Public Health Commons^™

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 …

Sexual Violence Within Marriage: A Case Study Of Rural Uttar Pradesh, M.E. Khan, John Townsend, Ranjana Sinha, Seema Lakhanpal

Reproductive Health

Until recently the study of sexual behavior, despite being a very important area of human behavior, has remained an untouchable subject. The sensitivity of the subject and difficulties collecting required information discouraged social scientists from venturing into this area of human behavior. However, the advent of AIDS and its rapid spread in India has changed the scenario. Today the study of sexual behavior is an important subject and both national and international agencies, as part of the AIDS control program, are encouraging research on the subject. This paper addresses a totally neglected area, which is sexual coercion within marriage. The …

Improved Reproductive Health And Std Services For Women Presenting To Family Planning Services In North Jakarta. Final Report Of Activities, Meiwita B. Iskandar, Catherine Vickers, Subadra Indrawati, Siti Nurul Qomariyah

Reproductive Health

The overall goal of this study was to develop an integrated program of reproductive tract infection/sexually transmitted disease (RTI/STD) clinical services within two family planning clinics in low-income neighborhoods in North Jakarta. Multiple training programs to introduce a standardized clinical evaluation for the detection, treatment, and management of RTI/STDs were conducted. Prior and subsequent to training, observations of health care provider (HCP) and client interactions were conducted to evaluate behavior changes among HCPs. Each consenting client received a standardized reproductive health history, a pelvic exam, and provided specimens for laboratory testing to detect RTIs. Through universal screening of the participants …

Emergency Contraception As An Element In The Care Of Rape Victims, Ricardo Vernon, Raffaela Schiavon, Silvia Elena Llaguno

Reproductive Health

In most states in Mexico, abortion is excluded as a crime in pregnancies resulting from rape. However, legislation does not specify the norms by which women can obtain a legal abortion, which makes it difficult to choose this alternative. A partial solution to unwanted pregnancies from rape would be to provide emergency contraception (EC). Psychologists were trained to provide information on EC to women who reported a rape at four public ministry agencies specialized in sexual crime. In addition, 11 medical backup referral centers were established. To scale up the strategy, workshops were provided to representatives from State Attorney General …

Postabortion Case Load Study In Egyptian Public Sector Hospitals, Egyptian Fertility Care Society, Population Council

Reproductive Health

There is an absence of reliable data on the incidence of incomplete abortion in Egypt. A diagnostic, descriptive study that neither tests an experimental intervention nor evaluates in a comprehensive manner the quality of postabortion medical care was undertaken to address this issue. The study is a cross-sectional observation of the volume and nature of the postabortion case load in Egyptian public-sector hospitals, and it responds to the following objectives: 1) Accurately estimate the number of women who present for postabortion treatment in ob/gyn in-patient facilities as a percentage of ob/gyn admissions in a representative sample of Egyptian public-sector hospitals …

Coping Processes Used By Mothers Of Triplets, Susan Mullen Kaplan

Health Services Research Dissertations

The purpose of the study was to identify and describe the coping processes used by mothers of triplets. Using a descriptive design, interpersonal comparisons of 92 mothers of triplets attending a national meeting of families of higher order multiples were made. Variables, in addition to sociodemographic characteristics, included coping processes, levels of depression, perceived availability of social support, and current stress levels. Coping processes were measured using the Ways of Coping Questionnaire (Folkman & Lazarus, 1988), derived from their cognitive-phenomenological theory of stress and coping. Level of depression was measured using the Zung Self-rating Depression Scale (Zung, 1965). Perceived availability …

Passage Or Pathology: Current Attitudes Toward Women's Aging In The Literature Of Menopause, Kaaren Gearhart Ancarrow

Institute for the Humanities Theses

Menopause is currently portrayed in the medical literature as a pathological 11 process resulting from "hormone deficiency." However, feminist writers contend that the climacteric is part of the normal female aging process and oppose the medicalization of menopause and the consequent inevitable hormone replacement therapy (HR T) promoted by the hegemonic medical and pharmaceutical industries. This paper explores the historical development of these two paradigms of menopause and their manifestations in samples of three classes of contemporary literature on the subject: gynecological textbooks, popular advice books written by physicians, and women's accounts. Five major themes are investigated using quantitative and …

Behavior And Attitudes Related To The Prevention Of Sexually Transmitted Disease And Unplanned Pregnancy, J. Lee Hoover

Dissertations

A sample of 214 persons was tested to determine the impact of gender role orientation, neuroticism, extraversion, authoritarianism, race, gender, and sexual orientation on attitudes and behavior relevant to the prevention of sexually transmitted disease and unintended pregnancy. Specifically measured was the impact of these factors on attitudes toward the condom as contraceptive, attitudes toward the condom as prophylactic, and reported condom use.

Gender role orientation was measured using the short form of the Bern Sex Role Inventory (BSRI) (Bern, 1978), neuroticism and extraversion were measured using the NEO-Five Factor Inventory (NEO-FFI) (Costa & McCrae, 1992), and authoritarianism was measured …

A Correlative Study Of An At-Risk Population And Low Birth Weight/Infant Mortality In A Northeast Oklahoma City Community, Estacia D. Thrower

McCabe Thesis Collection

Studies show that numerous and complex variables influence pregnancy outcomes and infant mortality rates. These variables include demographic, medical, physical, environmental, behavioral, and attitudinal factors and prenatal care. Improving the health of mothers and infants is a national challenge. In 1987, more than 3.8 million infants were born in the United States. Of these, 38,408 died before their first birthday. Although the infant mortality rate is at an all-time low, the pace of progress has slowed. According to Dr. Robert Deppen of the Oklahoma State Health Department, "In 1992, Oklahoma ranked 29th in the United States for infant mortality and …

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 …

What Is The Risk Of Teratogenicity With The Use Of Selective Serotonin Reuptake Inhibitors During Pregnancy?, Michael Z. Wincor, Mary Gutierrez, Ann Nguyen

Pharmacy Faculty Articles and Research

"The lifetime prevalence of major depressive disorder in women is 10 to 25%, with an average age of onset in the mid-20s.1 Over the nine years that the selective serotonin reuptake inhibitors (SSRis) have been available, for many prescribers, they have become first-line agents in the treatment of depression. In addition, sorne of them are also being used in the treatment of obsessive- compulsive disorder and panic disorder. In light of these facts, itis not unlikely that women of childbearing age would be treated with one of the SSRis. In considering the risks of exposing a fetus to an SSRI, …

Reintroducing Dmpa To The Philippine Family Planning Program: A Longitudinal Study Of Continuing Users And Drop-Outs, Population Council

Reproductive Health

In 1994, the Population Council, Manila, conducted an operations research (OR) project entitled “DMPA Monitoring and Follow-up Studies.” The activity was undertaken to provide accurate and timely support to the DMPA Reintroduction Program of the Department of Health. Commonly known as Depo-Provera, DMPA stands for Depo-Medroxy Progesterone Acetate, an extremely effective injectable contraceptive given every three months. This report focuses on the survey component of these studies which aims to comprehensively examine the influence on DMPA use of factors classified into the following eight major areas: socioeconomic and demographic characteristics; reproductive history; contraceptive history; adoption of DMPA; quality of care …

Living On A Fault Line: Political Violence Against Women In Algeria, Leila Hessini

Poverty, Gender, and Youth

This study raises three questions to better comprehend the crisis women face in Algeria today: how are the state and the opposition groups addressing and defining women’s contemporary status, what is the link between women’s status and violence against them, and what are the tactics both of resistance and accommodation that Algerian women are using to survive in such a context? Throughout this study, the term “Islamic Fundamentalists” refers to movements and people in Algeria who use the “recovery” of early principles of the Ideal Muslim Community to develop their idea of a future Islamic “social order,” with the ultimate …

Women's Perceptions Of Sexuality In Rural Giza, Hind Khattab

Poverty, Gender, and Youth

This study on sexuality among women in rural Giza, Egypt, is part of a broader project on women's health and reproductive morbidity conducted by the Population Council’s Reproductive Health Working Group. Reproductive tract infections (RTIs) and other ailments associated with reproduction among women in the rural community surveyed suggest that a heavy burden of disease is being borne by women living in underprivileged areas in this region. This research on sexuality has been conducted within a conceptual framework that uses a socio-cultural approach to health and illness. The investigation is an assessment of women's perception of and knowledge about sexuality …

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 …

Dmpa Injectable Use: Findings From The 21-Month Dmpa Monitoring Study, Population Council

Reproductive Health

This report presents the results of the DMPA Monitoring Study undertaken by the Population Council, Manila, as a technical assistance project for the DMPA Reintroduction Program of the Department of Health. The primary objective is to provide data on DMPA utilization and continuation rates to project the logistical needs of the program during the next three years. Data on availability of DMPA supplies and IEC (information, education, and communication) materials relating to DMPA were also monitored to provide some measure of effectiveness of the program's distribution system. The study covers a 21-month observation period from April 1994 to December 1995 …

Update - July 1995, Loma Linda University Center For Christian Bioethics

Update

In this issue:

-- Gender Discrimination in the Medical Community

[ Responses to the American Medical Association of the Use of Anencephalic Neonates as Organ Donors ]
-- Maintain the "Dead Donor Rule"
-- Stairway to Hell
-- Let Parents Choose
-- Revisiting the Issues

Identification Of Variables Influencing Women's Breast Cancer Detection, Sherri Duckworth Kemp

Loma Linda University Electronic Theses, Dissertations & Projects

This study investigated the variables influencing women's breast cancer detection behavior. Using social learning theory as an organizing framework. factors influencing women's decisions to seek breast cancer detection and the respondent's personal demographics were examined for their contribution to explaining women's decisions to seek breast cancer detection.

A [convience] sample from a university medical center provided data for the study. Data were gathered with a voluntary questionnaire. A total of 25 employees from the medical center participated in the study during the winter quarter of 1994.

The findings of the study provide insight into some of the variables affecting women's …

Addressing Women's Reproductive Health Needs: Priorities For The Family Welfare Programme, Shireen J. Jejeebhoy

Reproductive Health

India's national family welfare program has two objectives—to address the needs of families, notably women and children, and to reduce population growth rates. In reality, the program has been disproportionately focused on achieving demographic targets by increasing contraceptive prevalence. In this process, women's needs have been overlooked, in terms of poor reproductive health (RH). There is a need to reorient program priorities to focus more holistically on RH needs and on woman-based services that respond to health needs in ways sensitive to the sociocultural constraints women and adolescent girls face in acquiring services and expressing health needs. This report presents …

Development Of Approaches To Community Based Family Planning Outreach In Egypt: Assessment Of Raidats Rifiats Program, Population Council

Reproductive Health

Egypt’s family planning program officially began in 1965. Impressive gains in contraceptive use have been made since 1980, and the contraceptive prevalence rate increased from 24 percent in 1980 to 47 percent in 1992. Egypt’s National Population Policy addresses the nation’s population growth through multiple interventions designed to reduce fertility, including family planning (FP) services. FP accessibility is promoted through a network of public and NG0 FP clinics. A number of years ago, the Egyptian Family Planning Program began using the Raidats Rifiats program to extend services into rural communities. There is concern regarding the program’s ability to recruit women …

El Coletivo: Un Colectivo Feminista De Salud Y Sexualidad Femenina En Brasil, Margarita Diaz, Debbie Rogow, Jose Barzelatto

Poverty, Gender, and Youth

Este ejemplar de Quality/Calidad/Qualité narra la historia de un grupo de mujeres brasileñas que se formó en 1981 con el convencimiento compartido—no tan extendido entonces como ahora—de que los enfoques convencionales sobre la salud de la mujer y los servicios de planificación familiar estaban dominados por una perspectiva médica incapaz de dar cuenta de la relación entre sexualidad y anticoncepción, y que además restaba poder de las usuarias. Fundaron el Coletivo, que maneja una clínica, un instituto de capacitación, y un programa de educación pública que ha “dado voz” a miles de mujeres, ha proporcionado un liderazgo al gobierno brasileño …

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, …

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 …

The Coletivo: A Feminist Sexuality And Health Collective In Brazil, Margarita Diaz, Debbie Rogow, Jose Barzelatto

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité tells the story of a group of Brazilian women who came together in 1981 with the shared belief—not as widely understood then as it is now—that conventional approaches to women's health and family planning services were overly medicalized, incapable of dealing with the relationship between sexuality and contraception, and disempowering to clients. They started the Coletivo which runs a clinic, a training institute, and a public education program that has “given voice” to thousands of women, provided leadership to the Brazilian government and women’s health movement, and has been active in research and international policy affairs. …

What We Do And Do Not Know About The Menstrual Cycle Or, Questions Scientists Could Be Asking, Sioban D. Harlow, Sara A. Ephross

Reproductive Health

The objective of this paper is to consider from a public health perspective the types of questions researchers might be asking about the relationship between menstrual function and women’s health, and to evaluate to the extent to which these questions have or have not been addressed by the scientific community. Based on the findings in this report, it is obvious that a comprehensive program of research is needed in order to begin filling the myriad gaps in scientific knowledge about the menstrual cycle. Given the lack of knowledge about many fundamental aspects of menstrual function and about linkages between the …

Sexual Coercion And Reproductive Health: A Focus On Research, Lori L. Heise, Kirsten Moore, Nahid Toubia

Reproductive Health

Gender-based violence is ignored or denied in most societies and neglected by health professionals and researchers, yet it persists in almost all societies, and, in some, it is on the increase. This report is aimed at those in the family planning/reproductive health field who desire to conduct research or implement programs to address sexual violence and its impact on women's reproductive health. Furthermore, it contributes to a better understanding of the context of sexual coercion as well as its causes and consequences. The ideas presented herein are derived largely from a two-day meeting jointly organized by the Ebert Program in …

Improving The Counseling And Medical Care Of Postabortion Patients In Egypt, Population Council, Egyptian Fertility Care Society

Reproductive Health

This pilot study conducted in Cairo and Minya examined the effects of improving the medical care and counseling of post-abortion patients in Egypt. A pre-test/post-test, no control group study design was used to measure the effects of an intervention that upgraded physicians' clinical and interpersonal communication skills for the care of post-abortion patients, including counseling and family planning (FP). The study's surveys utilized direct interviews with staff working in the OB/GYN wards, structured observations of treatment procedures and counseling of post-abortion patients, and interviews with patients prior to discharge. Changes in the clinical management of post-abortion patients were introduced through …

Improving Community Based Family Planning Services And The Potential For Increasing Contraceptive Prevalence In Bangladesh, Amy Gale Dunston, Peter C. Miller

Reproductive Health

This report contains descriptions of 13 family planning (FP) projects recently implemented in Bangladesh. The results in terms of the contraceptive prevalence rate (CPR) are analyzed to investigate the degree to which improved FP service delivery in Bangladesh can increase contraceptive use in the present status of demand, investigate the programmatic factors most associated with increased prevalence, and make these projects more widely known. Criteria for inclusion included coverage of a geographic area where household distribution of contraceptive supplies was available, and where at least one measurement of CPR has been made through credible survey efforts since July 1988. The …

Follow-Up Study Among Iud Acceptors Of Java, R. Hasan M. Hoesni, M. Hasan, Anthony Tan, Jayanti Tuladhar, Jusuf S. Effendi, Bantuk Hadijanto, Pudjo Hartono

Reproductive Health

As of April 1993, an estimated 5.3 million women in Indonesia were using IUDs. In 1991, the IUD was the second most commonly used family planning method in Indonesia (13.4 percent). According to the Indonesia Demographic and Health Survey, in 1994 it became the third most commonly used method among currently married women (10.3 percent), primarily on the islands of Java and Bali. The National Family Planning Coordinating Board (BKKBN), in collaboration with the Faculties of Medicine, Diponegoro University in Semarang, Airlangga University in Surabaya, and BKS-Penfin in Bandung, conducted a "Follow-up Study Among IUD Acceptors of Java,” from November …

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 …