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Cost Estimation For Scale-Up Of Voucher Services In Kenya, Shubhra Kumar, Smita Sanghrajka, Benjamin Bellows
Cost Estimation For Scale-Up Of Voucher Services In Kenya, Shubhra Kumar, Smita Sanghrajka, Benjamin Bellows
Reproductive Health
This document reports on the Government of Kenya’s Output-Based Aid (OBA) vouchers program—an affordable strategy to meet the international and national objectives for improved maternal and reproductive health. To help achieve the global Millennium Development Goals related to maternal and child health, the Kenyan government has launched several initiatives including this Vision 2030 flagship program which harmonizes global and national objectives by improving access and enhancing equity in health service delivery. The report finds that the three maternal health MDG indicators—maternal mortality rate, rate of institutional deliveries, and contraceptive prevalence—can all be improved substantially by scaling up the OBA program. …
Day Of Dialogue: Expanding Opportunities For Increased Access To Emergency Contraception (Ec) In Nigeria, Population Council
Day Of Dialogue: Expanding Opportunities For Increased Access To Emergency Contraception (Ec) In Nigeria, Population Council
Reproductive Health
In order to create a supportive policy and service delivery environment for emergency contraception (EC) and improve uptake in Nigeria, the Population Council conducted a survey of service providers’ knowledge, attitudes, and practices regarding EC, supplemented by in-depth interviews with key opinion leaders regarding their perceptions. This study revealed gaps that have implications for policy and programming. In collaboration with the International Consortium for Emergency Contraception, the Population Council convened a “Day of Dialogue” on EC to discuss the key research findings and to recommend strategic considerations for repositioning EC within the country's family planning program. This report describes the …
Feasibility Of Routine Screening For Intimate Partner Violence In Public Health Care Settings In Kenya, Chi-Chi Undie, Catherine Maternowska, Margaret Mak'anyengo, Ian Askew
Feasibility Of Routine Screening For Intimate Partner Violence In Public Health Care Settings In Kenya, Chi-Chi Undie, Catherine Maternowska, Margaret Mak'anyengo, Ian Askew
Reproductive Health
This Population Council study tested the feasibility of implementing intimate-partner violence (IPV) screening protocols in healthcare settings in Kenya where sexual and gender-based violence service referrals could be executed. Providers drawn from these sites were trained to routinely screen for IPV and to refer IPV-positive clients identified through this process for further care. This study demonstrates that providers, given the training, are willing and able to incorporate IPV screening into their practice—one that they perform in a severely resource-constrained context. Likewise, the findings indicate that incorporating IPV screening questions into client intake forms in a variety of public healthcare settings …
Quality Of Care And Client Willingness To Pay For Family Planning Services At Marie Stopes International In Burkina Faso, Placide Tapsoba, Dalomi Bahan, Emily Forsyth Queen, Gisele Kaboré, Sally Hughes
Quality Of Care And Client Willingness To Pay For Family Planning Services At Marie Stopes International In Burkina Faso, Placide Tapsoba, Dalomi Bahan, Emily Forsyth Queen, Gisele Kaboré, Sally Hughes
Reproductive Health
Many sexual and reproductive health programs operating in a limited-resource setting face a challenging balancing act between making services accessible and affordable to clients, including those most in need, and remaining financially sustainable. To achieve these dual objectives, the Population Council, with Marie Stopes International in Burkina Faso (MSI BF), launched a willingness-to-pay (WTP) study that examined the current situation and numerous pricing options, proposing optimal prices for products and services. The process of implementing the WTP survey was insightful for MSI BF as it provided evidence on client satisfaction with services and willingness to contribute to the cost of …
Status Report On The Sexual And Reproductive Health Of Adolescents Living In Urban Slums In Kenya, Donatien Beguy, Joyce Mumah, Salome Wawire, Kanyiva Muindi, Lindsey Gottschalk, Caroline W. Kabiru
Status Report On The Sexual And Reproductive Health Of Adolescents Living In Urban Slums In Kenya, Donatien Beguy, Joyce Mumah, Salome Wawire, Kanyiva Muindi, Lindsey Gottschalk, Caroline W. Kabiru
Reproductive Health
This report highlights the sexual and reproductive health (SRH) challenges faced by adolescents living in slums in Nairobi, Kenya, as well as the perceptions and strategies that adolescents adopt to deal with each of these challenges. The results point to the fact that there is a range of experiences among adolescents with regard to knowledge, attitudes, and behaviors. Age, education, and marital status were often strongly associated with certain adolescent sexual and reproductive health experiences, highlighting the fact that targeted programs are needed to reach adolescents with SRH services at different stages of need. Consistent and persistent poverty reduction strategies …
High Hiv Incidence Among Male Injection Drug Users In Delhi, India, Waimar Tun, Lopamudra Saraswati, Mary Philip Sebastian, Vartika Sharma, Amita Yadav, Ira Madan, Ibou Thior, Avina Sarna
High Hiv Incidence Among Male Injection Drug Users In Delhi, India, Waimar Tun, Lopamudra Saraswati, Mary Philip Sebastian, Vartika Sharma, Amita Yadav, Ira Madan, Ibou Thior, Avina Sarna
HIV and AIDS
India has a large injection drug user (IDU) population estimated at 177,000. The overall national HIV prevalence is around 7.2 percent in this group, the highest among all key populations in the country. There is limited HIV incidence data among IDUs in India. In collaboration with Arise—Enhancing HIV Prevention Programs for At-Risk Populations, the Population Council initiated a prospective cohort study at five centers in Delhi to examine HIV incidence and behavior change both pre-introduction and post-introduction of HIV prevention services among IDUs. HIV transmission risk remains high among IDUs in Delhi despite targeted prevention interventions. Despite the widespread availability …
A Toolkit For Developing Bilingual Lexicons For International Hiv Prevention Clinical Trials, Catalina B. Ramirez, Natasha Mack, Barbara Friedland
A Toolkit For Developing Bilingual Lexicons For International Hiv Prevention Clinical Trials, Catalina B. Ramirez, Natasha Mack, Barbara Friedland
HIV and AIDS
No standardized process exists for developing a set of agreed upon terms, definitions, and translations in local languages that ensures participants understand both technical and nontechnical terms used in a clinical trial context. HIV prevention trials deal with a disease that is stigmatized and with sexual behaviors that may not be openly discussed, thus care must be taken in the selection of words to ensure terms are appropriate for use in the context of a clinical trial and understandable but not offensive. The lack of a standardized process can make it difficult for researchers to decide which words to use, …
From Problem-Solving To Research Utilization: How Operations Research And Program Evaluation Can Make Programs Better, Karen Foreit
From Problem-Solving To Research Utilization: How Operations Research And Program Evaluation Can Make Programs Better, Karen Foreit
HIV and AIDS
HIV treatment, care, and support, and PMTCT programs are most effective when based on the best available research evidence. This is the fundamental premise of evidence-based medicine. Equally well known is the dilemma of transforming evidence into practice, which is the subject of knowledge translation and implementation science. Even when the findings of clinical trials make their way into international and national program guidelines, they run up against competing priorities within public health and community programs, resource constraints, and institutional and human inertia. Understanding how to effectively change the approach used in program operations requires understanding how programs work in …
The Unfinished Agenda To Meet Fp2020 Goals: 12 Actions To Fill Critical Evidence Gaps, Ian Askew, Martha Brady
The Unfinished Agenda To Meet Fp2020 Goals: 12 Actions To Fill Critical Evidence Gaps, Ian Askew, Martha Brady
Reproductive Health
More than 200 million women in the developing world who want to avoid pregnancy are not using a modern contraceptive method. The international community convened at the London Family Planning Summit in July 2012 and strengthened their resolve to address unmet need. National governments, civil society, and the private sector committed US$2.6 billion toward the goal of making contraceptive information, services, and supplies available to an additional 120 million women and girls by 2020. This book elaborates on one of two influential publications disseminated by the Population Council that assess the situation: Reviewing the Evidence and Identifying Gaps in Family …
Approaches That Will Yield Greater Success When Implementing Self-Administered Electronic Data Capture Ict Systems In The Developing World With An Illiterate Or Semi-Literate Population, Stanley J. Mierzwa, Samir Souidi, Irene Friedland, Sarah A. Littlefield, Lauren L. Katzen, Craig Savel, Deborah Boccio, Saumya Ramarao
Approaches That Will Yield Greater Success When Implementing Self-Administered Electronic Data Capture Ict Systems In The Developing World With An Illiterate Or Semi-Literate Population, Stanley J. Mierzwa, Samir Souidi, Irene Friedland, Sarah A. Littlefield, Lauren L. Katzen, Craig Savel, Deborah Boccio, Saumya Ramarao
Reproductive Health
The Information Technology (IT) Group at the Population Council responded to a need for a technology solution that would help researchers obtain more accurate responses to survey questions that concerned subject matter of a sensitive nature. The IT Group had three goals: (1) to enhance research by obtaining the best data possible, (2) to operate successfully in the local environment and be welcomed by the local populations, and (3) to increase the efficiency and cost-effectiveness of the survey process. This paper outlines approaches to consider when designing and implementing self-administered information and communications technology (ICT) questionnaires in developing countries, and …
Shaping Demand And Practices To Improve Family Health Outcomes: Findings From A Quantitative Survey, Volume 3: Bihar, M.E. Khan, France Donnay, Usha Kiran Tarigopula, Kumudha Aruldas
Shaping Demand And Practices To Improve Family Health Outcomes: Findings From A Quantitative Survey, Volume 3: Bihar, M.E. Khan, France Donnay, Usha Kiran Tarigopula, Kumudha Aruldas
Reproductive Health
This report provides findings of a study undertaken to generate comprehensive information on eight target behaviors that have direct bearing on family health in rural Bihar. Behaviors include: 1) Increasing the proportion of deliveries that occur in a facility and mothers who have access to basic emergency obstetric care; 2) Increasing the proportion of safe deliveries at home; 3) Increasing the uptake of preventive postnatal-care services for newborns and mothers; 4) Increasing the practice of skin-to-skin care/Kangaroo Mother Care for newborns; 5) Increasing the practice of early and exclusive breastfeeding of infants during the first six months of life; 6) …
Using Evidence-Based Recommendations For Guidance, Guidelines And Scale-Up Strategies, Ian Askew
Using Evidence-Based Recommendations For Guidance, Guidelines And Scale-Up Strategies, Ian Askew
Reproductive Health
No abstract provided.
Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed
Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed
Reproductive Health
The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …
Reviewing And Interpreting Bodies Of Evidence For Preparing Practice Recommendations, Ian Askew
Reviewing And Interpreting Bodies Of Evidence For Preparing Practice Recommendations, Ian Askew
Reproductive Health
No abstract provided.
Challenges In Impact Evaluation, Anrudh K. Jain
Challenges In Impact Evaluation, Anrudh K. Jain
Reproductive Health
These notes are for a presentation given at the Consultation on Social and Behavioral Change Interventions for Enhancing Child Survival in South Asia organized by UNICEF, USAID, and Population Council in New Delhi, India. The slides identify challenges for conducting impact evaluations by describing the anticipated process for behavior change communication using women’s support groups, issues encountered in the process, and evaluation designs. Examples from the Population PAIMAN project are used to illustrate ways to address these challenges.
Gender-Based Violence: A Qualitative Exploration Of Norms, Experiences And Positive Deviance, Shireen J. Jejeebhoy, K.G. Santhya, Shagun Sabarwal
Gender-Based Violence: A Qualitative Exploration Of Norms, Experiences And Positive Deviance, Shireen J. Jejeebhoy, K.G. Santhya, Shagun Sabarwal
Reproductive Health
This report presents the findings of formative research the Population Council conducted, with support from UK aid, in the district of Patna, India that aimed to better understand the context of violence—physical, emotional, and sexual—against women and girls, and notably, the prevailing norms about men’s entitlement and women’s acquiescence to violence. Findings suggest that violence against women and girls is widespread and widely justified, that women are perceived as having few options but to tolerate violence, and that the most common response to violence is silence. At the same time, many women and some positive deviant men recognize the injustice …
Reviewing The Evidence And Identifying Gaps In Family Planning Research: The Unfinished Agenda To Meet Fp2020 Goals, Ian Askew, Martha Brady
Reviewing The Evidence And Identifying Gaps In Family Planning Research: The Unfinished Agenda To Meet Fp2020 Goals, Ian Askew, Martha Brady
Reproductive Health
The Population Council produced this paper to help guide discussions and considerations regarding the key evidence gaps and research investments needed to achieve the FP2020 goal and objectives. The paper focuses primarily on the social science, implementation, and operations research that will be needed to achieve the first three objectives. Research shows that through high-quality voluntary family planning (FP) programs, governments can reduce fertility and generate substantial improvements in health, wealth, human rights, and education. Family planning programs for the 21st century will require thoughtful design—engaging both public and private sectors—to meet the growing need for safe and effective FP …
Health And Life Skills Curriculum For The Adolescent Girls Empowerment Program (Agep), Population Council
Health And Life Skills 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 curriculum aimed to …
Follow-Up Study Of Migrant Adolescent Girls In Domestic Service Who Participated In The First Cohort Of The Filles Éveillées ("Girls Awakened") Program, Sarah Engebretsen
Follow-Up Study Of Migrant Adolescent Girls In Domestic Service Who Participated In The First Cohort Of The Filles Éveillées ("Girls Awakened") Program, Sarah Engebretsen
Poverty, Gender, and Youth
Circular migration (from rural to urban areas and back) among adolescents is common throughout West Africa, with the principle motivation being the search for economic opportunities, including domestic work. The evidence base on adolescent migration and domestic work is fairly thin. Evidence on programmatic effectiveness generally ends at program completion and does not follow adolescents over time. The current study follows a subsample of migrant adolescent girls in domestic service in urban Burkina Faso who participated in the first cohort of the Filles Éveillées (Girls Awakened) pilot program. Filles Éveillées was designed to provide migrant girls in domestic service with …
The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Rwanda 2010, Population Council
The Adolescent Experience In-Depth: Using Data To Identify And Reach The Most Vulnerable Young People—Rwanda 2010, Population Council
Poverty, Gender, and Youth
“The Adolescent Experience In-Depth: Using Data to Identify and Reach the Most Vulnerable Young People: Rwanda 2010” is part of a series of Population Council guides that draw principally on data from the Demographic and Health Surveys to provide decisionmakers at all levels—from governments, nongovernmental organizations, and advocacy groups—with evidence on the situation of adolescent girls and boys and young women aged 10–24 years. The data are presented in graphs, tables, and maps (wherever possible), providing multiple formats to make the information accessible to a range of audiences. Section I is the Foreword. Section II offers brief technical notes specific …
Kalkidan ('Promise'): Addressing Marital Transmission Of Hiv In Ethiopia, Banchiamlack Dessalegn, Annabel Erulkar
Kalkidan ('Promise'): Addressing Marital Transmission Of Hiv In Ethiopia, Banchiamlack Dessalegn, Annabel Erulkar
Poverty, Gender, and Youth
This program brief describes a Population Council initiative in three low-income areas of Ethiopia. Kalkidan (Amharic for “Promise”) is a three-year program designed to increase discussion and information-sharing on HIV and related topics between marital partners; to promote HIV prevention and health service utilization within marriage, including prevention of mother-to-child transmission (PMTCT) of HIV; and to build husbands’ support of their wives, as well as investment in their health and that of their children. Kalkidan recruits and trains community-based mentors to lead parallel discussion groups of husbands and wives, who periodically come together for joint sessions. The Population Council is …
Policy Brief: Adolescent Girls And Migration In The Developing World, Population Council
Policy Brief: Adolescent Girls And Migration In The Developing World, Population Council
Poverty, Gender, and Youth
When a migrant girl is successful, she creates a ripple effect through generations: families and future children will be better off because of her ability to finish school, get a job, and stay healthy. Despite the positive potential of migration for adolescent girls, migrant girls are largely ignored in policy and programs designed to reach migrants and adolescents. Because of their age and gender, migrant girls are especially vulnerable to risks such as exploitative employment. If these girls arrive at their destination and settle in safely, their diligence can enable them to capitalize on new opportunities and become productive, contributing …
Girls On The Move: Adolescent Girls & Migration In The Developing World, Miriam Temin, Mark R. Montgomery, Sarah Engebretsen, Kathryn M. Barker
Girls On The Move: Adolescent Girls & Migration In The Developing World, Miriam Temin, Mark R. Montgomery, Sarah Engebretsen, Kathryn M. Barker
Poverty, Gender, and Youth
Adolescent girls in developing countries are migrating to urban areas in ever greater numbers. While migration can be risky, for the majority of girls, migration can increase opportunities and economic stability and provide them with the autonomy to make decisions about their lives. Preventing the worst outcomes and helping girls succeed are essential to unlocking the benefits of migration. When migrant girls can take advantage of the benefits, they can be a powerful force for change in the developing world—improving lives and reducing poverty in their communities and countries. This Girls Count report examines the social and economic determinants of …
Demographic Dividend, A Window Of Opportunity For Development: Implications For South-South Cooperation, Selina F. Esantsi
Demographic Dividend, A Window Of Opportunity For Development: Implications For South-South Cooperation, Selina F. Esantsi
Reproductive Health
At the Inter-Ministerial Conference on “South-South Cooperation in Post ICPD and MDGs” held in Beijing in 2013, this presentation defined the demographic dividend and noted implications and potential benefits of this opportunity. Two case studies were presented—South Korean and Ghana—followed by suggestions for governments on how to harness this dividend. Suggestions include investing in child survival and health programs, building human capital, stabilizing the financial sector, and improving transparency and governance. The presentation concludes with specific ways for south–south collaboration to enhance this opportunity.
The Adolescent Girls Empowerment Program: Lessons Learned From The Pilot Test Program, Karen Austrian, Natalie Jackson Hachonda, Paul C. Hewett
The Adolescent Girls Empowerment Program: Lessons Learned From The Pilot Test Program, Karen Austrian, Natalie Jackson Hachonda, Paul C. Hewett
Poverty, Gender, and Youth
Adolescent girls in Zambia face a range of risks and vulnerabilities that compromise their healthy development into young women, and lack the social, health, and economic assets to mitigate these risks. The issues that girls are confronted with include high rates of gender-based violence, unsafe sex that puts them at risk for unwanted pregnancy and HIV infection, school dropout, lack of economic resources and income-generating options, and lack of agency and participation. The Adolescent Girls Empowerment Program (AGEP) has three major components: safe spaces groups in which girls meet once a week over the course of two years for training …
Understanding Unintended Pregnancy In Bangladesh: Country Profile Report, Fauzia Akhter Huda, Sabiha Chowdhuri, Yolande Robertson, Noushin Islam, Bidhan Krishna Sarker, Ashrafi Jahan Azmi, Laura Reichenbach
Understanding Unintended Pregnancy In Bangladesh: Country Profile Report, Fauzia Akhter Huda, Sabiha Chowdhuri, Yolande Robertson, Noushin Islam, Bidhan Krishna Sarker, Ashrafi Jahan Azmi, Laura Reichenbach
Reproductive Health
The objective of this report is to identify the determinants of unintended pregnancy and unmet need for family planning in Bangladesh and therefore provide a strong body of evidence that will contribute to issue identification, evidence generation, and communication for use of evidence in policy and programming. The evidence generated can be used to find ways to reduce the rate of unintended pregnancy and hence reduce the risk of abortion-related morbidity and mortality; ultimately this will aid Bangladeshi couples in reaching their fertility goals. Results demonstrate that Bangladesh has shown progress and promise in several areas of family planning and …
Mainstreaming Emergency Contraception In Developing Countries: A Toolkit For Policymakers And Service Providers, Wilson Liambila, Saumya Ramarao, Joyce Wanderi Maina, Mary W. Gathitu
Mainstreaming Emergency Contraception In Developing Countries: A Toolkit For Policymakers And Service Providers, Wilson Liambila, Saumya Ramarao, Joyce Wanderi Maina, Mary W. Gathitu
Reproductive Health
In late 2006, the Kenyan Ministry of Health (MOH), the Population Council, and Population Services International (PSI) launched an initiative to mainstream emergency contraception (EC) in Kenya. The initiative included a core set of activities aimed at improving overall awareness of EC across the country and strengthening the quality of EC services in both the public and private sectors. It was intended to serve as a model for other countries interested in improving access to EC, and to generate in-depth knowledge on EC program strategies and utilization characteristics in sub-Saharan Africa. The MOH drew lessons and experiences from the initiative …
Prevalence Of Hiv, Hepatitis B And C, And Co-Infection In A Cohort Of Male Injection Drug Users In Delhi, Lopamudra Saraswati, Mary Philip Sebastian, Avina Sarna, Vartika Sharma, Ira Madan, Dean Lewis, Ibou Thior, Waimar Tun
Prevalence Of Hiv, Hepatitis B And C, And Co-Infection In A Cohort Of Male Injection Drug Users In Delhi, Lopamudra Saraswati, Mary Philip Sebastian, Avina Sarna, Vartika Sharma, Ira Madan, Dean Lewis, Ibou Thior, Waimar Tun
HIV and AIDS
India has a large injection drug user (IDU) population estimated at 177,000 nationally with an HIV prevalence of 7.2 percent. Historically, the presence of IDU populations and associated HIV infection was concentrated in the northeastern states of the country. Recent evidence documents IDU populations in other parts of the country. Delhi has an estimated 17,000 IDUs and the second highest HIV prevalence in India at 18.3 percent. The probability of becoming infected with HIV after using an infected syringe ranges from 0.34 percent to 1.4 percent. By comparison, the risk for hepatitis C (HCV) ranges from 1.5 percent to 5 …
Assessment Of The Availability And Use Of Maternal Health Supplies In The Primary Health Care System In Amhara Region, Ethiopia, Sarah Raifman, Sisay Mellese, Kelemua Hailemariam, Ian Askew, Annabel Erulkar
Assessment Of The Availability And Use Of Maternal Health Supplies In The Primary Health Care System In Amhara Region, Ethiopia, Sarah Raifman, Sisay Mellese, Kelemua Hailemariam, Ian Askew, Annabel Erulkar
Reproductive Health
Maternal mortality in Ethiopia remains among the highest in the world. A UN Commission Report in 2012 identified 13 life-saving commodities—defined as medicines, medical devices, and health supplies—that effectively address avoidable causes of death during pregnancy and childbirth that, if more widely accessed and properly used, could significantly reduce preventable deaths among women. This assessment, conducted by the Population Council, evaluates the availability of these life-saving commodities that are essential for basic emergency obstetric and neonatal care, and safe and clean delivery services within primary health care in Ethiopia. The report concludes that Ethiopia’s pharmaceutical procurement and supply system is …
Do Public Health Services In Egypt Help Women Exercise Their Reproductive Rights?, Nahla G. Abdel-Tawab
Do Public Health Services In Egypt Help Women Exercise Their Reproductive Rights?, Nahla G. Abdel-Tawab
Reproductive Health
These slides present results from a Population Council study conducted in Egypt aimed at identifying factors that prevent Egyptian couples from attainment of their reproductive goals using a rights-based, gender-sensitive analysis of family planning service demand and supply. The analysis focused on six aspects of clients’ rights: clinic/provider readiness, accessibility and affordability, privacy and confidentiality, choice and autonomy, informed decisionmaking, and the right to complain. The presentation concludes with recommendations for closing gaps that exist with regard to protection of clients’ rights to autonomy, choice, informed decisionmaking, privacy, and confidentiality.