Medicine and Health Sciences Commons^™

Sterilization In The United States: Prevalence And Controversies, Carey Brown

Masters Theses & Specialist Projects

There have been many breakthroughs in birth control technologies, many of which have been beneficial for women. However, many feminists who advocate reproductive freedom also warn that freedom for some might lead to further oppression for others. The case in point is the practice of tubal ligation in the United States. Conflict theory indicates that the field of medicine is a social structure that is based upon capitalistic ideology and serves to perpetuate inequality. Feminist theory argues that medicine systematically disempowers women and that notions of family are very narrowly defined. This study examined the prevalence of tubal ligation among …

Social Identity And Substance Abuse In The Lesbian Community, Molly Kerby

Masters Theses & Specialist Projects

The purpose of this study was to determine the degree of substance use (alcohol, tobacco, and other drugs) among members of the lesbian community. Additionally, the investigator attempted to determine if there was a relationship between negative social identity and low selfesteem that is reflected in higher rates of substance abuse. The data collection method employed in this study was a type of nonprobability sampling procedure referred to as a purposive sample. The questionnaire was derived from instruments used by other researchers and validated by an expert panel. In order to select respondents from the lesbian population to be included …

Violence Prevention: Reaching Adolescents With The Message, James B. Tucker, James E. Barone, Julie G. Stewart, Robert J. Hogan, James A. Sarnelle, Michele M. Blackwood

Nursing Faculty Publications

To identify an effective medium for communicating with adolescents in a large-scale, cost-effective violence prevention program.

A set of youth violence prevention programs was established at The Stamford Hospital, a level II trauma center. The traveling version of the program was presented to middle school students in four parts: 1) a rap music video created by our violence prevention staff, 2) a facilitated discussion about dealing with anger, 3) a video of a trauma resuscitation in our emergency department, and 4) a commercial video of a teenage boy paralyzed after a gunshot wound. A written questionnaire with a five-point rating …

Patient Preference For The Management Of Mildly Abnormal Papanicolau Smears, Marta Meana, Donna E. Stewart, Gordon M. Lickrish, Joan Murphy, Barry Rosen

Psychology Faculty Research

The article provides information on a study that investigated management preference and desire for decision-making involvement in women who have received a first mildly abnormal Papanicolaou smear. The majority of women in this highly educated sample preferred active management of their mildly abnormal Pap smears, although a substantial minority either opted for the surveillance strategy or reported no strong preference. Furthermore, management preference in this sample was not related to knowledge but rather to level of state anxiety. This indicates that these decisions may be guided more by emotions than by facts. Research has shown repeatedly that abnormal Pap smears …

Street-Based Female Adolescent Puerto Rican Sex Workers: Contextual Issues And Health Needs, Margarita Burgos, Donna L. Richter, Belinda Reininger, Ann L. Coker, Ruth Saunders, Margarita Alegria, Mildred Vera

CRVAW Faculty Journal Articles

Adolescent sex workers potentially have many health needs but are included rarely in health assessments; therefore, little is known about their needs or how to reach them. This study examines the motivations, social context, and health needs of street-based adolescent sex workers. The results show these youths are more likely to experience negative health outcomes, such as unintended pregnancies and sexually transmitted infections, when they are using drugs or are depressed. These findings suggest the need for comprehensive programming to include individual, interpersonal, and greater environmental interventions. Examples for reaching adolescent sex workers are discussed.

Physical Violence During Pregnancy: Maternal Complications And Birth Outcomes, Vilma E. Cokkinides, Ann L. Coker, Maureen Sanderson, Cheryl Addy, Lesa Bethea

CRVAW Faculty Journal Articles

Objective: To assess the association between physical violence during the 12 months before delivery and maternal complications and birth outcomes.

Methods: We used population-based data from 6143 women who delivered live-born infants between 1993 and 1995 in South Carolina. Data on women's physical violence during pregnancy were based on self-reports of partner-inflicted physical hurt and being involved in a physical fight. Outcome data included maternal antenatal hospitalizations, labor and delivery complications, low birth weights, and preterm births. Odds ratios and 95% confidence intervals were calculated to measure the associations between physical violence, maternal morbidity, and birth outcomes.

Results: The prevalence …

Assessing The Potential Demand For And Effectiveness Of Integrating Sti/Hiv Management Services With Zimbabwe National Family Planning Council's Clinic-Based Family Planning Services, Baker Ndugga Maggwa, Ian Askew, Hazel M.B. Dube, Caroline S. Marangwanda, Sithokozille Simba, Ahmed Latif

Reproductive Health

HIV/AIDS is a threat to individual lives and the national economies of many sub-Saharan African countries, despite efforts to contain its spread. The region also suffers from high levels of other reproductive tract infections (RTIs), some of which increase the risk of sexual transmission of HIV. The control of RTIs is therefore seen not only as an important reproductive health care strategy, but as a key strategy in reducing the spread of HIV/AIDS. Most national health care programs in the region are actively seeking cost-effective ways of implementing an RTI management program that would reduce and prevent RTIs and HIV. …

Investigación Operativa En Planificación Familiar: Lecturas Selectas, James R. Foreit, Tomas Frejka

Reproductive Health

Desde que existen los programas de planificación familiar existe la investigación sobre este tema. En el nivel teórico, los investigadores examinan el efecto de la fertilidad sobre la salud y el desarrollo socioeconómico y estudian los determinantes de la fecundidad para los individuos y la poblaciones. En el nivel de las políticas, los estudios exploran el papel que juegan los programas de planificación familiar en la modificación de la fecundidad y la salud. El desarrollo de nuevos anticonceptivos se acompaña de pruebas clínicas y pre-introductorias en el contexto de los programas. Se llevan a cabo encuestas para medir los cambios …

Investing In Youth: Testing Community-Based Approaches For Improving Adolescent Sexual And Reproductive Health, Tamara Fetters, Fines Munkonze, Julie Solo

Reproductive Health

The world is now sustaining the largest number of youth in human history; today there are nearly 900 million 10–19-year-olds and their health and livelihood issues are becoming increasingly important to policymakers worldwide. In Zambia, as in many other countries, young people face severe problems, including limited access to jobs, secondary education, and health care. The social, economic, and peer pressures that youth face often lead to high levels of sexual activity, often with subsequent negative impacts on their sexual and reproductive health. In spite of the magnitude of the reproductive health problems facing youth, they still have limited access …

Housing And Population Health: A Review Of The Literature, Stephen Hwang, Esme Fuller-Thomson, J. David Hurlchanski, Toba Bryant, Youssef Habib, Wendy C. Regoeczi

Sociology & Criminology Faculty Publications

Research into the relationship between housing and health has frequently been narrowly focused, fragmented, and of marginal practical relevance to either housing or health studies. Population health research, in its reference to the importance of the social and physical environment, rarely mentions housing. While it has been recognized for some time that there is a need for the development of a co-ordinated, integrated and cumulative body of housing and health research, there is still very little formal co-ordination between housing policy and population health policy. More attention needs to be paid to measuring the nature and extent to which better …

L'Approche De L'Analyse Situationnelle Pour L'Évaluation Des Services De Planification Familiale Et De Santé De La Reproduction: Manuel De Recherche, Robert A. Miller, Andrew A. Fisher, Kate Miller, Lewis Ndhlovu, Baker Ndugga Maggwa, Ian Askew, Diouratie Sanogo, Placide Tapsoba

Reproductive Health

Une bonne prestation de services de planification familiale mettant l'accent à la fois sur l'accès et la qualité est la clé des objectifs interdépendants de satisfaction des besoins individuels et la réalisation du succès programmatique. L'analyse de situation (AS) fournit un lien nécessaire entre le responsable de programme et la cliente qu'il essaie de servir. Les données recueillies par l’AS offrent une image représentative du fonctionnement des composantes et permettent de «voir» l'expérience de la cliente. Les analyses situationnelles aident le responsable de programme à atteindre le plus grand but en termes de gestion—celui d’une administration efficace d'un service de …

The Tostan Story: Breakthrough In Senegal Ending Female Genital Cutting [Arabic], Population Council

Reproductive Health

In Senegal, elements of the Tostan education program were fundamental to the ending of the practice of female genital cutting (FGC) which has persisted for centuries, despite outside efforts to abolish such a dangerous and harmful operation. This paper is an attempt by those who lived through these events to share the experience with others. At a time when there has been little reduction in the numbers of women ending FGC in 28 African countries, when different programs and strategies have rarely succeeded in making an impact on the number of women still practicing FGC despite laws abolishing the tradition, …

Completing The Demographic Transition, John Bongaarts, Rodolfo A. Bulatao

Poverty, Gender, and Youth

Despite ongoing declines in fertility in many countries, the population of the world is experiencing a period of rapid expansion, and its size is expected to exceed 10 billion by the end of the demographic transition. Three causes of this growth are identified and quantified: 1) fertility above the replacement level of two surviving children per woman, 2) continuing declines in mortality, and 3) population momentum resulting from a young age structure. A set of simple analytic expressions is proposed for estimating these factors from standard demographic indicators. Population momentum is shown to be the main cause of future growth …

Measuring Living Standards With Proxy Variables, Mark R. Montgomery, Michele Gragnolati, Kathleen A. Burke, Edmundo Paredes

Poverty, Gender, and Youth

Very few demographic surveys in developing countries gather information on household income or consumption expenditure, despite the theoretical importance of these measures. Consequently, researchers have been forced to rely on ad hoc collections of proxy measures for living standards, and the properties of these proxies have not been systematically analyzed. In this research, we ask what hypotheses can be tested using proxy variables, and evaluate the performance of proxy measures in relation to consumption expenditures per adult, our preferred measure of living standards. We find that the proxy variables commonly employed in demographic research are very weak predictors of consumption …

The Decline Of Female Circumcision In Egypt: Evidence And Interpretation [Arabic], Omaima El-Gibaly, Barbara L. Ibrahim, Barbara Mensch, Wesley H. Clark

Poverty, Gender, and Youth

Female circumcision is widespread in Egypt. Research suggests that the practice persists because of a belief that circumcision will moderate female sexuality, that it will assure a girl’s marriageability, and that it is sanctioned by Islam. Using data from a nationally representative survey of adolescents, this paper investigates the prevalence and social correlates of circumcision among girls aged 10-19, the circumstances surrounding the procedure, and the attitudes of adolescents towards it. While the vast majority of adolescents are circumcised, a life table analysis indicates that girls today are at least 10 percentage points less likely to undergo female circumcision than …

Lessons From Community-Based Distribution Of Family Planning In Africa, James F. Phillips, Wendy L. Greene, Elizabeth F. Jackson

Poverty, Gender, and Youth

This paper reviews findings and experiences from efforts to implement community-based family planning services in sub-Saharan Africa. Although research suggests that community-based service delivery can contribute to contraceptive use, the magnitude of impact is often in doubt or is considerably less than was observed in similar projects in Asia in the 1970s and 1980s. Reasons for the constrained impact of community-based family planning in Africa are reviewed and assumptions about the efficacy and mechanism of community-based distribution (CBD) are discussed. Whereas several contrasting approaches to CBD have been tried, little is known about the relative merits of alternative CBD approaches.

Reproductive Decisionmaking In The Context Of Hiv/Aids In Ndola, Zambia, Naomi Rutenberg, Ann E. Biddlecom, Frederick A.D. Kaona

Reproductive Health

Family planning (FP) programs are increasingly being considered as a logical focal point for STD and HIV/AIDS prevention services because they serve large numbers of women at risk, address the sensitive issue of sexual behavior and fertility control, and the methods for preventing unwanted pregnancy and disease can be the same. FP programs, by providing contraceptive methods, are currently one of the few sources of assistance in the sub-Saharan African region for preventing perinatal transmission of HIV, while the promotion of barrier methods contributes to the prevention of heterosexual transmission. Given this potential, research is needed to understand how the …

Mortality Decline And The Demographic Response: Toward A New Agenda, Mark R. Montgomery

Poverty, Gender, and Youth

A central proposition of demographic transition theory is that declines in infant and child mortality can encourage subsequent declines in fertility. Even the earliest formulations of the theory recognized that fertility decline would occur only with a lag, but neither theory nor empirical work has explored the length of such lags. This paper urges that individual perceptions and beliefs about mortality risks, conspicuously absent from the demographic research agenda, be studied directly. It proceeds to link mortality perceptions to health care decisionmaking and investments in children. The paper concludes by calling for a new agenda on mortality decline. This agenda …

Case Finding And Case Management Of Chlamydia And Gonorrhea Infections Among Women: What We Do And Do Not Know, Nicole Haberland, Beverly Winikoff, Nancy L. Sloan, Christiana Coggins, Christopher J. Elias

Reproductive Health

As the world grapples with the HIV pandemic, the implementation of the agenda determined by the International Conference on Population and Development (1994) at Cairo, and the matter of providing health services of adequate quality in an ethical, gender-sensitive manner, new questions are arising about how to attend to reproductive tract infections, including sexually transmitted infections (STIs), among women. This paper reviews the results of validation studies of syndromic algorithms, other nonlaboratory clinically based tools, and risk scoring for finding women infected with chlamydia and gonorrhea, particularly among those attending family planning and antenatal clinics in developing countries. The results …

Estimating Costs Of Post-Abortion Services. General Hospital Aurelia Valdivieso, Oaxaca, Mexico, Population Council

Reproductive Health

Health care systems around the world are facing problems providing quality care with increasingly constrained resources. While modern practices and diagnostic tests have made pregnancy a much less risky event than in the past, not all pregnancies have a favorable outcome. Spontaneous abortion occurs in 15–45% of all known pregnancies, and studies show that 25% of all obstetric/gynecology hospital admissions are for incomplete abortion. Given the high level of resources devoted to treating this condition, it is imperative to develop cost-effective methodologies to provide quality care. Unsafe abortion performed by untrained and inexperienced providers is the fourth leading cause of …

Zimbabwe: Los Métodos De Detección De Itr En Mujeres No Son Cost-Efectivos, Population Council

Reproductive Health

Las infecciones del tracto reproductivo (ITR) son frecuentes en Zimbabwe. Muchas de estas infecciones aumentan el riesgo de contraer el virus de inmunodeficiencia humana (VIH). En 1998, el Consejo Nacional de Planificación Familiar de Zimbabwe (en inglés, ZNFPC) realizó un estudio de IO para evaluar la viabilidad de integrar el diagnóstico y tratamiento de ITR en su oferta de servicios. La población estudiada estaba constituida por 1,634 clientas de tres clínicas de ZNFPC. Se preguntó a las usuarias si presentaban dolor en la región abdominal inferior, flujo vaginal y otros síntomas de ITR; asimismo, se les examinó para detectar la …

Zimbabwe: Les Méthodes De Dépistage Des Iar Chez Les Femmes Sont Chères Et Inefficaces, Population Council

Reproductive Health

Les Infections de l’Appareil Reproductif (IAR) sont courantes au Zimbabwe. Beaucoup d’IAR augmentent le risque d’infection au Virus de l’Immunodéficience Humaine. En 1998, le Conseil National de Planification Familiale du Zimbabwe (ZNFPC) a entrepris une recherche opérationnelle afin d’évaluer la faisabilité de l’intégration du diagnostic des IAR et des services de traitement dans son menu de services. La population étudiée consistait en 1634 clientes de trois cliniques du ZNFPC. Chaque cliente a été interrogée sur les douleurs au bas ventre, les pertes vaginales et autres symptômes d’IAR. Elles ont ensuite été examinées pour des signes cliniques d’IAR, et ont subi …

Zimbabwe: Rti Screening Methods For Women Are Not Cost-Effective, Population Council

Reproductive Health

Reproductive tract infections (RTIs) are common in Zimbabwe. Many RTIs increase the risk of human immunodeficiency virus (HIV) infection. In 1998, the Zimbabwe National Family Planning Council (ZNFPC) conducted an operations research study to assess the feasibility of adding RTI diagnosis and treatment to its menu of services. The study population consisted of 1,634 clients at three ZNFPC clinics. Each client was asked about lower abdominal pain, vaginal discharge, and other RTI symptoms; examined for clinical signs of RTIs; and given laboratory tests to confirm the accuracy of diagnosis based upon symptoms and signs. Findings detailed in this brief were …

Peru: Providers' Compliance With Quality Of Care Norms, Federico R. Leon

Reproductive Health

Peru's Ministry of Health (MOH) introduced changes in its family planning service delivery strategy and set quality-of-care goals purported to ensure informed choice of methods and respect for the users’ reproductive intentions and rights. This study was designed to assess the extent to which providers comply with the guidelines in their daily routine. The study found that among the strongest elements of care are interpersonal relationships and free choice of methods. However, shortcomings were observed in screening for contraindications and information given to the client. The report includes a number of recommendations, including offering providers IEC materials, training, and supervision …

The Female Condom In Zimbabwe: The Interplay Of Research, Advocacy, And Government Action, Population Council

HIV and AIDS

During the past decade, a significant increase in reported cases of HIV/AIDS in Zimbabwe prompted the government, local organizations, and international donors to intensify prevention efforts. As part of this response, in November 1996 Zimbabwe’s National AIDS Coordinating Programme invited Population Services International to launch a social marketing program to promote the female condom, making this protective device widely available for the first time in Africa. After an acceptability study showed that Zimbabwean men and women liked using the female condom, leaders of these organizations encouraged public discussion and media attention, which helped pave the way to approval and introduction …

Indonesia: Analysis Of Conflicting Crisis-Related Research Results, Michelle Gardner, Lila Amaliah

Reproductive Health

This report aims to explain the discrepancies in crisis-related research results in Indonesia, and to recommend methodologies to enhance future crisis-related monitoring and surveillance. The discussion aims to identify where the discrepancies are in the readily available data, and how these discrepancies can be explained. The report does not attempt to clarify the impact that the economic crisis is having on the health status of women and children in Indonesia. Recommendations are made to deal with the following findings: Aggregation of data may hide important crisis impacts; attribution of identified changes to the economic crisis may be misleading; differences in …

Mexico: Training Health Providers On Domestic Violence, Susan Pick, Lydia Miranda

Reproductive Health

This project was designed to disseminate, expand use, and promote institutionalization of a program to train healthcare professionals to address domestic violence. The program was developed and implemented by the Instituto Mexicano de Investigación de Familia y Población (IMIFAP), a nongovernmental organization that promotes reproductive health. IMIFAP designed an 18-hour workshop, entitled “Health Services Respond to Domestic Violence,” to sensitize health professionals to domestic violence issues and develop strategies for recognizing and managing cases of domestic violence. Following the workshop, strong and significant increases in knowledge about domestic violence and its management in primary healthcare services were found. Workshop participants …

Reproductive Health Indicators: Moving Forward, Kelly Blanchard, Batya Elul, Saumya Ramarao

Reproductive Health

This report is designed to help researchers, program managers, policymakers, and advocates sift through and evaluate which potential indicators might be useful in a particular programmatic context. It was initially prepared as a background manuscript for a Population Council meeting on reproductive health indicators held in Cairo in March 1998. The manuscript has since been modified to incorporate ideas and comments expressed at that meeting, as well as to include input from other Population Council colleagues.

Literature Review: Challenging Hiv-Related Stigma And Discrimination In Southeast Asia: Past Successes And Future Priorities, Joanna Busza

HIV and AIDS

Pervasive stigma has surrounded HIV/AIDS since the beginning of the pandemic. In Southeast Asia, as elsewhere, it has been accompanied by discrimination, affecting transmission patterns and access to care and support. This paper describes the regional experience of stigma and discrimination and offers a review of community-based interventions that have attempted to reduce them. The evidence presented comes primarily from unpublished literature and anecdotal evidence gained through interviews with project staff throughout the region.

Quality Of Care And Utilisation Of Mch And Fp Services At Kenyan Health Facilities, Lewis Ndhlovu

Reproductive Health

Quality of services is playing an increasingly important role in many family planning (FP) programs. In 1995, a national Situation Analysis Study of 254 health facilities was conducted in Kenya to assess the status and quality of FP services in the country. An in-depth survey of a subsample of 28 health facilities was conducted the following year. From these facilities, 1,834 women were interviewed about their experiences with services at facilities when they sought antenatal, child health, and FP services. The goal of the survey was to examine the links between quality of care in FP services and contraceptive behavior. …