Kenya and Uganda have restrictive abortion laws dating from

Kenya and Uganda have restrictive abortion laws dating from the time of British rule. In both countries the constitution and penal code are not harmonised, leaving room for ambiguous interpretation of the legal environment. Standards and guidelines on reduction of morbidity and mortality due to unsafe abortion were developed by the respective ministries of health in Kenya in 2012, and in Uganda in 2015. These standards and guidelines were an expansion of existing national policies and standards and the 2012 WHO Technical Guidance on Safe Abortion, supported by the constitutions. However, the standards and guidelines were withdrawn in Kenya in December, 2013, and in Uganda in January, 2016, because of disagreements between stakeholders regarding their content. Absence of clear standards and guidelines specific to comprehensive abortion care atp gamma s vital questions on health-care access and provision—such as roles, eligibility, and responsibility—unanswered. At the time of the workshop, discussions between the Ugandan Ministry of Health and stakeholders were ongoing, including efforts to bring religious leaders who opposed the standards and guidelines to the table. Meanwhile, in Kenya, the withdrawal of the standards and guidelines was being petitioned in court by civil societies. Delegates emphasised the urgent need for a consensus regarding the standards and guidelines among stakeholders in Kenya and Uganda. In addition, a common interpretation of the legal environment was considered crucial, and therefore the constitution and penal code would need to be harmonised in both countries. In east Africa, the shortage of health-care providers trained in comprehensive abortion care is severely restricting women\'s access to care, and thus updated in-service comprehensive abortion-care training and quality pre-service training is imperative. Efforts to expand access to comprehensive abortion care through task sharing or shifting should also be prioritised, as they have been shown to be safe, effective, and highly acceptable to women. The harm reduction model, already in use within some settings in east Africa, was acknowledged as an important strategy to prevent unsafe abortions. The delegates also emphasised the opportunity for prevention of unintended pregnancies, which comprehensive abortion care entails. However, quality improvement of contraceptive services is needed to increase use of effective methods and ensure informed decision making. Quality comprehensive abortion care is also dependent on factors such as availability of misoprostol and effective contraceptives, known to be heavily affected by stock-outs in Kenya and Uganda within public facilities. Stock-outs at national dispensaries are unacceptable and should be addressed alongside the control of counterfeit misoprostol. Sensitisation and support for misoprostol and addressing of misconceptions at community, health-care, and decision-making levels were recognised as central to the implementation process.
In a passionate Editorial, defends a human rights approach to Zika virus, and includes mosquito control as part of the “sound recommendations, duly relayed by health authorities”. We would like to argue the case for a rights-based approach to mosquito control, which would be aimed not at small-scale tinkering in the environment but at large-scale urban transformation, as proposed in the early drafts of the . Such an approach encompasses, among others, the right to the city, the right to health, and the right to freedom of movement. Faria and colleagues suggest that large-scale patterns in human mobility, including the role of mega-events, should be assessed to understand the epidemiology of the virus. Since 2010, Brazil has hosted a series of mega-events, with delegations from all over the world. These have included the 2011 Military Games, the 2013 Salesian Youth Movement world meeting (with the Pope\'s visit), the 2013 Fédération Internationale de Football Association (FIFA) Confederations\' Cup, the 2014 FIFA World Cup, and all the preparatory games for the 2016 Olympics. Beyond changes in human mobility, there are other effects of hosting mega-events that should be discussed. Families living in well located informal settlements have been displaced from their homes to make way for mega-event structures and urban gentrification projects. By 2013, approximately 40 000 people had been removed from their homes in Rio de Janeiro as a direct consequence of mega-event stadium construction, and a greater number of these have been forced to move from informal settlements in areas with reasonable infrastructure to the outskirts of the cities on account of increased real estate valuation. They will join many already living in poor areas—where sanitary conditions and waste management are worse—increasing the proportion of the population forced to store water and the amount of garbage thrown in water streams, blocking water flow, both of which favour the proliferation of , the vector of Zika, dengue, and chikungunya viruses.