Medicine and Health Sciences Commons^™

Condom Availability In New York City Public High Schools: Relationships To Condom Use And Sexual Behavior., Sally Guttmacher, Lisa D. Lieberman, David Ward, Nick Freudenberg, Alice Radosh, Don Des Jarlais

Department of Public Health Scholarship and Creative Works

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago.

METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey.

RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in …

Implant Users: Over Five Years After Insertion (Further Analysis Of Previous Study Data), Jayanti Tuladhar, Joedo Prihartono

Reproductive Health

This secondary analysis report presents the characteristics of a subgroup of 235 women who are overdue in getting Norplant® implants removed after five years, factors related to the risk of nonremoval after five years, and issues related to accessing information about removal of implants. The main source of data for the present study is the “Norplant Implants® Assessment Study: Insertion, Use, and Removal” carried out in Indonesia in April 1996. This study consisted of a representative sample of 2,979 current and former Norplant users who had an insertion from April 1, 1987, to March 31, 1991, five or more years …

Beliefs And Practices About Reproductive Tract Infections: Findings From A Series Of Philippine Fgds, Marilou Palabrica-Costello, Carmeli Marie Chaves, Chona R. Echavez, Cecilia Conaco, Mariano Santiago

Reproductive Health

The past decade has been characterized by increasing concern about the medical, social, and economic problems associated with reproductive tract infections (RTIs). The goal of preventing and curing RTIs is now being prioritized by public health agencies in the developing world. Very little research has been conducted on the problem of RTIs in the local context, and it would be helpful for program managers if the knowledge and beliefs now being held about RTIs were more clearly delineated. Knowing more about the way in which these illnesses are viewed by the community, about traditional practices for preventing and curing RTIs, …

Using A Rapid Assessment Approach To Evaluate The Quality Of Care In An Integrated Program: The Experience Of The Family Health Division, Ministry Of Health, Botswana, Lucy Sejo Maribe, Baker Ndugga Maggwa, Ian Askew, Kate Miller

Reproductive Health

To strengthen existing efforts by the Government of Botswana in responding to the HIV/AIDS epidemic, USAID provided financial and technical assistance through the Botswana Population Assistance (BOTSPA) project. BOTSPA’s goal was to improve the quality and availability of family planning (FP) and sexually transmitted infection (STI) services through designing, implementing, and monitoring activities that would lead to the eventual institutionalization and sustainability of high-quality FP and STI/HIV/AIDS services. The Ministry of Health requested assistance from the Africa OR/TA Project II to develop and test an approach for routinely measuring the quality of service delivery and assessing skills retention by staff …

Integrating Sti/Hiv Management Strategies Into Existing Mch/Fp Programs: Lessons From Case Studies In East And Southern Africa, Baker Ndugga Maggwa, Ian Askew

Reproductive Health

Sub-Saharan Africa is confronting an HIV/AIDS epidemic and virtually all health programs in the region are seeking ways of preventing and reducing the spread of this virus. To compound the problem, the presence of certain sexually transmitted infections (STIs) is known to increase risk of the sexual transmission of HIV. The sub-Saharan region is believed to have some of the highest levels of STIs in the world, thus controlling STIs is not only an important reproductive health care strategy in itself but also a key strategy in reducing the spread of HIV. The strongest evidence to support this has come …

Integration Of Sti And Hiv/Aids With Mch-Fp Services: A Case Study Of The Busoga Diocese Family Life Education Program, Uganda, Joy Mukaire, Florence Kalikwani, Baker Ndugga Maggwa

Reproductive Health

The Family Life Education Project (FLEP) was started in 1986 by the Busoga Diocese of the Anglican Church of Uganda with assistance from Pathfinder International. The project provides integrated MCH, FP, STD, and HIV/AIDS services to more than 500,000 individuals through 48 clinics and 162 trained village health workers (VHWs). Each clinic serves an estimated 11,000 people living in a sub-Parish. Each sub-Parish has a health subcommittee selected by the community that is responsible for hiring clinic staff, identifying VHWs, and mobilizing resources for clinic staff salaries. Data suggest that the program is reaching a large number of clients through …

Integration Of Sti And Hiv/Aids With Mch-Fp Services: A Case Study Of The Nakuru Municipal Council's Project On Strengthening Std/Aids Control, James Kariba Wabaru, Bedan Kiare Kariuki, Baker Ndugga Maggwa

Reproductive Health

Kenya’s Nakuru Municipal Council (NMC) operates five clinics located primarily in residential areas with high concentrations of people. The clinics provide basic antenatal, child welfare, STI, and other curative services, and family planning services are available at four of the clinics. One provincial referral hospital operated by the Ministry of Health also provides MCH-FP and HIV/STI services in a special STI treatment clinic. The seven public health facilities in Nakuru Municipality are participating in a collaborative project with the Department of Community Health at the University of Nairobi, the University of Manitoba in Canada, and the Nairobi Municipal City Council. …

An Assessment Of Community-Based Family Planning Programs In Kenya, Jane Chege, Ian Askew

Reproductive Health

Kenya has a long history of using community-based distribution (CBD) as an integral part of its family planning (FP) program. The purpose of this study was to assess the role of CBD programs in terms of providing information and services, to learn more about the determinants of program effectiveness, and to attempt to compare the programs’ cost-effectiveness. Fieldwork was undertaken in mid-1995 when data were collected from seven of the major CBD programs in Kenya. Four rural and three urban programs were included, as were programs that remunerated their agents and those that did not, and programs that had full-time …

Scaling-Up Improved Postabortion Care In Egypt: Introduction To University And Ministry Of Health And Population Hospitals, Laila Nawar, Dale Huntington, Ezzeldin Osman Hassan, Hala Youssef, Nahla G. Abdel-Tawab

Reproductive Health

In Egypt, the legal, religious, and societal restrictions on abortion have constrained the provision of high-quality emergency health care services provided to postabortion patients, including links with family planning (FP) services. In 1994, a small-scale pilot study was conducted by the Egyptian Fertility Care Society and the Population Council's ANE OR/TA Project (1995) to improve postabortion care in Egypt. The study intervention included an intensive training program for physicians on the use of Manual Vacuum Aspiration instruments under local anesthesia. Physicians were also instructed in infection-control practices and counseling postabortion patients about their medical condition and FP. The study findings …

Emergency Contraception As An Element In The Care Of Rape Victims, Ricardo Vernon, Raffaela Schiavon, Silvia Elena Llaguno

Reproductive Health

In most states in Mexico, abortion is excluded as a crime in pregnancies resulting from rape. However, legislation does not specify the norms by which women can obtain a legal abortion, which makes it difficult to choose this alternative. A partial solution to unwanted pregnancies from rape would be to provide emergency contraception (EC). Psychologists were trained to provide information on EC to women who reported a rape at four public ministry agencies specialized in sexual crime. In addition, 11 medical backup referral centers were established. To scale up the strategy, workshops were provided to representatives from State Attorney General …

Postabortion Care Services In Kenya: Baseline Findings Of An Operations Research Study, Julie Solo, Deborah L. Billings

Reproductive Health

In Kenya, as throughout the world, the health consequences of unsafe abortion for women of reproductive age are significant. Hospital-based studies in Nairobi have shown that unsafely induced abortion accounts for as much as 35 percent of pregnancy-related mortality and at least 50 percent of hospitals’ gynecological admissions. The concept of postabortion care (emergency treatment, postabortion family planning counseling and services, links between emergency abortion treatment services and comprehensive reproductive health care) has gained wide acceptance as one model of providing comprehensive care to women suffering from abortion complications. Integration of these three components is rarely found in public health …

Male Involvement In Family Planning: A Kabp Study Of Agra District, Uttar Pradesh, M.E. Khan, Bella C. Patel

Reproductive Health

Although lack of male involvement in family planning has been a topic of research and discussion since the early 1980s, during the last five years it has become an important issue for women advocates, researchers, and many international agencies that are committed to reproductive health and gender equality. The large number of articles on this subject and growing number of conferences, research projects, and debates are testimonies to the importance of the issue, both from the programmatic point of view and as a process for bringing about a gender balance in men's and women's reproductive rights and responsibility. This paper …

Dmpa Provision In Pss Clinics In Uttar Pradesh: Costs And Prices, Saumya Ramarao, John Townsend, Leila Caleb-Varkey, Sudha Tiwari, Sneh Vishwanath, Harbans Singh

Reproductive Health

The injectable contraceptive DMPA was introduced in the private sector in India in 1993, contingent on completion of a post-marketing surveillance study of users. The commercial price of a dose of DMPA is about Rs. 150-180, exclusive of the fees of the medical provider. This price puts it beyond the reach of most Parivar Seva Sanstha (PSS) clients in need of safe and effective family planning (FP) services in Uttar Pradesh. Since April 1996, an experiment has been underway with three PSS clinics in Uttar Pradesh to study the effect of price on demand for DMPA. The study seeks to …

Counseling The Husbands Of Postabortion Patients In Egypt: Effects On Husband Involvement, Patient Recovery And Contraceptive Use, Nahla G. Abdel-Tawab, Dale Huntington, Ezzeldin Osman Hassan, Hala Youssef, Laila Nawar

Reproductive Health

An ANE OR/TA Project qualitative study conducted in 1995 probed into women’s perceptions of abortion in Egypt, and the stress that postabortion patients experience during recovery. That study drew attention to the important role husbands can play in their wives’ recovery and subsequent use of contraception. This study was designed to test the effects of involving husbands in the postabortion medical-care process. Overall, the study indicates that providing counseling to husbands of postabortion patients is feasible, as the majority of husbands either accompanied their wife on admission or at discharge from the hospital. However, administrative changes are needed to enhance …

Experience With Clinical Training In Postabortion Care In Egypt: Improving Medical And Interpersonal Skills, Sahar Hegazi, Dale Huntington

Reproductive Health

The Population Council’s Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project is collaborating with AVSC International to incorporate the addition of improved postabortion care procedures into the ongoing Safe Reproductive Health Care project. An element in the next phase of the program’s evolution was a two-day seminar held in Alexandria, Egypt. This seminar provided an opportunity for staff from ten hospitals that participated in the 1996–97 expansion program to present their own experience and impressions of the postabortion case-management procedures, and to discuss their strengths and weaknesses. This report presents an overview of this meeting’s presentations …

Youth Centres In Kenya: Evaluation Of The Family Planning Association Of Kenya Programme, Annabel Erulkar, Barbara Mensch

Reproductive Health

Since 1987, the Family Planning Association of Kenya (FPAK) has operated two youth centers, one in Nairobi and the other in Mombasa. The centers target unmarried youth aged 10–24 and their primary objective is reduction in incidence of sexual and reproductive-health-related problems. These centers offer recreational and sports facilities, counseling services, including reproductive health (RH) information, limited RH services, and referrals. In 1996, FPAK undertook a systematic evaluation of its youth-center program including a situation analysis of the centers, a survey in their catchment areas, and an analysis of program costs. The main strength of the program was found to …

Postabortion Case Load Study In Egyptian Public Sector Hospitals, Egyptian Fertility Care Society, Population Council

Reproductive Health

There is an absence of reliable data on the incidence of incomplete abortion in Egypt. A diagnostic, descriptive study that neither tests an experimental intervention nor evaluates in a comprehensive manner the quality of postabortion medical care was undertaken to address this issue. The study is a cross-sectional observation of the volume and nature of the postabortion case load in Egyptian public-sector hospitals, and it responds to the following objectives: 1) Accurately estimate the number of women who present for postabortion treatment in ob/gyn in-patient facilities as a percentage of ob/gyn admissions in a representative sample of Egyptian public-sector hospitals …

Reproductive Behavior Among Muslims In Uttar Pradesh, M.E. Khan, Bella C. Patel

Reproductive Health

Muslims form the largest minority group in India, according to the 1991 census, constituting about 12 percent of the country's population. India has the second largest Muslim population in the world. The growth rate of the Muslim population in India during the last three decades is somewhat higher than the non-Muslim population. The present paper, based on a large sample survey carried out in Uttar Pradesh, India, compares the reproductive behavior of Hindus and Muslims. An attempt has been made to examine the determinants of their differential fertility and family planning behavior.

The Situation Analysis Approach To Assessing Family Planning And Reproductive Health Services: A Handbook, Robert A. Miller, Andrew A. Fisher, Kate Miller, Lewis Ndhlovu, Baker Ndugga Maggwa, Ian Askew, Diouratie Sanogo, Placide Tapsoba

Reproductive Health

Good family planning service delivery emphasizing both access and quality is key to the related goals of satisfying individual needs and achieving programmatic success. Situation Analysis (SA) provides a needed link between the manager and the client he or she is trying to serve. The data marshaled for SA offer a representative picture of how subsystems are working and provide a way to “see” the client’s experience. Situation Analyses assist managers in achieving the broadest management goal—that of efficient administration of a vital health care service while keeping in view the ultimate goal—providing good care for those who seek it. …

Proceedings Of The Workshop On Integrating Reproductive Tract Infection Case Management In Lgu Health Centers, Population Council

Reproductive Health

This report documents the proceedings of a training workshop on reproductive tract infection (RTI) case management for physicians, nurses, and midwives in selected health centers of the Philippines. The training started with presentation of focus group discussion results emphasizing existing beliefs and perceptions of the community regarding RTIs. The results of the situation analysis served as an eye opener for many in that clients with RTI-related symptoms were found to be rather rare and not systematically managed in the health clinics. Many providers report that since they are not trained to handle such cases, they refer whoever comes with symptoms …

Improved Reproductive Health And Std Services For Women Presenting To Family Planning Services In North Jakarta. Final Report Of Activities, Meiwita B. Iskandar, Catherine Vickers, Subadra Indrawati, Siti Nurul Qomariyah

Reproductive Health

The overall goal of this study was to develop an integrated program of reproductive tract infection/sexually transmitted disease (RTI/STD) clinical services within two family planning clinics in low-income neighborhoods in North Jakarta. Multiple training programs to introduce a standardized clinical evaluation for the detection, treatment, and management of RTI/STDs were conducted. Prior and subsequent to training, observations of health care provider (HCP) and client interactions were conducted to evaluate behavior changes among HCPs. Each consenting client received a standardized reproductive health history, a pelvic exam, and provided specimens for laboratory testing to detect RTIs. Through universal screening of the participants …

Utilization Of Operations Research In Egypt, Sahar Hegazi

Reproductive Health

This study aims to maximize the utilization of operations research (OR) findings in Egypt to strengthen research efforts contributing to the improvement of the family planning (FP) and reproductive health (RH) care program. To date, the field of OR in Egypt has not conducted a systematic review of the utilization of the OR studies completed over the last decade. The long-term objective of this study, as noted in this report, was to maximize the utilization of OR and strengthen future efforts contributing to the improvement of the FP and RH care program in Egypt. The study’s sample included selected studies …

Absent And Problematic Men: Demographic Accounts Of Male Reproductive Roles, Margaret E. Greene, Ann E. Biddlecom

Poverty, Gender, and Youth

Both men and women make important contributions to the production of children, yet demographic studies of fertility and family planning have tended to focus on women alone. This paper traces the development of demography’s emphasis on women and describes how the limitations of its theoretical approaches to reproduction and empirical neglect of men have been mutually reinforcing. The paper is structured around four aims: 1) to describe why men have had a relatively low profile as subjects in demographic research on reproduction; 2) to explain growing interest in studying men’s roles; 3) to evaluate existing research on men in developing …

Transition To Adulthood Of Female Factory Workers: Some Evidence From Bangladesh, Sajeda Amin, Ian Diamond, Ruchira Tabassum Naved, Margaret Newby

Poverty, Gender, and Youth

The rapidly expanding sector of garment manufacturing for export is unusual for Bangladesh in that it employs young, unmarried women in large numbers. This paper examines data from a study on garment workers in Bangladesh to explore the implications of work for the early socialization of young women. For the first time young women are given an alternative to lives where they move directly from childhood into adulthood through early marriage and childbearing. Work creates a period of transition as contrasted with the abrupt assumption of adult roles at very young ages that marriage and childbearing mandate. It is argued …

Population And Poverty: A Review And Restatement, Geoffrey Mcnicoll

Poverty, Gender, and Youth

Worldwide in the 1990s over one billion persons are estimated to have a purchasing power of below a dollar per day, the conventional demarcation of “absolute poverty.” Other dimensions of poverty, extending beyond income measures to encompass a person’s broader capabilities and social functioning, are less empirically accessible. Poverty is commonly thought to be associated with high fertility and rapid population growth (regionally, South Asia and Africa have the highest poverty rates), but that view finds little support in the extensive statistical research literature on population and poverty. However, a clear-cut depiction of such an institutionally contingent relationship is not …

Reproductive Control In South Africa, Carol E. Kaufman

Poverty, Gender, and Youth

The controversial state-sponsored family planning program officially began in South Africa in 1974. Although the government did not implement the program on a racial basis, the program was widely believed to be linked with white fears of growing black numbers, and was attacked by detractors as a program of social and political control. In spite of the hostile environment, black women’s use of services steadily increased. Using historical and anthropological evidence, this paper delineates the links between the social and political context of racial domination and individual fertility behavior. It argues that the quantitative ‘success’ of the family planning program …

Gender Differences In The Schooling Experiences Of Adolescents In Low-Income Countries: The Case Of Kenya, Barbara Mensch, Cynthia B. Lloyd

Poverty, Gender, and Youth

Little research on education in developing countries has focused on adolescent issues at the same time, despite the fact that a growing proportion of young people are spending some time in school during the phase of their lives between puberty and marriage, there is little research on schooling as a key dimension of the adolescent experience. This paper examines the school environment in Kenya and the potential ways it can help or hinder adolescents. We focus on gender differences with a view toward illuminating some of the factors that may present particular obstacles or opportunities for girls. The paper begins …

Urbanization, Unemployment And Migration In Africa: Theory And Policy, Michael P. Todaro

Poverty, Gender, and Youth

During the past three decades, the cities of the developing world in general, and of Africa in particular, have witnessed a remarkable and in many ways unprecedented demographic growth spurt. Despite some slowdown in rates of increase in the past few years as a result of falling wages, contracting social services, and changing demographic trends, contemporary urban areas remain the growth poles of economic progress and the lightning rods of political and social unrest. Nowhere is this dilemma more visible nor the resulting problems more intractable than in the crowded cities of sub-Saharan Africa, where projections of urban population growth …

Study Of Adolescents: Dynamics Of Perception, Attitude, Knowledge And Use Of Reproductive Health Care, Syed Jahangeer Haider, Shamsun Nehar Saleh, Nahid Kamal, Alan Gray

Poverty, Gender, and Youth

Knowledge, perceptions, and behavior related to reproductive health (RH) and sexual matters underlie all the conditions that family planning/maternal and child health (FP/MCH) programs address, thus these are important issues for FP researchers, population policymakers, and service providers. To achieve significant levels of fertility or mortality declines, participation of adolescents in reproductive health programs, including FP/MCH, is essential. Studies focusing on sexuality and attitudes of adolescents on RH, and the interacting influences of family, community, and the social sector developmental programs (health, FP/MCH, education, women’s development) would give useful revelations. This report presents findings from a study that was designed …

Integrando La Sexualidad En La Planificación Familiar: La Experiencia De Tres Proyectos De Vih/Ets En América Latina Y El Caribe, Julie Becker, Elizabeth Leitman, Mahmoud F. Fathalla

Poverty, Gender, and Youth

Esta edición de Quality/Calidad/Qualité relata la experiencia de tres asociaciones de planificación familiar afiliadas con la International Planned Parenthood Federation/Western Hemisphere Region que han tratado de incorporar una estrategia de prevención del VIH/SIDA en su esquema de trabajo cotidiano. Se examina cómo BEMFAM/Brasil, ASHONPLAFA/Honduras, y FAMPLAN/Jamaica han logrado una transición hacia una oferta de servicios de planificación familiar más enfocada en los clientes mismos y más explícita en el tratamiento de temas sexuales. En cada uno de los tres países, el personal recibió capacitación especial que no sólo los habilitó para proveer información sobre el VIH/SIDA, sino que también les …