Terms of Reference for a Consultant Multi-Country Qualitative & Gender Equality Assessment Data Analysis
  1. Background
As part of the efforts to accelerate achievements in the Every Newborn Action Plan, the Born On Time program, implemented by consortium members (World Vision, Save the Children and Plan International), will contribute to the reduction of preterm birth rates (over the next five years) in targeted communities of Ethiopia, Mali and Bangladesh. These three countries are among those with the highest preterm birth rates - over 10% of births occurring before 37 weeks gestation. Together these countries account for an estimated 768,205 preterm births annually. In order to reach the most vulnerable populations within each country, the sub-national regions with some of the highest rates of newborn death will be targeted. These include the Rangpur division of Bangladesh; the Amhara region of Ethiopia; and the Sikasso region of Mali. To address the discriminatory socio-cultural norms and gender barriers that can lead to poor child mortality and maternal health outcomes, Born On Time will implement a comprehensive Gender Equality Strategy to redress existing gender gaps and address pervasive gender inequalities. For more information on project outcomes, please see Appendix A. As part of the baseline study of the program, data collection for a Qualitative & Gender Equality Assessment has been conducted to examine gender inequalities and other social factors in the three countries and their impact on health outcomes, with a focus on examining the social and gender equality dimensions and barriers related to: 1) access to health services; 2) use of health services; and 3) LINC factors[1]. More specifically, the Qualitative & Gender Equality Assessment has looked at the following issues:
  • Power dynamics at the household and community levels;
  • Distribution of resources at the household level (access to and control over);
  • Roles and responsibilities of women, girls, men and boys;
  • Cultural and religious taboos, myths and beliefs;
  • Knowledge, attitudes and practices regarding sexual and reproductive health and rights.
The findings of the Qualitative & Gender Equality Assessment will provide complementary contextual information that will deepen the consortium’s understanding of the data collected in the quantitative household survey and health facility assessment (i.e. contextual factors related to the quantitative results). Moreover, the findings will be used by the program’s staff to inform all program interventions so they can effectively respond to the specific needs and realities of female and male beneficiaries while addressing, whenever possible, the root causes of gender inequalities that might influence health outcomes. Ultimately, Born On Time’s existing Gender Equality Strategy will be updated to reflect the findings of the baseline study, including the findings of the Qualitative & Gender Equality Assessment. For more information on Born On Time’s Gender Equality Strategy, please see Appendix B. 2. Purpose of the Assignment and Key Tasks Born On Time is seeking to hire a Consultant to analyse the qualitative data collected in the three Born On Time countries through Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs). Information on the sample size is available in Annex C. More specifically, the Consultant will perform the following tasks:
  • Review program documentation (including data collection tools and baseline study methodology) and participate in briefing meetings with Born On Time’s Gender Equality Working Group in Canada.
  • Prepare a detailed work plan for the assignment, which would include information on the proposed timeline and methodology.
  • Read the transcripts and summary notes of the FGDs and KIIs performed in the three Born On Time countries.
  • Participate in country-specific briefing meetings with Born On Time staff at country-level and national consultants who collected the data in the three countries to receive additional contextual information as needed.
  • Describe, summarize and analyse the FGD and KII data for all three countries, using an analytical framework provided by Born On Time. All three countries will use the same analytical framework, but the analysis must be done separately/per country.
  • Produce a draft multi-country report summarizing the key findings from the analysis of the qualitative data in the three countries as well as a summary report which consolidates the main results from the three countries into a chapeau report.
  • Incorporate the feedback from Born On Time key staff into the reports before their final submission.
The Consultant will report contractually to Born On Time’s Program Director and will work closely with the Technical Lead of the Born On Time Gender Equality Working Group, who is responsible for overseeing the data analysis for the Qualitative & Gender Equality Assessment. Please note that the contract for this consultancy will be signed with World Vision Canada.
  1. Timeframe, Deliverables and Location
The consultancy will take place in April and May 2017 during which the consultant is expected to work up to 35 days. Final deliverables are expected by not later than May 31, 2017. Deliverables for this assignment include the following:
  1. detailed work plan
  2. draft multi-country report
  3. draft chapeau report
  4. final multi-country report
  5. final chapeau report
The consultancy is expected to be carried out in Canada and will not involve any international travel.
  1. Qualifications and Experience
  • Master degree in International Development/Relations, Women and Gender Studies, Health, or related field, or equivalent training/experience;
  • Minimum of 5 years of research experience conducting gender equality assessments, studies, analyses or evaluations, preferably in the field of international development;
  • Demonstrated experience in gender analysis of quantitative and qualitative data;
  • Expertise in gender equality issues in the health sector, particularly in the field of Maternal and Newborn Health and Adolescent Reproductive and Sexual Health;
  • Experience analysing qualitative data using Excel, NVivo, or other software;
  • Excellent report writing skills in English; fluency in French is an asset;
  • Knowledge of Born On Time countries (Bangladesh, Ethiopia and Mali) is an asset.
  1. Child Safeguarding
-The Consortium members implementing Born On Time are committed to the welfare of children around the world and accordingly, the Consultant must agree to abide by World Vision Canada’s policies concerning protection of children, a copy of which will be provided in advance of signature of the contract.
  1. Disclosure of Information
Any information relating to the business, operations or processes of the Consortium members that may be acquired by the Consultant during the course of the assignment shall be treated as confidential and shall not be disclosed to any other person, firm or company without World Vision Canada’s written authorization during the course of the assignment or at any other time. The Consultant may be required to sign a non-disclosure agreement with World Vision Canada to provide assurances of confidentiality. All intellectual property created during the course of the assignment will remain the exclusive property of World Vision Canada, on behalf of the Consortium.
  1. Application Process
If you are interested in this consultancy, please e-mail a resume, a letter of interest to carry out the assignment which clearly demonstrates a thorough understanding of this TOR, a financial offer, as well as samples of similar research reports by March 24th 2017 to jobs@savethechildren.ca with Subject heading “(Born on Time Consultant)”. We thank all applicants for their interest, however, only those selected for an interview will be contacted.   Appendix A. Project Summary
Project Subject Maternal and Newborn Health (MNCH)
Project Background Following the 2015 deadline for the Millennium Development Goals (MDGs), there has been a substantial reduction in under-five mortality rates. Despite decreasing rates in neonatal mortality, newborn deaths represent an increasing proportion of under-five mortality rising from 37% in 1990 to 44% in 2013[2]. Preterm birth is the single most significant cause of under-five mortality accounting for 17% of all under five deaths in 2013[3]. Preterm birth rates are increasing in many low and middle-income countries with 1 million babies dying from preterm birth complications every year[4]. Further, preterm birth complications are a significant cause of morbidity and life-long disability in the babies who survive.   As part of the efforts to accelerate achievements in the Every Newborn action plan, the Born On Time project, implemented by consortium members (World Vision, Save the Children and Plan), will contribute to the reduction of preterm birth rates over the next five years in targeted communities of Ethiopia, Mali and Bangladesh. These three countries are among those with the highest preterm birth rates - over 10% of births occurring before 37 weeks gestation. Together these countries account for an estimated 768,205 preterm births annually. In order to reach the most vulnerable populations within each country, the sub-national regions with some of the highest rates of newborn death will be targeted. These include the Rangpur division of Bangladesh; the Amhara region of Ethiopia; and the Sikasso region of Mali.
Overall Project Objectives Ultimate Outcome Reduction in neonatal mortality in Bangladesh, Ethiopia and Mali  Intermediate Outcomes Improved availability of quality,  gender responsive/ adolescent-friendly maternal, newborn and reproductive health services to prevent and care for preterm births among adolescent girls and women of reproductive age (WRA) in underserved areas in Bangladesh, Ethiopia and Mali Increased utilization of  quality, gender responsive/ adolescent-friendly maternal, newborn and reproductive health services to prevent and care for preterm births among adolescent  girls and WRA in underserved areas in Bangladesh, Ethiopia and Mali Enhanced utilization of evidence-based, gender-specific information on preterm birth data for decision making by staff at various levels of the health system Immediate Outcomes Strengthened capacity of facility-based health care providers (HCP) to implement and monitor, environmentally-safe, gender-responsive/adolescent-friendly quality maternal, newborn and reproductive health services for newborns, adolescent girls, pregnant  women and WRA to prevent and care for preterm births Strengthened  capacity of community  health workers (CHW) to provide quality, gender responsive/ adolescent-friendly  maternal, newborn and reproductive health services for newborns, adolescent girls, pregnant  women and WRA to prevent and care for preterm births Increased awareness among adolescent girls, pregnant women, WRA and male partners/family members of  healthy pregnancies and healthy behaviours, including sexual and reproductive health and rights (SRHR), nutrition, gender equality issues, male engagement, smoking cessation, maternal rest and breastfeeding promotion Increased  ability of adolescent girls, pregnant women and WRA, to access  gender-responsive/adolescent-friendly maternal, newborn, and reproductive health practices and services to prevent and care for preterm births Strengthened community  systems to support, promote and sustain access for adolescent girls, pregnant women and WRA to gender-responsive/adolescent-friendly maternal, newborn and reproductive health practices and services to prevent and care for preterm births Strengthened capacity to record, report and use  sex disaggregated birth, death and still birth data at national, subnational and community level
Specific Project Location/ Implementation Areas The project is implemented in the following 5 districts: Sikasso, Koutiala, Kadiolo, Kignan and Niéna.
Appendix B. Born On Time’s Gender Equality Strategy Born On Time’s initial gender analysis has revealed that one of the key gender inequalities contributing to preterm birth and poor Maternal and Newborn Health (MNH) and Adolescent Reproductive and Sexual Health (ARSH) outcomes is widespread child, early and forced marriage (CEFM). Despite the existence of laws prohibiting child marriage, the practice is pervasive in all three countries. In Bangladesh, 64% girls are married before 18[5] and 29.1% by 15 years. In Ethiopia, the national level figure shows that 63% of Ethiopian women aged 25-49 married before they were 18 and that the median age at first marriage is 16.5 years[6]. Amhara, the region in which the project will be implemented, has the lowest median age at first marriage (15.1 years).  In Mali, 15% of women aged 20-24 years old were married or in a union before they were 15 years old, and 55% of women aged 20-24 years old were married by 18[7].  The consequences and risks of early pregnancy on preterm birth, high child and maternal mortality and mother and child development are devastating. Another key gender inequality that contributes to preterm birth and poor MNH and ARSH outcomes is women’s and girls’ limited autonomy and decision-making power, particularly with regards to key issues such as pregnancy, birth spacing or child rearing. In all three countries, women’s limited mobility and agency often restrict their access to information or their ability to access MNH and ARSH services independently of their husbands or in-laws.  Women’s low or lack of financial independence to allocate resources for MNH and ARSH care and husbands’ lack of awareness about the importance of MNH and ARSH services all contribute to marginalization in accessing services. In Ethiopia, a research study conducted by World Vision has shown that women did not discuss their pregnancies with their in-laws, thinking they will not be allowed to deliver at a health facility – this despite reports which indicated that 45% of the time decisions were made jointly by the pregnant woman and her husband around seeking services[8]. Similarly, women’s and girls’ decision-making at the community level is limited, with women often excluded from community level health governance structures, limiting their voice in holding MNH and ARSH service providers accountable and resulting in the provision of services that are often ill-adapted to their unique needs and realities. Another important gender inequality with significant ramifications for MNH and ARSH and particularly preterm birth is the high prevalence of violence against women and girls. In Bangladesh, 87% of women have reported violence in the home[9], while in Mali, the 2012-2013 Demographic and Health Survey revealed that 38% of women over 15 years old have experienced physical violence[10]. Intimate partner violence or violence perpetrated by family members is a known factor leading to pre-partum (and post-partum) depression and other morbidities that lead to preterm birth. In Ethiopia, female genital mutilation/cutting (FGM/C) is a widespread harmful practice, including the operational region, with 74% of women and more than 24% of girls aged between 15 and 19 years being cut[11]. Female genital mutilation is strongly associated with negative reproductive health outcomes such as infection, obstructed labour, perineal tears, fistula and infertility. Women’s and girls’ low literacy levels in all three countries is another gender inequality that has an impact on preterm birth and poor MNH and ARSH outcomes. In Ethiopia, the literacy rate of persons who are 15 years old and older is 41.1% for females and 57.2% for males. In Mali, the literacy rate is 29.2% for females and 28.2% for males, while in Bangladesh, the literacy rate is 58.5% for females and 64.6% for males[12]. Low literacy levels amongst women and girls and gender disparities between men’s and women’s literacy rates limit women’s and girls’ access to ARSH and MNH-related information and/or services, since a person’s ability to access, understand and use information, whether it is written or verbal, is dependent on their opportunity to learn how to read and understand the language in which the information is communicated. In Ethiopia, the low ability of women to recognize the signs of pregnancy complications has been identified as one of the main causes of low skilled birth attendance in selected regions[13]. Cultural and religious taboos, myths and beliefs – which have clear gender underpinnings – also increase the risk of preterm birth given that they limit pregnant women’s preventive and care seeking behaviours.  For example, in Bangladesh, young women are shy to show their pregnant bodies to an unknown health provider and prefer traditional practitioners. Moreover, mobility during pregnancy is often restricted due to superstitions and beliefs in malicious, “evil spirit” or “free ranging spirit” who are believed to possess a woman when she travels alone outside her residence, especially in the early morning, at noon and at dusk. These spirits are blamed for several conditions including pre- and post-natal bleeding, miscarriage, preterm deliveries and still births. In Mali, religious and cultural beliefs limit women’s ability to adopt preventive health measures such as family planning, as women employing family planning are often seen as immoral. Cultural and religious taboos, myths and beliefs as the ones described above increase the risk for preterm birth and other MNH complications. Born On Time’s Gender Equality Approach to MNH and ARSH Programming To address the discriminatory socio-cultural norms and gender barriers that can lead to poor child mortality and maternal health outcomes, Born On Time will implement a comprehensive gender equality approach to MNH and ARSH programming. The project will work to redress existing gender gaps and address pervasive gender inequalities. Interventions include:
  • Empowering women and girls, notably by:
  • Addressing their knowledge gaps through both targeted and broad education and awareness raising activities related to sexual and reproductive health and rights, including risk factors that lead to preterm birth, lifestyle factors, danger signs and the importance of accessing services such as antenatal care (ANC), delivery by a skilled birth attendant, postnatal care (PNC), postpartum family planning, etc. All education initiatives directed at women and adolescent girls will integrate messaging on gender equality.
  • Increasing women’s and girls’ social capital through a range of actions, such as establishing or strengthening existing support groups of women and girls that seek to build the agency of women and girls and support them to raise their voice, and increase their social visibility and decision-making capacities within households and communities. A key element of increasing social capital for women and girls will be the mobilization of existing community-based structures and systems such as child protection, health, and school management committees to collaborate within their mandates and take action for the prevention of preterm birth. Women’s participation and representation in these structures will also be strengthened. Similarly, other key household influencers and decision-makers (e.g. mothers-in-law, grandmothers, etc.) will be sensitized and mobilized to promote utilization of gender-responsive/adolescent-friendly MNH and reproductive services by PW, WRA and adolescent girls. This will reduce harmful traditional norms and practices which perpetuate gender-based discrimination and inequality including CEFM, FGM/C, and gender-based violence.
  • Engaging men as active partners of change, notably through social and behaviour change communication activities including targeted male partner education and formation of male community groups to foster improved couple communication, gender equitable relationships (including distribution of household labour and power relations) and decision-making on key MNH and ARSH matters as well as educating men on preterm birth risks, and prevention. A key aspect of male engagement will be the systematic engagement of community gate-keepers, such as traditional and religious/faith leaders, so they can 1) actively promote utilization of MNH, ARSH and reproductive services by PW, WRA and adolescent girls; 2) spread awareness regarding the risks factors for preterm birth; and 3) from their respective platforms and spheres of influence, contribute to reducing harmful traditional norms and practices which perpetuate gender inequality, including CEFM, FGM/C, and gender-based violence.
  • Engendering newborn and reproductive health services, notably through capacity building activities on the gender equality dimensions of MNH and ARSH with health services providers/decision-makers, including CHWs, in order to support the delivery of quality, gender-responsive/adolescent friendly maternal, newborn and reproductive health services.
Appendix C. Information on the Sample Size[14] Focus Group Discussion Sample
  FGD Version   Target group to be interviewed (10-12 people per group) SC World Vision Plan
Total number of FGDs to be conducted Total number of FGDs to be conducted Total number of FGDs to be conducted
Version A Married adolescent girls (15-19 years old) who are pregnant or who have at least one child 10 12 3
Version A Married women (20-49 years old) with children under five years old 10 12 6
Version A Elder women (50 years and older) 10 12 3
Version B Married boys and men (15 years and older) with children under five years old 10 12 6
Version C Unmarried adolescent girls (15-19 years old) 10 12 3
Version C Unmarried adolescent boys (15-19 years old) 10 12 3
Total per Consortium Organization 60 72 24
Key Informant Interview Sample
  KII Version   Individual to be interviewed SC World Vision Plan
Total number of KIIs to be conducted Total number of KIIs to be conducted Total number of KIIs to be conducted
Version A Facility-based health workers 10 (5 f and 5 m) 12 (6 f and 6 m) 3
Version B Community health workers 10 (5 f and 5 m) 12 (6 f and 6 m) 3
Version C Religious leaders 10 (5 f and 5 m) 12 (2 f and 10 m) Up to 6  
Traditional leaders/elders 10 (5 f and 5 m) 12 (3 f and 9 m)
Version D Local government officials 10 (5 f and 5 m) 12 (6 f and 6 m) 0
Version E Women leaders 5 f 6 f Up to 6
Version F Members of Community Health Committees 10 (5 f and 5 m) 12 (6 f and 6 m) Up to 6
Total per Consortium Organization 65 78 18 (up to 24)
[1] LINC factors are risk factors which can lead to preterm birth:  unhealthy Lifestyles, maternal Infection, poor Nutrition and lack of access to Contraception (LINC). [2] You D, Hug L, Chen Y et al. Levels & Trends in Child Mortality Report 2014 [3] WHO, Born Too Soon: The Global Action Report on Preterm Birth, 2012 [4] WHO, Born Too Soon: The Global Action Report on Preterm Birth, 2012 [5] UNICEF, ‘State of the World’s Children in Numbers: Every child counts’ (2014). [6] EDHS 2011. [7] UNICEF’s State of the World’s Children 2015. [8] WVE, 2014. [9] Violence against Women Survey 2011, Bangladesh Bureau of Statistics [10] Enquête Démographique et de Santé (EDSM V), 2012-2013. [11] UNICEF, 2014. [12] UNESCO Institute of Statistics Database (2015). [13] WVE, 2014. [14] The exact number of FGDs and KIIs might slightly change after data collection.