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Full-Text Articles in Medicine and Health Sciences
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
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. …
Investing In Youth: Testing Community-Based Approaches For Improving Adolescent Sexual And Reproductive Health, Tamara Fetters, Fines Munkonze, Julie Solo
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 …
Completing The Demographic Transition, John Bongaarts, Rodolfo A. Bulatao
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
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 …
Lessons From Community-Based Distribution Of Family Planning In Africa, James F. Phillips, Wendy L. Greene, Elizabeth F. Jackson
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 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
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
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
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: Rti Screening Methods For Women Are Not Cost-Effective, Population Council
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
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
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
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
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 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
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
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. …
Population Weights In The International Order, Geoffrey Mcnicoll
Population Weights In The International Order, Geoffrey Mcnicoll
Poverty, Gender, and Youth
Population relativities play little part in the international system. A nation’s economic and military power is influenced by population size, but as one factor among many. Formal relations among states exclude population from consideration by the principle of sovereign equality. Three sources of possible change in this situation are explored, in which states would be “population-weighted” to a greater degree than before. Convergence of productivity levels around the world, expected by many, would bring the economic and population rankings of states more into line. Such convergence is occurring, but selectively and for the most part quite slowly. Anticipation of its …
Urban Growth In Developing Countries: A Review Of Projections And Predictions, Martin Brockerhoff
Urban Growth In Developing Countries: A Review Of Projections And Predictions, Martin Brockerhoff
Poverty, Gender, and Youth
Comparison of the United Nations’ earliest and most recent projections to the year 2000 suggests that urban and city growth in developing regions has occurred much more slowly than was anticipated as recently as 1980. A modified “urban population explosion” in developing countries since the 1970s conforms to explanatory models of urban growth developed by economists around 1980. Trends in productivity and terms of trade, in particular, have been highly favorable to agriculture as compared to manufacturing, presumably slowing migration to urban centers. Increases in national population growth rates have produced less than commensurate in rates of city growth, further …
The Decline Of Female Circumcision In Egypt: Evidence And Interpretation, Omaima El-Gibaly, Barbara L. Ibrahim, Barbara Mensch, Wesley H. Clark
The Decline Of Female Circumcision In Egypt: Evidence And Interpretation, 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 …
The Costs Of Integrating Reproductive Health Services: An Example Using Syndromic Management Of Stis In Family Planning Clinics In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Barbara Janowitz, Laura Johnson, Andrew Thompson, Caroline West
The Costs Of Integrating Reproductive Health Services: An Example Using Syndromic Management Of Stis In Family Planning Clinics In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Barbara Janowitz, Laura Johnson, Andrew Thompson, Caroline West
Reproductive Health
Estimates from the United Nations Population Fund indicate that the costs of family planning (FP) and other reproductive health (RH) services are increasing and that it will be difficult for donors and countries to meet these costs. Many institutions delivering RH services operate significantly below their physical capacity to see clients, and much of the equipment required for expanding RH services may already be available for use. The marginal costs of adding infrastructure could be low. Many institutions have staff that are not fully occupied, and thus the staff necessary to expand RH services may also be in place. In …
Expanding Men's Participation In Reproductive Health In Kenya, Bolaji M. Fapohunda, Naomi Rutenberg
Expanding Men's Participation In Reproductive Health In Kenya, Bolaji M. Fapohunda, Naomi Rutenberg
Reproductive Health
To increase men’s participation in family planning (FP) and reproductive health (RH) both for their own well-being and as gatekeepers to women’s health, the African Population Policy Research Center and the Population Council’s OR/TA Project II launched a study designed to explore best practices for delivering services to men. The study examined men’s knowledge, perceptions, and concerns about RH issues, including FP, and the social context of their knowledge. In sub-Saharan Africa, FP and reproductive health-care research and interventions place a disproportionate emphasis on women and largely ignore the role of men. As a result, male participation in FP and …
Demand For And Cost-Effectiveness Of Integrating Rti/Hiv Services With Clinic-Based Family Planning Services In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Sithokozille Simba, Hazel M.B. Dube, Rick Homan, Barbara Janowitz, Ahmed Latif, Peter R. Mason
Demand For And Cost-Effectiveness Of Integrating Rti/Hiv Services With Clinic-Based Family Planning Services In Zimbabwe, Baker Ndugga Maggwa, Ian Askew, Caroline S. Marangwanda, Sithokozille Simba, Hazel M.B. Dube, Rick Homan, Barbara Janowitz, Ahmed Latif, Peter R. Mason
Reproductive Health
The current spread of HIV/AIDS poses a major threat to individual lives and national economies in many sub-Saharan African countries. The region also has some of the highest levels of other reproductive tract infections (RTIs) in the world. Some of these RTIs increase the risk of sexual transmission of HIV infection. Thus, the control of RTIs is seen not only as an important reproductive health care strategy to alleviate symptoms of infection and long-term gynecological, obstetric, and neonatal complications, but also as a key strategy in reducing the spread of HIV/AIDS. As a result, all national health care programs in …
Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan
Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan
Reproductive Health
This book on family planning in India includes detailed empirical data and analysis of the various dimensions of quality of care in different regions of the country. Focus areas include: women’s perceptions of the care they receive; observations of provider-client interactions; barriers to quality of service delivery; existing interregional variations; contraceptive choice and interpersonal relations; technical quality of care; and the effect of the target system on the work style of outreach staff. All elements of the quality-of-care framework elaborated by Judith Bruce are well documented and their relationships to broader program constraints are clearly identified. The overall impression one …
Implementing A Reproductive Health Agenda In India: The Beginning, Saroj Pachauri
Implementing A Reproductive Health Agenda In India: The Beginning, Saroj Pachauri
Reproductive Health
At the International Conference on Population and Development (ICPD) in 1994, the nations of the world agreed to give special attention to girls’ education, women’s health, infant survival, and women’s empowerment, and to provide comprehensive reproductive health (RH) services to enable couples to achieve their reproductive goals. The government of India launched a reproductive and child health program in October 1997. This book begins a review of the processes underway to operationalize the program. It brings together several important initiatives at various stages of development and examines key policy and program issues based on empirical research and field experience. The …
Review Of The Policy Process In Bangladesh Following Icpd, Nancy J. Piet-Pelon, Ubaidur Rob, Syeda Nahid Mukith Chowdhury, Abul Barkat, Sushil Ranjan Howlader, Sharif M.I. Hossain, Ismat Bhuiya, Siraj-Us- Saleheen
Review Of The Policy Process In Bangladesh Following Icpd, Nancy J. Piet-Pelon, Ubaidur Rob, Syeda Nahid Mukith Chowdhury, Abul Barkat, Sushil Ranjan Howlader, Sharif M.I. Hossain, Ismat Bhuiya, Siraj-Us- Saleheen
Reproductive Health
The International Conference on Population and Development (ICPD) in Cairo in 1994 was the culmination of months of national and international discussions. The issues had been crafted into a Program of Action, which represented a potential shift in thinking. Delegates left the conference espousing a new paradigm and a broad definition of what people, especially women, should expect from their national health services. Governments were encouraged to recognize that the improved health status of women could only be achieved by a life-cycle approach and that health depended not only on good family planning information and services but on women’s empowerment …
Improving The Management Of Stis Among Mch/Fp Clients At The Nakuru Municipal Council Health Clinics, Julie Solo, Baker Ndugga Maggwa, James Kariba Wabaru, Bedan Kiare Kariuki, Gregory Maitha
Improving The Management Of Stis Among Mch/Fp Clients At The Nakuru Municipal Council Health Clinics, Julie Solo, Baker Ndugga Maggwa, James Kariba Wabaru, Bedan Kiare Kariuki, Gregory Maitha
Reproductive Health
In an effort to address the global crisis of HIV/AIDS and to reduce the spread of other sexually transmitted infections (STIs), maternal and child health/family planning (MCH/FP) programs have attempted to integrate the management of STIs into their services. This integration was endorsed at the 1994 International Conference on Population and Development in Cairo. However, as noted in this report, programs have encountered a number of difficulties as they try to effectively manage STIs in an MCH/FP setting. In particular, the effective detection and treatment of STIs has proven difficult among MCH/FP populations. This current study was developed to help …
The Cost Of Health Services At The Facilities Level Of The Nakuru Municipal Council, Nakuru, Kenya, Andrew Thompson, Barbara Janowitz, Julie Solo
The Cost Of Health Services At The Facilities Level Of The Nakuru Municipal Council, Nakuru, Kenya, Andrew Thompson, Barbara Janowitz, Julie Solo
Reproductive Health
The Nakuru Municipal Council (NMC), in Kenya, is concerned with the financial sustainability of its services and is considering increasing prices. The Council is currently charging for services but these fees are not based on the cost of providing services. Before changing its prices, the NMC wanted information on its costs because another strategy to improve financial sustainability is to decrease the costs of producing various services. Information on current costs of services can also help the NMC to determine ways to reduce these costs. The NMC, in collaboration with the Africa OR/TA II project and Family Health International, conducted …
Integrating Sti And Mch/Fp Services, Population Council
Integrating Sti And Mch/Fp Services, Population Council
Reproductive Health
The integration of STI and HIV/AIDS information and services into existing MCH/FP programs has been strongly supported in recent years, following recommendations from the 1994 Cairo ICPD. Moreover, it is now widely accepted that early detection and management of STIs can reduce the incidence of HIV infection. Thus, there are powerful incentives to increase efforts to broaden the capacity of MCH/FP programs to provide STI prevention and management information and services for their clients, both as a comprehensive reproductive health service and as a preventive measure for reducing the transmission of HIV. As described in this brief, the Africa OR/TA …
Testing Strategies To Improve Access To Emergency Contraception Pills: Prescription Vs. Prophylactic Distribution, John P. Skibiak, Yusuf Ahmed, M. Ketata
Testing Strategies To Improve Access To Emergency Contraception Pills: Prescription Vs. Prophylactic Distribution, John P. Skibiak, Yusuf Ahmed, M. Ketata
Reproductive Health
This report is the second in a series of research summaries produced in connection with the operations research project “Enhancing Access to Family Planning Services through the Introduction of Emergency Contraception.” Launched in September 1997, the project explores the many issues surrounding the introduction and delivery of emergency contraception services in a developing country context. The study described in this report compares two different approaches to overcoming barriers that prevent women from accessing emergency contraception during the 72-hour period when the first dosage of emergency contraception pills (ECPs) must be taken. In one approach, new family planning (FP) acceptors were …