Public Health Commons^™

Youth Talk About Sexuality: A Participatory Assessment Of Adolescent Sexual And Reproductive Health In Lusaka, Zambia, Tamara Fetters, Evans Mupela, Naomi Rutenberg

Reproductive Health

Thirty-six percent of Zambia’s 9 million inhabitants are between 10 and 19 years of age, and most adolescents are sexually active by their mid-teens. Pregnant teenagers have an elevated risk of maternal mortality and complications related to birth. In 1990, at Lusaka’s University Teaching Hospital, self-induced abortion accounted for up to 30 percent of maternal mortality, and one-quarter of these deaths occurred in women under 18 years. Sexually transmitted infections (STIs) are a major health problem for adolescents, yet only a small proportion protect themselves from pregnancy and STIs. There are many barriers to improving the situation, including opposition by …

Evaluation De La Prise En Charge De La Maternité Sans Risque Et De La Survie De L'Enfant Au Niveau Communautaire De Bazéga, Direction De La Santé Et De La Famille (Dsf), University Of Ouagadougou Demographic Research Unit (Uerd), Mwangaza, Population Council

Reproductive Health

No abstract provided.

Introduction Des Soins Obstétricaux D'Urgence Et De La Planification Familiale Pour Les Patientes Présentant Des Complications Liées À Un Avortement Incomplet, Population Council, Jpiego

Reproductive Health

En 1997, le Centre de Formation et de Recherche en Santé de la Reproduction en partenariat avec la Clinique Gynécologique et Obstétricale du CHU Le Dantec ont entrepris une étude de faisabilité sur l’introduction des Soins Après Avortement dans trois structures sanitaires de référence de la région de Dakar. Cette expérience pilote a été appuyée par le Population Council dans le cadre du projet de Recherche Opérationnelle et d’Assistance Technique (RO/AT II) en Afrique et par JHPIEGO qui a appuyé le volet Formation/Prestations de service. Elle s’inscrit dans le cadre de la mise en œuvre des recommandations issues des conférences …

Ensuring Community Participation In Mch/Fp Activities: Lessons Learned From A Pilot Project, Abbas Bhuiya, Ubaidur Rob, Maruf Rabban Quaderi

Reproductive Health

Family planning (FP) and maternal and child health (MCH) in Bangladesh have achieved commendable success in the recent past, mostly through a large-scale government service-delivery system supported by donors and nongovernmental organizations. Although encouraged by this success, there was concern about programmatic, financial, and social sustainability of the program, including quality of services. It is now believed that most of these concerns will be taken care of if effective community participation can be ensured. A pilot project was initiated in 1997 in Anowara, a low-FP-performing area in rural Chittagong, with assistance from the Population Council. The main objective of the …

Follow-Up Household Survey In Agra District, Jayanti Tuladhar, R.B. Gupta, V.S. Sridhar, Tilak Mukherjee

Reproductive Health

This follow-up household survey in Agra District, India, was conducted with funding from USAID under the Population Council’s Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project. The main objective of this study, as noted in this report, is to assess changes in the program indicators of family welfare activities, including some of the selected reproductive health indicators, from 1995 (before method-specific targets were withdrawn) and 1997 (30 months after targets were withdrawn). The study’s objectives are to detect changes in FP knowledge and use among currently married women in rural areas; detect changes in level of …

Follow-Up Household Survey In Sitapur District, Jayanti Tuladhar, R.B. Gupta, B.P. Thiagrajan, Tausif Alam Khan, Hemlata Sadhwani

Reproductive Health

This follow-up household survey in Sitapur, India, was conducted with funding from USAID under the Population Council's Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project. The main objective of the study, as noted in this report, is to assess changes in the program indicators of family welfare activities, including some of the selected reproductive health indicators, from 1994–95 (before the method-specific targets were withdrawn) and 1997 (30 months after the targets were withdrawn). The study has the following immediate objectives: detect changes in family planning (FP) knowledge and use among currently married women in rural areas; …

Monitoring Of Macro-Level Family Planning Quality Of Care Indicators, Meiwita B. Iskandar

Reproductive Health

The success of population development in Indonesia can be seen partly from success in reducing population growth. Population growth has declined from 2.32 percent (1971–80) to 1.98 percent (1980–90), and then to 1.66 percent (1990–95). The continued slowing of population growth is expected to bring expanded opportunities for economic development and improved quality of life. The success of family planning (FP) programs cannot be judged solely on reduction of population growth but should also be judged in terms of quality of care (QOC) and success in helping women achieve their reproductive goals. The Indonesian National Family Planning Coordinating Board (BKKBN) …

Towards Safe Womanhood: Supporting Safe Motherhood Initiatives And Women's Participation In Development, Meiwita B. Iskandar

Reproductive Health

Improvement in a woman’s quality of life is a prerequisite for development of human resources, because the quality of children’s physical and mental development is inextricably tied to the health and welfare of women as future mothers. If a mother is well protected during the pregnancy, birth, and postpartum period, the risk of illness and other problems in fetuses and newborn babies will be reduced. On the other hand, if a woman does not survive the pregnancy, birth, and postpartum period, her fetus or newborn will also be threatened. This paper provides a situation analysis of pregnant women, women in …

Technical Assistance To Enhance The Institutionalization Of Operations Research Within The Philippines Family Planning Program, Population Council

Reproductive Health

This technical assistance project supports the goal of the Asia Near East Operations Research and Technical Assistance (ANE OR/TA) project of helping strengthen family planning (FP)/reproductive health (RH) operations research (OR) capabilities in the Philippines. During the extension period of the ANE OR/TA project, four OR studies were implemented in the Philippines dealing with cross-cutting issues, including a study to assess the feasibility of integrating RTI management within FP/MCH programs; an intervention study dealing with improving quality of care via expanded FP counseling; an intervention to address high unmet need in Pangasinan Province; and an intervention study to increase male …

The Life Saver: The Mother Friendly Movement In Indonesia, Abdullah Cholil, Meiwita B. Iskandar, Rosalia Sciortino

Reproductive Health

The focus of this book is the Mother Friendly Movement in Indonesia, a collective effort to reduce maternal mortality. The idea of documenting the Mother Friendly Movement or Gerekan Sayang Ibu (GSI) was originally suggested by Her Excellency Mien Sugandhi, the State Minister for the Role of Women, Republic of Indonesia, in the belief that the Indonesian experience in reducing maternal mortality would be relevant to other countries struggling with the same problem. The authors were entrusted with producing an illustrated monograph on the pilot projects implemented in eight districts from June to December 1997. Besides extensively monitoring these activities, …

Male Involvement Through Reproductive Health Awareness In Bukidnon Province, The Philippines: An Intervention Study, Lita Palma-Sealza, Marilou P. Costello, Chona R. Echavez

Reproductive Health

Recent years have been characterized by an increasing consensus that, in order to support women's goals and aspirations, health programs directed to the improvement of women's and children's health must consider men's perspectives. Although family planning (FP) is often viewed as the woman's responsibility, men have an important role in decisions of whether FP will be practiced and which method will be used. Even though gender relations in the Philippines are often characterized as being relatively egalitarian, there are several reasons for believing that male involvement in FP is highly relevant for this country. Studies indicate that not only are …

Improving Quality Of Care In Fp/Rh Of Selected Communities Of Pangasinan Province: An Intervention Study, Zelda C. Zablan, Josefina V. Cabigon, Luzviminda Muego, Marilou P. Costello, Chona R. Echavez

Reproductive Health

This intervention study was designed to improve the quality of family planning (FP) services within the Integrated Family Planning and Maternal Health Program of the Pangasinan Population and Family Planning Program in the Philippines. It addresses high unmet need and studies the feasibility of enhancing quality of services by training service providers in fixed clinics and orienting outreach workers on the method of identifying women who have unmet need for FP. Four municipalities were chosen from the 47 municipalities comprising the province of Pangasinan and randomly assigned to experimental and control groups. Four indicators were used to match the chosen …

Dual Protection In An Integrated Community-Based Program: A Case Study Of Tanzania Family Health/Ministry Of Health Project In Mbeya, Grace Mbekem, Jane Chege

Reproductive Health

One of the most pressing challenges for health programs in most sub-Saharan African countries is effectively addressing the increasing prevalence of HIV/AIDS. Recent evidence suggests that controlling sexually transmitted diseases (STDs) through undertaking preventive measures, early diagnosis, and treatment significantly slows the spread of HIV/AIDS. In regard to STI/HIV, Maternal and Child Health (MCH) and Family Planning (FP) clients are described as “low risk” groups. However, in a number of sub-Saharan African countries, the reported levels of STDs are significantly high enough to justify use of limited resources to target this group for STD services. MCH/FP programs have begun to …

Condom Availability In New York City Public High Schools: Relationships To Condom Use And Sexual Behavior, Sally Guttmacher, Lisa D. Lieberman, David Ward, Nick Freudenberg, Alice Radosh, Don Des Jarlais

Department of Public Health Scholarship and Creative Works

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago. METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey. RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in …

Pregnancy Outcomes: A Study Testing A Model For Predicting Health Outcomes In Pregnancy, Tamera Ann Hart-Johnson

Dissertations and Theses

There is a persistent relationship between socioeconomic status and physical health outcomes found in the literature; however the variables mediating this relationship are many, and ways that they interact with each other are complex. The goal of understanding this relationship is to decrease the disparity in health by socioeconomic status.

This study tested a biopsychosocial model proposed by David Williams (1990) to explain the relationship between socioeconomic status and physical health outcomes. The model included the following latent factors: demographics, socioeconomic status, biomedical risk, medical care, psychosocial variables, and health outcomes. The model was tested through a secondary data analysis. …

Prenatal Cocaine Exposure And Mother–Infant Interaction: Implications For Occupational Therapy Intervention, Heather Miller-Kuhaneck

Occupational Therapy Faculty Publications

The literature from multiple disciplines on in utero cocaine exposure and mother–infant interaction and attachment was examined for possible relationships and implications for occupational therapists. Maternal cocaine use and neurobehavioral deficits in neonates prenatally exposed to cocaine may result in interactional difficulties between mother and infant. Knowledge of child development, sensory regulation, and infant cues will enable therapists to assist the mother in creating positive interactive experiences between herself and her child.

Opportunity, Community, And Teen Pregnancy In An Appalachian State, Robert Bickel, Susan Weaver, Tony Williams, Linda Lange

SHU Faculty Publications

Teen pregnancy has become an issue that educators and public policy makers are obliged to treat as a serious problem. Too often, explanations of teen pregnancy have included uncritical use of the notion of adolescents at risk. Recently, however, attention has been given to structurally-determined contextual factors in explaining teen pregnancy. Such contextual factors include economic and educational opportunities and costs, as well as chances for valued participation in socially and culturally stable communities. This interest in contextual factors parallels a development in the literature on high school dropouts. A data set previously employed to study variability in drop-out rates …

An Assessment Of Community-Based Family Planning Programs In Kenya, Jane Chege, Ian Askew

Reproductive Health

Kenya has a long history of using community-based distribution (CBD) as an integral part of its family planning (FP) program. The purpose of this study was to assess the role of CBD programs in terms of providing information and services, to learn more about the determinants of program effectiveness, and to attempt to compare the programs’ cost-effectiveness. Fieldwork was undertaken in mid-1995 when data were collected from seven of the major CBD programs in Kenya. Four rural and three urban programs were included, as were programs that remunerated their agents and those that did not, and programs that had full-time …

Counseling The Husbands Of Postabortion Patients In Egypt: Effects On Husband Involvement, Patient Recovery And Contraceptive Use, Nahla G. Abdel-Tawab, Dale Huntington, Ezzeldin Osman Hassan, Hala Youssef, Laila Nawar

Reproductive Health

An ANE OR/TA Project qualitative study conducted in 1995 probed into women’s perceptions of abortion in Egypt, and the stress that postabortion patients experience during recovery. That study drew attention to the important role husbands can play in their wives’ recovery and subsequent use of contraception. This study was designed to test the effects of involving husbands in the postabortion medical-care process. Overall, the study indicates that providing counseling to husbands of postabortion patients is feasible, as the majority of husbands either accompanied their wife on admission or at discharge from the hospital. However, administrative changes are needed to enhance …

The Parents' Experience Of Living In The Hospital With Their Sick Infant : A Phenomenological Study, Anne Bourke

Theses: Doctorates and Masters

The purpose of this phenomenological study was to describe the essential structure of the lived experience of what it was to be a resident parent on the ward in a public hospital with a sick infant. Many studies have highlighted both benefits and problems associated with the concept of parental participation in care. The role of the parents in hospital needs to be identified and expressed by both the parents and the nurses, in order to ellucidate the needs of parents who live in with their sick infant. Eight parents were interviewed regarding their experiences of "living in" the hospital …

Situation Analysis Of Lgu Health Centers For Integrating Rti Management Within The Philippines Fp/Mch Program, Jesus Encena, Carmeli Marie Chaves, Marilou P. Costello, Chona R. Echavez

Reproductive Health

A Situation Analysis (SA) was conducted in seven local government health centers as part of a larger project studying the feasibility of integrating RTI services within the existing Family Planning/Reproductive Health Program of the Department of Health (DOH). The SA was part of a series of baseline activities conducted by the Family Planning Operations Research and Training Project as part of its study on Integrating RTI Management in Local Government Unit Health Centers. It was conducted by Population Council, Manila, for the DOH. Participating health centers were located in a large and highly urbanized community, a medium-sized city, and two …

Integrating Sti/Hiv Management Strategies Into Existing Mch/Fp Programs: Lessons From Case Studies In East And Southern Africa, Baker Ndugga Maggwa, Ian Askew

Reproductive Health

Sub-Saharan Africa is confronting an HIV/AIDS epidemic and virtually all health programs in the region are seeking ways of preventing and reducing the spread of this virus. To compound the problem, the presence of certain sexually transmitted infections (STIs) is known to increase risk of the sexual transmission of HIV. The sub-Saharan region is believed to have some of the highest levels of STIs in the world, thus controlling STIs is not only an important reproductive health care strategy in itself but also a key strategy in reducing the spread of HIV. The strongest evidence to support this has come …

Integration Of Sti And Hiv/Aids With Mch-Fp Services: A Case Study Of The Nakuru Municipal Council's Project On Strengthening Std/Aids Control, James Kariba Wabaru, Bedan Kiare Kariuki, Baker Ndugga Maggwa

Reproductive Health

Kenya’s Nakuru Municipal Council (NMC) operates five clinics located primarily in residential areas with high concentrations of people. The clinics provide basic antenatal, child welfare, STI, and other curative services, and family planning services are available at four of the clinics. One provincial referral hospital operated by the Ministry of Health also provides MCH-FP and HIV/STI services in a special STI treatment clinic. The seven public health facilities in Nakuru Municipality are participating in a collaborative project with the Department of Community Health at the University of Nairobi, the University of Manitoba in Canada, and the Nairobi Municipal City Council. …

Integration Of Sti And Hiv/Aids With Mch-Fp Services: A Case Study Of The Busoga Diocese Family Life Education Program, Uganda, Joy Mukaire, Florence Kalikwani, Baker Ndugga Maggwa

Reproductive Health

The Family Life Education Project (FLEP) was started in 1986 by the Busoga Diocese of the Anglican Church of Uganda with assistance from Pathfinder International. The project provides integrated MCH, FP, STD, and HIV/AIDS services to more than 500,000 individuals through 48 clinics and 162 trained village health workers (VHWs). Each clinic serves an estimated 11,000 people living in a sub-Parish. Each sub-Parish has a health subcommittee selected by the community that is responsible for hiring clinic staff, identifying VHWs, and mobilizing resources for clinic staff salaries. Data suggest that the program is reaching a large number of clients through …

Integrating Rti Services In Primary Health Care System: Observations From An Operations Research In Uttar Pradesh, India, M.E. Khan, Saumya Ramarao, R.B. Gupta, Bella C. Patel, Leila Caleb-Varkey, Jayanti Tuladhar, Sanjeev Kumar, John Townsend

Reproductive Health

Evidence from community studies indicates that significant proportions of Indian women (30 percent) may have reproductive tract infections (RTIs). Given that women are in general asymptomatic and that even symptomatic women may not seek care, the estimates are the minimum levels of prevalence. Most women do not seek treatment for RTIs for such reasons as lack of awareness, acceptance that RTIs are part of women's lives, and lack of treatment facilities. On the supply side, in the public sector the treatment for RTIs is limited with most services provided through STD clinics in urban areas. Seeking treatment at STD clinics …

Implant Users: Over Five Years After Insertion (Further Analysis Of Previous Study Data), Jayanti Tuladhar, Joedo Prihartono

Reproductive Health

This secondary analysis report presents the characteristics of a subgroup of 235 women who are overdue in getting Norplant® implants removed after five years, factors related to the risk of nonremoval after five years, and issues related to accessing information about removal of implants. The main source of data for the present study is the “Norplant Implants® Assessment Study: Insertion, Use, and Removal” carried out in Indonesia in April 1996. This study consisted of a representative sample of 2,979 current and former Norplant users who had an insertion from April 1, 1987, to March 31, 1991, five or more years …

Iron Supplementation: Knowledge, Perceptions, And Usage Among Pregnant Women In Rural India, Jayanti Tuladhar, John Townsend, Nazir Haider, Leila Caleb-Varkey

Reproductive Health

In India, severe anemia has been one of the causes of high maternal mortality and death of newborns and infants due to low birthweight. The prevalence of anemia among women ages 15–44 is extremely high. The Government of India has provided iron and folic acid tablets (IFA) as a prophylaxis against nutritional anemia among pregnant women as part of the Child Survival and Safe Motherhood program and will continue to do so in the Reproductive and Child Health package. This paper presents findings of both qualitative and quantitative research conducted among pregnant women to investigate the extent of distribution and …

Dmpa Provision In Pss Clinics In Uttar Pradesh: Costs And Prices, Saumya Ramarao, John Townsend, Leila Caleb-Varkey, Sudha Tiwari, Sneh Vishwanath, Harbans Singh

Reproductive Health

The injectable contraceptive DMPA was introduced in the private sector in India in 1993, contingent on completion of a post-marketing surveillance study of users. The commercial price of a dose of DMPA is about Rs. 150-180, exclusive of the fees of the medical provider. This price puts it beyond the reach of most Parivar Seva Sanstha (PSS) clients in need of safe and effective family planning (FP) services in Uttar Pradesh. Since April 1996, an experiment has been underway with three PSS clinics in Uttar Pradesh to study the effect of price on demand for DMPA. The study seeks to …

Preventing Perinatal Transmission Of Hiv Costs And Effectiveness Of A Recommended Intervention, Robin D. Gorsky, P G. Farnham, Walter L. Straus, Blake Caldwell, D R. Holtgrave, R. J. Simonds, M F. Rogers, Mary Guinan

School of Public Health Faculty Research

In the United States, nearly all new human immunodeficiency virus (HIV) infections in children are acquired through perinatal (mother-to-infant) transmission. Each year, approximately 7000 infants are born to HIV-infected women in the United States.¹ Without intervention, an estimated 15-30% of these infants would become infected.² In 1994, results of the AIDS Clinical Trial Group (ACTG) Protocol 076 showed that treatment of infected pregnant women and their infants with zidovudine (ZDV) reduced the rate of perinatal HIV transmission from 25% to 8%.^3,4 Following these findings, the Public Health Service (PHS) issued recommendations for ZDV therapy to prevent perinatal …

Cattle, Co-Wives, Children, And Calabashes: Material Context For Symbol Use Among The Il Chamus Of West-Central Kenya, Alan J. Osborn

Department of Anthropology: Faculty Publications

This paper examines systemic contexts for symbol use among the Maa-speaking Il Chamus in the Lake Baringo region of west-central Kenya. The systemic context for symbols and material culture consists of the environmental constraints and behavioral responses that characterize pastoralist life in East Africa. The author's interest in this problem developed in response to Ian Hodder’s work among the Il Chamus, Pokot, and Tugen in the Baringo District. Unlike Hodder, however, the author argues that symbols and their use in East Africa can be more productively explained from a materialist perspective. Specifically, it is proposed that symbols affixed to certain …