Public Health Commons^™

Measuring The Impact Of Contraceptive Use On Unintended Pregnancy And Other Health Outcomes, Step Up Research Programme Consortium

Reproductive Health

This brief describes several statistical models that have been developed to estimate the number of health outcomes that will be averted because of contraceptive use. Concerns have been expressed that this range of approaches—which overlap in the impacts they estimate, but sometimes use different inputs, mathematical algorithms, and assumptions, and may produce different results—may be confusing for policymakers, managers, and donors who want to measure or evaluate these impacts. To address these concerns, the STEP UP consortium convened two expert meetings to review the estimation methods used; come to consensus on methodologies and assumptions, where possible; and provide guidance to …

Balika Fact Sheet: Highlight On Gender And Rights, Population Council

Poverty, Gender, and Youth

Data presented in this Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Gender and Rights,” reveal that attitudes about gender equitability differ across domains and by the background characteristics of respondents in terms of education, marital status, and age. Those who are married, less educated, and young are less aware of gender equality and rights including domestic violence, autonomy, and confidence. The data suggest specific areas where interventions may produce positive outcomes. The BALIKA survey included a number of questions to measure the values held about gender equality in terms of marriage expectations, …

Provision Of Adolescent Reproductive And Sexual Health Services In India: Provider Perspectives, Shireen J. Jejeebhoy, K.G. Santhya, Santosh Kumar Singh, Shilpi Rampal, Komal Saxena

Poverty, Gender, and Youth

The recently launched Rashtriya Kishor Swasthya Karyakram (RKSK) program seeks to enable all adolescents and youth to realize their full potential by making informed decisions concerning their health and well-being and by accessing the services and support they need to implement their decisions. To realize this vision, the RKSK framework acknowledges the strengthening of Adolescent Friendly Health Clinics (AFHCs) and providing correct knowledge and information through counseling services as two of its seven critical components. As the government makes an effort to roll out the RKSK program at scale across the country, reviewing the experiences of the AFHCs established under …

Substance Abuse Recovery: Mind, Body, And Soul, Chinwendu Opara, Aisha Uddin

Bridging the Gaps Posters 2014

No abstract provided.

A Mother's Paradox: Choosing A Birthing Method In The 21st Century, Jenae Franklin

Pitzer Senior Theses

Investigating childbirth, one of the biggest moments of a woman’s life, this thesis examines the reasons behind women’s preferred birthing methods. This research explores the fundamental decisions women make during the birthing process: the amount of prenatal care mothers will receive, the type of health care provider they will use, picking the place of delivery, views on technological and medical interventions, and outlooks on natural childbirth. In addition to an extensive literature review, in-depth interviews with mothers, midwives, and obstetricians are used to examine the various controversies of childbirth. This thesis begins with a review of the transition from midwives …

A Risk Prediction Model For The Assessment And Triage Of Women With Hypertensive Disorders Of Pregnancy In Low-Resourced Settings: The Minipiers (Pre-Eclampsia Integrated Estimate Of Risk) Multi-Country Prospective Cohort Study, Beth A. Payne, Jennifer A. Hutcheon, J. Mark Ansermino, David R. Hall, Zulfiqar Ahmed Bhutta, Shereen Z. Bhutta, Christine Biryabarema, William A. Grobman, Henk Groen, Farizah Haniff, Jing Li, Laura A. Magee, Mario Merialdi, Annettee Nakimuli, Ziguang Qu, Rozina Sikandar Sultanali, Nelson Sass, Diane Sawchuck, D. Wilhelm Steyn, Mariana Widmer, Jian Zhou, Peter Von Dadelszen

Department of Obstetrics & Gynaecology

Background: Pre-eclampsia/eclampsia are leading causes of maternal mortality and morbidity, particularly in low- and middle- income countries (LMICs). We developed the miniPIERS risk prediction model to provide a simple, evidence-based tool to identify pregnant women in LMICs at increased risk of death or major hypertensive-related complications.

Methods and Findings: From 1 July 2008 to 31 March 2012, in five LMICs, data were collected prospectively on 2,081 women with any hypertensive disorder of pregnancy admitted to a participating centre. Candidate predictors collected within 24 hours of admission were entered into a step-wise backward elimination logistic regression model to predict a composite …

Dating Violence On Small Rural College Campuses: Are Administrator And Student Perceptions Similar?, Jean Allen Oldham

Theses and Dissertations--Kinesiology and Health Promotion

In recent years dating violence has become more and more prevalent on college campuses. Reports of the range of dating violence vary widely, with studies reporting from 20% to 85% of college women experiencing dating violence. However, almost all research has been conducted among urban and/or large colleges and universities, with virtually no attention to what is happening on small and/or rural college and university campuses.

When a possible 20% of college women have experienced dating violence on college campuses, there becomes a crucial need for administration at a college to have an accurate assessment of the college’s liability, and …

Behind The Mirrors: Examining The Role Of African American Cosmetologists And Salons In Domestic Violence Advocacy And Education, Pangela H. Dawson

Theses and Dissertations--Educational Policy Studies and Evaluation

African American beauty salons across the country have historically served as settings for social interaction, political activism, and community organizing in the African American community. These settings often offer opportunities for intimacy between cosmetologists and their clients. Research findings suggest that the unique bonds between women in salons can be a viable option when providing health intervention and education to large numbers of women. Data indicates that salon campaigns and promotions which focused on health issues such as stroke and diabetes education, breast and cervical cancer awareness, healthy living, and smoking cessation, have been efficacious in changing unhealthy habits or …

Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Facility-Based Workshops, Population Council

Reproductive Health

The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Facility-Based Workshops” is to orient service providers on the RMC concept along with a set of evidence-based interventions to promote RMC. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to RMC and the RMC Resource Package. Demonstrate knowledge and use of Values Clarification and Attitude Transformation (VCAT) theory and practice. Discuss selected evidence-based strategies that reduce disrespect and abuse. Discuss participants’ …

Balika Fact Sheet: Highlight On Marriage, Population Council

Poverty, Gender, and Youth

Early marriage deprives girls of the opportunity for personal development and their rights to full reproductive health and well-being, education, and participation in civil life. Bangladesh stands out in international comparisons as having an extraordinarily early age at marriage for girls and a considerable average age difference in marriage between girls and their husbands. This Bangladeshi Association for Life Skills, Income, and Knowledge for Adolescents (BALIKA) fact sheet, “Highlight on Marriage,” concludes: In Bangladesh, marriage remains early by most standards and the majority of girls still get married before reaching the legal age of 18 years. By age 19, more …

Adolescent Girls Empowerment Programme: Research And Evaluation Baseline Technical Report, Paul C. Hewett, Karen Austrian, Erica Soler-Hampejsek, Jere R. Behrman, Christine A. Kelly, Dela Kusi-Appouh, Fiammetta Bozzani, Barbara Mensch, Minyoi Maimbolwa

Poverty, Gender, and Youth

The theory of change behind the Adolescent Girls Empowerment Program (AGEP) posits that adolescent girls are empowered by acquiring social, health, and economic assets. Girls can draw on these assets to reduce vulnerabilities and expand opportunities, thereby increasing their likelihood of completing school, delaying sexual debut, and reducing the risk of early marriage, unintended pregnancy, acquisition of HIV, and so on. AGEP serves vulnerable adolescent girls in Zambia aged 10–19 in two age cohorts: 10–14-year-olds and 15–19-year-olds. AGEP operates in ten “master sites,” five urban and five rural, in four provinces of Zambia. The three core components of AGEP in …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Strengthening The Evidence Base On Social Accountability For Improving Family Planning And Reproductive Health Programs, Victoria Boydell, Jill Keesbury, Kelsey Wright

Reproductive Health

The concept of accountability is important in the family planning (FP) and reproductive health (RH) sector, building on a rich history of community involvement and civil society participation. There are three categories of FP/RH accountability initiatives: tracking donor and government financial commitments, tracking national-level program implementation, and tracking service-delivery outcomes. The third category, often referred to as “social accountability,” includes the efforts of citizens and civil society to scrutinize and hold duty bearers to account for providing promised services, most often at the subnational or community levels. Social accountability is premised on the assumption that increased and targeted citizen and …

Assessing The Potential Market For A Progesterone Contraceptive Vaginal Ring (Pcvr) As A New Contraceptive Option In Sub-Saharan Africa Using Needs-Based Market Segmentation, Francis Obare, Deepa Rajamani, Saumya Ramarao

Reproductive Health

Developing countries, especially in sub-Saharan Africa, have disproportionately high unmet contraceptive needs compared to other regions, and especially high levels of unmet need for spacing pregnancies. To address some of sub-Saharan Africa’s barriers to effective contraception, there is renewed focus on new methods that offer greater ease of use. New methods under investigation would not require daily action, their use would be controlled by women themselves, and they would require no medical providers or significant health-system infrastructure for service delivery. Contraceptive vaginal rings hold great potential by offering not only ease of use but a safe and effective FP solution. …

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Mexico, Karla Berdichevsky, Claudia Diaz, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. …

Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Balochistan government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Balochistan—about 35 percent of the deaths in this age group are pregnancy-related. Approximately 3,000 women die each year in Balochistan due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The maternal …

Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Khyber Pakhtunkhwa (KP) government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in KP—about 27 percent of the deaths in this age group are pregnancy-related. Approximately 1,700 women die each year in KP due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. …

Increasing Access To Family Planning In Ghana Through Policy Change: Task-Sharing To Enable Auxiliary Nurses To Provide Contraceptive Implant Services, Population Council

Reproductive Health

Ghana has made significant progress toward reducing the maternal mortality ratio but the rate is still unacceptably high. Up to 26 percent of married Ghanaian women have unmet need for family planning and one in four currently married women is using a modern contraceptive method. Satisfying unmet need for family planning could cut the number of maternal deaths by almost a third. One factor contributing to low usage of modern methods is shortage of trained staff, particularly those skilled in providing long-acting reversible and permanent methods. Until recently, implant services were provided primarily by Ghana Health Service (GHS) trained midwives, …

Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family …

An Evaluation Of Population Services Zimbabwe’S Mobile Outreach Model, Ravikanthi Rapiti, Saiqa Mullick

Reproductive Health

This report documents a service evaluation of Population Services Zimbabwe’s (PSZ) mobile outreach program in four provinces of Zimbabwe. The evaluation was conducted by the Population Council between September and October 2013. It provides key findings on the quality of the PSZ outreach program in expanding choice and access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of contraception, as well as recommendations for PSZ and other family planning programs to consider in scaling up and strengthening mobile outreach services. The evaluation, conducted by the Population Council, was designed to focus on various components of quality including adequate information …

Facilitator's Guide For Training On Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan, Subrato Mondal

Reproductive Health

Social and behavior change communication (SBCC) interventions are now incorporated within state project implementation plans and increasing resources are being allocated for SBCC activities. A close monitoring of SBCC activities and an evaluation in terms of reach and effectiveness among intended audiences is thus necessary. This calls for a serious effort to build the capacity of monitoring and evaluation (M&E) personnel to monitor and evaluate performance of SBCC activities. FHI 360’s Improving Healthy Behaviors Program, funded by USAID, aims to provide technical assistance to strengthen the capacities of public program managers at the national, state, and district level to monitor …

Increasing Choice Of And Access To Family Planning Services Via Outreach In Rajasthan, India, Kumudha Aruldas, M.E. Khan, Jaleel Ahmad, Anvita Dixit

Reproductive Health

This report documents a service evaluation of Marie Stopes (MS) India’s mobile outreach program in the state of Rajasthan, which was conducted by the Population Council between March and October 2012. This study was made possible through the United States Agency for International Development (USAID)-funded Support for International Family Planning Organizations–Marie Stopes International project. It provides important findings on the safety and effectiveness of MS India’s outreach program in expanding choice and access to long-acting reversible contraception methods and voluntary surgical permanent methods of contraception, as well as recommendations for MS India and other family planning programs to consider in …

Induced Abortions And Unintended Pregnancies In Pakistan, 2012, Population Council

Reproductive Health

The 2012–13 PDHS (Pakistan Demographic and Health Survey) shows that gains in contraceptive prevalence over the past decade have been small, and unmet need has remained high. Using data from a 2012 national study on post-abortion care, we estimate 2.2 million abortions occurred in Pakistan in 2012, and an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 for 2002. Even accounting for an underestimation of abortion incidence (private sector abortion services could not be included) in the prior study, the abortion rate in Pakistan has likely increased substantially between 2002 and …

Maternal Health Commodity Landscaping Exercise: A Snapshot Of The Bangladesh Program, Sharif M.I. Hossain, Saumya Ramarao, Ismat Ara Hena, Ubaidur Rob

Reproductive Health

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders …

Reaching The Unreached Through Community Mobilization In An Innovative And Sustainable Way, Arupendra Mozumdar, M.E. Khan, Subrato Mondal

Reproductive Health

This study shows the potential of Self Help Groups (SHGs) to deliver health messages that increase women’s knowledge. The intervention for this operations research (OR) study included a day-long training for Swasth Sakhis in the experimental area. A total of 11 trainings were organized, all conducted by Population Council staff. Before the intervention, at baseline, 803 women from eligible households were interviewed for the quantitative assessment. At endline, 470 women were followed up. Additionally, 16 in-depth interviews with women, Swasth Sakhis, and Rajiv Gandhi Mahila Vikas Pariyojana staff were conducted in the experimental area to understand how the intervention was …

Sexual And Reproductive Health Of Women Living With Hiv In Egypt: Unmet Needs And Unfulfilled Dreams, Doaa Oraby, Nahla G. Abdel-Tawab

Reproductive Health

The gender profile of the HIV/AIDS epidemic has changed since it emerged 30 years ago when infections were concentrated in key populations of men such as injecting drug users and men who have sex with men. In 2012, women accounted for nearly 50 percent of the estimated 35.3 million people living with HIV/AIDS globally. In the Middle East and North Africa, 44 percent of infected adults are women. The past 30 years have also witnessed remarkable improvements in access to high-quality information and medical services, including services for prevention of mother-to-child transmission of the virus. With care and treatment for …

Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq

Reproductive Health

This report presents an argument for prioritizing family planning to achieve the maternal, child, and development goals of four major provinces in Pakistan, using the latest available provincial data, especially the Pakistan Demographic and Health Survey 2012-13. The analysis is based on provincial projections generated by the Population Council. Opportunities for enhancing family planning are identified, and the number of maternal, infant, and child lives that could be saved in each province through an accelerated family planning program is estimated. The analysis establishes that none of the provinces are on track to meet Millennium Development Goals 4 or 5. The …

Kenya Country Profile: A Status Check On Unintended Pregnancy In Kenya, Joyce Mumah, Jessica Brinton, Caroline W. Kabiru, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Kenya’s mothers are dying at an alarming rate: a woman giving birth in Kenya has a 1 in 38 chance of dying due to inadequate reproductive health services. In response, in 2014 Kenya’s First Lady Margaret Kenyatta launched the Beyond Zero campaign to create awareness and raise funds to tackle maternal mortality and morbidity and improve child health. This brief offers six policy and programmatic recommendations to address significant sexual and reproductive health challenges highlighted throughout the report. These recommendations take into account the policy context in Kenya, which is evolving at a rapid rate in part because of the …

Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Although Kenya has made significant progress in ensuring its citizens’ right to reproductive health, many Kenyans still lack access to or fail to use contraceptives, in part because of the lack of quality family planning (FP) services. Through the STEP UP research program, the African Population and Health Research Center developed a comprehensive country profile report that outlines the status, causes, and consequences of unintended pregnancy in Kenya. One of the most prominent findings was how important public health facilities are to reducing unmet need for FP. In order to solidify gains achieved and make further progress, concerted commitment from …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …