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Understanding Factors Influencing Adverse Sex Ratios At Birth And Exploring What Works To Achieve Balance: The Situation In Selected Districts Of Nepal, Mahesh Puri, Anand Tamang

Poverty, Gender, and Youth

The goal of this study is to identify programs and sociocultural factors underlying disparities in sex ratios at birth in some parts of Nepal, by comparing the situation in districts with high and normal sex ratios at birth and among under-5 children. Findings are expected to inform the design of programs intended to raise the value of girls in general and counter the practice of gender-biased sex selection in particular. The study was conducted in two adjoining hill districts of the western development region of Nepal, namely Kaski (where sex ratios are adverse) and Tanhaun (where sex ratios are normal). …

Adolescent Girls Initiative-Kenya: Financial Education Curriculum, Kibera, Population Council

Poverty, Gender, and Youth

The Adolescent Girls Initiative–Kenya builds the social, health, and economic assets of adolescent girls in urban slums and Northeastern Kenya. This collection of learning sessions was designed to prepare adolescent girls for the financial responsibilities of adulthood. The sessions were developed to be delivered without a lot of resources or materials, with limited time available for training. The guide contains step-by-step descriptions of the learning activities as well as background information.

Adolescent Girls Initiative-Kenya: Health And Life Skills Curriculum, Kibera, Population Council

Poverty, Gender, and Youth

The Adolescent Girls Initiative–Kenya builds the social, health, and economic assets of adolescent girls in urban slums and Northeastern Kenya. This collection of learning sessions was designed to increase adolescent girls’ knowledge of reproductive health and sexuality; reinforce and promote attitudes and behaviors that will lead to a better quality of life; and instill skills among adolescents to enable them to overcome the challenges of growing up and becoming responsible adults including communication skills, decision-making, assertiveness, setting goals and resisting peer pressure. The sessions were developed to be delivered without a lot of resources or materials, with limited time available …

Union Health And Family Welfare Centers In Chittagong And Munshiganj: Are They Ready To Provide 24-Hour Normal Delivery Services?, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Shongkour Roy, Afsana Fatema Noor

Reproductive Health

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. Yet, Family Welfare Visitors (FWVs) posted at UHFWCs perform only 0.3 percent of deliveries. This means that UHFWCs and FWVs are not optimally utilized to increase the rate of institutional deliveries. …

Willingness To Pay For Contraceptive Vaginal Rings In Nigeria, Salisu Mohammed Ishaku, Ayodeji Oginni, Godwin Unumeri, Deepa Rajamani

Reproductive Health

During the last two decades, Nigeria’s contraceptive prevalence rate (CPR) for modern methods remained at 10 percent, one of the lowest rates in sub-Saharan Africa. Following the renewed global commitments culminating in the 2012 London Summit on Family Planning with promises to reach an additional 120 million new users of modern contraceptives worldwide, Nigeria’s Federal Ministry of Health set a new target of raising Nigeria’s CPR to 36 percent by 2018. One way to accomplish this is by meeting the contraceptive needs of women in the immediate postpartum period and beyond. Attention is being focused on making proven contraceptive methods …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Mmr In Punjab, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood

Reproductive Health

Pakistan is one of the six countries that account for more than 50 percent of the world’s maternal deaths. Each year, there are nearly 14,000 pregnancy-related deaths. Although maternal mortality has fallen from 533 per 100,000 live births in 1990–91 to 276 in 2006–07, Pakistan has not been able to achieve its Millennium Development Goal target of reducing maternal mortality to 140 per 100,000 live births by 2015. Planners require a method that can provide reliable subnational estimates easily, cost effectively. and with greater regularity. The Research and Advocacy Fund offered support to the Government of Pakistan to assess the …

Fertility Transitions In Kenya And Ghana: Trends, Determinants And Implications For Policy And Programs, Ian Askew, Baker Ndugga Maggwa, Francis Onyango

Reproductive Health

The literature on fertility transitions in the sub-Saharan Africa region suggests that an early transition was observed across nearly all age groups, socioeconomic groups, and countries. This workshop report analyzes fertility transitions in Ghana and Kenya which are influenced by a multiplicity of factors, with marked similarities and differences between each country. Paradoxically, these analyses and critiques of policy and programming experiences suggest that, if enabling women and couples to achieve their wanted fertility rates within a rights-based approach that reduces inequities as well as reducing TFR toward replacement level are the goals of a national family planning program, then …

Engaging The Missing Link: Evidence From Falah For Involving Men In Family Planning In Pakistan—Case Study, Seemin Ashfaq, Maqsood Sadiq

Reproductive Health

This report describes FALAH’s experience of engaging men in its target communities, which bears out the finding of recent studies that Pakistani men are ready, indeed eager, to be involved directly in family planning. Implementation of the FALAH approach to male engagement in 20 districts across Pakistan’s four provinces shows that male engagement can be implemented on a large scale and that it can be synchronized with interventions that target women together with men, as is the case with interactive theatre, or separately, as with the male and female falahi workers. The findings from this case study are relevant for …

Landscape Analysis On Pre-Eclampsia And Eclampsia In Bangladesh, Charlotte E. Warren, Sharif M.I. Hossain, Rahat Ara Nur, Kanij Sultana, Karen Kirk, Amy Dempsey

Reproductive Health

Globally more than 800 women die every day from preventable complications related to pregnancy and childbirth, and 99 percent of these deaths occur in developing countries. Every day approximately 7,200 babies are stillborn. Pre-eclampsia and eclampsia (PE/E) contribute significantly to these mortalities. Eclampsia is the second most common direct cause of maternal death in Bangladesh followed by post-partum hemorrhage. Through the Ending Eclampsia project, the Population Council is seeking to expand access to proven, underutilized interventions and commodities for the prevention, early detection, and treatment of PE/E. In resource-poor countries, particularly Bangladesh, magnesium sulphate (MgSO4) for management of severe PE/E, …

Willingness To Pay For Contraceptive Vaginal Rings In Kenya, Wilson Liambila, Deepa Rajamani, Francis Obare, Saumya Ramarao, Harriet Birungi, Heather Clark

Reproductive Health

Despite progress made in reducing fertility and increasing the contraceptive prevalence rate in Kenya, many women still experience high unmet need for contraception. Part of the challenge in addressing current levels of unmet need is the limited use of contraception by women during the first 12 months postpartum. New methods are needed that offer greater ease of use, are women-initiated, and do not require significant medical provider involvement for service delivery. One such method is the Progesterone Vaginal Ring (PVR), a reversible contraceptive that according to clinical trial data is safe and effective for breastfeeding women. New product introduction strategies …

Delivering Contraceptive Vaginal Rings: Review Of Postpartum And Postnatal Care Programs In Nigeria, Godwin Unumeri, Salisu Mohammed Ishaku

Reproductive Health

Postpartum family planning is a major component of postpartum care services. The Population Council is working to introduce an additional method of contraception in Nigeria—the Progesterone Contraceptive Vaginal Ring (PCVR). The PCVR is administered vaginally but acts systemically to inhibit ovulation. The PCVR contains natural progesterone and is meant for breastfeeding women to augment lactational amenorrhea. As the Council conducts a series of activities as a prelude to eventual introduction of the PCVR in sub-Saharan Africa, including Nigeria, the detailed evaluation of the postpartum program environment is very important. Understanding the prevailing postpartum and postnatal care landscapes will be crucial …

Delivering Contraceptive Vaginal Rings: Review Of Postpartum Service Packages In Kenya, Wilson Liambila, Saumya Ramarao, Heather Clark

Reproductive Health

The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time, yet this is the most neglected period for the coverage and provision of quality care. The building blocks of the WHO health systems model were applied in describing the status and health system structures that support the provision of postpartum and postnatal care (PNC) services in Kenya. Many opportunities exist for facilitating the delivery of the Population Council’s Progesterone Contraceptive Vaginal Rings (PCVR) within PNC services in Kenya, such as integration with other primary health care …

Delivering Contraceptive Vaginal Rings—Task Shifting And Task Sharing In The Delivery Of Family Planning Services: Experiences From Kenya, Wilson Liambila, Saumya Ramarao, Heather Clark

Reproductive Health

This report describes the task-shifting and task-sharing policies and experiences relevant to the provision of family planning (FP) services in Kenya and the potential place for contraceptive vaginal rings. The feasibility, effectiveness, and acceptability of mid- and lower-level providers in the provision of FP services is documented. The report highlights how the provision of integrated RH/FP/HIV services could be delivered by various levels in the national health care system through task-sharing. Opportunities for facilitating delivery of the Population Council’s Progesterone Contraceptive Vaginal Ring (PCVR) within the national health care system in Kenya are also described. Kenya has in place policies …

Offering Progesterone Contraceptive Vaginal Rings For Postpartum Women Through Integrated Family Planning And Immunization Services, Ishita Chattopadhyay, John Townsend, Saumya Ramarao

Reproductive Health

This technical report describes a model for providing the Population Council’s Progesterone Contraceptive Vaginal Ring (PCVR) through integrated FP/Immunization (FP/I) services, the core components of the model, the types of inputs required, and the steps for introduction and scale-up. It describes how the PCVR can be offered to breastfeeding women in the first year following childbirth. A methodology for implementation of the PCVR-Family Planning/Immunization model (also referred to as PCVR-FP/I) has been designed to introduce the PCVR in the context of accessibility, choice, equity, and, quality. A proposed structure to introduce and integrate the PCVR has been outlined and described …

Reducing Maternal And Child Mortality In Sindh: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This Population Council/Evidence Project policy brief explains why FP must be prioritized in Sindh, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. Evidence shows that FP is one of the most powerful tools at the government’s disposal for a rapid reduction in maternal, infant, and child mortality. FP’s wider health benefits include reduced anemia among women; lower …

Reducing Maternal And Child Mortality In Khyber Pakhtunkhwa: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family Planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This Population Council/Evidence Project policy brief explains why family planning must be prioritized in Khyber Pakhtunkhwa, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. By fulfilling the existing unmet need for birth spacing and limiting, it is possible to prevent 37 percent of maternal deaths and 57 percent of infant deaths. FP’s wider health benefits include reduced …

Reducing Maternal And Child Mortality In Balochistan: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This brief explains why FP must be prioritized in Balochistan, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. By fulfilling the existing unmet need for birth spacing and limiting, it is possible to prevent 41 percent of maternal deaths, 35 percent of infant deaths, and 74 percent of young child deaths. FP’s wider health benefits include reduced …

The Raise Health Initiative For Workers, Companies, And Communities, The Evidence Project

Reproductive Health

RAISE Health is an initiative to improve the health of factory and farm workers (women and men) in developing countries through changes in global and corporate policies and workplace practices. Effective management of workplace health is good for companies and workers alike, resulting in better health and morale, better labor-management relations, empowerment of women, and better use of company health investments. Worker health is typically one of the most neglected areas in business operations. As this activity brief notes, RAISE Health is a major activity of the USAID-funded Evidence Project. The goal of the initiative is to utilize the existing …

Progesterone Vaginal Ring: A Call-To-Action To Fill Critical Gaps In Post-Partum Family Planning, Population Council

Reproductive Health

The progesterone vaginal ring (PVR) is a safe and effective method of contraception for lactating women. It is a priority medicine on the WHO’s Essential Medicines List and is included in the Medical Eligibility Criteria for family planning providers. Developed by the Population Council, the PVR is an intravaginal ring that provides women who breastfeed at least four times a day with a contraceptive option as early as four weeks after giving birth. The PVR provides a new option to reduce unmet need among new mothers, allow women to safely space their pregnancies, and improve the health of women and …

Willingness To Pay For Contraceptive Vaginal Rings In Senegal, Babacar Mane, Fatou Mbow, Deepa Rajamani, Nafissatou Diop, Saumya Ramarao

Reproductive Health

Contraceptive vaginal rings are an innovative category of products that have not been introduced into any sub-Saharan African country. As a result, there is little experience to guide the introductory pricing for the PVR and the one-year NES/EE CVR when it becomes available. The evidence generated by this consumer willingness to pay, and provider/procurer study has shed light on critical aspects of PVR introduction in Senegal. In general, the results generated here complement and reinforce findings from an acceptability study of the PVR and stakeholder discussions that have been occurring over the past three years. Results confirm that contraceptive vaginal …

Gender Considerations Along The Hiv Treatment Cascade: An Evidence Review With Priority Actions, Melanie Croce-Galis, Jill Gay, Karen Hardee, What Works Association, Population Council

Reproductive Health

This treatment brief provides policymakers and program implementers with evidence about the impact of gender dynamics on treatment access and adherence and the gender-related gaps in treatment research and programming. It also includes priority actions that can be taken to better address gender within treatment programming and raises questions for implementation science in order to achieve the global 90-90-90 goal. This brief draws from What Works for Women and Girls: Evidence for HIV Interventions and uses the WHO treatment cascade framework to identify and analyze major gender considerations in providing antiretroviral therapy to those living with HIV in low- and …

Population Briefs, Vol. 20, No. 2, Population Council

Population Briefs

IN THIS ISSUE: Preclinical study shows microbicide gel’s effectiveness against HIV and other viruses | Ensuring that family planning programs respect, protect, and fulfill women’s rights | The influence of rural women’s autonomy on marital violence in four Indian states | Meeting the needs of adolescent girls: Using research to develop and implement programs that improve girls’ lives

Baseline Survey Of Nigerian Media Coverage Of Youth Sexual And Reproductive Health And Hiv And Aids Related Issues, January 1st–December 31st, 2012, Population Council

HIV and AIDS

To promote more informed public dialogue on youth vulnerabilities, responses to HIV/AIDS, and positive changes in relevant policies and programs via learning and advocacy interventions at the state and national levels in Nigeria, the Population Council commissioned a study of the print and electronic media’s coverage of HIV/AIDS and sexual and reproductive health–related issues among youth aged 15–24 years in Nigeria for the period January 1 to December 31, 2012. The study entailed a content analysis of four national and two regional newspapers, and an online forum that is one of the most frequently visited social media sites in Nigeria. …

Retention Of Adolescents Living With Hiv In Care, Treatment, And Support Programs In Uganda, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Joanne Lyavala Okullu, Celestin Bakanda, Stephen Okoboi, Francis Obare

HIV and AIDS

Understanding the extent to which adolescents aged 10–19 years who are living with HIV are retained in HIV care, treatment, and support is important for informing the design of effective services for this population to better meet their needs across three main areas of HIV and AIDS programming: treatment; care and support; and prevention. Retention in HIV programs is, in turn, important for positive clinical outcomes including viral suppression and survival. In 2013–2014, The AIDS Support Organization and the Population Council undertook a study to generate evidence on factors associated with retention of adolescents in HIV and AIDS programs in …

Hiv/Aids Vulnerabilities, Discrimination, And Service Accessibility Among Nigeria's Youth, Population Council

HIV and AIDS

This report documents the findings of a study implemented between August 2011 and July 2012 that sought to provide a comprehensive, evidence-based picture of the HIV-related issues facing Nigerian youth and the prevailing legal, policy, and programmatic responses. The study was designed to establish a basis for a sharper focus on youth within the national response to HIV. Researchers conducted an analytical review of the relevant literature on factors associated with HIV risk-taking and health-seeking behaviors among young people aged 15–24 in Nigeria. In addition, qualitative and quantitative analyses enabled an evaluation of the factors associated with young people’s sexual …

Sexuality, Gender Roles, And Domestic Violence In South Asia, M.E. Khan, John Townsend, Pertti J. Pelto

Reproductive Health

In the past 15 years, there has been a notable increase in research on and interest in sexuality, masculinity, domestic violence, gender inequities in South Asia, yet the dimensions of men’s and women’s concepts of masculinity and sexuality, changing patterns of gender roles, and the nature of violence remain partly understood.

Focusing mainly on Bangladesh and India, the 16 chapters in this book are designed to deepen our understanding of sexuality, HIV and AIDS, and gender relations in South Asia. The chapters explore topics such as marital and extramarital sexual relations, socioeconomic and sexual security of female garment workers, gender …

Population Briefs, Vol. 20, No. 1, Population Council

Population Briefs

IN THIS ISSUE: “Anything can happen anytime”: Perceived lack of safety among girls in South Africa | Expanding contraceptive options for breastfeeding women: Introduction of the progesterone contraceptive vaginal ring | Reducing unmet need for contraception: Helping women to continue effective use | Estimating the size of key populations in Nairobi, Kenya

Population Briefs, Vol. 20, No. 3, Population Council

Population Briefs

IN THIS ISSUE: Ethiopian projects build girls’ assets to help them avoid HIV, other risks | New insight into sexuality, gender issues, and gender-based violence in South Asia | Client and provider perspectives on adolescent reproductive and sexual health services in India | New study provides first global accounting of urban water sources and stress

Program And Policy Considerations For Tenofovir Gel In India: An Overview, Population Council

HIV and AIDS

The 2011 National Sentinel Surveillance estimated that 1.9 million people in India aged 15 and older were living with HIV. An estimated 39 percent are women. Given the urgent need for HIV-prevention options for women, a number of efforts are underway to prepare for introduction of tenofovir gel should it be shown to be effective. One of these is a guide to assist policymakers and program managers in identifying the most strategic opportunities for introducing tenofovir gel. The guide includes three related components: a landscape analysis, a discussion guide for key opinion leader interviews, and a program planning tool. The …

Nutrition Education Curriculum For The Adolescent Girls Empowerment Program (Agep), Population Council

Poverty, Gender, and Youth

The Adolescent Girls Empowerment Program (AGEP) in rural and urban Zambia aims to build social, health, and economic assets of adolescent girls. A safe spaces component is at the core of AGEP. Girls groups, under the guidance of a female mentor from the same community, provide a safe and supportive learning environment. The meetings are critical in building social assets for vulnerable girls—including friendships, self-esteem, trusting relationships with adults, and social support. The training content over the course of the year varies from sexual and reproductive health and life skills to financial education and nutrition training. This collection is focused …