Public Health Commons^™

Ensuring Adolescents In Bihar Stay—And Learn—In School, Sapna Desai, Neelanjana Pandey, Ashish Kumar Gupta

Poverty, Gender, and Youth

The Government of India has invested in improving education through two key programs for universal access to, and retention in, secondary education. In Bihar, the Population Council found high levels of enrollment among younger adolescents, with limited gender disparity. Retention beyond elementary school, however, was low, and learning outcomes—literacy and numeracy—were poor. This policy brief focuses on two challenges to preparing Bihar's adolescents for the future: universal enrollment and retention in secondary school. The brief outlines recommendations that the government invest in secondary schooling, improve school facilities, support and evaluate quality teaching inputs and curriculum changes, remove economic and social …

More Than Brides Alliance: Baseline Report, Malawi, Christine A. Kelly, Andrea J. Melnikas, Sajeda Amin, James Mkandawire, Hamza Daud

Poverty, Gender, and Youth

The More Than Brides Alliance seeks to improve the lives of adolescent girls and includes activities across multiple domains (reproductive health, education, gender norms, and livelihoods, to name a few). The Population Council conducted baseline surveys of adolescents in select areas of two districts in Malawi as part of an evaluation of interventions to delay marriage. The goals of the baseline were to: 1) provide information about the current situation and context for adolescent girls in select areas in Malawi in order to inform the intervention; 2) provide a benchmark against which changes resulting from the intervention may be measured …

More Than Brides Alliance: Baseline Report, Mali, Andrea J. Melnikas, Sajeda Amin, Sarah Engebretsen, Mouhamadou Gueye

Poverty, Gender, and Youth

The More Than Brides Alliance seeks to improve the lives of adolescent girls and includes activities across multiple domains (reproductive health, education, gender norms, and livelihoods, to name a few). The Population Council conducted baseline surveys of adolescents in select areas of two regions in Mali (Sikasso and Segou) as part of an evaluation of interventions to delay marriage. Findings suggest that girls in these communities have a demonstrated need for interventions to address their vulnerabilities. Additional data collection will help explore some of these topics in greater depth and provide a more nuanced understanding of the situation of adolescent …

Measuring Disrespect And Abuse To Promote Respectful Maternity Care, Population Council

Reproductive Health

The Heshima project developed several study instruments to measure disrespect and abuse throughout the study’s formative, baseline, and endline stages. The quasi-experimental implementation research design applied a mixed methods approach to understanding the meaning and factors that drive disrespect and abuse in maternity settings in Kenya. These tools allowed the project to measure the prevalence of disrespect and abuse in this setting, as well as the changes affected by the project.

The Heshima project involved a complex set of multi-level interventions that sought to curb disrespectful and abusive practices during childbirth and promote dignified and respectful maternity care. The evidence …

Risk Factors For Pre-Eclampsia And Eclampsia In Belize, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Belize.

Risk Factors For Pre-Eclampsia And Eclampsia In Cambodia, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Cambodia.

Risk Factors For Pre-Eclampsia And Eclampsia In Guatemala, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Guatemala.

Risk Factors For Pre-Eclampsia And Eclampsia In Nepal, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Nepal.

Status Of Sexual And Reproductive Health And Rights In Zambia: Comprehensive Sexuality Education And Adolescents Sexual And Reproductive Health, Population Council

Reproductive Health

In 1994, the International Conference on Population and Development affirmed that sexual and reproductive health and rights (SRHR) are human rights. The Government of the Republic of Zambia has fully committed to fulfilling the SRHR of all people by ratifying 11 international instruments of law (seven global and four regional treaties). This brief is Part 2 of a three-part series entitled “Status of Sexual and Reproductive Health and Rights in Zambia,” reporting on progress, gaps, and existing challenges in SRHR. The brief shows that overall, based on the assessment framework and informed by desk reviews and consultative processes, Zambia is …

Strengthening The Role Of Patent And Proprietary Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Salisu Mohammed Ishaku

Reproductive Health

In Nigeria, overall modern contraceptive use is very low, however 60 percent of modern contraceptive services are obtained from private providers, including Patent and Proprietary Medicine (PPM) shops, which provide more than half of these private-sector services. PPM shops are owned by Patent and Proprietary Medicine Vendors (PPMVs) licensed to sell patent or proprietary drugs. Current regulations do not permit PPMVs to sell or administer injectable contraceptives, though, because they are not regarded as sufficiently trained. Given this, it is an opportune time to generate evidence that can drive policy action to formally engage and train PPMVs in the provision …

The Need For Improved Information Exchange Between Family Planning Providers And Clients, Population Council

Reproductive Health

The information exchanged during a contraceptive visit is important because providers need to understand clients’ reproductive intentions and clients need to receive adequate information about the method options and possible method-related side effects and problems. Little is known about how information exchange has changed over time and across countries, so FP2020 identified 17 core indicators to track progress made by FP programs, including the method information index (MII). The purpose of this study is to address the following issues: how the MII varies among countries, how it changes between two surveys in the same country, how it varies by type …

Understanding Adolescent And Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth Friendly Service Programming, Aparna Jain, Hussein Ismail, Elizabeth Tobey, Annabel Erulkar

Reproductive Health

To meet the unique sexual and reproductive health needs of its large adolescent and youth population, Ethiopia’s government has expanded and institutionalized youth-friendly services (YFS) at all levels of the health system. To help inform and improve these efforts, the Evidence Project, in collaboration with USAID/Ethiopia and the Ethiopian Federal Ministry of Health, conducted a study on adolescents’ and young people’s use of and opinions on YFS. Results showed that young people were satisfied overall with the health services they received, regardless of whether it was basic health services or YFS. Awareness and use of YFS was low, but many …

Using Data To Target And Scale-Up Girls' Support Programs And Child Marriage Prevention, The Evidence Project

Reproductive Health

Though child marriage is declining globally, it is estimated that over 100 million girls under age 18 will be married in the next decade. A 2012 review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that offered incentives, such as conditional cash transfers or provision of school materials, and those that empower girls directly through interventions such as girls’ groups and training. The Berhane Hewan program in Ethiopia (meaning ‘Light for Eve’ in Amharic) was one of the earliest to test child marriage prevention interventions in sub-Saharan Africa. The …

Status Of Sexual And Reproductive Health And Rights In Zambia: Violence Against Women And Hiv/Aids Prevention And Treatment, Population Council

Reproductive Health

In 1994, the International Conference on Population and Development affirmed that sexual and reproductive health and rights (SRHR) are human rights. The Government of the Republic of Zambia has fully committed to fulfilling the SRHR of all people by ratifying 11 international instruments of law. This brief is Part 3 of a three-part series entitled “Status of Sexual and Reproductive Health and Rights in Zambia,” reporting on progress, gaps, and existing challenges in SRHR. Using a human rights–based approach, the Government of Zambia and collaborators, with technical facilitation by the Population Council, conducted an assessment of the status of SRHR …

Strengthening School-Based Sexual And Reproductive Health Education And Services In Accra, Ghana, Nancy Termini Lachance, Terence Adda-Balinia

Reproductive Health

This evidence brief presents results of a study aimed to assess the acceptability and feasibility of two proposed solutions for strengthening the content and delivery of in-school sexual and reproductive health (SRH) programs in Ghana. The study was conducted in Nima, a suburb of Accra, where stakeholders agreed there was a need for enhanced SRH services in school. The study explored providing comprehensive in-school SRH education to adolescents using trained psychologists and health workers to deliver and explain comprehensive sexuality education to adolescents and link them as needed to outside services. There was unanimous agreement that adolescent SRH needs are …

Ensuring Contraceptive Security Through Effective Supply Chains, Moazzam Ali

Reproductive Health

Establishing and maintaining well-functioning supply chains that meet the needs of public and private sectors, as well as health professionals at all levels in family planning programs, will play a critical role in reducing unmet need for modern contraception in low and middle income countries. This evidence brief identifies two evidence-based solutions to address the challenges faced by these countries: increasing the visibility of product flows and user demand, and leveraging the expertise of the private and public sector to ensure a total market approach to supply-chain management. Strengthening the capacity of public and private-sector family planning providers and managers …

Improving Family Planning Service Delivery In Humanitarian Crises, Chi-Chi Undie, Rajat Khosla, Karl Blanchet

Reproductive Health

Meeting family planning (FP) needs in humanitarian emergencies is challenging but feasible, and could present opportunities for reaching marginalized, remote, or otherwise underserved populations. Although high-quality evidence on family planning in emergencies is needed to improve access to voluntary FP services in humanitarian settings, this evidence brief identifies several promising, evidence-based interventions that can help improve uptake: provide comprehensive SRH services in line with global norms, provide a full range of family planning methods via mobile clinics, train mobile health workers to provide short-acting methods, second refugee providers to health facilities to provide FP in humanitarian settings, train community health …

Bangladesh: Using Strong Evidence And Strategic Collaboration To Increase Access To Menstrual Regulation With Medication, Nancy Termini Lachance, Sharif M.I. Hossain

Reproductive Health

Through close cooperation with the Ministry of Health and Family Welfare of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and program expansions to increase access to menstrual regulation with medication (MRM). Study results demonstrate that MRM is acceptable and effective in Bangladesh, and has thus been legalized and folded into the national FP program and scaled up nationwide. However, ongoing observation and studies are still needed to understand whether the efficacy and acceptability of MRM remains the case when services are delivered at scale on a national level. Furthermore, …

Introduction And Approval Of Menstrual Regulation With Medication In Bangladesh: A Stakeholder Analysis, Fauzia Akhter Huda, Sadia Afrin, Bidhan Krishna Sarker, Hassan Rushekh Mahmood, Anadil Alam

Reproductive Health

Despite the significant progress that the government of Bangladesh has made toward introducing menstrual regulation with medication (MRM) into the national health program, there has been no systematic documentation on the introduction of MRM in Bangladesh, and on the approval process of local manufacturing of the mifepristone-misoprostol combination for menstrual regulation. This Research Report presents findings from the stakeholder analysis which was initiated to document the entire process of introducing MRM in the country. Findings from key informant interviews indicated some crucial factors that facilitated the process; these are presented here according to a four-part policy analysis framework: context, content, …

Harmonizing National Abortion And Pregnancy Prevention Laws And Policies For Sexual Violence Survivors With The Maputo Protocol, Jill Thompson, Chi-Chi Undie, Avni Amin, Ronald Johnson, Rajat Khosla, Ian Askew, Leopold Ouedraogo, Triphonie Nkurunziza, Sarah Rich, Elizabeth Westley, Melissa Garcia

Reproductive Health

In April 2016, the Population Council, the World Health Organization (WHO), and the International Consortium for Emergency Contraception (ICEC) convened a three-day regional technical meeting aimed at helping participating countries meet their obligations under the Maputo Protocol to protect and promote the reproductive health rights of women and girls, with a special emphasis on survivors of sexual and intimate partner violence. Participants included representatives from six countries in sub-Saharan Africa—Botswana, Ethiopia, Kenya, Malawi, Rwanda, and Zambia—as well as international and regional experts on reproductive health, law, and human rights. Presentations and discussions focused primarily on the prevention and management of …

What Do Users Really Want?, Saumya Ramarao, John Townsend, James Sailer

Reproductive Health

No abstract provided.

Addressing Pregnancy Prevention Needs Of Adolescents In East And Southern Africa Through Education And Health Sector Partnerships, Harriet Birungi, Chi-Chi Undie, Esther Lwanga Walgwe, Francis Obare, Caroline W. Kabiru, Joyce Mumah

Reproductive Health

No abstract provided.

Method-Specific Attributes That Influence Choice Of Future Contraception Among Married Women In Nairobi’S Informal Settlements, Joyce Mumah, John B. Casterline, Kazuyo Machiyama, Marylene Wamukoya, Caroline W. Kabiru, John C. Cleland

Reproductive Health

No abstract provided.

Women's Perceptions And Experiences Of Family Planning By Contraceptive Methods In Kenya And Bangladesh: Preliminary Results, Kazuyo Machiyama, Joyce Mumah, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John C. Cleland, John B. Casterline

Reproductive Health

No abstract provided.

Reasons For Unmet Need For Family Planning, With Attention To The Measurement Of Fertility Preferences In Kenya And Bangladesh, Joyce Mumah, Kazuyo Machiyama, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John B. Casterline, John C. Cleland

Reproductive Health

No abstract provided.

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Bangladesh, Karen Kirk, Amy Dempsey

Reproductive Health

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal deaths, however, despite the progress, there are still between 5,000 and 6,000 maternal deaths every year, with 20 percent the result of pre-eclampsia and eclampsia (PE/E). To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E at the national level, Ending Eclampsia conducted a systematic review of papers in Bangladesh published between 2000 and 2015 specifically looking at issues around the quality of care, gaps in the evidence, and barriers to accessing PE/E services. The main …

Access To Reproductive Health And Hiv Services Among Young Mothers In Tanzania, Francis Obare, Annette Almeida, George Odwe, Jamilla Mwanga, Chi-Chi Undie, Maurice Hiza, Feddy Mwanga

Reproductive Health

This report presents findings from a Population Council study that examined the experiences of young mothers in Tanzania with accessing reproductive health and HIV services during pregnancy, delivery/pregnancy termination, and the postpartum period. The overall objective of the study was to generate evidence on access to reproductive health and HIV services among young mothers aged 12–19 years in Tanzania in order to inform programming and actions to better meet their needs. It specifically examined their experiences with accessing reproductive health (safe motherhood and contraception) and HIV (testing and counseling, PMTCT, antiretroviral therapy, and early infant diagnosis) services as well as …

Adolescent Friendly Health Corners (Afhcs) In Selected Government Health Facilities In Bangladesh: An Early Qualitative Assessment, Sigma Ainul, Iqbal Ehsan, Tasmiah Tanjeen, Laura Reichenbach

Reproductive Health

With high rates of early marriage, especially among girls, a significant proportion of adolescents in Bangladesh need sexual and reproductive health services (SRH), including contraceptive information. To address this gap and ensure that adolescents throughout the country, including unmarried adolescents, have access to SRH services through public health facilities, the Maternal and Child Health Services Unit of the Directorate General of Family Planning, with financial and technical assistance from development partners, has begun establishing Adolescent Friendly Health Corners (AFHCs) at selected government facilities at district and union levels. The Evidence Project/Population Council was asked to assess the implementation of the …

Adolescent Pregnancy In Zambia, Population Council

Reproductive Health

In 2015, the Population Council in conjunction with UNFPA conducted a study that drew on data from the 2013–14 Zambia Demographic and Health Survey and the 2010 Census of Population and Housing to identify where adolescent pregnancy is most likely to occur in Zambia. Using a literature review, key informant interviews among organizations working with adolescents, and in-depth interviews with adolescent girls, the study also identified key factors that lead to adolescent pregnancy. Study findings reaffirmed that adolescent pregnancies are high in Zambia, potentially undermining girls’ human rights and compromising their opportunity to fully realize their socioeconomic development potential. This …

Adolescents In Bangladesh: A Situation Analysis Of Programmatic Approaches To Sexual And Reproductive Health Education And Services, Sigma Ainul, Ashish Bajracharya, Laura Reichenbach, Kate Gilles

Reproductive Health

The health of Bangladesh’s 29.5 million adolescents, who make up nearly one-fifth of the country’s total population, is critical to the country’s future, but issues surrounding adolescent sexual and reproductive health (ASRH) remain taboo. ASRH initiatives have been implemented by both the Government of Bangladesh and nongovernmental organizations, but with limited coordination, documentation, or evaluation, making it difficult to know what worked well and what did not. This report presents findings from a comprehensive review and situation analysis of ASRH programming in Bangladesh, carried out by the Evidence Project/Population Council, with financial support from USAID/Bangladesh, as part of a larger …