Sexual Rights Research Articles

Social Cultural Norms Associated with Early Marriages among Adolescents: Case Study of Chadiza District, Eastern Province of Zambia

Zambia is ranked 16th among countries with the highest rate of child marriage in the world. According to some studies conducted, child marriage rates in the country stand at 42 per cent of women aged between 20 and 24 years married by the attainment of the age of 18 years old. The main objective of this study was to investigate social cultural norms associated with sexuality and child marriages among adolescents in Chadiza district, Eastern province of Zambia. The mixed method design both quantitative and qualitative was used because it provides the researcher with a more comprehensive view of the phenomena being studied in this case, social cultural norms associated with sexuality and child marriages. A Systematic sampling technique was used where every third household was selected for inclusion in the study sample and 150 respondents from which 100 girls and 50 boys were selected by applying a fixed interval. The study findings indicated that most cultural practices in the study area especially initiation ceremonies provoked a girl child to opt for an early sexual debut and early marriage. On the age at first sexual debut, results showed that the minimum age to engage in sexual intercourse by the respondents was 12 years while the maximum age was 22 years for both genders. The study further unearthed the reality that girls’ initiation ceremonies exposed most girls to risk behaviours. After graduating from initiation ceremonies girls wanted to experiment whether they were really sexually able to handle any man since that is what they were taught in their initiation ceremonies a situation which led to early sexual debut among young girls and subsequently to early or teenage pregnancies and early marriages. The study recommends that the Zambian government through the responsible Ministry should regulate initiation ceremonies that pass on bad cultural practices to the adolescents and girls in particular. While appreciating the role initiation ceremonies play in preparing the adolescents for adult responsibilities, there is need to restructure the curriculum for initiation ceremonies to include sexual reproductive health rights and responsibilities.

Ntombi Vimbela! Sexual violence risk reduction intervention: pre and one-year post assessments from a single arm pilot feasibility study among female students in South Africa

BackgroundThe extremely high prevalence of sexual violence victimisation reported among female students in South African public higher education demands urgent action to develop, rigorously evaluate and scale effective prevention interventions. This article details findings from a pilot feasibility study of Ntombi Vimbela! a campus sexual violence risk reduction intervention developed to tackle the high burden of sexual violence in higher education institutions in South Africa.MethodsNtombi Vimbela! (NV!) is a sexual violence risk reduction intervention that comprises sexuality empowerment, gender and social norm change, early-risk identification, self-defence, resistance and mental wellbeing components. NV! is comprised of ten workshop sessions running for 3.5 h each. Workshops are co-delivered by two trained peer facilitators per group of at most 20 first-year female students. One-year post-intervention quantitative outcome assessments were remotely completed by 98 participants who participated in the NV! pilot workshops. Qualitative assessments were conducted with 35 participants through in-depth telephone interviews (IDTIs).FindingsOne year after attending NV! workshops, most participants reported improved awareness of sexual rights, assertive communication, shifts in gender equitable beliefs, reductions in rape myth acceptance, improved expressed sexual relationship power sexual decision-making, and improved negotiation within their intimate relationships. Participants’ depressive symptoms also significantly decreased. Many participants improved awareness of sexual assault risk and vigilance, including using self-protection strategies such as removing themselves from environments where alcohol intoxication posed sexual assault risks. Some participants used assertive communication to withstand peer pressure to engage in risky sexual behaviours. Most participants scored highly on the self-defence efficacy scale. Some participants were exposed to and successful in using verbal and physical resistance strategies in potential sexual assault risky situations.ConclusionThese findings indicate the potential beneficial effects of NV! as a campus sexual violence risk reduction intervention at one-year post-intervention, which must be evaluated in a future rigorous randomised control trial.Pilot trial registered atClinicalTrials.gov NCT04607564 on 29/10/2020.

La legalización del aborto en Argentina: protección de los derechos de las mujeres, niñas y personas que gestan

The fight for the legalization of abortion as a right of women and other people who give birth is part of the struggle for sexual and reproductive rights, and it has feminist movements as its main articulators. In the global south, we observe a mismatch in the guarantee of this right. Countries with similar realities that experienced the resumption of women's movements in the last decade did not have the same success and sometimes suffered setbacks. Unlike Brazil, for instance, Argentina experienced an important victory in 2020, the law of voluntary termination of pregnancy. Based on the partial results of the research entitled “The legalities and illegalities of the right to abortion in Latin America and the Caribbean”, which is currently analyzing the successful Argentine experience of legalizing the right to abortion, we intend to discuss some elements that will help to reveal which were the forces and arguments used in the fight for this right, sometimes expressed in the struggles of the referred movements, as well as an overview of the formerly conservative legislation and the current one, which considers the diversity of women, girls and people who give birth in that country.

Impacts of Protecting Life in Global Health Assistance policy in Nepal: a qualitative study

BackgroundDespite the legalization of abortion in 2002 and the concerted efforts of the Ministry of Health and Population, abortion services remain inaccessible for many Nepali women. In 2017, the United States government enacted the Protecting Life in Global Health Assistance (PLGHA) policy, which prohibited international non-governmental organizations (INGOs) from receiving United States global health assistance from providing abortion services or referrals or engaging in advocacy on liberalizing abortion laws that may have had an impact on abortion services. Though this policy was revoked in January 2021, there is a need to assess its impacts in Nepal and mitigate its lingering effects, if any.MethodsWe conducted in-depth interviews with 21 national-level stakeholders selected purposively on the basis of their experiences and expertise in sexual and reproductive health and rights (SRHR) in Nepal. Interviews were conducted two times: first between August and November 2020 when PLGHA was in place, and then between July and August 2021 after PLGHA was revoked. Interviews were digitally recorded, transcribed, translated and analysed thematically.ResultsMost participants reported that the implementation of PLGHA created gaps in SRHR services, affecting marginalized and underserved populations in Nepal. Participants reported that this policy has compromised the work of INGOs and civil society organizations (CSOs), posing additional risk to the sustainability of SRHR program achievements made so far. Beyond funding loss, participants also mentioned that PLGHA curtailed their freedom, with limited working areas and partnerships for CSOs leading to low or no utilization of services. Most participants welcomed the revocation of PLGHA and hoped it would have positive impacts on SRHR services by permanently repealing PLGHA. Most participants believed that the revocation of PLGHA opened opportunities for new funding and could re-establish partnerships and collaboration, though immediate results had not yet been seen.ConclusionsPLGHA had negative impacts on access to and quality of SRHR services. The Nepal government and other donor agencies need to bridge the funding gap created by the policy. The revocation of the policy has created the hope of bringing positive impacts in SRHR sector; however, the implementation of revocation at the ground level and impacts made on SRHR programs in Nepal remains to be explored.

Estimating the economic impact of COVID-19 disruption on access to sexual and reproductive health and rights in Eastern and Southern Africa.

The Coronavirus disease 2019 (COVID-19) resulted in the disruption of Sexual and Reproductive Health Rights (SRHR) services in the Eastern and Southern Africa region. To date, studies estimating the impact of COVID-19 disruptions have mainly focused on SRHR services without estimating the economic implication. We used national service coverage data on the effectiveness of interventions from the lives saved tool (LiST), a mathematical modeling tool that estimates the effects of service coverage change in mortality. We computed years lost due to COVID-19 disruption on SRHR using life expectancy at birth, number of years of life lost due to child mortality, and life expectancy at average maternal death. We calculated the economic value of the lives saved, using the values of statistical life year for each of the countries, comparing 2019 (pre-COVID-19) to 2020 (COVID-19 era). The total life-years lost were 1,335,663, with 1,056,174 life-years lost attributed to child mortality and 279,249 linked to maternal mortalities, with high case-fatality rates in the Democratic Republic of Congo, Burundi, and Tanzania. The findings show COVID-19 disruptions on SRHR services between 2019 and 2020 resulted in US$ 3.6 billion losses, with the highest losses in Angola (USD 777 million), South Africa (USD 539 million), and Democratic Republic of Congo (USD 361 million). The monetized value of disability adjusted life years can be used as evidence for advocacy, increased investment, and appropriate mitigation strategies. Countries should strengthen their health systems functionality, incorporating and transforming lessons learned from shock events.

Abortion under the aegis of women’s sexual and reproductive rights and health - legal analysis of European Parliament Resolution 2020/2215 (INI)

Rad donosi pravnu analizu Rezolucije o stanju u pogledu seksualnog i reproduktivnog zdravlja i prava u EU-u u kontekstu zdravlja žena 2020/2215 (INI) te njezinih metodoloških i terminoloških aspekata. Analitičkom metodom razrađena je formalnopravna, materijalnopravna i šira sadržajna struktura ovog dokumenta s ciljem prikaza pravne utemeljenosti kako intervencije na ovom području tako i sadržaja, ali i obuhvatnosti uključenih prava s obzirom da se ovaj dokument koristi proširenim pojmom seksualnog i reproduktivnog zdravlja i prava te pobačaj proklamira kao temeljno ljudsko pravo, za što nema osnove u suvremenom međunarodnopravnom sustavu temeljnih ljudskih prava na koji se izrijekom poziva. Detaljnom pravnom egzegezom nastoji se ukazati na metodološke, terminološke i sadržajne nedostatke ovog dokumenta koji razmatra važna pitanja seksualnog i reproduktivnog zdravlja žena, ali ih nadilazi kako svojom formalnopravnom tako i sadržajnom strukturom, a osobito političkim ciljevima usmjerenima na stvaranje novih prava i kulturnih obrazaca. U tu je svrhu ova analiza provedena uz paralelni okvirni prikaz šireg konteksta suvremenih procesa stvaranja novih prava koji su sami po sebi nužni, ali postoje određeni pravni, društveni i etički parametri na koje ukazujemo i koje je u tim procesima potrebno poštivati, a koji su jamac vladavine prava koja štiti i od pretjerane političke moći.

Women's experience of infertility & treatment – A silent grief and failed care and support

Infertility is one of the components of sexual and reproductive health and rights, but is not as widely addressed as pregnancy, birth, and contraception. Infertility is a global problem, and it is estimated that around 186 million individuals are affected worldwide. Infertility and infertility treatment impact on women’s overall wellbeing including their mental, emotional, sexual and spiritual health. Anxiety and depression is prevalent in these women. This study sought to explore the experiences of women going through infertility and IVF in a global context. This study is a metasynthesis with a meta-ethnographic analysis design based on 19 qualitative research studies, including 503 women, focusing on women’s experiences of infertility and IVF treatments. Three main themes were identified; the personal reproductive trauma, the impact of and on relationships, and being failed by the healthcare system and society. The personal trauma and experiences included stress, grief, inability to focus, chock, insomnia, anxiety, withdrawing from others, sense of hopelessness and guilt and shame. The infertility and IVF journey also either caused conflicts in relationships or helped the couples to grow stronger. At the same time, relationships with friends and family were strained due to isolation and feeling stigmatized, and not understood. Finally, the healthcare system and providers lacked adequate support, holistic and caring care, and the women felt dehumanized and failed by the healthcare system. It is therefore critical that the healthcare system provide the time, information and support needed to deal with infertility and IVF to maintain quality of life and wellbeing.

Towards Achieving improved access to youth-friendly Sexual Reproductive Health and Rights (SRHR) services in Cross River State (CRS) Nigeria; Sustaining Evidence-Driven Advocacy through the CRS SRHR policy.

Towards Achieving improved access to youth-friendly Sexual Reproductive Health and Rights (SRHR) services in Cross River State (CRS) Nigeria; Sustaining Evidence-Driven Advocacy through the CRS SRHR policy.

'To get freedom, one went abroad a lot': British Homosexual Men and Continental Europe as a Site of Emancipation, 1950-75.

This article traces the leisure travel of British homosexual men in continental Europe between 1950 and 1975. The aim of this article is to challenge narratives of British post-war sexual rights discourses as isolated from continental Europe. Taking a transnational approach, which examines the ways in which Britain was embedded in processes of social and cultural change across Europe, it charts informal encounters and networks of cultural communication forged by homosexual men themselves during the post-war tourist boom. Using Oral Histories deposited at the British Library Sound Archive, I emphasize the role of homosocial spaces in the production and performance of the sexual self and establish how affluence provided access to spaces for sexual self-development during a period when homosexuality remained criminalized in Britain. It explores two distinct types of holidays taken by homosexual travellers, examined via a life writing approach-the Amsterdam city break and the southern European beach holiday-and shows how these experiences shaped their self-conception and hopes for a more tolerant society at home. In revealing how foreign forms of homosexual sociability influenced domestic politics, I argue for a stronger emphasis on British entanglements with continental Europe when tracing political and social transformations during the post-war period.

Collective resilience and resistance in hybrid times: gender struggles in Germany, Turkey and Sweden

In activist circles, the concept of resilience seems to have captured the spotlight once enjoyed by resistance. Instead of treating resilience as antithetical to resistance, and a discursive neoliberal vehicle that seeks individual solutions to collective problems, this article demonstrates its relationality to resistance in the context of online/offline struggles of feminist and LGBTI + activists challenged by mobilizations against gender and sexual rights. Reflecting on the discussions and outputs of a series of digital workshops involving activists from Germany, Turkey and Sweden, the article investigates from a transnational perspective the meanings and aspects of collective resilience in the anti-gender context, and what resilience entails in the increasing online/offline hybridity of activism. Three themes emerge from this investigation: the connectedness of resistance and resilience across scale and context, the pronouncing of care and support networks as activist resources, and the emergence of the need and efforts to develop new alliances and solidarity structures in the face of the dual challenges of anti-gender mobilizations and neoliberalism. Resistance and resilience are intertwined in gender struggles taking place in the anti-gender context, in that the cultivation of resilience through care networks, the mobilization of positive affect, and the formation of dynamic and flexible solidarities enable and help sustain resistances in the online/offline interface. While online/offline hybridity offers opportunities to develop and sustain individual/collective resources, the article finds, attention should be paid to the processes of exclusion of underprivileged women and queer people in hybrid times.

Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study

PurposeTo evaluate the effects of a comprehensive sexuality education (CSE) intervention on short-term psychosocial outcomes related to healthy sexuality among very young adolescents in urban Indonesia. MethodsA quasi-experimental study was conducted between 2018 and 2021 with students aged 10-14 years at 18 schools in Indonesia (Lampung, Denpasar, Semarang). Three schools per site were purposefully selected to receive the SEmangaT duniA RemajA intervention, a two-year, rights-based teacher-led CSE intervention delivered in classrooms (or online after the 2020 COVID-19 outbreak); and matched with three control schools. Surveys were completed by 3,825 students at pre- and posttest (82% retention). The final analytical sample included 1852 intervention and 1483 control students (N = 3,335). Difference-in-difference analysis was conducted to examine the intervention effect on healthy sexuality competencies (knowledge, skills, and attitudes) and personal sexual well-being. ResultsBaseline characteristics for intervention and control groups were similar in terms of sex (57% female) and age (mean 12 years). Students receiving SEmangaT duniA RemajA demonstrated significantly greater increase in competencies, including greater pregnancy knowledge, more gender equal attitudes, and communication about sexual and reproductive health and rights, compared to controls. There was no intervention effect on personal sexual well-being, except for self-efficacy to prevent pregnancy. Subgroup analysis indicated more significant effects among females and students in Semarang and Denpasar, than males or students in Lampung. DiscussionWhile findings demonstrate the potential for CSE programs to improve healthy sexuality competencies in early adolescence, the effect appears to be highly contextualized which may be due to varying levels of implementation quality, especially since the COVID-19 outbreak.

The role of gender inequities in women's access to reproductive health services: a population-level study of Simiyu Region Tanzania

BackgroundAmref Health Africa, with support from Global Affairs Canada, examines if women's access to reproductive health services in Tanzania is affected by Gender social norms, decision-making power, roles and responsibility, and access to resources in relation to the utilization of reproductive Health Services in Tanzania. A Gender Need Assessment (GNA) was conducted in five districts in ' 'Tanzania Simiyu Region to improve the infrastructure, supply, quality, and demand for integrated Reproductive, Maternal, Newborn, and Child and Adolescent Health (RMNCAH), Nutrition, and Water, Sanitation, and Hygiene (WASH) services. The analysis identifies gender as a fundamental maternal and child health driver through existing gender inequality at the household and community levels that dictates women's status.MethodsThe qualitative assessment involved data collected from gender- and age-desegregated focus group discussions (FGDs) and in-depth interviews (IDIs) of key informants in three districts; Bariadi, Busega, and Meatu, in Simiyu region, Tanzania. Participants comprised 8-10 married women and men, unmarried women and men, and adolescent boys and girls. A total of 129 participants were involved in the FGDs.ResultsThis paper reports the critical drivers influencing gender inequality in Simiyu by detailing how Gender inequality affected women's access to reproductive health care in relation to; gender social norms, decision-making power, access to resources at the household and community level, roles and responsibilities, including men's and 'boys' roles are more valued than the roles and responsibilities of women and girls resulted to limited free time to do things for themselves, such as visiting the health facilities for RMNCAH.ConclusionsThis paper explored gender-based enablers and/or barriers influencing women and girls' realization of their sexual and reproductive health and rights. It was found that social norms, decision-making powers, and lack of access to and control over resources presented as key barriers. In contrast, continuous community sensitization and increased scope of women's participation in decision-making served as enabling environment to overcome gender inequities that influence woman's use of RMNCAH services in Tanzania. Such insights will shape interventions geared towards valuing differences in a manner that overcome gender inequities that influence woman's use of RMNCAH services in Tanzania.

School, Online Communities and Creative Workshops as Spaces for Non-normative Pre-teen Gendered and Sexual Cultures

This study focuses on how space acts in shaping non-normative pre-teen gendered and sexual cultures. It was conducted in Northern Finland and consists of an arts-based case study of a group of 12- to 13-year-old students, who during our creative workshops on gender, sexuality and power reflected on the possibilities of gender and sexual diversity in their everyday lives. Inspired by feminist new materialist scholarship, which focuses on spatiality and materiality in co-constituting gendered and sexual meanings, in the analysis, we explore how school and social media—two central life spheres of today’s youth—act in affording distinct possibilities for transgressive gender and sexuality as well as attachments to LGBTIQ+ communities. Furthermore, the analysis indicates how non-normative relationalities can be supported in school-based creative workshops. By mapping how spaces co-constitute non-normative gender and sexuality, we can develop them to promote the sexual rights and welfare of young people.

Migrant and Refugee Youth's Sexual and Reproductive Health and Rights: A Scoping Review to Inform Policies and Programs.

Objectives: Migrants and refugee youth (MRY) in Western nations are less likely to participate in sexual reproductive health (SRH) services. Consequently, MRY are more likely to encounter adverse SRH experiences due to limited access to and knowledge of SRH services. A scoping review was conducted to examine MRY's understanding of and the implications for inclusive sexual and reproductive health and rights (SRHR) programs and policies. Methods: A systematic search of literature across seven academic databases was conducted. Data were extracted following Partners for Dignity and Rights' Human Rights Assessment framework and analysed using the thematic-synthesis method. Results: 38 literature (peer-reviewed, 24 and grey, 14) were considered eligible for inclusion. The findings highlighted significant barriers and the under-implementation of SRHR support and services by MRY. Key policy implications include a need for programs to support MRY's SRHR education, diversity, equity and inclusiveness and privacy protections. Conclusion: The review shows that the emerging evidence on MRY SRHR suggests gaps in practices for resourcing policies and programs that promote sustainable SRH for vulnerable populations. Policies for MRY's SRHR should prioritise programs that focus on diversity, equity and inclusion with targeted education and community resourcing strategies for sustainability.

A human right to pleasure? Sexuality, autonomy and egalitarian strategies

A growing focus on pleasure in human rights discourse has been used to address patterns of sexual exclusion, often when addressing the problems of people with disabilities (PWD). As convincingly...

Current Polarization: Religion and Sexual Wellbeing for Earning Equal Rights for Sexual Health and Reproductive Rights in Indonesia

Current Polarization: Religion and Sexual Wellbeing for Earning Equal Rights for Sexual Health and Reproductive Rights in Indonesia

Paradoxes of Patrimony: Family Planning, Youth Volunteering, and Becoming "Big" in Uganda

Abstract: This article examines the experiences and motivations of young volunteers engaged in the development domain of sexual and reproductive health and rights in Uganda. While promoting various family-planning projects, volunteers deftly navigated human-rights discourses of international donors, norms of religious leaders, and development narratives of national policymakers as they attempted to advance their own life projects. Through the creation of new narratives and their agency, the volunteers translated, reformed, and re-presented Global North development discourse as part of a situated theorization on development problems. Simultaneously these educated, middle-class youth embraced the discursively vague field of family planning as the likeliest avenue for social mobility by becoming "big" within national and local patrimonial and patriarchal systems. Although such family-planning programs do seem to allow some volunteers to achieve their goals, they paradoxically reproduce the patriarchal systems that gender-equality NGOs aim to dismantle.

LGBTQ Politics in Nicaragua: Revolution, Dictatorship and Social Movements by KarenKampwirth. University of Arizona Press, 2022. 361 pp.

The Journal of Latin American and Caribbean AnthropologyEarly View BOOK REVIEW LGBTQ Politics in Nicaragua: Revolution, Dictatorship and Social Movements by Karen Kampwirth. University of Arizona Press, 2022. 361 pp. Ana-Maurine Lara, Corresponding Author Ana-Maurine Lara [email protected] University of Oregon Email: [email protected]Search for more papers by this author Ana-Maurine Lara, Corresponding Author Ana-Maurine Lara [email protected] University of Oregon Email: [email protected]Search for more papers by this author First published: 29 May 2023 https://doi.org/10.1111/jlca.12664Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. REFERENCES Borland, Katherine. 2006. Class, Gender, and Sexuality in Nicaraguan Festival. University of Arizona Press. Friedman, Elisabeth Jay, ed. 2018. Seeking Rights from the Left: Gender, Sexuality, and the Latin American Pink Tide. Durham, NC: Duke University Press. Heumann, Silke. 2014. “The Challenge of Inclusive Identities and Solidarities: Discourses on Gender and Sexuality in the N icaraguan Women's Movement and the Legacy of S andinismo.” Bulletin of Latin American Research 33 (3): 334– 349. Howe, Cymene. 2013. Intimate activism: The struggle for sexual rights in postrevolutionary Nicaragua. Durham, NC: Duke University Press. Lancaster, Roger N. 1999. “ ‘That we should all turn queer?’: Homosexual stigma in the making of manhood and the breaking of a revolution in Nicaragua.” In Culture, society and sexuality, edited by G. Parker Richard and Aggleton Peter, 120– 138. New York, NY: Routledge. Mogrovejo, Norma. 2000. Un amor que se atrevió a decir su nombre: la lucha de las lesbianas y su relación con los movimientos homosexual y feminista en América Latina. Madrid, Spain: Editora Plaza y Valdés. Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Social workers’ perceptions of intimate relationships of people with intellectual disabilities in residential settings

Summary People with intellectual disabilities still struggle to enjoy intimate and sexual relationships. Social workers have a potentially key role in realizing the intimate and sexual rights of people with intellectual disabilities, particularly in residential settings. However, we still know relatively little about the meaning social workers attribute to such relationships. The present study addresses this lacuna by examining the perceptions and practices of 15 Israeli social workers in residential settings. Findings Drawing on thematic analysis of semi-structured interviews, two key themes are identified: (1) Intimate relationships as a human need, and (2) Intimacy with a question mark. Combined, these themes depict an ambivalent position toward residents’ intimate and sexual relationships. Applications The study's findings highlight the need to incorporate intimacy and sexuality within social work education, with a particular focus on people with intellectual disabilities and positive aspects of intimacy and sexuality. From a policy perspective, the findings urge state and professional authorities to develop national guidelines on realizing intimate rights.

Can payment by results ensure equitable access to contraceptive services? a qualitative case study

BackgroundThe Leave No One Behind (LNOB) agenda compels sexual and reproductive health and rights (SRHR) implementers to focus on the multiple and intersecting forms of discrimination and inequalities. One strategy to address these is Payment by Results (PbR). Using the Women’s Integrated Sexual Health (WISH) programme as a case study, this paper examines if and how PbR can ensure equitable reach and impact.MethodsGiven the complexity of PbR mechanisms, a theory-based approach was used in the design and analysis of this evaluation, drawing on four case studies. These were conducted by reviewing global and national programme data and by interviewing 50 WISH partner staff at national level and WISH programme staff at global and regional levels.ResultsThe case studies found that inclusion of equity-based indicators in the PbR mechanism had demonstrable effects on people’s incentives, on how systems work, and on modes of working. The WISH programme was successful in achieving its desired programme indicators. The use of Key Performance Indicators (KPIs) clearly incentivised several strategies for service providers to innovate and reach adolescents and people living in poverty. However, there were trade-offs between performance indicators that increased coverage and others that increased equitable access, as well as several systemic challenges that limited the possible incentive effects.ConclusionsThe use of PbR KPIs incentivised several strategies to reach adolescents and people living in poverty. However, the use of global indicators was too simplistic, resulting in several methodological issues.