidence that together can start to answer the question of how to shift power dynamics in favour of the right to SRH, and that is useful to decision-makers in SRH programme development.
Veena Sriram and Kerry Scott kindly offered thought partnership and feedback on possible methods for the review. This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author s and has not been edited for content. Contributors MS, VB and SMT developed the methodology and reviewed the same 10 manuscripts to ensure the reliability of the inclusion and exclusion criteria. MS extracted the data and wrote the first draft of the paper.
VB and SMT made substantial comments on the first draft, including writing new text. AI, GS and IA offered substantive input and drafted some text, particularly regarding the framing of the paper and discussion. All authors read and approved the final manuscript. Provenance and peer review Not commissioned; externally peer reviewed. Supplemental material This content has been supplied by the author s.
Any opinions or recommendations discussed are solely those of the author s and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. You will be able to get a quick price and instant permission to reuse the content in many different ways. Skip to main content. Log In More Log in via Institution. Log in via OpenAthens. Log in using your username and password For personal accounts OR managers of institutional accounts.
Forgot your log in details? Register a new account? Forgot your user name or password? Search for this keyword. Advanced search. Log in via Institution. You are here Home Archive Volume 7, Issue 4 A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. Email alerts. Article Text. Article menu. Original research. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power.
Abstract Introduction Power shapes all aspects of global health. Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Statistics from Altmetric. Background Power shapes all aspects of global health: from the policies governing healthcare availability, accessibility, acceptability and quality to the health status of populations and inequities therein.
The concept of power Power as a concept has deep and rich conceptual antecedents spanning many disciplines. Methods Since we were interested in how programmes seek to change power relations rather than whether they changed power relations, our search focused on papers that describe programmes that aim—implicitly or explicitly—to address power, even if results are not provided. View this table: View inline View popup.
Table 1 Search terms applied. Table 2 Inclusion and exclusion criteria. Figure 1 The social ecological model. NGO, non-governmental organisation. Patient and public involvement Because this paper is not directly related to patient care, this research was done without patient involvement.
Results We present some basic attributes of the included papers, and then go on to present the programmes by level of the social ecological model. Supplemental material [bmjghsupp Organisational Twenty-eight programmes, just under a third of the total, addressed the organisational level.
Lessons learned The papers described lessons learnt regarding programmes seeking to alter power relations in order to improve SRH. Table 3 Key themes and power-related lessons learnt from SRH literature. Discussion Nature of existing evidence about power in SRH programmes This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
The right to SRH as a governmental obligation Perhaps in part because they are empirical research on programmes to address specific health concerns and behaviours, the studies reviewed are somewhat removed from the larger question of how governments can address the power-related drivers of SRH inequities. Sustainability and scale Almost all of the programmes reviewed were led by NGOs, universities or research institutions, though they typically were implemented within the public sector.
Limitations Our review has several limitations. Conclusion Power and the right to SRH is a big topic. Ethics statements Patient consent for publication Not applicable. Ethics approval Not applicable. Acknowledgments Veena Sriram and Kerry Scott kindly offered thought partnership and feedback on possible methods for the review. Analysing power and politics in health policies and systems.
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