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The Rationale And Relevance Of Existing Cadres Of Frontline Health Workers And Potential For New Mid-Level Cadres, Oladimeji Oladepo, Ekechi Okereke, Akinwumi Akinola Jan 2018

The Rationale And Relevance Of Existing Cadres Of Frontline Health Workers And Potential For New Mid-Level Cadres, Oladimeji Oladepo, Ekechi Okereke, Akinwumi Akinola

Reproductive Health

Front-line health workers (FLHWs) are expected to perform necessary maternal, newborn, and child (MNCH) services appropriately and effectively; however, few studies have investigated the extent to which FLHWs perform requisite primary health care (PHC) services. This study seeks to better understand not only FLHWs’ knowledge and performance of MNCH services, but the factors promoting and inhibiting their services in selected rural local government areas of Nigeria’s Bauchi and Cross River states. It also investigates the potential for a new PHC worker cadre, soliciting stakeholders’ perceptions about its feasibility for addressing maternal and newborn disease burdens in rural communities. The study’s …


Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli Jan 2018

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.


Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte Jan 2018

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …


Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance Jan 2018

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …


The Perspectives Of Men In Mexico City About Vasectomy—Brief, Isabel Vieitez Martínez, Adriana Ramos Jan 2018

The Perspectives Of Men In Mexico City About Vasectomy—Brief, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

On November 17, 2017, Mexico City took part in the global World Vasectomy Day campaign promoting men’s participation in family planning, especially through no-scalpel vasectomy (NSV). During the event the Population Council Mexico conducted an exploratory study to better understand the reasons men chose NSV, as well as their concerns before and after the procedure. The study found that the principal reason for seeking NSV among men surveyed was their achievement of a desired family size, for themselves and their partners. The study further reveals the need to disseminate information through mass media, social networks, and all levels of the …


Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren Jan 2018

Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and …


Changes In Fgm/C In Somaliland: Medical Narrative Driving Shift In Types Of Cutting, Richard A. Powell, Mohamed Yussuf Jan 2018

Changes In Fgm/C In Somaliland: Medical Narrative Driving Shift In Types Of Cutting, Richard A. Powell, Mohamed Yussuf

Reproductive Health

In Somalia, female genital mutilation/cutting (FGM/C) prevalence is nearly universal at 98 percent. This qualitative study sought to explore: 1) views and experiences of married and unmarried men and women on FGM/C and potential changes in its practice; 2) individual, family, and societal factors contributing to any changes, or continuation of FGM/C; 3) the knowledge, views, and experiences of healthcare workers who offer FGM/C services and their role as change agents rather than providers; and 4) how healthcare systems’ capacities can be strengthened for management and prevention. The study finds that normative changes appear to be occurring in Somaliland society …


Fgm/C Decision-Making Process And The Role Of Gender Power Relations In Sudan, Ahmed Gamal Eldin, Suad Babiker, Majdi Sabahelzain, Muna Eltayeb Jan 2018

Fgm/C Decision-Making Process And The Role Of Gender Power Relations In Sudan, Ahmed Gamal Eldin, Suad Babiker, Majdi Sabahelzain, Muna Eltayeb

Reproductive Health

This study by the Population Council, Nairobi and partners aimed to contribute to a better understanding of female genital mutilation/cutting (FGM/C) in Sudan and the way different families perceive the practice and make FGM/C-related decisions. The ultimate goal was to inform interventions aimed at accelerating the pace of positive behavioral and social norm change and eventually promote the abandonment of all forms of FGM/C in Sudan. The findings indicate that although parents often make the final decision to cut or not cut their daughters, they do not act in isolation but are influenced by dominant social norms and by other …


Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte Jan 2018

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …


Exploring The Nigerian Health System's Response To Female Genital Mutilation/Cutting, Otibho Obianwu Jan 2018

Exploring The Nigerian Health System's Response To Female Genital Mutilation/Cutting, Otibho Obianwu

Reproductive Health

Although Nigeria has shown a steady long-term decline in female genital mutilation/cutting (FGM/C) prevalence, the practice remains widespread. This study brief outlines the Population Council’s Evidence to End FGM/C research program, which, in collaboration with the Federal Ministry of Health, will conduct a diagnostic assessment in order to: 1) examine how the healthcare sector supports the prevention of FGM/C; 2) determine the role of the healthcare sector in the management of FGM/C-related complications and the quality of care offered to clients; and 3) identify possible solutions for strengthening the healthcare system’s capacity to manage and prevent FGM/C. Findings are intended …


Understanding Medicalisation Of Female Genital Mutilation/Cutting (Fgm/C): A Qualitative Study Of Parents And Health Workers In Nigeria, Otibho Obianwu, Adetayo Adetunji, Osasuyi Dirisu Jan 2018

Understanding Medicalisation Of Female Genital Mutilation/Cutting (Fgm/C): A Qualitative Study Of Parents And Health Workers In Nigeria, Otibho Obianwu, Adetayo Adetunji, Osasuyi Dirisu

Reproductive Health

This community-based, cross-sectional qualitative study was conducted in four communities in Nigeria’s Delta, and was conceptualized to address gaps in our understanding of medicalization of female genital mutilation/cutting (FGM/C) and to provide critical evidence needed to effectively design abandonment interventions. The study findings reveal that the social norms driving FGM/C practice remain entrenched despite a shift to medicalization. They also reflect the tendency of parents and health workers to view FGM/C, whether traditional or medicalized, as a minor procedure with few complications and significant benefits that would positively impact a daughter’s future status as a wife and mother. Findings reveal …


Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren Jan 2018

Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren

Reproductive Health

Pre-eclampsia and eclampsia (PE/E)—life-threatening high blood pressure and excess protein in the urine after 20 weeks gestation—is a leading cause of pregnancy-related deaths. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. The Population Council implemented a two-phase intervention involving training, mentoring, and supervising providers at secondary facilities on detection and management of PE/E patients (Phase 1), and training primary health care (PHC) providers to administer a modified loading dose of magnesium sulphate and refer women to secondary health facilities for monitoring (Phase 2). This brief describes the Population Council’s …


Shifts In Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Samuel Kimani, Caroline W. Kabiru Jan 2018

Shifts In Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Samuel Kimani, Caroline W. Kabiru

Reproductive Health

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these …


Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain Jan 2018

Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain

Reproductive Health

Study findings reveal that many Kenyan women living with HIV are comfortable receiving family planning (FP) services from community health volunteers and with proper training and support, community health volunteers have the potential to provide integrated FP/HIV services. Community-based integrated FP/HIV services could help connect women living with HIV who want to prevent or postpone a pregnancy to contraceptive services, which can reduce unintended pregnancies and in turn maternal mortality and vertical transmission of HIV. This implementation research study offers evidence of the feasibility, quality of care, and acceptability of using community health volunteers to integrate family planning into HIV/AIDS …


Trends In Medicalisation Of Female Genital Mutilation/Cutting: What Do The Data Reveal?, Bettina Shell-Duncan, Carolyne Njue, Zhuzhi Moore Jan 2018

Trends In Medicalisation Of Female Genital Mutilation/Cutting: What Do The Data Reveal?, Bettina Shell-Duncan, Carolyne Njue, Zhuzhi Moore

Reproductive Health

Despite the emergence of international consensus that female genital mutilation/cutting (FGM/C) is a violation of human rights, a focus on medicalization remains salient because of concerns that FGM/C is increasingly being performed by healthcare professionals and may be impeding progress toward abandonment of FGM/C. To investigate these claims, this study draws on nationally representative survey data from 26 countries, and addresses the following three questions: 1) What are the major patterns and trends in medicalisation? 2) Is there an association between medicalization and rates of change in prevalence of FGM/C? and 3) Is there an association between medicalization and support …


Understanding The Key Elements For Designing And Implementing Social Marketing Campaigns To Inform The Development Of Creative Approaches For Fgm/C Abandonment In Sudan, Widad Ali A/Rahman, Samia Al Nagar, Randa H. Gindeel, Arwa Salah Jan 2018

Understanding The Key Elements For Designing And Implementing Social Marketing Campaigns To Inform The Development Of Creative Approaches For Fgm/C Abandonment In Sudan, Widad Ali A/Rahman, Samia Al Nagar, Randa H. Gindeel, Arwa Salah

Reproductive Health

Social marketing campaigns (SMCs) have gained prominence in female genital mutilation/cutting (FGM/C) abandonment efforts, but there is a dearth of information on how these programs are designed and implemented, and their perceived impact. Understanding the implementation process and the effectiveness of these campaigns is critical for drawing lessons to improve existing programs and inform the design and scale up of SMCs in other regions/countries. This mixed-method study sought to address this gap by assessing the design and implementation of existing SMC programs in Sudan. While the study findings demonstrate several strengths of existing programs, including strong partnerships and extensive needs …


Baseline Evaluation Of Project Mesha In Bihar: Factsheet Results 2017-2018, Population Council Jan 2018

Baseline Evaluation Of Project Mesha In Bihar: Factsheet Results 2017-2018, Population Council

Reproductive Health

This fact sheet presents baseline results for an evaluation survey among women who were the primary decisionmakers in the rearing of goats in Bihar, India. The study underpins the Aga Khan Foundation’s implementation of “Project Mesha,” a community-based program to develop the potential of goat farming among women goat rearers in four blocks of Muzaffarpur district. The aim of the project is to increase the income and empowerment of women goat rearers through the implementation of Project Mesha in JEEViKA-run self-help groups. The fact sheet includes data on demographic and household profiles; goat ownership, rearing, income, and productive resources; access …


Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson Jan 2018

Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson

Reproductive Health

Both the family planning sector and the environmental sector will be interested in this synopsis of findings from a study of the first four years of the Tuungane integrated population, health, and environment (PHE) project in Tanzania. The objectives of the Tuungane Project are to achieve healthier families, healthier forests, and healthier fisheries, using an integrated, cross-sectoral approach. Analyses of the 2011 baseline and 2016 midline quantitative data, and additional qualitative data from 2016, measured the project’s progress and shed light on the contribution of the project interventions to building resilience, and on the links between family planning and other …


Collaborative Work With Somaliland Stakeholders To Increase Evidence Based Decision Making In Fgm/C, Chantalle Okondo Jan 2018

Collaborative Work With Somaliland Stakeholders To Increase Evidence Based Decision Making In Fgm/C, Chantalle Okondo

Reproductive Health

The Population Council collaborated with partners Orchid Project and Somaliland Family Health Association to pilot a new approach to disseminating research findings in order to increase the impact of evidence-based decisionmaking in program, policy, and investments in female genital mutilation/cutting (FGM/C). This brief reports on a recent workshop that utilized an open space approach to encourage review of recent key evidence on FGM/C in Somaliland; explore UNICEF’s six elements of abandonment and their relevance to the Somaliland context; link research with decisionmaking; and develop action plans. Participants identified six key themes for further reflection: behavioral/social change, medicalization, policy, child rights, …


Expanding The Evidence Base And Networks For Sexual Violence Response In East And Southern Africa—Completion Report For The Period May 2014–February 2018, Population Council Jan 2018

Expanding The Evidence Base And Networks For Sexual Violence Response In East And Southern Africa—Completion Report For The Period May 2014–February 2018, Population Council

Reproductive Health

This is the final report of the Expanding the Evidence Base and Networks for Sexual Violence Response program, which, over the years, has enabled regional partners to collectively test and document experiences in tackling violence against children and sexual and gender-based violence (SGBV) in humanitarian contexts. To foster SGBV prevention and ensure that responses to SGBV are effective, the program has targeted a range of stakeholders, including influential regional bodies; the health, education, and justice sectors; and children and refugees—as survivors as well as members of communities where prevention is being promoted. The program has helped to change the way …


Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Kogi State, Salisu Mohammed Ishaku Jan 2018

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Kogi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Kogi state on post-intervention landscape changes in: programmatic and …


Medicalisation Of Female Genital Mutilation/Cutting In Sudan: Shift In Types And Providers, Nafisa Bedri, Huda Sherfi, Ghada Rudwan, Sara Elhadi, Wafa Elamin Jan 2018

Medicalisation Of Female Genital Mutilation/Cutting In Sudan: Shift In Types And Providers, Nafisa Bedri, Huda Sherfi, Ghada Rudwan, Sara Elhadi, Wafa Elamin

Reproductive Health

This study by the Population Council and the Gender and Reproductive Health and Rights Resource and Advocacy Center aimed to inform the development of future interventions by generating evidence on the drivers of the shifts in the practice of female genital cutting/mutilation (FGM/C) in Sudan. Researchers conducted a community-based cross-sectional, comparative, mixed-methods study that examined shifts in the type of cut, its level and significance, as well as the supply and demand factors associated with medicalization. They also explored interventions and alternative approaches that may prevent medicalization and the sustenance of the practice of FGM/C, including re-infibulation. The study finds …


Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi Jan 2018

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina …


The Perspectives Of Men In Mexico City About Vasectomy, Isabel Vieitez Martínez, Adriana Ramos Jan 2018

The Perspectives Of Men In Mexico City About Vasectomy, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

As part of World Vasectomy Day, the Population Council Mexico conducted an exploratory study about the reasons and concerns that led men to seek a no-scalpel vasectomy (NSV) during the 24-hour “Vasectomy-athon” in Mexico City in 2017. This study was intended as the first part of a longer cohort study that would follow up with the men, and their partners, to learn about their experiences with the procedure and its effects, if any, on their relationships. Based on the findings, the report recommends that the Mexican Ministry of Health (SSA) continue integrating NSV information, counseling, and services within the National …


Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan Jan 2018

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to …