Public Health Commons^™

Participatory Research Results From Training With The Mabinti Tushike Hatamu Out-Of-School Girls Program: Tanzania 2015, Kelly Hallman, Ilan Cerna-Turoff, Neema Matee

Poverty, Gender, and Youth

The Mabinti Tushike Hatamu (Girls let’s be leaders!) program is designed to test and evaluate strategies for reducing the vulnerability of out-of-school adolescent girls in Tanzania aged 10–19 years to HIV/AIDS, pregnancy, and unfavorable life outcomes. MTH is led by the Tanzania AIDS Commission, implemented by Restless Development, and supported by UNICEF. The Population Council developed a strategy for Restless Development to capture the richness of its activities. The Council designed a training session and a companion toolkit in participatory action research for community volunteers, aged 19–23 years, to use within their girl groups. This report describes the findings from …

Building Assets Toolkit: Developing Positive Benchmarks For Adolescent Girls—Resource Manual, Judith Bruce, Sarah Engebretsen, Kimberly Glazer

Poverty, Gender, and Youth

This document contains the Building Assets Toolkit’s Resource Manual, which includes valuable information about building meaningful program content as well as detailed notes on each asset for use in the toolkit’s “Asset Building Exercise.” This exercise is designed to involve multiple stakeholders in determining what assets girls need in order to survive and thrive. The Building Assets Toolkit is an approach for developing programs for specific segments of girls that will prepare them to better face the challenges of growing up. It will help program managers understand the needs of the girls in their community, engage stakeholders at different levels …

Panel Survey Of Young People In Egypt (Sype) 2014: Generating Evidence For Policies And Programs—Summary Report, Rania Roushdy, Maia Sieverding

Poverty, Gender, and Youth

This document contains the Summary Report to the Panel Survey of Young People in Egypt (SYPE) 2014: Generating Evidence for Policy, Programs, and Research. SYPE, which was first conducted in 2009 among Egyptian youth aged 10–29, focuses on education, employment, health, family formation, migration, reproductive health, social issues, and civic/political participation. The second round, SYPE 2014, was conducted in the wake of two youth-led revolutions (2011 and 2013). SYPE 2014 attempts to understand changes that occurred among Egyptian youth over the period between the two rounds through targeting the same group of respondents of the 2009 survey in 2014 to …

Panel Survey Of Young People In Egypt (Sype) 2014: Generating Evidence For Policy, Programs, And Research—Appendix, Rania Roushdy, Maia Sieverding

Poverty, Gender, and Youth

This document contains the Appendix to the Panel Survey of Young People in Egypt (SYPE) 2014: Generating Evidence for Policy, Programs, and Research, consisting of 39 Indicator Tables. SYPE, which was first conducted in 2009 among Egyptian youth aged 10–29, focuses on education, employment, health, family formation, migration, reproductive health, social issues, and civic/political participation. The second round, SYPE 2014, was conducted in the wake of two youth-led revolutions (2011 and 2013). SYPE 2014 attempts to understand changes that occurred among Egyptian youth over the period between the two rounds through targeting the same group of respondents of the 2009 …

Understanding Factors Influencing Adverse Sex Ratios At Birth And Exploring What Works To Achieve Balance: The Situation In Selected Districts Of Nepal, Mahesh Puri, Anand Tamang

Poverty, Gender, and Youth

The goal of this study is to identify programs and sociocultural factors underlying disparities in sex ratios at birth in some parts of Nepal, by comparing the situation in districts with high and normal sex ratios at birth and among under-5 children. Findings are expected to inform the design of programs intended to raise the value of girls in general and counter the practice of gender-biased sex selection in particular. The study was conducted in two adjoining hill districts of the western development region of Nepal, namely Kaski (where sex ratios are adverse) and Tanhaun (where sex ratios are normal). …

Is Agep Building Assets For Vulnerable Girls In Zambia? Preliminary Research Findings, Population Council

Poverty, Gender, and Youth

The Adolescent Girls Empowerment Program (AGEP) is a randomized controlled trial that evaluates a multisectoral program intended to increase girls’ social, health, and economic resources. AGEP involves over 10,000 vulnerable girls aged 10–19 in Zambia. The girls participate in weekly girls’ group meetings (safe spaces), receive vouchers for health services, and open savings accounts. AGEP operates in ten sites—five urban and five rural—across four provinces in Zambia. The AGEP evaluation is based on the randomization of girls to participate in one of four arms of the program: 1) safe spaces only, 2) safe spaces + health voucher, 3) safe spaces …

Respectful Maternity Care Resource Package, Charity Ndwiga, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Alice Maranga, Christine Ochieng, Mary Wanjala, Beatrice Chelang'at, Anne Njeru, Annie Gituto, George Odhiambo, Faith Mbehero, Lucia Maina, Jeremiah Maina

Reproductive Health

The Respectful Maternity Care Resource Package is a set of manuals, tools, and resources to ensure high-quality, respectful maternal and newborn health services. The resources help program managers, health workers, and technical advisors set up workshops and trainings for facility-based providers and community health workers. The workshops provide practical, low-cost, and easily adaptable strategies to improve respectful care.

The Respectful Maternity Care Resource Package was developed by the Heshima project as part of the USAID Translating Research into Action (TRAction) project.

Training facility-based health providers

• Facilitator’s guide
• Orientation slide deck
• Participant’s guide

Training community health workers

• Facilitator’s guide
• Orientation slide …

Delivering Contraceptive Vaginal Rings, Population Council

Reproductive Health

To bolster sustainable contraceptive delivery and use, USAID recently proposed a renewed focus, articulating five key areas to address unmet need for family planning: Method Choice, Total Market Approach, Family Planning Workforce, Social and Behavior Communication Change, and Strengthened Supply Systems. In its Delivering Contraceptive Vaginal Rings project, the Population Council has entered into a cooperative agreement with USAID to introduce two new modern contraceptive methods in developing markets: the progesterone contraceptive vaginal ring (PCVR), a three-month ring designed specifically for spacing while breastfeeding, and an investigational one-year contraceptive vaginal ring—the Nestorone®/EthinylEstradiol contraceptive vaginal ring (NES/EE CVR)—that can be used …

Marie Stopes International's Sifpo Project—Strengthening International Family Planning Organizations, October 2010–September 2015, Population Council

Reproductive Health

The Population Council was a partner in the Strengthening International Family Planning Organizations (SIFPO) project implemented by Marie Stopes International. SIFPO’s mandate was to increase use of voluntary family planning (FP) services globally by strengthening selected international FP organizations with global reach and an extensive, multicountry network of FP clinics for achieving maximum program impact and synergies. This report outlines the Council’s role within the project: evaluate effectiveness of MSI’s FP programs to identify successful best practices and approaches; assist MSI to disseminate the findings of some or all evaluations; strengthen MSI’s internal research and metrics capacity with thematic workshops …

Union Health And Family Welfare Centers In Chittagong And Munshiganj: Are They Ready To Provide 24-Hour Normal Delivery Services? (Brief), Population Council

Reproductive Health

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. In rural areas, public-sector health facilities, including UHFWCs, contribute to only 12 percent of institutional deliveries. Until now, Family Welfare Visitors (FWVs) posted at UHFWCs performed only 0.3 percent of deliveries. …

Progesterone Vaginal Ring: Prevents Pregnancy, Population Council

Reproductive Health

This fact sheet provides information about how the progesterone vaginal contraceptive ring works to prevent pregnancy. The progesterone vaginal ring (PVR) offers a novel way of delivering safe and effective contraceptives for lactating women. When used by such women it prevents pregnancy by inhibiting follicular growth, hence preventing ovulation; reinforcing the inhibitory effect of breastfeeding on ovulation; extending postpartum amenorrhea; and thickening the cervical mucus, thus inhibiting sperm from meeting the egg. The PVR expands the range of contraceptives available to lactating women and has the potential to contribute to improving maternal and infant health.

Progesterone Vaginal Ring: Safe For Mothers And Babies, Population Council

Reproductive Health

This fact sheet provides basic information on the safety and effectiveness of the progesterone vaginal contraceptive ring. It works as a contraceptive by reinforcing the inhibitory effect of breastfeeding on ovulation and extending postpartum amenorrhea. The PVR is an effective and safe contraceptive for mothers, their babies, and their sexual partners. This method vastly expands the range of contraceptive choices available for nursing women.

Progesterone Vaginal Ring: Beneficial Role In Birth Spacing, Population Council

Reproductive Health

As a result of growing urbanization and changing social norms concerning the role of women in developing countries, the duration of exclusive breastfeeding and its impact as a contraceptive strategy has been reduced. This has given rise to the need for a contraceptive method that can extend the infertile period following delivery, especially in countries where access to other contraceptives is limited and where longer duration of breastfeeding is a social norm and a major benefit to infant health. This project brief provides information on the progesterone vaginal ring (PVR), which can enhance the effect of breastfeeding on birth spacing. …

Union Health And Family Welfare Centers In Chittagong And Munshiganj: Are They Ready To Provide 24-Hour Normal Delivery Services?, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Shongkour Roy, Afsana Fatema Noor

Reproductive Health

To date, the Directorate General of Family Planning (DGFP) of Bangladesh’s Ministry of Health and Family Welfare has established approximately 3,900 Union Health and Family Welfare Centers (UHFWCs) in rural areas providing: family planning; menstrual regulation; vaccinations; and general, reproductive, and maternal health services six days a week. About 1,500 UHFWCs have been upgraded with the necessary staff and equipment to provide normal delivery services round-the-clock in rural areas. Yet, Family Welfare Visitors (FWVs) posted at UHFWCs perform only 0.3 percent of deliveries. This means that UHFWCs and FWVs are not optimally utilized to increase the rate of institutional deliveries. …

Introduction Of Dmpa In Public Health Facilities Of Uttar Pradesh And Rajasthan: An Evaluation, M.E. Khan, Anvita Dixit, Jaleel Ahmad, G. Pillai

Reproductive Health

India is committed to achieving the goals of FP2020, which, besides substantially increasing new contraceptive users, also demands adopting a rights-based approach and ensuring easy access, choice, and good quality services. The contraceptive method mix in India has been dominated by female sterilization for a long time. No new contraceptive method has been added to the national family welfare program for decades. Use of injectable contraceptives was approved in 1994 in the private sector, but is still not part of the national program. Recently some initiatives have been taken to make Depo Medroxyprogesterone Acetate (DMPA) available through the public sector …

Reasons For Low Modern Contraceptive Use—Insights From Pakistan And Neighboring Countries, Batool Zaidi, Sabahat Hussain

Reproductive Health

This literature review forms part of an extensive research project to determine why, despite evident demand, contraceptive prevalence remains so low in Pakistan, especially for modern methods. The research has been conducted by the Population Council with the support of the Research and Advocacy Fund (RAF) and comprises four component studies: review of relevant academic, program, and policy literature; qualitative study of perspectives of men, women, and service providers in the country on family planning; situation analysis of contraceptive quality, supply, and access factors at health facilities; and examination of supply-chain issues affecting the availability of contraceptives. This review presents …

Willingness To Pay For Contraceptive Vaginal Rings In Nigeria, Salisu Mohammed Ishaku, Ayodeji Oginni, Godwin Unumeri, Deepa Rajamani

Reproductive Health

During the last two decades, Nigeria’s contraceptive prevalence rate (CPR) for modern methods remained at 10 percent, one of the lowest rates in sub-Saharan Africa. Following the renewed global commitments culminating in the 2012 London Summit on Family Planning with promises to reach an additional 120 million new users of modern contraceptives worldwide, Nigeria’s Federal Ministry of Health set a new target of raising Nigeria’s CPR to 36 percent by 2018. One way to accomplish this is by meeting the contraceptive needs of women in the immediate postpartum period and beyond. Attention is being focused on making proven contraceptive methods …

Using The Community Informant Based (Made-In And Made-For) Methodology For Estimating Mmr In Punjab, Ali M. Mir, Saleem Shaikh, Mumraiz Khan, Irfan Masood

Reproductive Health

Pakistan is one of the six countries that account for more than 50 percent of the world’s maternal deaths. Each year, there are nearly 14,000 pregnancy-related deaths. Although maternal mortality has fallen from 533 per 100,000 live births in 1990–91 to 276 in 2006–07, Pakistan has not been able to achieve its Millennium Development Goal target of reducing maternal mortality to 140 per 100,000 live births by 2015. Planners require a method that can provide reliable subnational estimates easily, cost effectively. and with greater regularity. The Research and Advocacy Fund offered support to the Government of Pakistan to assess the …

Investigating The Low Patterns Of Modern Contraceptive Use In Pakistan, Iram Kamran, Zeba Tasneem, Tahira Parveen, Yasmin Zehra Zaidi

Reproductive Health

This report documents the study “Investigating the Low Patterns of Modern Contraceptive Use in Pakistan” conducted by the Population Council Pakistan in 2014 as part of an extensive research project to determine why use of modern contraceptives in the country remains so low despite large unmet need. The family planning (FP) scenario in Pakistan has changed significantly in recent years, and it is now recognized that the reasons most often cited for unmet need require reappraisal, with qualitative research required for a deeper understanding of the attributes, experiences, reservations, and preferences that women, men, and service providers associate with specific …

Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Nafissatou Diop, Kate Reiss, Eva Burke

Reproductive Health

Marie Stopes International and the Population Council conducted a study on the knowledge and practice of misoprostol provision among pharmacy workers in Senegal, as part of the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) research program. This study helped guide strategies for expanding provision and proper delivery in pharmacies of misoprostol, a drug which is highly effective and acceptable for treating postpartum hemorrhage and post-abortion complications. Amplified communication about the product can contribute to an increase in demand from providers in all sectors. However, as demand for the product increases, the supply chain must be strengthened to respond …

Community Opinion Leaders In Ghana Speak Out On Adolescent Sexuality: What Are The Issues?, Selina F. Esantsi, Francis Onyango, Gloria Quansah Asare, Emmanuel Kuffour, Placide Tapsoba, Harriet Birungi, Ian Askew

Reproductive Health

This policy brief reports on a study that is a component of a larger study that assessed the sexual and reproductive health (SRH) needs of adolescents in four slums in two regions of Ghana. The study’s focus on this perspective stems from the fact that there is a lack of evidence surrounding the outlook of community opinion leaders on adolescent reproductive health in this setting. Understanding what adults think about major adolescent SRH issues in their communities (including the SRH rights of adolescents, adult–adolescent communication about SRH issues, and service-seeking and sexual behavior outcomes) provides insight into how adults perceive …

Are Parents Talking To Adolescents About Sexuality? Evidence From Four Slums In Ghana, Selina F. Esantsi, Francis Onyango, Gloria Quansah Asare, Emmanuel Kuffour, Placide Tapsoba, Harriet Birungi, Ian Askew

Reproductive Health

This evidence brief summarizes the essential information from a part of a larger study that assessed the sexual and reproductive health (SRH) needs of adolescents in four slums in two regions of Ghana. The objective of this brief is to provide evidence to support and facilitate the improvement of parent–adolescent communication on sexuality. This study echoes several other studies by providing evidence that a majority of parents are not opposed to in-school sex education for their children and welcome the idea of empowering themselves (parents) to have productive discussions with their children. Nevertheless, there is a mismatch between the proportion …

What Are The Sexual And Reproductive Health Needs Of Adolescents In Ghana’S Slums?, Selina F. Esantsi, Gloria Quansah Asare, Placide Tapsoba

Reproductive Health

To address the need for quality evidence on the sexual and reproductive health (SRH) needs of adolescents in slums, the STEP UP project conducted a study in four slum settings in Ghana. This policy brief highlights key points, including the need for a well-designed, comprehensive sex education curriculum; interventions that address sexual coercion and violence as an integral component of current adolescent reproductive health programs; and the need to involve all stakeholders including parents/guardians and community leaders in addressing adolescent SRH needs. Evidence from the study can be used to improve ASRH programming so that it better meets the needs …

Invest In Urban Youth Sexual And Reproductive Health To Achieve A Demographic Dividend In Africa, Joyce Mumah, Jessica Brinton, Carol Mukiira, Caroline W. Kabiru, Chimaraoke O. Izugbara

Reproductive Health

The future of Africa depends on its ability to harness the potential of its young people. Making the right investments in youth—particularly those in urban areas—can enable the region to experience substantial economic growth and sustainable national development for current and future generations. This policy brief reports on a number of recommendations to help African governments and Ministries of Health and Education realize the demographic dividend; incorporate economic empowerment programs into urban programming and budget allocation; integrate training on the provision of quality and effective youth-friendly services for health workers; and revitalize school health programming.

Expanding Access To Secondary School Education For Teenage Mothers In Kenya: A Baseline Study Report, Chi-Chi Undie, Harriet Birungi, George Odwe, Francis Obare

Reproductive Health

Carried out in Homa Bay County, Kenya, this study provides a baseline assessment involving the following data collection components: a household survey with out-of-school teenage girls (regardless of whether they had ever been pregnant or not), teenage mothers, and their household heads; and a school survey with secondary school principals and students. The objectives of the study were to: 1) foster an understanding of the current situation and context in regard to out-of-school teenage mothers and their potential support systems for school re-entry at the household and school levels; 2) clarify possible solutions for promoting school re-entry on the part …

Availability, Use And Quality Of Care For Medical Abortion Services In Private Facilities In Kenya, Wilson Liambila, Francis Obare, Edward Ikiugu, Vitalis Akora, Jesse Njunguru, Michael Njuma, Kate Reiss, Harriet Birungi

Reproductive Health

The overall goal of this study was to generate evidence on the availability, use, and quality of care for medical abortion services in private facilities (pharmacies and clinics) in Kenya. With the passing of a new constitution in 2010, there was renewed interest in the right to health and the need to reduce the high levels of maternal morbidity and mortality arising from unsafe abortion in the country. In spite of recent developments, there is limited understanding of the extent to which the changes have influenced the provision of medical abortion information and services in the country, the acceptability of …

Conceptualizing And Measuring Unintended Pregnancy And Birth: Moving The Field Forward, Population Council

Reproductive Health

Given the complexity of conceptualizing and measuring unintended pregnancy, STEP UP convened an expert group meeting in Accra, Ghana with the objectives of contributing to a clearer understanding and agreed-upon definition of unintended pregnancy; reviewing existing approaches to the conceptualization and measurement of unintended pregnancy; drawing from existing approaches to propose and draft indicators, metrics, data collection instruments, and analysis strategies for measuring and tracking unintended pregnancy through multiple data collection procedures; and identifying challenges and opportunities for communicating evidence on unintended pregnancy and informing policy, planning, and investment decisions. Following presentations and discussions on these issues, participants reviewed the …

Understanding The Reproductive Health Needs Of Adolescents In Selected Slums In Ghana: A Public Health Assessment, Selina F. Esantsi, Francis Onyango, Gloria Quansah Asare, Emmanuel Kuffour, Placide Tapsoba, Harriet Birungi, Ian Askew

Reproductive Health

Over the past decade, adolescent sexual and reproductive health (ASRH) concerns have increasingly been on the development agenda of the government of Ghana. This concern has been driven by such factors as early age of sexual debut, early childbearing, and prevalence of HIV/AIDS among this subgroup of the population. The overall objective of the study was to generate evidence on the knowledge, perceptions, and practices regarding ASRH among slum communities in Ghana. The findings of the study indicate a need for intensifying efforts to inform and educate adolescents living in the slums about responsible and healthy attitudes toward sexuality, delaying …

Education Sector Response To Early And Unintended Pregnancy: A Review Of Country Experiences In Sub-Saharan Africa, Harriet Birungi, Chi-Chi Undie, Ian Mackenzie, Anne Katahoire, Francis Obare, Patricia Machawira

Reproductive Health

In Sub-Saharan Africa (SSA), early and unintended pregnancy leads to a colossal loss of educational opportunities for girls. Existing studies that show associations between early/unintended pregnancy and school dropout lead to critical questions about how the education sector is responding to the issue in SSA. Conducted from August 2014 to April 2015, this review was devoted to an examination of such responses across six countries: Botswana, Kenya, Malawi, Tanzania, Uganda, and Zambia. The review focused on several key issues, including: education-sector policies for pregnant students and adolescent mothers; integration of pregnancy prevention into sexuality education curricula; the school environment as …

Fertility Transitions In Kenya And Ghana: Trends, Determinants And Implications For Policy And Programs, Ian Askew, Baker Ndugga Maggwa, Francis Onyango

Reproductive Health

The literature on fertility transitions in the sub-Saharan Africa region suggests that an early transition was observed across nearly all age groups, socioeconomic groups, and countries. This workshop report analyzes fertility transitions in Ghana and Kenya which are influenced by a multiplicity of factors, with marked similarities and differences between each country. Paradoxically, these analyses and critiques of policy and programming experiences suggest that, if enabling women and couples to achieve their wanted fertility rates within a rights-based approach that reduces inequities as well as reducing TFR toward replacement level are the goals of a national family planning program, then …