Public Health Commons^™

Clinic-Based Investigation Of The Typology And Self-Reporting Of Fgm In Egypt, Population Council

Reproductive Health

This clinic-based study of female genital mutilation (FGM) was designed and carried out by the Egypt Fertility Care Society to gather detailed information on the types of FGM practiced in Egypt. The study involved interviews with clinic clients to elicit information about their experience and attitudes concerning FGM, and gynecological examinations by specially trained OB/GYN physicians. In all, 93% of the women in this study were found to have some type of FGM. The study's findings were incorporated in the final report of the 1995 Egyptian Demographic and Health Survey, with the aim of contributing to the scientific understanding of …

A Situation Analysis Of The Maternal And Child Health/Family Planning (Mch/Fp) Program In Botswana, Benjamin Baakile, Lucy Sejo Maribe, Baker Ndugga Maggwa, Robert A. Miller

Reproductive Health

Botswana has a rapid annual population growth rate and a high total fertility rate. It also has one of the highest levels of contraceptive use in sub-Saharan Africa. Infant and under-5 mortality rates have fallen, yet maternal mortality remains high. The Government of Botswana has developed an extensive network of health care facilities that provide services through an integrated approach. Family planning (FP) services are available at all three levels of the MOH system (hospitals, clinics, health posts). Services for managing sexually transmitted diseases (STDS) have recently undergone a substantial change with the introduction of the Syndromic Approach to STD …

Substance And Form In Scientific Evidence: What Daubert Didn't Do, Samuel R. Gross

Book Chapters

On its face, Daubert v. Merrell Dow Pharmaceuticals was about as easy a case as the Supreme Court gets. The plaintiffs claimed that their birth defects were caused by the anti-nausea drug Bendectin, which their mothers had used during their gestation. In response to a motion for summary judgment by the defendant, the plaintiffs presented affidavits of eight expert witnesses who offered their opinions - based on a variety of studies - that Bendectin was indeed the culprit. The federal district court that heard the motion granted summary judgment to the defendant, and the Ninth Circuit affirmed. Both lower courts …

Community Participation In Health, Family Planning And Development Activities: A Review Of International Experiences, Abbas Bhuiya, Fatima Yasmin, Farida Begum, Ubaidur Rob

Reproductive Health

The family planning (FP)/maternal and child health (MCH) program in Bangladesh has achieved success in the recent past, mostly through a large-scale government service-delivery system with support and cooperation from donors and nongovernmental organizations. There is concern about the financial and social sustainability of the program. Other issues include achievement of replacement-level fertility within a stipulated period and improvement of MCH-FP service quality. It is widely believed that most of the concerns will be taken care of with effective community participation. Before activating community initiatives, it is worth carrying out action research. A literature review was completed from July to …

Quality Of Family Planning Programme In India: A Review Of Public And Private Sector, Dileep V. Mavalankar

Reproductive Health

Increasing attention has been paid to quality of care (QOC) in family planning (FP) during the last few years, and there have been several initiatives to strengthen QOC in FP in the developing world. This paper reviews the quality of the FP program in India’s public and private sectors, and examines six elements: choice of methods, information given to clients, technical competence, interpersonal relations, continuity of care and follow-up, and appropriate constellation of services. Overall, the paper finds that not much attention has been paid to QOC and hence the level is quite low. Evidence and observations indicate that QOC …

Gente Joven: Un Diálogo Sobre La Sexualidad Con Adolescentes Mexicanos, Magaly Marques, John M. Paxman, Judith Bruce

Poverty, Gender, and Youth

Este número de Quality/Calidad/Qualité relata la experiencia de Gente Joven, un programa de educacion sexual para adolescentes en Mexico. Gente Joven comenzó reconociendo una realidad: que los problemas relativos a la sexualidad no desaparecen por mucho que tratemos de negar su existencia. A través de los años los dirigentes de Gente Joven han aprendido, y siguen aprendiendo, muchas lecciones sobre como diseñar un programa eficaz para adolescentes. En estas páginas ellos comparten algunas de esas experiencias y el epilogo explora con mayor detalle un tema que Gente Joven ha identificado como su próximo gran desafío: una reconsideración del programa desde …

Integration Of Sti And Hiv/Aids Services With Mch/Fp Services: A Case Study Of The Mkomani Clinic Society In Mombasa, Kenya, Amina Twahir, Baker Ndugga Maggwa, Ian Askew

Reproductive Health

Most national MCH-FP programs in sub-Saharan Africa are shifting their programmatic strategies toward a broader reproductive health service approach that includes integrating STI and HIV/AIDS services into existing MCH-FP programs. This is based on the belief that integration will lead to more cost-effective and better-quality service, and maximize use of existing resources. There is an assumption that the basic infrastructure for the MCH-FP programs can absorb the extra demands of the STI/HIV/AIDS services with minimal additional inputs and that staff providing MCH-FP services require only minimal training to be able to provide STI/HIV/AIDS services. There is a further assumption that …

A Model Of Costs Of Rti Case Management Services In Uttar Pradesh, Saumya Ramarao, John Townsend, M.E. Khan

Reproductive Health

The Government of India has adopted a Reproductive and Child Health (RCH) approach as the basis of its new family welfare policy. One component of RCH is management of reproductive tract infections (RTIs). The Population Council's Asia and the Near East Operations Research and Technical Assistance (ANE OR/TA) Project, in collaboration with the State of Uttar Pradesh, Ministry of Health and Family Welfare, is conducting a study on the feasibility and cost of providing RTI case management at the primary-care level. The estimated annual cost of RTI case management at the district level would be about US$64,000. From the analysis, …

Indonesia: Utilization Of Completed Operations Research Studies, Meiwita B. Iskandar, Subadra Indrawati

Reproductive Health

In the past eight years, many operations research (OR) programs were implemented in Indonesia to increase the availability, accessibility, and acceptability of services desired by family planning (FP) users. OR has also been employed to improve quality and sustainability by studying the performance, efficiency, and effectiveness of services delivered by providers. Nonetheless, relatively little is known about the true effects of OR studies in identifying and solving program problems in order to support the planning and coordinating of a particular program. Measuring utilization of OR results is not simple. In 1989, USAID signed its last bilateral assistance agreement with the …

Lactational Amenhorrhoea Method For Birth Spacing In Uttar Pradesh, India: Supporting Technical Data, Leila Caleb-Varkey, John Townsend

Reproductive Health

Following the International Population and Development Conference in Cairo, there has been widespread consensus in the international community that family planning (FP) programs must be people-centered and focus not just on contraception, but on the reproductive health (RH) of men and women throughout their lives. This policy brief reviews the research and policy implications of promoting the Lactational Amenorrhea Method (LAM) as a component of FP counseling in India. The Government of India and the Population Council are using a pregnancy-based approach in Uttar Pradesh to improve the delivery of FP services through the rural primary health care system. Introducing …

Issues In Essential Obstetric Care, Diana Measham, Virginia Kallianes

Reproductive Health

This report summarizes the proceedings of a meeting on essential obstetric care (EOC) convened by the Population Council on behalf of the Inter-Agency Group for Safe Motherhood (IAG). This technical meeting was held to clarify the definition of EOC, bridge the gap between research and program planning, and stimulate field-level activity. The president of the Population Council closed and summarized the meeting by noting that the IAG is making progress, but that work remains to be done. Progress will begin to occur more rapidly when we are able to prove that lives have been saved and to state definitively that …

Health Attitude Changes As A Result Of Participating In A Worksite Prenatial Education Program, Vickie Gibson

Masters Theses & Specialist Projects

The purpose of this study was to determine whether differences in health beliefs exist between participants attending worksite prenatal education classes and participants receiving only prenatal education self-help materials. A multiple treatment study was performed on a sample of convenience of 169 women enrolled in Fruit of the Loom's worksite prenatal education program. Group 1 subjects received class and materials while Group 2 subjects received materials only. Study participants were asked to complete an 18-item Likert scale questionnaire prior to enrolling in the program and again upon completion. Sixty-two subjects completed both the pre- and posttest questionnaires. Analysis of covariance …

Effect Of Nutrition Intervention On The Outcomes Of Pregnancy: A Rural Urban Comparison, Ranjita Misra

Health Services Research Dissertations

The present study examines the effect of nutritional intervention on two outcomes of pregnancy: birth weight of the baby and gestational age. The study further examines the difference in nutritional intervention in rural and urban areas. The research method used is ex-post facto design. Data for the study is extracted from the health records and tracking sheets of women participating in the Nutrition Intervention Project in Virginia Department of Health. Path analysis and effects analysis are used to analyze the causal and direct effect of the independent variables and each of the outcome variables. A model has been developed grounded …

Families In Focus: New Perspectives On Mothers, Fathers, And Children, Judith Bruce, Cynthia B. Lloyd, Ann Leonard, Patrice L. Engle, Niev Duffy

Poverty, Gender, and Youth

Despite the rhetoric of recent years lamenting the loss of the "traditional family," families have never fit nicely into any single model. "Family" may refer to people linked by marriage or kinship or to people claiming descent from common ancestors. People may form and extend families by adopting or fostering children, defining nonrelatives as family, or establishing consensual partnerships. Families are as adaptable as they are diverse, reconfiguring themselves over their life cycles and evolving to accommodate the myriad pressures of the external world. This book focuses on families with dependent children specifically—on the roles of mothers, fathers, and children, …

Violence In The Womb, Violence In The World: The Effects Of Fetal Exposure To Alcohol, Drugs, And Nicotine, Aileen R. Wynne

Theses

This project will focus on prenatal substance abuse and the long term adverse effects of birth defects in the offspring of these women. The focus will discuss a relationship between the drug exposed fetus as a predictor of later development of behavior problems , running along the continuum from antisocial behavior to aggression and violence.

Research will show that of the three leading contributors to birth defects , Fetal Alcohol Syndrome is number one, greater than Downs Syndrome and Spina Bifida. The risk factors of prenatal substance abuse will be described as use of alcohol , other drugs , and …

Doing More With Less: The Marie Stopes Clinics In Sierra Leone, Nahid Toubia, Grace Ebun Delano

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité reports on the Marie Stopes Sierra Leone (MSSL) organization which pursues its goals with compassion and ambition, despite seemingly insurmountable economic hardships. MSSL has established a service model that many programs in richer countries should try to imitate. Several particularly important lessons emerged, including: creative, skillful management, well-organized and flexible financial administration, and human motivation and perseverance can enable an organization to overcome financial difficulties; family planning is an integral part of people's reproductive and general health concerns and can dovetail with concern for development in useful and practical ways; men appreciate being involved in the …

An Exploratory Study Of The Psycho-Social Stress Associated With Abortions In Egypt, Dale Huntington, Laila Nawar, Dalia Abdel Hady

Reproductive Health

An operations research study was conducted to investigate the concerns of postabortion patients in Egypt to improve counseling that women receive. A corollary use of the study results is the development of sensitive survey research questions for measuring incidence of induced abortion. This study utilized qualitative research methods by conducting in-depth interviews with postabortion patients in El Galaa and El Menia University Hospitals and focus group discussions with family planning clients and noncontracepting women. For all types of postabortion patients the most salient issue was physical survival of an extremely painful experience. All postabortion patients were acutely concerned about their …

Women’S-Perceived Quality In Postpartum Care, Maryland A. Hunter

Theses and Dissertations (ETD)

Increased competition among healthcare organizations for the obstetric consumer market has led to increased interest in women’s perceptions of their obstetric experience. This study explored women’s perceptions of quality and women’s perceptions of benefits for women who received family-centered postpartum care (FCPPC) and women who received traditional postpartum care (TPPC). The study also assessed the relationship between women’s-perceived quality (WPQ) and women’s-perceived benefit (WPB) for those receiving FCPPC and those receiving TPPC. Quality and beneficence are the two concepts of Larrabee’s (1992) model of quality operationalized in this study. The sample consisted of 60 postpartum women, 30 receiving care on …

Psychosocial Determinants Of Age-Appropriate Immunizations Of Infants In Norfolk, Virginia, Hoda Youssef Atta

Health Services Research Dissertations

This study represents an investigation of psychosocial factors affecting age-appropriate immunizations of infants in Norfolk, Virginia. A household survey was conducted in Norfolk, Virginia, from 4/93-8/93, to assess immunization coverage of children 12-30 months of age. This survey included a total of 389 children in the target age range. A subset of 201 mothers were randomly selected and reinterviewed to assess their knowledge and attitudes and the relationships of these factors to age-appropriate immunizations at 12 months of age. Sixty-two percent of children were not age-appropriately immunized at 12 months of age. Almost all mothers (99%) considered vaccines to be …

The Influence Of Prepregnancy Weight And Maternal Weight Gain : On Birth Weight Among Black Wic Participants In San Bernardino County, Marta Lukas Sovyanhadi

Loma Linda University Electronic Theses, Dissertations & Projects

Birth records show that San Bernardino County has the highest black infant mortality rate of the 16 counties in California with the largest proportion of African-Americans births. Although total infant deaths in San Bernardino County had fallen to 8.6 per 1,000 live births by 1992, the infant mortality rate among the black population of the county was close to two times higher at 16.8 per 1,000. This is the first study to address the high infant mortality rate among blacks in San Bernardino County. Factors which may affect the black infant mortality rate were examined.

Subjects were drawn from a …

Population Policy In Bangladesh: A Review Of Ten Priority Areas, Barkat-E- Khuda, Abul Barkat, Javed Helali, Peter C. Miller, John G. Haaga

Poverty, Gender, and Youth

One of the most important factors contributing to the success of Bangladesh’s FP-MCH Program in recent years has been the strong support provided at the policy level by all the governments of Bangladesh since independence. This has given the government confidence and supported the development of a coherent set of policies at the implementation level. However, the success of policies at one stage in the development of a family planning (FP) program carries with it the need for changes in policy to support the program at the next stage. In Bangladesh, if the nation is to attain the demographic goals …

Factors That Contribute To The Varying Performance Of Bspos And Bhws In The Delivery Of Family Planning Services In Iloilo City, Fely David, Fely Chin

Reproductive Health

In 1992, the Population Council established the Family Planning Operations Research and Training (FPORT) Program in the Philippines. It brought together program managers and regional researchers to identify problem areas that might benefit from operations research. From Western Visayas (Region VI), the City Population Office (CPO) of Iloilo City in collaboration with the Social Science Research Institute of the Central Philippine University, identified a problem concerning the poor performance of volunteer family planning (FP) workers and undertook to study it. The study focused on the Barangay Service Point Officers (BSPOs) who assist in the delivery of FP services under the …

Gente Joven/Young People: A Dialogue On Sexuality With Adolescents In Mexico, Magaly Marques, John M. Paxman, Judith Bruce

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the experience of one adolescent sexuality program, Gente Joven in Mexico. Gente Joven began by acknowledging reality: that the problems related to teenage sexuality will not go away simply by denying their existence. Along the way Gente Joven learned, and is continuing to learn, many lessons about how to build a successful program for adolescents. Here they share their experiences and the Afterword explores in greater depth one particular issue that Gente Joven has identified as its next major challenge: re-examining their work with young people from a gender perspective.

Rethinking Postpartum Health Care, Martha Brady, Beverly Winikoff

Reproductive Health

These proceedings come from papers and discussions as part of the Population Council invitational seminar entited "Rethinking Postpartum Health Care," in 1992. The seminar on postpartum reproductive health was the fifth in a series of seminars convened by the Population Council as part of its Robert H. Ebert Program on Critical Issues in Reproductive Health and Population. The program focuses on four topics: 1) improving and devising new approaches to postpartum care; 2) improving the quality of care in family planning and reproductive health services; 3) managing unwanted pregnancy and preventing the consequences of unsafe abortion; and 4) bringing attention …

Employment-Based Family Planning Services, Placide Tapsoba, Ian Askew, J. Tunde Taylor Thomas, Sering Falu Njie, Momodou Jasseh

Reproductive Health

Although The Gambia Family Planning Association (GFPA) has always been interested in promoting contraceptive use in the Greater Banjul Area (GBA), insufficient funds and the need to prioritize program expansion in rural areas hindered this. The GFPA operates two clinics in GBA, open to few workers. The government has three Family Planning and Maternal and Child Health clinics in Banjul, also used by few workers. Factory managers, trade union leaders, and the GFPA believe that a well-organized family planning (FP) education and service delivery program could benefit employees and employers. This operations research study tested the feasibility of a work-based …

Book Review, Ann Marie Wheatcraft

RISK: Health, Safety & Environment (1990-2002)

Review of: ROBERT H. BLANK, MOTHER AND FETUS: CHANGING NOTIONS OF MATERNAL RESPONSIBILITY. (Greenwood Press 1992) [207 pp.], Appendix, bibliography, figures, index, preface, tables. LC-91- 38029; ISBN 0-313-27639-0. [$45.00 cloth. 88 Post Road West, Box 5007, Westport CT 06881.]

Identified Barriers To Well Child Care For Homeless Children Under Age Thirteen, Judith G. Riemer

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to identify barriers perceived by homeless families to well child care for their children under age thirteen and to determine if there is a relationship between perceived barriers and duration of homelessness. Using an investigator-modified version of Melnyk's Barriers Scale and a demographic measure, a convenience sample of homeless families (N = 53) from three transitional shelters in two southern California counties were surveyed via questionnaire. Barriers to well child care for homeless children were identified. No relationship was determined to exist between duration of homelessness and perceived barriers using a measurement of correlation.

Homeless Children Having Children, Yvonne M. Vissing

New England Journal of Public Policy

Homeless teenagers who have babies pose a significant population of concern for those in health and human services. This article explores demographic, structural, and economic changes for homeless young and single-parent families. It proposes that their homelessness is due to these barriers and the problems that result. Case studies illustrate the process of troubled teens becoming homeless women with babies. Policy recommendations for assisting these youngsters are offered.

By And For Women: Involving Women In The Development Of Reproductive Health Care Materials, Valerie J. Hull, Barbara L. Ibrahim, Nadia Farah, Blanca Figueroa, Margaret Winn

Poverty, Gender, and Youth

The studies in this issue of Quality/Calidad/Qualité describe three efforts to involve women in the development of reproductive health care materials in different settings in the developing world. In Cairo, a women's health collective produced a comprehensive reference book for women; in Peru, a woman's group, with the extensive involvement of their nonliterate audience, developed a series of illustrated teaching materials; and in the South Pacific, an all-woman production crew produced three motivation and teaching videos developed in response to the expressed needs of Pacific Island women. Despite contrasts in the characteristics of the intended audiences, the development process, and …

Por Y Para Mujeres: Motivando Su Participación En El Desarrollo De Materiales Para La Atención En Salud Reproductiva, Valerie J. Hull, Barbara L. Ibrahim, Nadia Farah, Blanca Figueroa, Margaret Winn

Poverty, Gender, and Youth

Los estudios en este número de Calidad/Quality/Qualité describen tres esfuerzos para involucrar a las mujeres en el desarrollo de materiales de atención de salud reproductiva en diferentes escenarios del mundo en desarrollo. En El Cairo, un colectivo de salud de mujeres elaboró un libro comprehensivo de consulta para mujeres; en Perú, un grupo de mujeres, con una gran participación de su audiencia analfabeta, desarrolló una serie de materiales ilustrados para la enseñanza; y en el Pacífico del Sur, un grupo de producción integrado por mujeres, produjó tres videos motivacionales y para la enseñanza, desarrollados como respuesta a las necesidades expresadas …