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Completing The Fertility Transition In The Developing World: The Role Of Educational Differences And Fertility Preferences, John Bongaarts

Poverty, Gender, and Youth

This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition based on data from DHS surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in more and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This finding implies that the educational composition of the population remains a key predictor of overall fertility …

The Living Arrangements Of Older Adults In Sub-Saharan Africa In A Time Of Hiv/Aids, Zachary Zimmer, Julia Dayton

Poverty, Gender, and Youth

The detrimental consequences of the AIDS epidemic for older adults in sub-Saharan Africa suggest the need to investigate their characteristics, living situations, and well-being. In this study, we examine the living arrangements of persons aged 60 and older in 16 countries. Data come from the household roster component of recent Demographic and Health Surveys. The focus is on the tendency of the elderly to live with children and grandchildren, and we examine distributions and determinants. Results show that older adults in sub-Saharan Africa live in a variety of household arrangements. Men are more likely to be living in a nuclear …

Completing The Fertility Transition In The Developing World: The Role Of Educational Differences And Fertility Preferences [Arabic], John Bongaarts

Poverty, Gender, and Youth

This study summarizes patterns of educational differentials in wanted and unwanted fertility at different stages of the fertility transition based on data from DHS surveys in 57 less developed countries. As the transition proceeds, educational differentials in wanted fertility tend to decline and differentials in unwanted fertility tend to rise. An assessment of fertility patterns in more and less developed countries with low fertility concludes that these differentials are likely to remain substantial when less developed countries reach the end of their transitions. This finding implies that the educational composition of the population remains a key predictor of overall fertility …

Women's Denial Of Having Experienced Female Genital Cutting In Northern Ghana: Explanatory Factors And Consequences For Analysis Of Survey Data, Elizabeth F. Jackson, Patricia Akweongo, Evelyn Sakeah, Abraham Hodgson, Rofina Asuru, James F. Phillips

Poverty, Gender, and Youth

Although many cross-sectional social surveys have included questions about female genital cutting status and correlated personal characteristics, no longitudinal studies have been launched that permit investigation of response biases associated with such surveys. This paper reports on a longitudinal study of women aged 15 to 49 in rural northern Ghana. The self-reported circumcision status of women interviewed in 1995 was compared with the status they reported when they were interviewed again in 2000 after the government began enforcing a law banning the practice and public information campaigns against it were launched. In all, 13 percent of respondents who reported in …

Determinants Of Old-Age Mortality In Taiwan, Zachary Zimmer, Linda G. Martin, Hui-Sheng Lin

Poverty, Gender, and Youth

Relationships among socio-demographic characteristics, general assessments of health, and old-age mortality are well established in developed countries. There is also an increasing focus on the connection between early-life experiences and latelife health. This paper tests these and other associations using representative survey data from Taiwan on the population aged 60 and older in 1989, 1993, and 1996 that have been linked to data on deaths between 1989 and 1999 from a national death registry. The study also explores the possible influence of Taiwan’s Universal Health Insurance Program, instituted in 1995, and whether or not the survival of some groups of …

Cultural Norms And Behavior Regarding Vaginal Lubrication During Sex: Implications For The Acceptability Of Vaginal Microbicides For The Prevention Of Hiv/Stis, Sarah Braunstein, Janneke Van De Wijgert

Reproductive Health

This paper presents the results of an extensive review of the literature pertaining to the relationship between vaginal lubrication and the acceptability of microbicides, spermicides, and male and female condoms. The review highlights the need for research that better elucidates norms, preferences, and practices regarding lubrication during sex within and across countries. The second part of the report presents the results of the first phase of a qualitative study on lubrication during sex showing that diverse personal and cultural factors shape preferences and practices and may ultimately affect the acceptability of microbicides. The immediate challenge is to provide women with …

Reproductive Health Services In Kwazulu Natal, South Africa: A Situation Analysis Study Focusing On Hiv/Aids Services, Lewis Ndhlovu, Catherine Searle, Robert A. Miller, Andrew A. Fisher, Ester Snyman, Nancy L. Sloan

HIV and AIDS

This Horizons report examines the readiness of reproductive health services in South Africa, which are primarily geared to women, to deliver HIV and AIDS treatment, care, and prevention services. The goal of the study was to obtain information from a representative sample of provincial health care facilities offering reproductive health services in KwaZulu Natal to meet the growing demand for HIV/AIDS-related services. Ninety-eight hospitals, community health centers, and clinics participated in the situation analysis that identified gaps in service delivery and determined priorities for service integration. Results of the study were presented to a large audience of Department of Health, …

Microfinance And Households Coping With Hiv/Aids In Zimbabwe: An Exploratory Study, Carolyn Barnes, Erica Keogh, Nontokozo Nemarundwe, Loveness Nyikahadzoi, Ellen Weiss

HIV and AIDS

This study, conducted in Zimbabwe, sought to better understand the relationship between a microfinance program, Zambuko Trust, and how microentrepreneurs’ households cope with the impact of HIV/AIDS. The study examined how HIV/AIDS is affecting Zambuko’s operations and what microfinance institutions (MFIs) can do to lessen the impact of HIV/AIDS on their clients and operations. The findings indicate several small yet important ways that MFI programs help microentrepreneurs and their families respond to these impacts through access to credit and business management training. Participation in a microfinance program led to income smoothing and better financial management, which can help households mitigate …

Replication Of The Tostan Programme In Burkina Faso: How 23 Villages Participated In A Human Rights-Based Education Programme And Abandoned The Practice Of Female Genital Cutting In Burkina Faso, Nafissatou J. Diop, Edmond Bagde, Djingri Ouoba, Molly Melching

Reproductive Health

This document is a summary of the process followed in implementing a community-based education program in Burkina Faso. The Population Council initiated a collaboration between two NGOs, Tostan in Senegal and Mwangaza Action in Burkina Faso, to replicate the program for improving women’s reproductive health and contributing to the end of female genital cutting (FGC). In Burkina Faso, the participants (men and women) held discussions to analyze the problems faced by their communities and to find appropriate solutions. Many positive changes occurred in the participating villages: the communities now promote reproductive health and human rights and work to improve public …

Testing Balanced Counseling To Improve Provider-Client Interaction In Guatemala's Moh Clinics, Federico R. Leon, Carlos Brambila, Marisela De La Cruz, John H. Bratt, Julio Garcia Colindres, Benedicto Vasquez, Carlos Morales

Reproductive Health

The job aids–assisted Balanced Counseling Strategy adopted by Guatemala’s Ministry of Health required specific instructions for use by nonprofessional providers and an intervention that assured provider compliance with the behavioral requirements of the new paradigm. Results show that the trained providers outperformed the controls in quality of care at each level of session length, but used nine extra minutes per session on average. Nonprofessional providers can take advantage of the job aids–assisted Balanced Counseling Algorithm and substantially improve their quality of care. Extra time invested in counseling new family planning clients will be easily absorbed insofar as they continue to …

Improving Quality Of Care For Family Planning Services In Uganda, Joel Okullo, Quinto Okello, Harriet Birungi, Ian Askew, Barbara Janowitz, Carmen Cuthbertson, Florence Ebanyat

Reproductive Health

The Regional Centre for Quality of Health Care at Makerere University, Uganda in collaboration with the Delivery of Improved Services for Health II Project, the Ministry of Health (MOH), and the Population Council’s FRONTIERS Program, conducted an operations research project to help the MOH improve the quality of family planning services with the aim of helping couples better attain their reproductive goals. The study developed a package of interventions (the Yellow Star Programme—YSP) that sought to increase the readiness of clinics to offer basic family planning services, to improve provider motivation, and to empower clients to request quality services. The …

Assessment Of Pilot Health Project Outcome Indicators: West Bank/Gaza, Laila Nawar, Dale Huntington, Ibrahim Kharboush, Nancy Ali, Mahmoud Shaheen

Reproductive Health

The Pilot Health Project (PHP) was designed to address Palestinian women’s most pressing reproductive health needs. This report presents results from a single cross-sectional study that was conducted by the Health, Development, Information and Policy Institute (HDIP) between May and August 2000 in order to determine the baseline measures for the PHP’s key outcome indicators among healthcare providers and clients in the PHP clinics. Based on the findings reflected by the study, a number of recommendations were made that need to be followed up and implemented by the Improved Village and Community Health Services Project. These include the need for …

Changing Family Planning Scenario In India: An Overview Of Recent Evidence, K.G. Santhya

Reproductive Health

Over the decades, there has been a substantial increase in contraceptive use in India. The direction, emphasis and strategies of the Family Welfare Programme have changed over time. However, meeting the contraceptive needs of considerable proportions of women and men and improving the quality of family planning services continue to be a challenge. The 1990s witnessed a growing recognition of this, and several innovative policy and programme initiatives have been launched to address these issues. This paper reviews and synthesises evidence from surveys and studies conducted in the 1990s and thereafter on contraceptive use dynamics and the unmet need for …

One-Year Client Impacts Of Quality Of Care Improvements Achieved In Peru, Federico R. Leon, Santiago Roca, Alex Rios, Adriana Zumaran, Ana Rosa Feijoo

Reproductive Health

This report presents a one-year assessment of quality-of-care improvements in Peru, following provider training on the job aids–assisted Balanced Counseling Strategy. Results showed significant enhancement of quality of care, an increase in session length, and improved client knowledge of the method chosen when this was an IUD or hormonal method. Correlational findings suggested that better impacts can be achieved in provincial primary health facilities than in larger settings like clinics or hospitals in capital cities. The results are important because: 1) other studies have failed to show significant impacts of controlled quality-of-care improvements on the use of contraception; and 2) …

Non-Consensual Sexual Experiences Of Young People: A Review Of The Evidence From Developing Countries, Shireen J. Jejeebhoy, Sarah Bott

Reproductive Health

Although there is increasing evidence of risky consensual sex among young people in developing countries, non-consensual sexual experiences among them have rarely been studied and few interventions have been designed to protect them from the risks of such experiences. However, what is available suggests that coercion and unwantedness may play a considerable role in the sexual relations of young people—girls and young women but also boys and young men. The implications of non-consensual sexual experiences for young people’s rights, their health and development and the risks they pose in the transition to adulthood are enormous. This review collates what is …

Evaluating Operations Research Utilization: Guidelines For Assessing Process And Impact, M. Celeste Marin, Jane T. Bertrand

Reproductive Health

The Population Council has been providing technical assistance and conducting Operations Research (OR) studies in family planning and reproductive health for over two decades. These studies are designed to identify problems and test strategies to resolve those problems, providing program managers, administrators, and policymakers with the information they need to improve service-delivery systems. The ultimate goal is that strategies tested through OR will be adopted, leading to changes in policy or operational procedures at institutional, national, or international levels. These changes are what we refer to as impact. The purpose of the new approach to evaluation described in this Evaluation …

Testing A Model For The Delivery Of Emergency Obstetric Care And Family Planning Services In The Bolivian Public Health System, Deborah L. Billings, Eliana Del Pozo, Hugo Arevalo

Reproductive Health

Unsafe abortion is a serious public health problem in Bolivia, accounting for up to 25 percent of maternal mortality. Postabortion care (PAC) was recognized as a priority public health action in Bolivia in 1994 and the operations research project summarized in this report was undertaken at the request of the Ministry of Health to help guide the improvement of PAC services in the country’s revised health plan. Improvements were made in the following areas: informing women of their health status after the uterine evacuation procedure; elements of the procedure itself (instrument to be used, pain control, possible risks); and informing …

Postabortion Family Planning Operations Research Study In Perm, Russia, Irina Savelieva, John M. Pile, Inna Sacci, Ratha Loganathan

Reproductive Health

EngenderHealth, the Population Council’s FRONTIERS program, and the Research Center of Obstetrics, Gynecology, and Perinatology of the Russian Academy of Medical Sciences, with support from the Perm Health Departments, undertook an operations research study to test models for increasing contraceptive use and reducing the repeat abortion rate among abortion clients in Perm, Russia. The study also assessed the direct and indirect costs of abortion and contraceptive use incurred by women in the year following their index abortion (the abortion which took place the day of entry into the study). The findings of the study were significant for the training interventions …

Taking Postabortion Care Services Where They Are Needed: An Operations Research Project Testing Pac Expansion In Rural Senegal, Engenderhealth

Reproductive Health

EngenderHealth, in collaboration with the Ministry of Health, conducted an operations research project to examine the feasibility of introducing an integrated three-element model of postabortion care (PAC) services in secondary- and primary-level sites in two predominantly rural regions in Senegal. The intervention provided health personnel with: 1) training to improve clinical competence, counseling, infection prevention, and general care; 2) technical assistance, materials, and support to aid in overcoming challenges; and 3) ongoing monitoring and supervision. The project findings attest to the benefits of expanding existing PAC programs in rural settings and suggest that the advantages of such an expansion outweigh …

Actions That Protect: Promoting Sexual And Reproductive Health And Choice Among Young People In India, Shireen J. Jejeebhoy, Mary Philip Sebastian

Reproductive Health

This paper synthesises the evidence on the sexual and reproductive health situation of young people in India, and explores what we know about underlying factors that place them at risk of or protect them from unsafe and unwanted sexual and reproductive health experiences. The picture that emerges suggests that substantial proportions of young people experience risky or unwanted sexual activity, do not receive prompt or appropriate care, and experience adverse reproductive health outcomes. Contextual factors such as poverty, gender imbalances and lack of education or livelihood opportunities clearly increase the vulnerability of youth. Other factors at the family, community and …

Public Health And National Security In The Global Age: Infectious Diseases, Bioterrorism, And Realpolitik, David P. Fidler

Articles by Maurer Faculty

No abstract provided.

The Ghana Community-Based Health Planning And Services Initiative: Fostering Evidence-Based Organizational Change And Development In A Resource-Constrained Setting, Frank K. Nyonator, John Koku Awoonor-Williams, James F. Phillips, Tanya C. Jones, Robert A. Miller

Poverty, Gender, and Youth

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programs actually do. An approach to evidence-based policy development has been launched in Ghana that bridges the gap between research and program implementation. The Community-based Health Planning and Services (CHPS) initiative employs strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteers, resources, and cultural institutions to support community-based primary health care. Over the 1999 to 2002 period, 100 out of the 110 districts in Ghana adopted a CHPS initiative. This paper reviews features of the initiative …

Empowering Communities To Respond To Hiv/Aids: Ndola Demonstration Project On Maternal And Child Health: Operations Research Final Report, Hope Humana, Linkages, National Food And Nutrition Commission, Ndola District Health Management Team, Horizons Program, Zambia Integrated Health Project

HIV and AIDS

A pre–post intervention study conducted in Zambia by Horizons and local NGOs and governmental organizations demonstrated that HIV voluntary counseling and testing (VCT) and infant feeding counseling (IFC) to mothers attending maternal and child health (MCH) clinics are vital components of any mother-to-child transmission (MTCT) reduction strategy, whether or not antiretrovirals (ARVs) are available. These interventions enable mothers to make informed and healthy decisions. Data from the Ndola Demonstration Project yielded encouraging results from efforts to improve the capacity of mothers to make informed decisions about their own health and the health of their infant. The interventions succeeded in raising …

Creation Of A Unified Management Information System For Three Ngos In The West Bank And Gaza, Health, Development, Information And Policy Institute

Reproductive Health

The goal of the Pilot Health Project (PHP) has been to improve the health status of Palestinian women and children. To further this goal, the Health, Development, Information and Policy Institute (HDIP) was given the responsibility to develop a management information system (MIS) for the collection, storage, processing, and dissemination of information for PHP clinics. In cooperation with the Palestinian Ministry of Health (MOH) and various healthcare providers and MIS professionals, HDIP worked through a carefully organized and highly participatory process to design and develop the MIS for the PHP. This report reviews that process and presents the features of …

Improving Postpartum Care Among Low Parity Mothers In Palestine, Center For Development In Primary Health Care (Cdphc)

Reproductive Health

In an effort to improve the health status of Palestinian women and their children in the West Bank and Gaza, USAID, in collaboration with the Palestinian Ministry of Health and a number of NGOs, designed and funded a 28-month pilot activity, the Pilot Health Project (PHP), that was expected to have a positive impact on the health of women and children. This report describes the results of the intervention designed to measure the effectiveness of a second home visit on low-parity women in 1) improving their knowledge and practices regarding their own health as well as the health of their …

Emergency Operations Rural Household Food And Livelihood Security Baseline: Midland And Masvingo Provinces, Zimbabwe. Care., John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Lesotho Vulnerability Assessment. Care., John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Underlying Causes Of Livelihood Insecurity Among The Poor In Malawi: The Testing Of Five Hypotheses. Care., John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Livelihood Monitoring For Southeast Bangladesh. Care., John Mazzeo

John Mazzeo, Ph.D.

No abstract provided.

Dengue, Aedes Aegypti, And Hurricane Reconstruction In The Caribbean And Central America: Prevention And Control Following A Natural Disaster, Frank Cortez Flores

Frank Cortez Flores

Abstract: Dengue is currently the most important vector-borne viral disease affecting people, in terms of both morbidity and mortality. Repeated epidemics of dengue and dengue hemorrhagic fever afflicting millions of individuals occur annually in tropical and subtropical areas of the world, including The Caribbean and Central America, inhabited by the Aedes aegypti mosquito.

Accordingly, the main purpose of this study was to identify and address the dominating factors influencing the resurgence of dengue fever following a natural disaster such as a hurricane.

This study also depicted an arguable approach to dengue surveillance as well as described existing efforts to prevent, …