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Manual For Designing Community Based Interventions For Preventing Postpartum Hemorrhage (Pph) Using Misoprostol: Standardized Pilot-Test Training Manual, Saumya Ramarao, Tekle-Ab Mekbib, Sarah Raifman

Reproductive Health

This manual is a comprehensive, standardized, step-by-step guide for Population Council staff to use when designing and implementing community-based pilot interventions for the prevention of postpartum hemorrhage using misoprostol. The introduction and background section provide basic information about maternal mortality, normal and abnormal pregnancy, and postpartum hemorrhage. This section also describes prevailing methods of prevention and treatment for postpartum hemorrhage, active management of the third stage of labor, and use of misoprostol for the prevention and control of postpartum hemorrhage. The second half of the manual focuses on how to develop a protocol for an intervention study on misoprostol. It …

Sexual Violence: Setting The Research Agenda For Kenya, Catherine Maternowska, Jill Keesbury, Nduku Kilonzo

Reproductive Health

This research agenda is the result of a stakeholders’ meeting held in Nairobi on June 11–12, 2008, that identified, developed, and prioritized areas for research on sexual violence in Kenya. The meeting was convened by the Population Council, Liverpool VCT, Care & Treatment, and the International Centre of Reproductive Health, Kenya. Kenya’s research agenda is premised on the need to generate the evidence required to impact policy formulation and services strengthening. Knowledge gaps that form the basis of key research areas identified include the need to: 1) Understand the nature, contexts, and prevalence of sexual violence; 2) Document and evaluate …

Multi-Sectoral Approaches To Preventing Sexual Assault And Domestic Violence: A Collective Force To Stop The Violence, Population Council

Reproductive Health

The Multi-Sectoral Approaches to Preventing Sexual Assault and Domestic Violence Symposium took place May 6–7, 2009, in Gauteng, South Africa. The symposium aimed to: increase awareness of sexual assault and domestic violence and its relationship to HIV and AIDS among decision-makers; promote evidence-based programming for practitioners; advocate for increased preventative measures and service delivery around sexual and gender-based violence (SGBV) in the public and private sectors; facilitate networking, strengthen and develop partnerships, and create opportunities for ongoing collaboration between key stakeholders; and inspire a coordinated plan of action for prevention that supports the government’s 365-day plan. South Africa has some …

Ecp Handbook: Introducing And Mainstreaming The Provision Of Emergency Contraceptive Pills In Developing Countries, Sharif M.I. Hossain, M.E. Khan, Ricardo Vernon, Jill Keesbury, Ian Askew, John Townsend, Victoria Rumbold

Reproductive Health

For many women, emergency contraceptive pills (ECPs) offer an opportunity to prevent unintended pregnancy following contraceptive method failure, rape, or unprotected sex. Access to this safe, effective option remains an essential element of women’s quality reproductive health care. However, ECPs remain inaccessible across much of the world, particularly in developing countries where limited commodity supplies, provider competency, public awareness, and misinformation routinely coalesce to restrict availability. While ECPs have been introduced on a pilot basis in many countries, their effective integration into both the public and private sectors has lagged. Successful interventions are guided by the principle that provision of …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. The Reference Guides in this publication provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures and standards included here are based on the process developed by PROCOSI, but the approach and standards can …

Reference Guides For Health Care Organizations Seeking Accreditation For High-Quality, Gender-Sensitive Reproductive Health Services—Appendixes, Patricia Riveros, Erica Palenque, Ricardo Vernon, Ignacio Carreno, John H. Bratt

Reproductive Health

Bolivia’s Integral Health Coordination Program (PROCOSI), a network of 33 nongovernmental organizations (NGOs) providing reproductive health care, has long promoted gender sensitivity as a necessary component of high-quality health care. PROCOSI encourages member NGOs to address gender-based differences in roles, relationships, access to services, and service needs in their reproductive health programs. Included in this document are the Appendixes to “The Reference Guides for Health Care Organizations Seeking Accreditation for High-Quality, Gender-Sensitive Reproductive Health Services,” which provide guidance to help health-care organizations and NGOs implement high-quality, gender-sensitive standards to achieve certification for their member clinics and administrative centers. The procedures …

Improving The Quality Of Family Planning And Reproductive Tract Infection Services For Urban Slum Populations: Demand-Based Reproductive Health Commodity Project, Md. Noorunnabi Talukder, Ubaidur Rob, Md. Mafizur Rahman

Reproductive Health

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. …

Mainstreaming Emergency Contraception In Kenya: Final Project Report, Jill Keesbury, Wilson Liambila, Francis Obare, Paul Kuria

Reproductive Health

For more than a decade, advocates have sought to improve access to emergency contraception (EC) around the world. These efforts have been highly successful in Europe and North America, have generated much debate in Latin America, and are beginning to take hold in Asia. In Africa, however, the success of EC programs remains limited. Even in countries where the regulatory environment is favorable, resource constraints within the public sector limit the ability to provide consistent and quality EC services at low cost. In a growing number of African countries, the private sector has emerged to fill these gaps, increasing access …

Being (Becoming Empowered In Nursing Growth): Training Guide For Nursing Students On Sexuality And Gender, Maryann Washington

Reproductive Health

This training guide was produced as part of a Health and Population Innovation Fellowship administered by the Population Council, India, and aims to help the faculty of nursing students to deliver comprehensive sexuality education effectively and efficiently, to help trainee nurses see the whole picture of sexuality in its matrix of safety, pleasure, reproduction, illness, and health. The package is called ‘BEING’ (acronym for Becoming Empowered in Nursing Growth) as it is assumed that, if delivered well, it could empower nurses’ growth to address these issues.

The Copperbelt Model Of Integrated Care For Survivors Of Rape And Defilement: Testing The Feasibility Of Police Provision Of Emergency Contraceptive Pills, Jill Keesbury, Mary Zama, Sudha Shreeniwas

Reproductive Health

The Zambian Ministry of Home Affairs (Police Service), Ministry of Health (MOH) and the Population Council collaborated on an operations research study designed to improve services for survivors of gender-based violence (GBV). Specifically, the study tested the feasibility of police provision of emergency contraception (EC). It also hypothesized that the intervention could strengthen GBV services at both police and health facilities through an increased emphasis on multisectoral collaboration. Based on the study’s findings, national scale-up of this program has been widely endorsed. The following recommendations are offered to guide such scale-up: ensure that a dedicated EC pill is available through …

The Refentse Model For Post-Rape Care: Strengthening Sexual Assault Care And Hiv Post-Exposure Prophylaxis In A District Hospital In Rural South Africa, Julia C. Kim, Ian Askew, Lufuno Muvhango, Ntabozuko Dwane, Tanya Abramsky, Stephen Jan, Ennica Ntlemo, Jane Chege, Charlotte Watts

Reproductive Health

The Refentse study aimed to develop a nurse-driven, post-rape care model that could be integrated into existing reproductive health/HIV services within a rural South African hospital, and to evaluate the impact of this model on the quality of care delivered. Following the intervention, there were significant improvements in the quality of clinical history and examination, and the provision of pregnancy testing, emergency contraception, STI treatment, HIV counseling and testing, post-exposure prophylaxis (PEP), trauma counseling, and referrals. The report concludes that it is possible to improve sexual assault services including PEP within a rural South African hospital at modest cost, using …

Translating Medical Evidence Into Practice: Working With Communities And Providers To Promote Active Management Of The Third Stage Of Labour, B. Subha Sri

Reproductive Health

Although postpartum hemorrhage is a leading cause of death in India, and despite the fact that active management of the third stage of labor (AMTSL) has been established as a best practice, efforts to promote it have been limited. This paper documents the experiences of a project that aimed to enable the translation of available evidence regarding AMTSL into practice through two strategies, at community and provider levels respectively. Community-level activities included efforts to build awareness regarding safe delivery practices, sensitize individuals regarding the rights perspective and their entitlement to safe services, and facilitate the translation of this awareness into …

Premarital Sexual Behaviour Among Unmarried College Students Of Gujarat, India, Rachna Sujay

Reproductive Health

The aim of this report is to explore experiences of sexual relations and factors (including, for example, those at the individual, parental, peer, and college levels) associated with premarital sex, safe and otherwise, among college-going male and female students in Gujarat, India. Findings suggest that awareness of sexual and reproductive matters was relatively limited, attitudes to premarital sex typically gendered, and fewer than half of all students had been exposed to sexuality education in school or college. Romantic partnerships and physical intimacy were reported by considerable proportions of male and female students; premarital sex among notable minorities; and unsafe sex, …

Medical Response To Male Same-Sex Sexuality In Western India: An Exploration Of 'Conversion Treatments' For Homosexuality, Ketki Ranade

Reproductive Health

This report aims to explore the use of conversion therapy by healthcare providers in Western India to treat homosexuals, the criteria used for selecting clients for conversion therapy, the types of therapies employed, and perceived outcomes of such therapies. In contrast to most international guidelines for treatment of homosexuality, conversion therapy still seems to be practiced by many healthcare providers in India. Findings suggest that providers’ attitudes, understanding, and assumptions regarding normative and non-normative sexuality, homosexuality, marriage, procreation, and change or cure of homosexual sexual orientation makes up a complex belief system that has not incorporated some of the latest …

Exploring The Lives Of Youth In The Bpo Sector: Findings From A Study In Gurgaon, Monisha Vaid

Reproductive Health

This report seeks to fill gaps in information on the lives of unmarried youth in the business process outsourcing (BPO) sector in India. Specifically, it documents young people’s self-efficacy and their connections with their family and peers, as well as their sexual experiences and substance use practices. The findings presented in this report reiterate the fact that BPO employment not only provides young adults with a profitable and challenging work environment, but also has other positive outcomes: many young BPO employees associated their increased independence and self-efficacy to their employment in this sector, many reported close peer networks, and many …

An Assessment Of Sexual And Gender Based Violence In Wajir District, North Eastern Kenya, Gladys K. Mwangi, Guyo W. Jaldesa

Reproductive Health

A 2006 baseline survey conducted by CARE Kenya indicated that sexual and gender-based violence (SGBV) is widespread throughout Kenya’s North Eastern Province. Other findings revealed that high levels of stigma and gender imbalances are associated with sexual violence and female genital mutilation (FGM) and that a coordinated approach to responding to the service needs of survivors is missing. As noted in this report, there is limited awareness of the legal mechanisms available to survivors. The Population Council’s study in Wajir District ascertained the need for and possible components of an integrated and comprehensive services model that could meet the needs …

Feasibility, Acceptability, Effect, And Cost Of Integrating Counseling And Testing For Hiv Within Family Planning Services In Kenya, Wilson Liambila, Charlotte E. Warren, Saiqa Mullick, Ian Askew, Rick Homan, Ibrahim Mohammed, Robert Ayisi, Margaret Gitau, Josephine Kibaru, Mary W. Gathitu, Judith Maua, Helton Jilo, Juma Mwangi, John Njoroge, Anthony K. Wanyoro, Peter Mohammed Njuguna, Andrew Mboche

Reproductive Health

FRONTIERS supported the Division of Reproductive Health and the National AIDS and STI Control Program of the Kenya Ministry of Health to design, implement, and compare two models of integrating counseling and testing (CT) for HIV within family planning (FP) services in terms of their feasibility, acceptability, cost, and effect on the voluntary use of CT, as well as the quality of FP services. The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion, and counseling and testing with FP services, and are effective …

Extending Prevention Of Mother-To-Child Transmission Through Postpartum Family Planning In Lesotho, Charlotte E. Warren, Semakaleng Phafoli, Bosielo Majara, Thato Tsukuluet

Reproductive Health

Recognizing the need to improve the care and follow up of mothers and infants in the postpartum period, the Lesotho Ministry of Health and Social Welfare (MOHSW), with technical support from the Frontiers in Reproductive Health (FRONTIERS) of Population Council and funding from PEPFAR/RHAP/USAID, carried out an operations research project to strengthen the existing postpartum care services. This study had a specific focus on strengthening linkages with existing PMTCT follow-up and family planning services during the postpartum period by changing the number, timing, and content of postpartum consultations that a woman and her newborn should receive. The key findings indicated …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury

Reproductive Health

This manual equips trainers with appropriate knowledge on emergency contraceptive pills (ECPs). Emergency contraception (EC) refers to any method of contraception that can be used by a woman to prevent an unwanted pregnancy within three days of unprotected intercourse or a contraceptive accident such as condom leakage. This manual discusses ECPs and the provision of related services. After a day’s training, trainers have the knowledge and skills necessary to train service providers and workers on ECPs. The manual is divided into four sessions. The first provides an overview of the demographic and reproductive health (RH) situation in South and South …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Highlighting Marital Hiv Risk And Promoting Premarital Vct In Nyanza Province, Kenya, Ben Ochieng, Annabel Erulkar

Reproductive Health

This report describes a project undertaken in Kenya by the Population Council, in collaboration with PATH and Kendu Adventist Hospital, whose objectives were: 1) to design and implement educational strategies to raise awareness of the risks of HIV and early marriage; 2) to promote voluntary counseling and testing (VCT) for couples; and 3) to support and empower newly married girls through community-based clubs. The report notes that the strong technical support and leadership provided by the partners led to successful implementation of most project activities. The partnership enabled scarce resources to be shared, and has ensured that the comparative advantages …

Sharing Experiences With Comprehensive Responses To Adolescent Reproductive Health Needs In Africa, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

In 1999, the Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) project, began a three-year collaboration in Senegal on an adolescent reproductive health (ARH) pilot project that showed that a multisectoral, multidisciplinary approach can increase knowledge, enhance attitudes, and foster positive behaviors for reproductive health. Following requests from several neighboring countries, and given the long collaboration with WHO, FRONTIERS initiated efforts in 2007 to enable utilization of these findings in other African countries. The purpose of this report is to promote the utilization of multisectoral approaches for improving ARH programming by governments, donors, and national and international agencies in francophone …

A Situation Analysis Of Care And Support For Rape Survivors At First Point Of Contact In India And Bangladesh, M.E. Khan, Aruna Bhattacharya, Ismat Bhuiya, Aditi Aeron

Reproductive Health

A situation analysis of post-rape care services available at the first point of contact was conducted in three cities in India and four cities in Bangladesh. The aim of this investigation was to gather information that could be used in the development of a comprehensive care and support system for the rape survivor. Secondarily, the study field-tested sensitive and practical tools that could be used in the future for large-scale situation analyses of the rape survivor services. The results demonstrated that there is no uniform service provision protocol to follow for managing rape survivors at health facilities in India or …

Sexual And Gender Based Violence In Africa: Key Issues For Programming, Population Council

Reproductive Health

The Population Council is supporting a multisectoral and multicountry network of partners dedicated to strengthening sexual and gender-based violence (SGBV) services. Initiated in 2006, the network aims to promote a comprehensive approach to preventing and managing SGBV throughout the region. The implementing partners aim to develop feasible, effective, and efficient models for a comprehensive response to the needs of SGBV survivors; strengthen services that address the health, psychological, and criminal justice consequences of violence; and reduce the determinants of violent behavior within communities. This brochure summarizes the key points of a literature review by the Population Council on SGBV designed …

Taller Regional De Utilización De Resultados De Investigación Operativa Para Incrementar El Acceso, La Calidad E Integración De Los Servicios Anticonceptivos En América Latina Y El Caribe, M. Estela Rivero-Fuentes, Antonieta Martin

Reproductive Health

En octubre de 2007, el programa Fronteras de la Salud Reproductiva (FRONTERAS) realizó un taller regional de tres días en La Antigua, Guatemala, para difundir los resultados de sus proyectos de investigación operativa. Durante el taller, los participantes escucharon los avances en la metodología anticonceptiva y escucharon las estrategias efectivas que probó FRONTERAS para incrementar el acceso al DIU y la vasectomía; la integración de la planificación familiar con los servicios posparto, postaborto y PTMI. Los investigadores habloaron sobre los resultados de los estudios, los gerentes de los programas explicaron cómo se usaban los instrumentos y se habló de la …

Guía Operativa Para Programas De Educación Sexual Y Servicios De Salud Reproductiva Para Jóvenes, Ofelia Aguilar, Lorena Santos, Marisa Diaz Infante, Rocio Mejia, Ricardo Vernon, Antonieta Martin

Reproductive Health

El presente libro tiene como fin poner al alcance de personas y organizaciones interesadas en establecer políticas y programas de servicios y educación sexual para los jóvenes, una guía basada en el Programa Gente Joven que implementa la Fundación Mexicana para la Planeación Familiar, A.C. (MEXFAM). Consideramos que los componentes y las actividades de este programa pueden ser adaptados en otras latitudes y así enriquecer proyectos orientados al trabajo con jóvenes.

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The purpose of this book is to make available, to people and organizations interested in establishing policies and programs on sexual education and services for young people, a …

Lutte Contre La Pratique De L'Excision Au Mali: De L'Approche Santé À L'Approche Basée Sur Les Droits De L'Enfant-Rapport D'Evaluation Du Programme Du Centre Djoliba, Anta Fall Diagne

Reproductive Health

Depuis les années 1980, Save the Children Suède soutient des activités visant à éliminer la pratique de l'excision organisées par le Centre Djoliba au Mali. Le but de cette évaluation est d'examiner l'impact du programme du Centre Djoliba sur la vie de communautés sélectionnées et en utilisant une approche basée sur les droits de l'homme et de l'enfant, pour examiner les changements majeurs dans les communautés cibles. Cette approche a conduit à une meilleure compréhension de ces droits et à la volonté des communautés d’essayer d’intégrer les connaissances acquises sur ces droits dans leur vie quotidienne. Cependant, l'environnement socioéconomique défavorable …

Managing And Preventing Female Genital Cutting (Fgm/C) Among The Somali Community In Kenya, Maryam Sheikh Abdi, Guyo W. Jaldesa, Ian Askew

Reproductive Health

This report details the Council’s innovative work with religious leaders to reduce the practice of FGM/C in the Somali community in Northern Kenya. In the mid to late 2000s, through the USAID Frontiers project, the Council successfully engaged religious leaders and scholars as community educators to correct the customary misconception that FGM/C is a requirement of Islam. Through sermons and training sessions, these leaders were able to dis-associate FGM/C from Islam, raise public awareness about the harms associated with the practice, and encourage its abandonment.

Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga

Reproductive Health

In 1998–99, a village empowerment program was implemented in the Thiès/Fatick and Kolda regions of Senegal by the nongovernmental organization Tostan, to mobilize communities to hold public declarations in support of abandoning harmful traditional practices, including female genital mutilation/cutting (FGM/C) and child marriage. The information presented in this report indicates that many did end the practices following a public declaration, however, the lack of follow-up in the field and the absence of support mechanisms pose a large obstacle. Nevertheless, the program achieved significant results: knowledge of life skills resulting in positive changes and a shift in the perception of FGM/C …