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This article is one of three synthesis reports resulting from an integrated assessment (IA) of artisanal and small-scale gold mining (ASGM) in Ghana. Given the complexities that involve multiple drivers and diverse disciplines influencing ASGM, an IA framework was used to analyze economic, social, health, and environmental data and to co-develop evidence-based responses in collaboration with pertinent stakeholders. We look at both micro- and macro-economic processes surrounding ASGM, including causes, challenges, and consequences. At the micro-level, social and economic evidence suggests that the principal reasons whereby most people engage in ASGM involve “push” factors aimed at meeting livelihood goals. ASGM provides an important source of income for both proximate and distant communities, representing a means of survival for impoverished farmers as well as an engine for small business growth. However, miners and their families often end up in a “poverty trap” of low productivity and indebtedness, which reduce even further their economic options. At a macro level, Ghana’s ASGM activities contribute significantly to the national economy even though they are sometimes operating illegally and at a disadvantage compared to large-scale industrial mining companies. Nevertheless, complex issues of land tenure, social stability, mining regulation and taxation, and environmental degradation undermine the viability and sustainability of ASGM as a livelihood strategy. Although more research is needed to understand these complex relationships, we point to key findings and insights from social science and economics research that can guide policies and actions aimed to address the unique challenges of ASGM in Ghana and elsewhere.

186and ineffective use of barrier contraceptives 8 and the decreased value placed on virginity. 9 To date, however, few studies have investigated young people's perceptions of the problem.To design appropriate interventions, it is important to know about adolescents' knowledge of and experience with STDs and about their health-seeking behavior related to STDs. For example, we need information about adolescents' knowledge of and attitudes toward using condoms for STD prevention, their use of various types of health providers for the treatment of STDs and their attitudes toward partner notification. It is widely recognized that Nigerian adolescents do not use existing reproductive health services. 10 This poor utilization of public services is probably largely attributable to the fact that such services do not specifically address the needs and concerns of adolescents.Eliciting adolescents' views on reproductive health in communities where sexuality is not openly discussed can be problematic. A quantitative research design yields limited information on this complex Miriam J. Temin is a population and reproductive health officer/Michigan international development associate

Mercury use in small-scale gold mining is ubiquitous across Ghana but little is known about the extent to which such activities have contaminated community residents and miners. Here, occupational exposures to elemental mercury (via urine sampling) and dietary exposures to methylmercury (via hair sampling) were assessed among 120 participants recruited from a mining community located in the Talensi-Nabdam District of Ghana’s Upper East region during summer 2009. More than one-fifth of the participants had moderately high levels of urinary mercury (>10 µg/L) and 5% had urine mercury levels that exceeded the WHO guideline value of 50 µg/L. When participants were stratified according to occupation, those active in the mining industry had the highest mercury levels. Specifically, individuals that burned amalgam had urine mercury levels (median: 43.8 µg/L; mean ± SD: 171.1 ± 296.5 µg/L; n=5) significantly higher than median values measured in mechanical operators (11.6 µg/L, n=4), concession managers/owners (5.6 µg/L, n=11), excavators that blast and chisel ore (4.9 µg/L, n=33), individuals that sift and grind crushed ore (2.2 µg/L, n=47), support workers (0.5 µg/L, n=14), and those with no role in the mining sector (2.5 µg/L, n=6). There was a significant positive spearman correlation between fish consumption and hair mercury levels (r = 0.30) but not with urine mercury (r = 0.18) though further studies are needed to document which types of fish are consumed as well as portion sizes. Given that 200,000 people in Ghana are involved in the small-scale gold mining industry and that the numbers are expected to grow in Ghana and many other regions of the world, elucidating mercury exposure pathways in such communities is important to help shape policies and behaviors that may minimize health risks.