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Articles 1 - 30 of 39
Full-Text Articles in Medicine and Health Sciences
Reproductive Health Care In The Time Of Covid-19: Perspectives Of Poor Women And Service Providers From Rahim Yar Khan, Punjab, Iram Kamran, Tahira Parveen, Rehan M. Niazi, Irfan Masood
Reproductive Health Care In The Time Of Covid-19: Perspectives Of Poor Women And Service Providers From Rahim Yar Khan, Punjab, Iram Kamran, Tahira Parveen, Rehan M. Niazi, Irfan Masood
Reproductive Health
This study was conducted by the Population Council in Rahim Yar Khan district of Punjab, with the support of the United Nations Population Fund (UNFPA), to uncover urgently needed evidence about the challenges and needs of poor women and health care providers during the COVID-19 pandemic. Over 200 poor women—beneficiaries of the Benazir Income Support Programme (BISP), one of the largest social protection programs in the world—and 60 public and private sector health care providers participated in this investigation of BISP beneficiaries’ knowledge of COVID-19, the effects of the pandemic on their lives, mental health and wellbeing, and their access …
Facing Covid-19: Knowledge, Attitudes, Practices, And Challenges Of Healthcare Providers, Population Council
Facing Covid-19: Knowledge, Attitudes, Practices, And Challenges Of Healthcare Providers, Population Council
Reproductive Health
This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). During this study, 60 health care providers that represented 60 unique health facilities in Punjab’s Rahim Yar Khan district were interviewed by telephone, to evaluate how much they know about COVID-19 symptoms, prevention, and treatment, as well as their individual attitudes, practices, and challenges during the ongoing pandemic. To assess how the situation evolved during the critical first three months of …
Poor Women's Reproductive Health And Family Planning Challenges And Needs During The Covid-19 Pandemic, Population Council
Poor Women's Reproductive Health And Family Planning Challenges And Needs During The Covid-19 Pandemic, Population Council
Reproductive Health
This research brief describes findings from the Population Council study Reproductive Healthcare in the Time of COVID-19: Perspectives of Poor Women and Service Providers from Rahim Yar Khan, Punjab with the support of the United Nations Population Fund (UNFPA). The study conducted 164 interviews by telephone with beneficiaries of the Benazir Income Support Programme (BISP) in Rahim Yar Khan, Pakistan, previously surveyed in 2019, to determine how much those most vulnerable to the effects of COVID-19 know about the disease and its effects, in addition to understanding the pandemic’s effects on their lives, including their mental health and well-being as …
Advocating Corporate Policy Change On Women's Health And Family Planning: Lessons From The Environmental Movement, Matthew Mcfall, Carolyn Rodehau, David Wofford
Advocating Corporate Policy Change On Women's Health And Family Planning: Lessons From The Environmental Movement, Matthew Mcfall, Carolyn Rodehau, David Wofford
Reproductive Health
This brief presents key lessons from the environmental movement on effective strategies for driving changes in corporate policies and practices and creating new mechanisms for holding businesses accountable for environmental impacts. Corporate policies and voluntary and “soft law” standards may be unfamiliar to many women’s health advocates, but they are likely to have increasing importance in the years to come. The global health community can learn from the experience of environmentalists on how to engage businesses on Corporate Social Responsibility (CSR) standards and corporate practices around women’s health. The brief offers six recommendations for moving forward.
Health Needs, Health Seeking Pathways, And Drivers Of Health Seeking Behaviors Of Female Garment Factory Workers In Cambodia: Findings From A Qualitative Study In Phnom Penh And Kandal Provinces, Population Council, The Evidence Project
Health Needs, Health Seeking Pathways, And Drivers Of Health Seeking Behaviors Of Female Garment Factory Workers In Cambodia: Findings From A Qualitative Study In Phnom Penh And Kandal Provinces, Population Council, The Evidence Project
Reproductive Health
Existing information on Cambodian garment factory workers’ (GFWs) barriers to health services has generally come from project implementation documents or general baseline studies of these projects, rather than independent, rigorous studies that specifically examine the health needs and health-seeking behaviors of workers. Since previous studies did not include specific indicators related to workers’ health needs and health-seeking behaviors, they cannot offer a complete picture of these important issues. To fill this critical knowledge gap, in partnership with the National Institute of Public Health, the Evidence Project/Population Council conducted a formative qualitative study under the USAID-funded WorkerHealth project to improve the …
Evaluation Of The Effectiveness Of The Herhealth Model For Improving Sexual And Reproductive Health And Rights Knowledge And Access Of Female Garment Factory Workers In Bangladesh, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach
Evaluation Of The Effectiveness Of The Herhealth Model For Improving Sexual And Reproductive Health And Rights Knowledge And Access Of Female Garment Factory Workers In Bangladesh, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach
Reproductive Health
The Population Council, under its USAID-funded Evidence Project, partnered with Bangladesh’s Business for Social Responsibility program to conduct operational research to evaluate the effectiveness of the HERhealth model for improving female factory workers’ health, and to find ways to optimize program inputs and processes to support future scale-up of the intervention. This report presents findings from a pre- and post-intervention quantitative study of female factory workers from 10 factories; a qualitative study with factory managers, service providers, and implementing partners; and self-administered retention assessments of the Peer Health Educators from six factories in Dhaka, Gazipur, and Narayanganj districts. Findings from …
Married Young Women And Girls' Family Planning And Maternal Heath Preferences And Use In Ethiopia, Aparna Jain, Elizabeth Tobey, Hussein Ismail, Annabel Erulkar
Married Young Women And Girls' Family Planning And Maternal Heath Preferences And Use In Ethiopia, Aparna Jain, Elizabeth Tobey, Hussein Ismail, Annabel Erulkar
Reproductive Health
Married young women and girls are the primary users of youth-centered sexual and reproductive health services in Ethiopia and, given the health risks associated with early and closely-spaced pregnancies, represent an especially important population to reach with sexual and reproductive health services. This brief looks specifically at the needs and preferences for family planning and reproductive health services among married young women and girls, with recommendations for how to more effectively ensure that they have access to those services.
Workplace Health And The Garment Sector In Cambodia, Bunmey Yat, Carolyn Rodehau, David Wofford, Ashish Bajracharya
Workplace Health And The Garment Sector In Cambodia, Bunmey Yat, Carolyn Rodehau, David Wofford, Ashish Bajracharya
Reproductive Health
In Cambodia, there has been considerable investment in improving the well-being of factory workers. Understanding the key stakeholders and their roles in improving worker health is essential for policy change and ensuring that interventions achieve sustainable, long-term impact in and around the workplace. This policy brief presents selected findings from a stakeholder and situational analysis undertaken by the Cambodia Worker Health Coalition (WorkerHealth) to understand the stakeholder landscape and policy environment for women’s health in the garment industry in Cambodia, with the objective of identifying leading stakeholders and their relationships, as well as strategies and opportunities for collaboration. Collaboration and …
Creating A Culture Of Evidence Use: Using An Innovative Knowledge Translation Platform To Inform Hiv/Aids Programming For Women And Girls, Jill Gay, Melanie Croce-Galis, Karen Hardee, Amelia Peltz
Creating A Culture Of Evidence Use: Using An Innovative Knowledge Translation Platform To Inform Hiv/Aids Programming For Women And Girls, Jill Gay, Melanie Croce-Galis, Karen Hardee, Amelia Peltz
Reproductive Health
Given that moving evidence from a study to policy, programs, and practice can often take a decade or more, what is the best way to get evidence into the hands of those developing policies and programs to speed its use? Enhancing the use of evidence in policies and programs through an innovative web-based knowledge platform, What Works for Women: Evidence for HIV/AIDS Interventions, resulted in major changes in National Strategic HIV Plans plus Concept Notes submitted to the Global Fund to Fight AIDS, Tuberculosis and Malaria in 14 countries in Africa, Asia, and Latin America. This paper documents how components …
Method-Specific Attributes That Influence Choice Of Future Contraception Among Married Women In Nairobi’S Informal Settlements, Joyce Mumah, John B. Casterline, Kazuyo Machiyama, Marylene Wamukoya, Caroline W. Kabiru, John C. Cleland
Method-Specific Attributes That Influence Choice Of Future Contraception Among Married Women In Nairobi’S Informal Settlements, Joyce Mumah, John B. Casterline, Kazuyo Machiyama, Marylene Wamukoya, Caroline W. Kabiru, John C. Cleland
Reproductive Health
No abstract provided.
Garment Sector Health Interventions In Cambodia: A Comprehensive Review, Molyaneth Heng, Ashish Bajracharya
Garment Sector Health Interventions In Cambodia: A Comprehensive Review, Molyaneth Heng, Ashish Bajracharya
Reproductive Health
As part of the WorkerHealth project, the Evidence Project/Population Council conducted a comprehensive review of garment sector health interventions, particularly reproductive health (RH) and family planning (FP)–focused projects, in Cambodia during the last five years. The results from the review support WorkerHealth’s objective of enabling evidence-based decisionmaking and programming related to the health and well-being of female garment factory workers in Cambodia, by documenting the range of garment sector health interventions and identifying best practices and gaps in programming and evaluation. This review identified a number of priority actions for current and future garment sector health interventions to consider in …
Evaluation Of The Herhealth Intervention In Bangladesh: Baseline Findings From An Implementation Research Study, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach
Evaluation Of The Herhealth Intervention In Bangladesh: Baseline Findings From An Implementation Research Study, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach
Reproductive Health
The Business for Social Responsibility's (BSR) HERproject is a collaborative initiative that strives to empower low-income women working in global supply chains in 14 countries worldwide. One of the HERproject’s three pillars is HERhealth, which seeks to improve the health-related knowledge and behaviors, and access to health services and products, of low-income working women. In Bangladesh, HERhealth specifically addresses reproductive health and family planning needs. BSR asked the Evidence Project/Population Council to conduct an implementation science study assessing the effectiveness of BSR’s HERhealth model in Bangladesh. This study is one of the first studies of female garment workers in Dhaka …
Promoting Respectful Maternity Care Resource Package—Implementing Respectful Maternity Care In Kenya, Population Council
Promoting Respectful Maternity Care Resource Package—Implementing Respectful Maternity Care In Kenya, Population Council
Reproductive Health
The Respectful Maternity Care (RMC) Resource Package was developed by the Heshima project as part of the USAID Translating Research into Action (TRAction) project. The resource package is designed to be used by program managers, supervisors, trainers, technical advisors, and others who organize or facilitate RMC training workshops on sexual and reproductive health as well as skills training in emergency obstetric and newborn care. The resource package provides experienced facilitators with background information, materials, instructions, and tips for promoting respectful care in reproductive, maternal, and newborn health services in both facilities and communities. The resource package also includes tools for …
Contraceptive Use And Fertility Intentions Among Women Living With Hiv In Kenya And Swaziland, Integra Initiative
Contraceptive Use And Fertility Intentions Among Women Living With Hiv In Kenya And Swaziland, Integra Initiative
Reproductive Health
At the end of 2013, an estimated 35 million people were living with HIV, and sub-Saharan Africa was disproportionately affected. With major efforts directed at expanding access to life-saving antiretroviral therapy in sub-Saharan Africa, many people are living longer with HIV, leading productive and sexually active lives. Unintended pregnancies and the potential of vertical transmission are some of the challenges faced by women living with HIV. Understanding the fertility preferences and reproductive decisions of these women is vital for informing efforts to enable them to achieve these desires effectively and safely. The “Steps to Integration” series provides a guide on …
Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab
Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab
Reproductive Health
The gender profile of the HIV/AIDS epidemic has changed since it emerged 30 years ago when infections were concentrated in key populations of men such as injecting drug users and men who have sex with men. In 2012, women accounted for nearly 50 percent of the estimated 35.3 million people living with HIV/AIDS globally. In the Middle East and North Africa, 44 percent of infected adults are women. The past 30 years have also witnessed remarkable improvements in access to high-quality information and medical services, including services for prevention of mother-to-child transmission of the virus. With care and treatment for …
Exploring Positive Women's Lives In Namakkal District, India, P. Kousalya, Deepika Ganju
Exploring Positive Women's Lives In Namakkal District, India, P. Kousalya, Deepika Ganju
Reproductive Health
This report describes an initiative that was undertaken to document the experiences of HIV-positive ever-married women in Namakkal district, Tamil Nadu, India. The initiative sought to explore the circumstances in which women learned about their HIV status; their feelings on finding out they were HIV-positive; the nature of husband–wife relationships prior to and following disclosure of women’s HIV status; the extent of support or discrimination that women experienced from family members, friends, and neighbors; treatment-seeking behaviors; and women’s perspectives about ways in which the multiple needs of HIV-infected women can be met. Drawing on the testimonies of these women gathered …
Anti-Trafficking Programs In South Asia: Appropriate Activities, Indicators And Evaluation Methodologies, Dale Huntington
Anti-Trafficking Programs In South Asia: Appropriate Activities, Indicators And Evaluation Methodologies, Dale Huntington
Reproductive Health
Throughout South Asia, men, women, boys, and girls are trafficked within their own countries and across international borders against their wills in what is essentially a clandestine slave trade. The Congressional Research Service and the U.S. State Department estimate that between 1 to 2 million people are trafficked each year worldwide with the majority originating in Asia. Root causes include extreme disparities of wealth, increased awareness of job opportunities far from home, pervasive inequality due to caste, class, and gender bias, lack of transparency in regulations governing labor migration, poor enforcement of internationally agreed-upon human rights standards, and the enormous …
Indonesia: Train Journalists To Write About Reproductive Health, Frontiers In Reproductive Health
Indonesia: Train Journalists To Write About Reproductive Health, Frontiers In Reproductive Health
Reproductive Health
After government control over the media was liberalized in 1998, Indonesian journalists had a new mandate to explore new issues and foster public debate. Several studies had found evidence that women’s health worsened from 1997–99, yet media coverage of this topic was limited. To increase press coverage of reproductive health (RH) topics, the Population Council conducted an 18-month media project in collaboration with the State Ministry for Women’s Empowerment and other key agencies. The project focused on improving RH knowledge and reporting skills among 22 print journalists. Project staff monitored RH coverage in 22 major newspapers, magazines, and tabloids. After …
Reproductive Tract Infections: A Guide For Programme Managers, Sarah Hawkes, Anjali Nayyar, Johannes Van Dam, Kevin R. O'Reilly, Bidia Deperthes, Dinesh Agarwal
Reproductive Tract Infections: A Guide For Programme Managers, Sarah Hawkes, Anjali Nayyar, Johannes Van Dam, Kevin R. O'Reilly, Bidia Deperthes, Dinesh Agarwal
Reproductive Health
Reproductive tract infections (RTIs) including sexually transmitted infections represent a silent worldwide pandemic that adversely impacts the reproductive health (RH) of women and men. Various community- and hospital-based studies in India have provided insights into the magnitude of the problem. The International Conference on Population and Development (1994) emphasized integration of RH services to meet the needs of men and women especially with prevention and management of RTIs/STIs. The emergence of HIV and the identification of STIs as a risk factor for the spread of HIV have further lent a sense of urgency for a programmatic response to address this …
Strengthening Social Science Research On Women's Health: Lessons Learned From A Capacity Building Programme, M.E. Khan, Bella C. Patel, John Townsend
Strengthening Social Science Research On Women's Health: Lessons Learned From A Capacity Building Programme, M.E. Khan, Bella C. Patel, John Townsend
Reproductive Health
The International Conference on Population and Development in 1994 led to an upsurge in interest in implementing reproductive health (RH) programs worldwide. The urgency to act has led to the development of disparate activities in several developing countries including India. While programs have been growing in numbers, their quality is in question. A fundamental problem has been lack of capacity at all levels of the health service system to respond to the paradigm shift articulated by the advocates of the reproductive health and rights agenda. To redesign programs, considerable research must be undertaken to understand the health needs and sociocultural …
Testing Alternative Channels For Providing Emergency Contraception To Young Women, John P. Skibiak, Mangala Chambeshi-Moyo, Yusuf Ahmed
Testing Alternative Channels For Providing Emergency Contraception To Young Women, John P. Skibiak, Mangala Chambeshi-Moyo, Yusuf Ahmed
Reproductive Health
In September 1997, the Population Council and Lusaka’s University Teaching Hospital (UTH) launched a 15-month study to identify and explore the range of issues relating to the introduction of emergency contraception (EC) within a developing country context. The study allowed clinic-based family planning providers to accumulate enough first-hand experience to be able to identify strategies for overcoming difficulties associated with the introduction or delivery of EC services. One issue on most participants’ minds was the need to expand the delivery of EC services toward young women, especially out-of-school women, who are harder to reach. Participants recommended that future research activities …
Integrating A Reproductive Health Framework Within Primary Care Services: The Experience Of The Reproductive Health Intervention Study, Karima Khalil, Abdel Moneim Farag, Assem Anwar, Dina Galal, Olfia Kamal, Karraze Shorbagi, Miral Breebaart, Hind Khattab, Nabil Younis, Huda Zurayk
Integrating A Reproductive Health Framework Within Primary Care Services: The Experience Of The Reproductive Health Intervention Study, Karima Khalil, Abdel Moneim Farag, Assem Anwar, Dina Galal, Olfia Kamal, Karraze Shorbagi, Miral Breebaart, Hind Khattab, Nabil Younis, Huda Zurayk
Reproductive Health
This paper is part of the Policy Series in Reproductive Health, which shares research undertaken by the Reproductive Health Working Group (RHWG). It describes the Reproductive Health Intervention Study, which designed and tested a model of essential reproductive health (RH) services. RHWG was established in 1988 as part of a special program on the health of women and children within the context of the family and community initiated by the Population Council’s Regional Office for the West Asia and North Africa region. The paper identifies a framework of basic service components that address RH and shows that their delivery is …
Strengthening Reproductive Health Services In Africa Through Operations Research, Population Council
Strengthening Reproductive Health Services In Africa Through Operations Research, Population Council
Reproductive Health
The health status of women, men, and children in sub-Saharan Africa remains the poorest in the world. Moreover, virtually every country in the region is suffering mediocre economic growth or economic decline, thereby reducing the ability of their health care systems to respond adequately, and increasing dependence on external donor assistance. In terms of reproductive health (RH), the region is faced with high levels of unwanted fertility; high levels of maternal, child, and infant morbidity and mortality; and an almost exponential growth in HIV prevalence. Access to and quality of RH services remains poor in most countries, thereby maintaining unmet …
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 …
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 …
Integrating Rti Service With Primary Health Care, Population Council
Integrating Rti Service With Primary Health Care, Population Council
Reproductive Health
The reproductive health (RH) movement worldwide has brought reproductive tract infections (RTIs) under sharp focus as an urgent health need of women. While RTIs are preventable or treatable, they are often the cause of infertility, ectopic pregnancy, cervical cancer, fetal loss, low birth-weight infants, infant blindness, and neonatal pneumonia. The adverse health effects of RTIs, particularly STIs, is much higher for women than men. Recent research has demonstrated that RTIs are closely linked to other areas of health care like family planning (FP), safe motherhood, child survival, and HIV prevention. Hence, each could significantly contribute to the reduction and control …
Country Profile Of Women's Health And Development In Indonesia, Population Council
Country Profile Of Women's Health And Development In Indonesia, Population Council
Reproductive Health
The “Country Profile of Women’s Health and Development in Indonesia” contains a thorough review of the following: Geographical, Political, Socio-Demographic, and Economic Profile of Indonesia; Status of Women; and Women’s Health Status. In view of the complexity of the problems facing women, the document concludes that Indonesia needs a plan for the future with a gender perspective that prioritizes increased life expectancy, legal protection, and empowerment for women. To reach this goal, Indonesia started by ratifying the Convention on the Elimination of All forms of Discrimination Against Women (CEDAW) and set it into law in 1984. This convention, together with …
Emergency Contraception As An Element In The Care Of Rape Victims, Ricardo Vernon, Raffaela Schiavon, Silvia Elena Llaguno
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
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 …
Integrating Rti Services In Primary Health Care System: Observations From An Operations Research In Uttar Pradesh, India, M.E. Khan, Saumya Ramarao, R.B. Gupta, Bella C. Patel, Leila Caleb-Varkey, Jayanti Tuladhar, Sanjeev Kumar, John Townsend
Integrating Rti Services In Primary Health Care System: Observations From An Operations Research In Uttar Pradesh, India, M.E. Khan, Saumya Ramarao, R.B. Gupta, Bella C. Patel, Leila Caleb-Varkey, Jayanti Tuladhar, Sanjeev Kumar, John Townsend
Reproductive Health
Evidence from community studies indicates that significant proportions of Indian women (30 percent) may have reproductive tract infections (RTIs). Given that women are in general asymptomatic and that even symptomatic women may not seek care, the estimates are the minimum levels of prevalence. Most women do not seek treatment for RTIs for such reasons as lack of awareness, acceptance that RTIs are part of women's lives, and lack of treatment facilities. On the supply side, in the public sector the treatment for RTIs is limited with most services provided through STD clinics in urban areas. Seeking treatment at STD clinics …