Medicine and Health Sciences Commons^™

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Ebonyi, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina …

Shifts In Female Genital Mutilation/Cutting In Kenya: Perspectives Of Families And Health Care Providers, Samuel Kimani, Caroline W. Kabiru

Reproductive Health

Despite compelling reasons and efforts to eradicate female genital mutilation/cutting (FGM/C) in Kenya, the practice has persisted, albeit with some changes. This study sought to understand the shifts in FGM/C among families and healthcare providers from selected Kenyan communities that practice FGM/C. Our findings highlight similarities and differences across three distinct Kenyan communities. FGM/C appears to persist through two models: first, shifts (changes) in the practice, notably cutting at a younger age, lesser cutting; and second, through stability and consistency with minimal change. The two diverse models appear to rely on and sustain social norms that support FGM/C in these …

Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain

Reproductive Health

Study findings reveal that many Kenyan women living with HIV are comfortable receiving family planning (FP) services from community health volunteers and with proper training and support, community health volunteers have the potential to provide integrated FP/HIV services. Community-based integrated FP/HIV services could help connect women living with HIV who want to prevent or postpone a pregnancy to contraceptive services, which can reduce unintended pregnancies and in turn maternal mortality and vertical transmission of HIV. This implementation research study offers evidence of the feasibility, quality of care, and acceptability of using community health volunteers to integrate family planning into HIV/AIDS …

The Perspectives Of Men In Mexico City About Vasectomy, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

As part of World Vasectomy Day, the Population Council Mexico conducted an exploratory study about the reasons and concerns that led men to seek a no-scalpel vasectomy (NSV) during the 24-hour “Vasectomy-athon” in Mexico City in 2017. This study was intended as the first part of a longer cohort study that would follow up with the men, and their partners, to learn about their experiences with the procedure and its effects, if any, on their relationships. Based on the findings, the report recommends that the Mexican Ministry of Health (SSA) continue integrating NSV information, counseling, and services within the National …

The Perspectives Of Men In Mexico City About Vasectomy—Brief, Isabel Vieitez Martínez, Adriana Ramos

Reproductive Health

On November 17, 2017, Mexico City took part in the global World Vasectomy Day campaign promoting men’s participation in family planning, especially through no-scalpel vasectomy (NSV). During the event the Population Council Mexico conducted an exploratory study to better understand the reasons men chose NSV, as well as their concerns before and after the procedure. The study found that the principal reason for seeking NSV among men surveyed was their achievement of a desired family size, for themselves and their partners. The study further reveals the need to disseminate information through mass media, social networks, and all levels of the …

The Rationale And Relevance Of Existing Cadres Of Frontline Health Workers And Potential For New Mid-Level Cadres, Oladimeji Oladepo, Ekechi Okereke, Akinwumi Akinola

Reproductive Health

Front-line health workers (FLHWs) are expected to perform necessary maternal, newborn, and child (MNCH) services appropriately and effectively; however, few studies have investigated the extent to which FLHWs perform requisite primary health care (PHC) services. This study seeks to better understand not only FLHWs’ knowledge and performance of MNCH services, but the factors promoting and inhibiting their services in selected rural local government areas of Nigeria’s Bauchi and Cross River states. It also investigates the potential for a new PHC worker cadre, soliciting stakeholders’ perceptions about its feasibility for addressing maternal and newborn disease burdens in rural communities. The study’s …

Tracing Change In Female Genital Mutilation/Cutting: Shifting Norms And Practices Among Communities In Narok And Kisii Counties, Kenya, Dennis Matanda, Chantalle Okondo, Caroline W. Kabiru, Bettina Shell-Duncan

Reproductive Health

In Kenya, there has been a steady and marked decline in the prevalence of female genital mutilation/cutting (FGM/C) but there is great variance in the prevalence of FGM/C across the country, with prevalence remaining high among certain ethnic groups such as Somali, Samburu, Kisii, and the Maasai. The objectives of this study were: 1) to explore whether and how unprogrammed factors or programmed FGM/C interventions (alternative rites of passage, legal and policy measures, religious-oriented approaches, promotion of girls’ education, intergenerational dialogues, use of rescue centers, and other undocumented approaches) influence community values deliberation in Narok and Kisii counties; 2) to …

Trends In Medicalisation Of Female Genital Mutilation/Cutting: What Do The Data Reveal?, Bettina Shell-Duncan, Carolyne Njue, Zhuzhi Moore

Reproductive Health

Despite the emergence of international consensus that female genital mutilation/cutting (FGM/C) is a violation of human rights, a focus on medicalization remains salient because of concerns that FGM/C is increasingly being performed by healthcare professionals and may be impeding progress toward abandonment of FGM/C. To investigate these claims, this study draws on nationally representative survey data from 26 countries, and addresses the following three questions: 1) What are the major patterns and trends in medicalisation? 2) Is there an association between medicalization and rates of change in prevalence of FGM/C? and 3) Is there an association between medicalization and support …

Understanding Medicalisation Of Female Genital Mutilation/Cutting (Fgm/C): A Qualitative Study Of Parents And Health Workers In Nigeria, Otibho Obianwu, Adetayo Adetunji, Osasuyi Dirisu

Reproductive Health

This community-based, cross-sectional qualitative study was conducted in four communities in Nigeria’s Delta, and was conceptualized to address gaps in our understanding of medicalization of female genital mutilation/cutting (FGM/C) and to provide critical evidence needed to effectively design abandonment interventions. The study findings reveal that the social norms driving FGM/C practice remain entrenched despite a shift to medicalization. They also reflect the tendency of parents and health workers to view FGM/C, whether traditional or medicalized, as a minor procedure with few complications and significant benefits that would positively impact a daughter’s future status as a wife and mother. Findings reveal …

Understanding The Key Elements For Designing And Implementing Social Marketing Campaigns To Inform The Development Of Creative Approaches For Fgm/C Abandonment In Sudan, Widad Ali A/Rahman, Samia Al Nagar, Randa H. Gindeel, Arwa Salah

Reproductive Health

Social marketing campaigns (SMCs) have gained prominence in female genital mutilation/cutting (FGM/C) abandonment efforts, but there is a dearth of information on how these programs are designed and implemented, and their perceived impact. Understanding the implementation process and the effectiveness of these campaigns is critical for drawing lessons to improve existing programs and inform the design and scale up of SMCs in other regions/countries. This mixed-method study sought to address this gap by assessing the design and implementation of existing SMC programs in Sudan. While the study findings demonstrate several strengths of existing programs, including strong partnerships and extensive needs …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

Expanding Access To Integrated Family Planning Intervention Packages For Married Adolescent Girls In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Hassan Rushekh Mahmood, Sadia Afrin, Anisuddin Ahmed, Nafis Al Haque, Bidhan Krishna Sarker

Reproductive Health

This research report describes an intervention study conducted among married adolescent girls aged 15–19 years in four urban slums of Dhaka, Bangladesh. Objectives of the study were to examine the acceptability and feasibility of forming married adolescent girls’ clubs, and involving community health volunteers (Shasthya Skebikas) and marriage registrars to increase access to family planning (FP) information and services, to promote the uptake of long-acting reversible contraceptive methods, and to provide FP information to newlywed couples at the time of marriage registration. The study findings revealed that a noteworthy number of married adolescent girls received FP-related information, mostly from the …

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 …

Status Of Sexual And Reproductive Health And Rights In Zambia: Contraception And Family Planning, Preventing Unsafe Abortion And Accessing Post Abortion Care, And Maternal Health, Population Council

Reproductive Health

In 1994, the International Conference on Population and Development affirmed that sexual and reproductive health and rights (SRHR) are human rights. The Government of the Republic of Zambia has fully committed to fulfilling the SRHR of all people by ratifying 11 international instruments of law. This brief is Part 1 of a three-part series entitled “Status of Sexual and Reproductive Health and Rights in Zambia,” reporting on progress, gaps, and existing challenges in SRHR. Using a human rights–based approach, the Government of Zambia and collaborators, with technical facilitation by the Population Council, conducted an assessment of the status of SRHR …

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.

Measuring Disrespect And Abuse To Promote Respectful Maternity Care, Population Council

Reproductive Health

The Heshima project developed several study instruments to measure disrespect and abuse throughout the study’s formative, baseline, and endline stages. The quasi-experimental implementation research design applied a mixed methods approach to understanding the meaning and factors that drive disrespect and abuse in maternity settings in Kenya. These tools allowed the project to measure the prevalence of disrespect and abuse in this setting, as well as the changes affected by the project.

The Heshima project involved a complex set of multi-level interventions that sought to curb disrespectful and abusive practices during childbirth and promote dignified and respectful maternity care. The evidence …

Compte Rendu De La Réunion Régionale Des Comités De Plaidoyer Pour Avortement Médicalisé, Fatou Mbow

Reproductive Health

En partenariat avec le Ministère de la Santé et de l'Action Sociale, particulièrement la Direction de la santé de la reproduction et de la survie de l’enfant et le comité national de plaidoyer pour l’accès à l’avortement médicalisé (Taskforce), le bureau du Population Council du Sénégal a organisé une réunion régionale des comités/associations de plaidoyer pour avortement médicalisé de l’Afrique de l’ouest francophone. La réunion a eu lieu le 24 octobre 2017 à Dakar, Sénégal. Elle avait pour but de discuter des avancées notées dans l’accès à l’avortement médicalisé et mettre en exergue les efforts des pays de la région …

Risk Factors For Pre-Eclampsia And Eclampsia In Belize, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Belize.

Risk Factors For Pre-Eclampsia And Eclampsia In Cambodia, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Cambodia.

Risk Factors For Pre-Eclampsia And Eclampsia In Guatemala, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Guatemala.

Risk Factors For Pre-Eclampsia And Eclampsia In Nepal, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Nepal.

Status Of Sexual And Reproductive Health And Rights In Zambia: Comprehensive Sexuality Education And Adolescents Sexual And Reproductive Health, Population Council

Reproductive Health

In 1994, the International Conference on Population and Development affirmed that sexual and reproductive health and rights (SRHR) are human rights. The Government of the Republic of Zambia has fully committed to fulfilling the SRHR of all people by ratifying 11 international instruments of law (seven global and four regional treaties). This brief is Part 2 of a three-part series entitled “Status of Sexual and Reproductive Health and Rights in Zambia,” reporting on progress, gaps, and existing challenges in SRHR. The brief shows that overall, based on the assessment framework and informed by desk reviews and consultative processes, Zambia is …

Strengthening The Role Of Patent And Proprietary Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Salisu Mohammed Ishaku

Reproductive Health

In Nigeria, overall modern contraceptive use is very low, however 60 percent of modern contraceptive services are obtained from private providers, including Patent and Proprietary Medicine (PPM) shops, which provide more than half of these private-sector services. PPM shops are owned by Patent and Proprietary Medicine Vendors (PPMVs) licensed to sell patent or proprietary drugs. Current regulations do not permit PPMVs to sell or administer injectable contraceptives, though, because they are not regarded as sufficiently trained. Given this, it is an opportune time to generate evidence that can drive policy action to formally engage and train PPMVs in the provision …

The Need For Improved Information Exchange Between Family Planning Providers And Clients, Population Council

Reproductive Health

The information exchanged during a contraceptive visit is important because providers need to understand clients’ reproductive intentions and clients need to receive adequate information about the method options and possible method-related side effects and problems. Little is known about how information exchange has changed over time and across countries, so FP2020 identified 17 core indicators to track progress made by FP programs, including the method information index (MII). The purpose of this study is to address the following issues: how the MII varies among countries, how it changes between two surveys in the same country, how it varies by type …

Understanding Adolescent And Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth Friendly Service Programming, Aparna Jain, Hussein Ismail, Elizabeth Tobey, Annabel Erulkar

Reproductive Health

To meet the unique sexual and reproductive health needs of its large adolescent and youth population, Ethiopia’s government has expanded and institutionalized youth-friendly services (YFS) at all levels of the health system. To help inform and improve these efforts, the Evidence Project, in collaboration with USAID/Ethiopia and the Ethiopian Federal Ministry of Health, conducted a study on adolescents’ and young people’s use of and opinions on YFS. Results showed that young people were satisfied overall with the health services they received, regardless of whether it was basic health services or YFS. Awareness and use of YFS was low, but many …

Using Data To Target And Scale-Up Girls' Support Programs And Child Marriage Prevention, The Evidence Project

Reproductive Health

Though child marriage is declining globally, it is estimated that over 100 million girls under age 18 will be married in the next decade. A 2012 review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that offered incentives, such as conditional cash transfers or provision of school materials, and those that empower girls directly through interventions such as girls’ groups and training. The Berhane Hewan program in Ethiopia (meaning ‘Light for Eve’ in Amharic) was one of the earliest to test child marriage prevention interventions in sub-Saharan Africa. The …

Status Of Sexual And Reproductive Health And Rights In Zambia: Violence Against Women And Hiv/Aids Prevention And Treatment, Population Council

Reproductive Health

In 1994, the International Conference on Population and Development affirmed that sexual and reproductive health and rights (SRHR) are human rights. The Government of the Republic of Zambia has fully committed to fulfilling the SRHR of all people by ratifying 11 international instruments of law. This brief is Part 3 of a three-part series entitled “Status of Sexual and Reproductive Health and Rights in Zambia,” reporting on progress, gaps, and existing challenges in SRHR. Using a human rights–based approach, the Government of Zambia and collaborators, with technical facilitation by the Population Council, conducted an assessment of the status of SRHR …

Strengthening School-Based Sexual And Reproductive Health Education And Services In Accra, Ghana, Nancy Termini Lachance, Terence Adda-Balinia

Reproductive Health

This evidence brief presents results of a study aimed to assess the acceptability and feasibility of two proposed solutions for strengthening the content and delivery of in-school sexual and reproductive health (SRH) programs in Ghana. The study was conducted in Nima, a suburb of Accra, where stakeholders agreed there was a need for enhanced SRH services in school. The study explored providing comprehensive in-school SRH education to adolescents using trained psychologists and health workers to deliver and explain comprehensive sexuality education to adolescents and link them as needed to outside services. There was unanimous agreement that adolescent SRH needs are …

Ensuring Contraceptive Security Through Effective Supply Chains, Moazzam Ali

Reproductive Health

Establishing and maintaining well-functioning supply chains that meet the needs of public and private sectors, as well as health professionals at all levels in family planning programs, will play a critical role in reducing unmet need for modern contraception in low and middle income countries. This evidence brief identifies two evidence-based solutions to address the challenges faced by these countries: increasing the visibility of product flows and user demand, and leveraging the expertise of the private and public sector to ensure a total market approach to supply-chain management. Strengthening the capacity of public and private-sector family planning providers and managers …