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Population, Family and Reproductive Health

Research and Practice Highlights

Don't panic over declining fertility ratesDon’t Panic Over Declining Fertility Rates — and Don’t Let Anyone Guilt You

By Leslie Root, Karen Benjamin Guzzo and Alison Gemmill, PhD, PFRH Assistant Professor

The supposed gap between the number of children people say is ideal and the number they’re having is not as alarming as it might seem. And lower fertility rates have benefits as well as costs. Read the full article in the Washington Post.

For further information contact Alison Gemmill.



PFRH Lori Heise, PhD, Professor, receives the October 2019 Elsevier Atlas AwardMeasuring psychological abuse by intimate partners:

Constructing a cross-cultural indicator for the Sustainable Development Goals
Lori Heise
, PhD, Professor
Recipient of the Elsevier Atlas Award October 2019

Each month the Elsevier Atlas Award recognizes research that could significantly impact people's lives around the world.

"The Sustainable Development Goals (SDGs) to address gender equality and empowerment set out to “eliminate all forms of violence against all women and girls in public and private spheres, including trafficking and sexual and other types of exploitation” by the year 2030. These goals include psychological violence as well as physical forms of violence.  The only trouble is that there hadn’t been a standard way to measure psychological or emotional abuse as needed to make meaningful cross-cultural comparisons. Now, an Atlas award-winning team of researchers has used a sophisticated analysis to come up with a relatively simple and meaningful three-level index to do just that. Their findings appear in the journal SSM – Population Health."
Read the full interview with Kendall Morgan, PhD. 

For further information contact Lori Heise



Bill & Melinda Gates Institute

Gates Institute Celebrates 20 Years of Scholarship & Science for Social Change

Gates 20th Anniversary CelebrationFrom left: Former JHSPH Dean Al Sommer, PFRH Chair Cynthia Minkovitz, Luminary Awardee Jotham Musinguzi, JHSPH Dean Ellen MacKenzie, former JHSPH Dean Michael Klag, and Gates Institute Director Jose "Oying" Rimon II

In 2019, the Bill & Melinda Gates Institute for Population and Reproductive Health celebrates our 20th anniversary - 20 Years of Scholarship & Science for Social Change.

On September 12, over 200 of our closest colleagues and friends, including 10 Luminary Award winners, past and current Gates Institute Directors, and Deans from Johns Hopkins Bloomberg School of Public Health, joined together to celebrate the 20 year legacy of the Gates Institute.

Learn more about our 20th anniversary celebrations - from recognizing youth leaders in family planning to convening global reproductive health experts to chart the course forward to universal health coverage – by checking out the latest edition of Positive Disruptions, a quarterly round-up of activities, events and news from the Bill & Melinda Gates Institute for Population and Reproductive Health (sign up for the newsletter here). To view photos from all the special events, visit the Gates Institute photo gallery.

Gates 20th Anniversary CelebrationFrom left: Gates Institute Director Jose "Oying" Rimon II, Former JHSPH Dean Al Sommer, Powerful Conversation Speaker Dr. Leana Wen, Vice Dean for Public Health and Community Engagement Dr. Joshua Sharfstein, and, former JHSPH Dean Michael Klag

Throughout the month of September, the Gates Institute hosted three Powerful Conversations on Leadership, which featured conversations between eminent figures in public health who have effected transformational change for women, men, and families all over the world.

The special series kicked off on September 17 with a dynamic discussion between Dr. Al Sommer, Former Dean, Johns Hopkins Bloomberg School of Public Health and Jose "Oying" Rimon II, Director, Bill & Melinda Gates Institute for Population and Reproductive Health, who discussed the benefits that mentorship had on each of their professional and personal lives throughout their career.

The following week on September 24, we welcomed Dr. Leana Wen, Visiting Professor at the George Washington University School of Public Health and Dr. Joshua Sharfstein, Vice Dean for Public Health and Community Engagement at Johns Hopkins Bloomberg School of Public Health. The pair spoke about the challenges each have faced on their path to leadership and offered insight on overcoming them.

The powerful speaker series concluded on September 26, World Contraception Day, with a high-energy talk with Dr. Tlaleng Mofokeng, Author and Vice Chairperson of the Sexual and Reproductive Justice Coalition of South Africa and Susan Krenn, Executive Director, Johns Hopkins University Center for Communication Programs discussed the challenges talking about sex, pleasure, and breaking stigma.

The 20th Anniversary Celebrations concluded on September 26 with the Gates Institute's annual World Contraception Day (WCD) Celebration, a day dedicated to improving awareness of contraception and enabling young people to make informed choices on their sexual and reproductive health.

Activities during the WCD event included family planning-themed trivia with prizes, a relationship expert answering questions on sexual health and pleasure, a display of contraceptive devices from around the world (courtesy of Johns Hopkins University’s Center for Communication Programs), and contraceptive-themed cupcakes and cookies - as well as the famous Gates Institute photobooth.

Participants in the Global Health Leadership Accelerator, which brought together some of the brightest minds in public health during an intensive two-week program aimed to impart innovative approaches to leadership, program management, policy analysis, communications, and advocacy, dressed up in creative contraceptive-themed costumes and energized the crowd. We also gave away free “Gates Institute” condoms and information about World Contraception Day, the Gates Institute, the 120 Under 40 program, and FP Voices. The room was packed with students, faculty and staff. 

Together with our partners, the Bill & Melinda Gates Institute for Population and Reproductive Health has made immeasurable strides towards our family planning and reproductive health goals. We thank all of our partners, sponsors, and mentors for their collaboration the last 20 years - and look forward to even bigger strides in the coming 20!

The Advance Family Planning (AFP)

Advance Family PlanningThe Advance Family Planning (AFP) initiative recently commemorated five years of advocacy achievements in India. Through its local partners Foundation for Reproductive Health Services India, Jhpiego, Pathfinder International, and Population Foundation of India, AFP catalyzed better implementation of existing policies, secured new policies in high impact areas, and ensured sustainable funding for family planning access. More than 118.6 million women of reproductive age potentially benefited from AFP’s advocacy spanning 42 districts across six states. Policy improvements impacted 3,342 health facilities, which started or improved family planning services to meet the needs of their locality. AFP mobilized 673 million Indian rupees (US $9.77 million) for family planning over the course of the initiative, meaning that every dollar invested in advocacy secured more than $2 in budget allocations. India is now graduating from the project.

During a graduation seminar on September 30, 2019, government officials from Assam, Bihar, Jharkhand, Maharashtra, Rajasthan and Uttar Pradesh committed to expanding access to quality family planning by sustaining local advocacy working groups that led the change in India. Donors and corporate partners also affirmed the need for on-going strategic investments to address challenges around quality, informed choice, and private sector engagement.

Read Expanding Family Planning Access Through Advocacy: Five Years of Progress for more information. 

TCI- Photo of Victor IgharoThe Challenge Initiative (TCI)

The Transformational Power of TCI Coaching: Lessons from the Nigeria Experience

A key characteristic that sets The Challenge Initiative (TCI) apart from other health and development programs is its focus on coaching for capacity transfer. TCI’s coaching model aligns with its distinct demand-driven approach, which emphasizes local investment and decision-making and promotes local ownership while strengthening capacity and sustainability. TCI’s coaching approach believes that individuals and teams are capable of generating their own solutions, with the coach supplying supportive, experience-based and discovery-based approaches and frameworks.

TCI’s coaching approach centers on helping others expand their view: to shift from seeing only problems that need to be ‘solved,’ to recognizing that opportunity is often disguised as obstacles. As a result, TCI has adopted a “Lead, Assist, Observe” coaching model, supported by its online learning platform TCI University, to strengthen individuals’ capacity and create organizational and system-level changes by activating and strengthening existing structures and systems to design, implement and monitor TCI proven approaches.

In a series of videos, Victor Igharo, Chief of Party for TCI Nigeria, shares some words of wisdom about key coaching tips learned from the Nigerian experience implementing TCI.


Gates Institute Website



Child and Adolescent Health Measurement Initiative (CAHMI)

Wrapping up another year at APHA!

The Child and Adolescent Health Measurement Initiative wrapped up a great week at the American Public Health Association (APHA) Annual Meeting, November 2-6, in Philadelphia, Pennsylvania. In addition to exhibiting CAHMI resources to nearly 13,000 attendees, team members presented four CAHMI projects.

  1. Payment for Progress: Investing to Catalyze Child and Family Well-Being Using Personalized and Integrated Strategies to Address Social and Emotional Determinants of Health highlighted three priorities that address payment models in the US healthcare system and emphasized the importance of approaches to children’s health care that proactively promote positive social and emotional well-being and prevent risks like ACEs.
  2. Moving Toward Flourishing for US Children: Building Family Resilience and Connection Amidst Ongoing Adversity focused on measuring human flourishing among US children, specifically those facing adverse childhood experiences.
  3. Care Path for Kids The CARE_PATH Coaching Model is a tool to engage families in improving quality outcomes of care for their child.
  4. Promoting Public and Population Health Leveraging State Marijuana Tax Funds: Recommendations to Promote a Restorative, Trauma-Informed Approach to California Proposition 64 Marijuana Tax Funds was about engaging stakeholders in California to advance trauma-informed approaches in the expenditures of marijuana tax dollars from Proposition 64: The Control, Regulate and Tax Adult Use of Marijuana.

All projects are led by PI and CAHMI Director Dr. Christina Bethell. Abstracts were presented by Dr. Narangerel Gombojav (Assistant Scientist) and Mary Wahl (Research Program Manager).

Thank you to all who stopped by our table and listened to our presentations! We can’t wait to attend next year’s conference.

NEW NSCH Data are Now Available on the DRC!

The Data Resource Center for Child and Adolescent Health (DRC), a project for the CAHMI, recently released the child and family health measures from the combined 2017-2018 National Survey of Children’s Health (NSCH). These estimates are now available through the Interactive Data Query on! The combined 2017-2018 NSCH is the second multi-year data set since the redesign of the NSCH in 2016 and includes data from 52,129 children ages 0-17 years.

Combined DRC downloadable data sets for 2017-2018 NSCH will be available in winter 2020. Single year 2018 NSCH estimates, downloadable data sets, and codebooks will be available through the DRC in spring 2020. Data sets for the NSCH can be downloaded for free. 

New Publication Release

JAMA Pediatrics released an article in September written by Dr. Christina Bethell and Dr. Narangerel Gombojav (et al) titled “Positive Childhood Experiences and Adult Mental and Relational Health in a Statewide Sample: Associations Across Adverse Childhood Experiences Levels”. The study suggests positive childhood experiences, such as supportive family interactions, caring relationships with friends, and connections in the community, are associated with reductions in chances of adult depression and poor mental health and increases in the chances of having healthy relationships in adulthood. 

Center Website



Center for Adolescent Health

Developing an Intervention is Only the Beginning

CAH - Sexual Health and RelationshipsIn 2014, the Center for Adolescent Health at Johns Hopkins Bloomberg School of Public Health partnered with Baltimore City Public Schools and the Baltimore City Health Department to address the high rates of substance use, interpersonal violence, and sexual risk-taking among middle school-aged students across the city. The goal of this partnership was to expand risk prevention efforts through the addition of a sexual and reproductive health unit to the LifeSkills Training curriculum in middle school classrooms.

A Bit of Background

Baltimore City has a history of implementing the evidence-based intervention, LifeSkills Training (LST), in middle schools, primarily among high-risk 6th graders. LST for middle school is a skills-based cognitive behavioral prevention program delivered over three years during grades 6-8 that focuses on building competence in personal self-management, social competence, and risk behavior resistance. Originally developed as a tobacco prevention curriculum and later expanded to include prevention of other substance use and youth violence, LST has been widely implemented in diverse contexts, and has been shown to reduce the risks of alcohol, tobacco, drug abuse and violence among middle school students.

We thought to ourselves, “Instead of creating a new program, why not add sexual and reproductive health content to LST?”

We talked to the developers of LST. They agreed this would be a good idea.

We took on a partner-informed approach to developing a supplemental sexual and reproductive health (SRH) unit for LST. The development of this supplemental SRH unit was informed by existing theories, content experts, and most importantly school personnel. The resulting supplemental SRH unit consists of nine 45-minute sessions offered to 7th and 8th grade students, each aligned with specific learning objectives. The SRH unit incorporates gender inclusive, medically accurate, and developmentally appropriate content that aligns with National Health Education Standards. The unit mirrors existing LST modules in terms of length, flow, layout, facilitator instructions, focus on prevention, and utilization of a student workbook.

This, of course, was only the beginning.

We still need effectiveness data, right? Yes!

Field testing of the final supplemental SRH unit is currently being implemented in two schools. This includes pre- and post-test assessments from students, fidelity assessments from facilitators, as well as an analysis of school and community level trends. We are eagerly awaiting the findings from the evaluation research to know if the supplemental SRH unit has the intended preventative effect on adolescent sexual risk taking.

And what about ensuring high quality implementation? Thought about that too.

We developed a Planning Workbook to offer an overview of the supplemental SHR unit. This Planning Workbook provides detailed activities and resources to guide pre-implementation (i.e. getting ready for the intervention) and implementation of the unit. It is intended to be used by administrators, teachers, and other school staff who serve grades 6-8 and are involved in the decision-making and implementation delivery of these unit.

We are happy with the distance we’ve come but also clear that we still have a long journey ahead! 

Center Website



Early Childhood Services Research Program

Leveraging Data to Advance the Field of Home Visiting

HRSA has awarded a contract for the project entitled “Developing Strategies to Facilitate Cross-Model Collaboration and Data Sharing” to a team at Bloomberg School of Public Health with substantial support from Child Trends and James Bell Associates.  Dr. Anne Duggan serves as the Project Director. 

One of the key challenges in conducting research in the home visiting field is avoiding data collection fatigue. Large amounts of home visiting data are already collected for a myriad of reasons: performance measurement, fidelity monitoring, research, and administrative or programmatic needs. These existing data sources provide a unique opportunity for researchers to answer critical questions about what aspects of home visiting work for which families without the monetary and non-monetary costs of collecting additional, potentially duplicative data. This project aims to facilitate dialogue across home visiting models and in collaboration with HRSA and other stakeholders around how we can leverage existing data to answer critical research questions of precision home visiting.

Goals for this project include:

HARC’s 2020 Collaborative Science of Home Visiting Meeting

The Home Visiting Applied Research Collaborative (HARC) is pleased to announce the fifth annual Collaborative Science of Home Visiting meeting on Wednesday, January 29, 2020 at the Grand Hyatt Washington. The meeting will be held from 8am-2pm, immediately preceding the National Home Visiting Summit. The HARC Meeting is an interactive opportunity for HARC members to learn about innovative methods to promote precision home visiting. The meeting agenda includes panel presentations by HARC members who use innovative research methods to study precision home visiting, workshops by HARC Team members, updates on current HARC activities and opportunities to network with other HARC members.

This year HARC is also offering a Precision Home Visiting Research Preconference Workshop on Tuesday, January 28, 2020 from 2-5pm. This workshop is for a limited number of accepted applicants who will meet in small groups to discuss their ideas for precision home visiting research with HARC team members and other investigators. The goal of the Preconference Workshop is to build the capacity of those who are highly motivated to carry out precision home visiting research. Intended participants in the workshop are those who plan to initiate a funding proposal or study within six months that embodies the principles of precision home visiting research. For more information, visit the HARC website!

For more information on the Early Childhood Services Research Team, please visit our webpage.

Center Website



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