Medicine and Health Sciences Commons^™

Introduction Of Quality Of Care And A Gender Perspective In Reproductive Health Service Organizations In Latin America And The Caribbean, Patricia Riveros, Antonieta Martin, Ricardo Vernon

Reproductive Health

In 2005 and with the technical assistance of the Frontiers in Reproductive Health (FRONTIERS) Program, the Integrated Health Coordination Program (PROCOSI), a Bolivian network of 33 nongovernmental organizations, designed and tested a set of four guidelines to help organizations deliver high-quality reproductive health services with a gender perspective. The guidelines were: 1) to present a strategy to certify organizations as “gender sensitive” healthcare providers; 2) to present the knowledge staff members should know to be certified; 3) to describe procedures to collect and analyze the data to evaluate implementation of the strategy; and 4) to describe how to assess strategy …

From Pilot To Program: Scaling Up The Kenya Adolescent Reproductive Health Project, Humphres Evelia, Japheth Nyambane, Harriet Birungi, Ian Askew, Rikka Trangsrud, Eva Muthuuri, Irene Chaami, Agnes Odawa, Lucy Musyoka, Susan Mutungi, Margaret Githuiya, Joan Omuruli

Reproductive Health

The Population Council’s Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Heath collaborated with three Government of Kenya ministries—Education; Health; and Gender, Sports, Culture and Social Services—to design and implement the Kenya Adolescent Reproductive Health Project with the goals of: improving knowledge about reproductive health and encouraging a responsible and healthy attitude toward sexuality among adolescents, delaying the onset of sexual activity among younger adolescents, and decreasing risky behaviors among sexually active adolescents. Key findings from the pilot project showed that the three ministries could successfully implement these interventions with high participation among parents and youth. …

Lutte Contre La Pratique De L'Excision Au Mali: De L'Approche Santé À L'Approche Basée Sur Les Droits De L'Enfant-Rapport D'Evaluation Du Programme Du Centre Djoliba, Anta Fall Diagne

Reproductive Health

Depuis les années 1980, Save the Children Suède soutient des activités visant à éliminer la pratique de l'excision organisées par le Centre Djoliba au Mali. Le but de cette évaluation est d'examiner l'impact du programme du Centre Djoliba sur la vie de communautés sélectionnées et en utilisant une approche basée sur les droits de l'homme et de l'enfant, pour examiner les changements majeurs dans les communautés cibles. Cette approche a conduit à une meilleure compréhension de ces droits et à la volonté des communautés d’essayer d’intégrer les connaissances acquises sur ces droits dans leur vie quotidienne. Cependant, l'environnement socioéconomique défavorable …

L’Introduction De L’Identification Systématique Pour Réduire Les Besoins Non Satisfaits En Santé : Manuel Du Manager, Ricardo Vernon, James R. Foreit, Emma Ottolenghi

Reproductive Health

Ce manuel est conçu pour aider les décideurs, les gestionnaires, les superviseurs et les prestataires de programmes à introduire le dépistage systématique dans leurs services de santé. Le dépistage systématique peut améliorer la santé des femmes en répondant à de multiples besoins non satisfaits en matière de services de santé reproductive et autres. Ce manuel fournit : les activités nécessaires à la mise en œuvre du dépistage systématique ; comment sélectionner les installations, les services à dépister et qui sera dépisté ; l'élaboration, l'adaptation et le prétest systématiques d'une liste de contrôle de dépistage ; des conseils pour les agents …

Senegal: Education And Public Declarations Contribute To Tostan's Success, Population Council

Reproductive Health

In 1998, the nongovernmental organization Tostan implemented a village empowerment program in southern and western Senegal to help communities, especially women, improve living and health conditions in their villages, and to mobilize villages to hold public declarations supporting abandonment of harmful practices, particularly female genital mutilation/cutting (FGM/C) and child marriage. The program included modules on hygiene, literacy and numeracy, human rights, and children’s and women’s health. The Tostan approach has since been implemented more broadly in Senegal and in Burkina Faso, Guinea, and Sudan. In 2005–06, FRONTIERS evaluated the long-term impact of the program, focusing on the abandonment of FGM/C …

Kenya: Training Can Enhance Providers' Management Of Fgm/C And Willingness To Advocate Against The Practice, Population Council

Reproductive Health

In 2004, FRONTIERS collaborated with UNICEF on a study of female genital mutilation/cutting (FGM/C) in Kenya’s Somali community and on ways of managing maternal care for cut women. The study showed that the health-care system in North Eastern Province, where many Somalis live, is ill prepared to deal with women who have been cut, particularly infibulated women who are pregnant or delivering. The study recommended improving providers’ ability to counsel and treat pregnant cut women as part of an overall improvement of maternal care, and strengthening providers’ role as behavior change agents within communities. In 2005, FRONTIERS launched an intervention …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Africa Regional Sexual And Gender-Based Violence Network Consultation: Technical Exchange And Planning Meeting, Population Council

Reproductive Health

In March 2008, the Population Council brought together members of the Africa Regional Sexual and Gender Based Violence (SGBV) Network for a South-South technical exchange meeting. The objectives were to identify best practices from existing programs, provide an evidence base for new programming, and develop mechanisms for South-South technical assistance. As detailed in this report, discussions covered the medical, legal, and psychosocial issues associated with SGBV prevention and response activities. Participants identified the following: Protocols and guidance documents are essential for ensuring comprehensive, quality response at all levels. Enabling access and utilization of the full range of medical services remains …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Kenya And Ethiopia: Community And Religious Leaders Are Effective Advocates For Hiv Testing For Young Couples, Population Council

Reproductive Health

Early marriage is common for girls in much of sub-Saharan Africa. A common belief is that marriage protects them from HIV, but studies show that married girls are at much higher risk from HIV and from maternal morbidity and mortality. FRONTIERS conducted operations research in Ethiopia and Kenya to assess the acceptability and feasibility of community-based interventions to raise awareness of the HIV risks of early marriage and promote the use of HIV counseling and testing (C&T) services by couples. The studies were an initial phase in a planned four-year intervention; this brief reports on the feasibility of the approach. …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Assessing The Need And Opportunities For Improved Linkages Between Conditional Cash Transfers And Reproductive Health Programs In Latin America And The Caribbean, Ricardo Vernon, M. Estela Rivero-Fuentes

Reproductive Health

The objective of this project was to document the structure and functioning of conditional cash transfer (CCT) programs in Latin America and the Caribbean, to assess opportunities for improved linkages between CCTs and reproductive health programs, and to explore the role that operations research may have in the improvement of CCT programs. Activities were conducted in the Dominican Republic, El Salvador, Honduras, Jamaica, Nicaragua, and Peru. Operational problems identified by CCT programs included the targeting and selection of beneficiaries, monitoring compliance with conditions for receiving cash transfers, the systems used to provide the transfers, and management weaknesses. Recommendations are made …

Dominican Republic, Haiti, Nicaragua: Women Living With Hiv Have Unmet Family Planning Needs, Population Council

Reproductive Health

Women living with HIV in the Dominican Republic, Haiti, and Nicaragua are marginalized in many ways, including their access to family planning (FP) services. Making FP services accessible to persons living with HIV (PLWH) is one of four key strategies that WHO promotes in its comprehensive approach to prevent HIV infections in infants and young children. This strategy also increases the coverage and quality of FP services among a population commonly underserved and at high risk of unplanned pregnancy. Expanded access to antiretroviral therapy in many developing countries has improved the life expectancies and health of many PLWH who are …

Multisectoral Youth Rh Interventions: The Scale-Up Process In Kenya And Senegal, Stephanie Joyce, Ian Askew, Anta Fall Diagne, Nafissatou J. Diop, Humphres Evelia

Reproductive Health

As in many developing countries, young people in Kenya and Senegal (aged 10–20) account for about 25 percent of the population. To ensure their future contribution to their countries, it is of vital strategic importance to safeguard their welfare. Rapid social change in both countries exposes youth to sexual and reproductive health (RH) risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Beginning in 1999, the Population Council’s FRONTIERS program conducted operations research studies that tested the feasibility, acceptability, and cost of a public-sector, multisectoral intervention to enhance young people’s RH knowledge and behavior. Study findings showed …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Burkina Faso: Political Will, Law Enforcement, And Educational Campaigns Appear To Be Reducing Fgm/C, Population Council

Reproductive Health

In 2006, FRONTIERS collaborated with the National Committee Against the Practice of FGM/C on an analysis of recent trends in female genital mutilation/circumcision (FGM/C) in rural and urban Burkina Faso. The study, conducted to help develop policies and programs for FGM/C abandonment in Burkina Faso and more widely in Africa, had three components: a description of the institutional, political, and programmatic environ­ment in Burkina; a secondary analysis of data from existing studies; and an assessment of the community’s perceptions and behavior regarding FGM/C, as well as the factors that contribute to abandonment or continuation of the practice. For the policy …

Taller Regional De Utilización De Resultados De Investigación Operativa Para Incrementar El Acceso, La Calidad E Integración De Los Servicios Anticonceptivos En América Latina Y El Caribe, M. Estela Rivero-Fuentes, Antonieta Martin

Reproductive Health

En octubre de 2007, el programa Fronteras de la Salud Reproductiva (FRONTERAS) realizó un taller regional de tres días en La Antigua, Guatemala, para difundir los resultados de sus proyectos de investigación operativa. Durante el taller, los participantes escucharon los avances en la metodología anticonceptiva y escucharon las estrategias efectivas que probó FRONTERAS para incrementar el acceso al DIU y la vasectomía; la integración de la planificación familiar con los servicios posparto, postaborto y PTMI. Los investigadores habloaron sobre los resultados de los estudios, los gerentes de los programas explicaron cómo se usaban los instrumentos y se habló de la …

Increasing Women's Use Of The Iud For Family Planning, Ricardo Vernon

Reproductive Health

The intrauterine device (IUD) is highly effective, easy to use, and has few side effects. The device costs the provider about US$2 and offers a duration of protection that makes it the most cost-effective of the temporary methods if used for two years or more. The IUD's many advantages also make it a good alternative for reducing unmet need for long-term contraception around the world. Between 5 and 17 percent of all married women of reproductive age in 53 less developed countries do not want to have more children but are not using a contraceptive method. Because the IUD can …

Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi

Reproductive Health

In 2001, the World Health Organization issued guidance on a new model of antenatal care (ANC) called goal-oriented or focused antenatal care (FANC), for implementation in developing countries. The new model reduces the number of required antenatal visits to four, and provides focused services shown to improve maternal outcomes. FANC emphasizes helping women maintain normal pregnancies by identifying existing health conditions, detecting emerging complications, promoting health, preparing for a healthy birth, and educating clients on postpartum care including nutrition, breastfeeding, and family planning. Trials conducted in Argentina, Cuba, Saudi Arabia, and Thailand proved that FANC was safe and was a …

Dissocier Les Mutilations Génitales Féminines De L'Islam, Ibrahim Lethome Asmani, Maryam Sheikh Abdi

Reproductive Health

Les mutilations ou excisions génitales féminines (MGF/E) sont pratiquées dans au moins 28 pays d'Afrique subsaharienne, quelques pays du Moyen-Orient et d'Asie, et parmi les populations immigrées de ces pays en Europe, en Amérique du Nord et en Australie. Dans le monde, on estime que 100 à 140 millions de filles et de femmes ont subi cette pratique, et au moins trois millions de filles sont à risque chaque année. La communauté ethnique somalienne au Kenya ainsi qu'en Somalie, à Djibouti et en Éthiopie pratique l'excision depuis des siècles et la pratique semble être restée largement inchangée. Le programme FRONTIERS …

Assessment Of Knowledge And Attitudes Of Married Women On Maternal And Newborn Health (Mnh) In Selected Union Councils Of Project Districts, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The World Health Organization estimates that 585,000 women die from pregnancy-related conditions each year. Pregnancy-related conditions, including dysfunctional labor, hemorrhage, infection, toxemia, and unsafe abortion, are the leading cause of death among women of reproductive age in many developing countries. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan, through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to …

South Africa: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The South African government wishes to expand availability and use of counseling and testing (C&T) for HIV. One option is to integrate C&T into well-attended services, such as family planning (FP). In 2004, the Population Council began a three-year study with the Department of Health in North West Province. The study tested the feasibility, acceptability, and cost of two models for integrating HIV prevention services within established FP programs, and evaluated their quality against standard practice. In the testing-model clinics, providers provided C&T services at the same consultation; in the referral-model clinics, providers offered HIV counseling and referred clients to …

Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury

Reproductive Health

This manual equips trainers with appropriate knowledge on emergency contraceptive pills (ECPs). Emergency contraception (EC) refers to any method of contraception that can be used by a woman to prevent an unwanted pregnancy within three days of unprotected intercourse or a contraceptive accident such as condom leakage. This manual discusses ECPs and the provision of related services. After a day’s training, trainers have the knowledge and skills necessary to train service providers and workers on ECPs. The manual is divided into four sessions. The first provides an overview of the demographic and reproductive health (RH) situation in South and South …

Guía Operativa Para Programas De Educación Sexual Y Servicios De Salud Reproductiva Para Jóvenes, Ofelia Aguilar, Lorena Santos, Marisa Diaz Infante, Rocio Mejia, Ricardo Vernon, Antonieta Martin

Reproductive Health

El presente libro tiene como fin poner al alcance de personas y organizaciones interesadas en establecer políticas y programas de servicios y educación sexual para los jóvenes, una guía basada en el Programa Gente Joven que implementa la Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM). Consideramos que los componentes y las actividades de este programa pueden ser adaptados en otras latitudes y así enriquecer proyectos orientados al trabajo con jóvenes.

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The purpose of this book is to make available, to people and organizations interested in establishing policies and programs on sexual education and services for young people, a …

Kenya: Islamic Scholars Find No Religious Justification For Fgm/C, Population Council

Reproductive Health

In 2004, FRONTIERS undertook a study on the cultural basis of female genital mu­tilation and cutting (FGM/C) in Kenya’s Somali community. The study showed universal support for FGM/C, and indicated that one of the major justifications is the perception that Islam requires female as well as male genital cutting. Interviews with informants showed that belief in the religious justification overrides arguments about the health and human rights aspects and the knowledge that it is illegal in Kenya. In 2005, FRONTIERS launched an intervention to engage the community in discussions about FGM/C to clarify the religious position. FRONTIERS arranged symposia involving …

India: Quality Assurance Procedure Monitors And Improves Quality Of Services, Population Council

Reproductive Health

A quality assurance (QA) procedure was pilot-tested and subsequently scaled up throughout the state of Gujarat, India, after demonstrating that a 65-item checklist is an efficient tool for identifying and remedying gaps in service delivery. From 2004–06, FRONTIERS developed and tested a standardized QA procedure. The State Ministry of Health and Family Welfare (MOHFW) used the procedure to assess health-care services in rural clinics in two pilot districts each in the states of Gujarat and Maharashtra. Based on positive results, the State MOHFW expanded the QA procedure in a phased manner throughout all 25 districts of Gujarat. The model is …

Malaria In Pregnancy Pilot Projects Nationally Adopted In Kenya And Malawi, Population Council

Reproductive Health

Kenya and Malawi have developed national policies to prevent malaria in pregnancy. Measures to prevent malaria among antenatal clients were shown to be sustainable several years after pilot interventions ended. In Malawi, the approach has been expanded nationwide. In most malaria-endemic areas of Africa, women in their first and second pregnancies have the highest risk of acquiring malaria and, consequently, of malaria-associated anemia and low birth-weight. Two USAID-funded interventions aimed at strengthening the prevention and management of malaria in pregnancy were pilot-tested at the district level in Kenya (1998–2002) and Malawi (1998–2004). As noted in this brief, the goal was …

Kenya: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The Kenyan government’s reproductive health policy highlights service integration and quality of care. While integrating counseling and testing (C&T) for HIV into family planning (FP) can potentially increase the range of services to clients at risk from sexually transmitted infections (STIs) including HIV, few studies have documented the feasibility, effects, or costs of such integration. From 2005–07, the Population Council worked with the Kenyan Ministry of Health to test the feasibility of two models for integrating C&T into existing FP services. Both models featured client education on HIV prevention during FP visits. Providers were trained to routinely use the Balanced …

Financial Capacity Building For Ngo Sustainability, John H. Bratt, Rick Homan, Barbara Janowitz, James R. Foreit

Reproductive Health

While demand for family planning and reproductive health services is increasing worldwide, a number of recent trends threaten the financial sustainability of donor-supported NGOs that provide these services. First, the U.S. Agency for International Development has seen its funding for population assistance decline since 1995. A second reason is the growth of government-funded programs that provide these services for low-income clients, which reduced the need for NGOs to focus programs entirely on the poor. Health-sector reform has created opportunities for NGOs via public–private partnerships in some countries, but sustained public-sector support is unlikely given limited economic growth in domestic economies …

Delinking Female Genital Mutilation/Cutting From Islam, Ibrahim Lethome Asmani, Maryam Sheikh Abdi

Reproductive Health

Female genital mutilation or cutting (FGM/C) is practiced in at least 28 countries in sub-Saharan Africa, a few countries in the Middle East and Asia, and among immigrant populations from these countries in Europe, North America, and Australia. Worldwide, an estimated 100 to 140 million girls and women have undergone the practice, and at least three million girls are at risk each year. The Somali ethnic community in Kenya as well in Somalia, Djibouti, and Ethiopia, has practiced female genital cutting for centuries and the practice appears to have remained largely unchanged. The Population Council’s FRONTIERS program carried out two …