Public Health Commons^™

Senegal: Education And Public Declarations Contribute To Tostan's Success, Population Council

Reproductive Health

In 1998, the nongovernmental organization Tostan implemented a village empowerment program in southern and western Senegal to help communities, especially women, improve living and health conditions in their villages, and to mobilize villages to hold public declarations supporting abandonment of harmful practices, particularly female genital mutilation/cutting (FGM/C) and child marriage. The program included modules on hygiene, literacy and numeracy, human rights, and children’s and women’s health. The Tostan approach has since been implemented more broadly in Senegal and in Burkina Faso, Guinea, and Sudan. In 2005–06, FRONTIERS evaluated the long-term impact of the program, focusing on the abandonment of FGM/C …

Kenya: Islamic Scholars Find No Religious Justification For Fgm/C, Population Council

Reproductive Health

In 2004, FRONTIERS undertook a study on the cultural basis of female genital mu­tilation and cutting (FGM/C) in Kenya’s Somali community. The study showed universal support for FGM/C, and indicated that one of the major justifications is the perception that Islam requires female as well as male genital cutting. Interviews with informants showed that belief in the religious justification overrides arguments about the health and human rights aspects and the knowledge that it is illegal in Kenya. In 2005, FRONTIERS launched an intervention to engage the community in discussions about FGM/C to clarify the religious position. FRONTIERS arranged symposia involving …

Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi

Reproductive Health

In 2001, the World Health Organization issued guidance on a new model of antenatal care (ANC) called goal-oriented or focused antenatal care (FANC), for implementation in developing countries. The new model reduces the number of required antenatal visits to four, and provides focused services shown to improve maternal outcomes. FANC emphasizes helping women maintain normal pregnancies by identifying existing health conditions, detecting emerging complications, promoting health, preparing for a healthy birth, and educating clients on postpartum care including nutrition, breastfeeding, and family planning. Trials conducted in Argentina, Cuba, Saudi Arabia, and Thailand proved that FANC was safe and was a …

Operations Research For Managers Of Reproductive Health Programs, James R. Foreit, M.E. Khan

Reproductive Health

The course presented in this publication defines operations research (OR) as the study of factors under the control of health program managers and other decision-makers. The purpose of OR is to improve programs and provide information for management decision-making. Successful OR is characterized by a close collaboration between program managers and researchers throughout the study. The course focuses on OR as a branch of the behavioral sciences and deals with formative research and field experiments. It concentrates on improving the research knowledge of managers who have had little or no training in research. The focus of this interactive course is …

Multisectoral Youth Rh Interventions: The Scale-Up Process In Kenya And Senegal, Stephanie Joyce, Ian Askew, Anta Fall Diagne, Nafissatou J. Diop, Humphres Evelia

Reproductive Health

As in many developing countries, young people in Kenya and Senegal (aged 10–20) account for about 25 percent of the population. To ensure their future contribution to their countries, it is of vital strategic importance to safeguard their welfare. Rapid social change in both countries exposes youth to sexual and reproductive health (RH) risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Beginning in 1999, the Population Council’s FRONTIERS program conducted operations research studies that tested the feasibility, acceptability, and cost of a public-sector, multisectoral intervention to enhance young people’s RH knowledge and behavior. Study findings showed …

India: Quality Assurance Procedure Monitors And Improves Quality Of Services, Population Council

Reproductive Health

A quality assurance (QA) procedure was pilot-tested and subsequently scaled up throughout the state of Gujarat, India, after demonstrating that a 65-item checklist is an efficient tool for identifying and remedying gaps in service delivery. From 2004–06, FRONTIERS developed and tested a standardized QA procedure. The State Ministry of Health and Family Welfare (MOHFW) used the procedure to assess health-care services in rural clinics in two pilot districts each in the states of Gujarat and Maharashtra. Based on positive results, the State MOHFW expanded the QA procedure in a phased manner throughout all 25 districts of Gujarat. The model is …

Kenya And Ethiopia: Community And Religious Leaders Are Effective Advocates For Hiv Testing For Young Couples, Population Council

Reproductive Health

Early marriage is common for girls in much of sub-Saharan Africa. A common belief is that marriage protects them from HIV, but studies show that married girls are at much higher risk from HIV and from maternal morbidity and mortality. FRONTIERS conducted operations research in Ethiopia and Kenya to assess the acceptability and feasibility of community-based interventions to raise awareness of the HIV risks of early marriage and promote the use of HIV counseling and testing (C&T) services by couples. The studies were an initial phase in a planned four-year intervention; this brief reports on the feasibility of the approach. …

South Africa: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The South African government wishes to expand availability and use of counseling and testing (C&T) for HIV. One option is to integrate C&T into well-attended services, such as family planning (FP). In 2004, the Population Council began a three-year study with the Department of Health in North West Province. The study tested the feasibility, acceptability, and cost of two models for integrating HIV prevention services within established FP programs, and evaluated their quality against standard practice. In the testing-model clinics, providers provided C&T services at the same consultation; in the referral-model clinics, providers offered HIV counseling and referred clients to …

Increasing Women's Use Of The Iud For Family Planning, Ricardo Vernon

Reproductive Health

The intrauterine device (IUD) is highly effective, easy to use, and has few side effects. The device costs the provider about US$2 and offers a duration of protection that makes it the most cost-effective of the temporary methods if used for two years or more. The IUD's many advantages also make it a good alternative for reducing unmet need for long-term contraception around the world. Between 5 and 17 percent of all married women of reproductive age in 53 less developed countries do not want to have more children but are not using a contraceptive method. Because the IUD can …

Assessing Integration Methodology (Aim): A Handbook For Measuring And Assessing The Integration Of Family Planning And Other Reproductive Health Services, M. Estela Rivero-Fuentes, Saumya Ramarao, Ricardo Estrada, Charlotte E. Warren, Saiqa Mullick, Ian Askew, Harriet Birungi, John Townsend, Susana Medina

Reproductive Health

Several international statements over the past two decades have endorsed the integration of family planning (FP) services with other reproductive health (RH) services as a means of expanding availability and access for potential users. Many rationales underlie the move toward integrating FP with other services. First is that it provides benefits to the client and the program. Moreover, there is the expectation that the costs to the health system of configuring two or more services will cost less than providing them independently. However, there is still little empirical evidence available about integration of services. Over time, a number of methodologies …

Financial Capacity Building For Ngo Sustainability, John H. Bratt, Rick Homan, Barbara Janowitz, James R. Foreit

Reproductive Health

While demand for family planning and reproductive health services is increasing worldwide, a number of recent trends threaten the financial sustainability of donor-supported NGOs that provide these services. First, the U.S. Agency for International Development has seen its funding for population assistance decline since 1995. A second reason is the growth of government-funded programs that provide these services for low-income clients, which reduced the need for NGOs to focus programs entirely on the poor. Health-sector reform has created opportunities for NGOs via public–private partnerships in some countries, but sustained public-sector support is unlikely given limited economic growth in domestic economies …

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …

Dissocier Les Mutilations Génitales Féminines De L'Islam, Ibrahim Lethome Asmani, Maryam Sheikh Abdi

Reproductive Health

Les mutilations ou excisions génitales féminines (MGF/E) sont pratiquées dans au moins 28 pays d'Afrique subsaharienne, quelques pays du Moyen-Orient et d'Asie, et parmi les populations immigrées de ces pays en Europe, en Amérique du Nord et en Australie. Dans le monde, on estime que 100 à 140 millions de filles et de femmes ont subi cette pratique, et au moins trois millions de filles sont à risque chaque année. La communauté ethnique somalienne au Kenya ainsi qu'en Somalie, à Djibouti et en Éthiopie pratique l'excision depuis des siècles et la pratique semble être restée largement inchangée. Le programme FRONTIERS …

Africa Regional Sexual And Gender-Based Violence Network Consultation: Technical Exchange And Planning Meeting, Population Council

Reproductive Health

In March 2008, the Population Council brought together members of the Africa Regional Sexual and Gender Based Violence (SGBV) Network for a South-South technical exchange meeting. The objectives were to identify best practices from existing programs, provide an evidence base for new programming, and develop mechanisms for South-South technical assistance. As detailed in this report, discussions covered the medical, legal, and psychosocial issues associated with SGBV prevention and response activities. Participants identified the following: Protocols and guidance documents are essential for ensuring comprehensive, quality response at all levels. Enabling access and utilization of the full range of medical services remains …

Study Of Sexually Transmitted Infections Among Urban Men In Pakistan: Identifying The Bridging Population, Ali M. Mir, Laura Reichenbach, Abdul Wajid, Mumraiz Khan

Reproductive Health

Pakistan currently has low levels of HIV infection, however the country is considered at high potential risk for an HIV epidemic. In major cities there are large concentrations of individuals whose behaviors make them extremely vulnerable to the rapid spread of HIV and of classical sexually transmitted infections (STIs), including male and female sex workers, men who have sex with men, and injecting drug users. HIV can spread to the general population through individuals who have contact with both high-risk groups and the general heterosexual population (the “bridging population”). Identifying the bridging population and bridging behaviors among urban men and …

Assessment Of Knowledge And Attitudes Of Married Women On Maternal And Newborn Health (Mnh) In Selected Union Councils Of Project Districts, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The World Health Organization estimates that 585,000 women die from pregnancy-related conditions each year. Pregnancy-related conditions, including dysfunctional labor, hemorrhage, infection, toxemia, and unsafe abortion, are the leading cause of death among women of reproductive age in many developing countries. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan, through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Kenya: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The Kenyan government’s reproductive health policy highlights service integration and quality of care. While integrating counseling and testing (C&T) for HIV into family planning (FP) can potentially increase the range of services to clients at risk from sexually transmitted infections (STIs) including HIV, few studies have documented the feasibility, effects, or costs of such integration. From 2005–07, the Population Council worked with the Kenyan Ministry of Health to test the feasibility of two models for integrating C&T into existing FP services. Both models featured client education on HIV prevention during FP visits. Providers were trained to routinely use the Balanced …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Delinking Female Genital Mutilation/Cutting From Islam, Ibrahim Lethome Asmani, Maryam Sheikh Abdi

Reproductive Health

Female genital mutilation or cutting (FGM/C) is practiced in at least 28 countries in sub-Saharan Africa, a few countries in the Middle East and Asia, and among immigrant populations from these countries in Europe, North America, and Australia. Worldwide, an estimated 100 to 140 million girls and women have undergone the practice, and at least three million girls are at risk each year. The Somali ethnic community in Kenya as well in Somalia, Djibouti, and Ethiopia, has practiced female genital cutting for centuries and the practice appears to have remained largely unchanged. The Population Council’s FRONTIERS program carried out two …

Introduction Of Quality Of Care And A Gender Perspective In Reproductive Health Service Organizations In Latin America And The Caribbean, Patricia Riveros, Antonieta Martin, Ricardo Vernon

Reproductive Health

In 2005 and with the technical assistance of the Frontiers in Reproductive Health (FRONTIERS) Program, the Integrated Health Coordination Program (PROCOSI), a Bolivian network of 33 nongovernmental organizations, designed and tested a set of four guidelines to help organizations deliver high-quality reproductive health services with a gender perspective. The guidelines were: 1) to present a strategy to certify organizations as “gender sensitive” healthcare providers; 2) to present the knowledge staff members should know to be certified; 3) to describe procedures to collect and analyze the data to evaluate implementation of the strategy; and 4) to describe how to assess strategy …

Provider Perspectives On Informed Consent In Female Sterilisation Services: Findings From A Facility-Based Study In Chennai, Raja Lakshmi

Reproductive Health

The objective of this paper is to explore the perceptions and experiences of providers with regard to the process of informed consent in the provision of female sterilization services in Chennai, south India. It describes the quality of information provided to clients of sterilization, providers’ attitudes toward clients and the quality of decisionmaking, as well as the quality of the consent-taking process in this setting. In addition, providers’ perceptions of the importance of informed consent are discussed. Findings strongly suggest the need to train and sensitize providers in public as well as private facilities on their ethical responsibilities of ensuring …

Developing Regional Operations Research Training Capacity In South Asia, M.E. Khan, James R. Foreit, Sohini Roychowdhury, F. Ram, Chander Shekhar

Reproductive Health

This project’s overall objective was to create a self-sustaining regional operations research (OR) training and research center for South Asia at the International Institute of Population Sciences (IIPS), in Mumbai, India. The goal was to institutionalize operations research (OR) in IIPS by building the teaching and research capabilities of the faculty and research team. Capacity building was accomplished through a training of trainers that included an OR workshop in Nepal, two four-day OR workshops for program managers, one ten-day OR workshop for researchers, and a four-day scientific-writing course for researchers and program managers to provide guidelines for preparing research articles …

Situation Analysis Of The Sexual And Reproductive Health And Hiv Risks And Prevention Needs Of Older Orphaned And Vulnerable Children In Nyanza Province, Kenya, Milka Juma, Ian Askew, Alan Ferguson

Reproductive Health

The increasing number of children in Kenya who are orphaned or made vulnerable (OVC) from HIV/AIDS and other factors calls for a holistic understanding of their situation so that effective programs to address their needs can be designed. This is especially important for those areas hardest hit by the HIV/AIDS pandemic, such as Nyanza Province. Little is known about the vulnerabilities of older orphans to risky sexual behavior, and whether they are more vulnerable than nonorphans. The Department of Children’s Services has initiated a cash transfer program to households taking care of OVC. The main objective is to provide a …

Emergency Contraception, Female Condoms And Iuds In Kenya's Public Sector: Findings From A National Diagnostic Assessment, Jill Keesbury, Benter Owino, Spike Bradford

Reproductive Health

In 2005, the Kenya Ministry of Health, Department of Reproductive Health (DRH), began an initiative to strengthen the provision of emergency contraception (EC) in the public sector. As a first step, 700,000 units of the dedicated EC product Postinor 2 were procured by UNFPA for use in government facilities and select providers were trained on its administration. In 2006, the DRH requested assistance from ECafrique, the African Forum on Emergency Contraception, to expand access to the product. This report documents the results of a diagnostic assessment conducted at the outset of this initiative. It examines the provision and utilization of …

Kenya: Multisectoral Engagement Increases Support For Adolescent Reproductive Health, Frontiers In Reproductive Health

Reproductive Health

In 1999, FRONTIERS launched the Kenya Adolescent Reproductive Health Project (KARHP), testing a multisectoral approach to improving young people’s reproductive health knowledge and behavior at community, school, and health-facility levels in two pilot districts in the Western Province. The intervention involved three key government ministries—Education, Science and Technology, Health, and Gender, Sports, Culture, and Social Services—with input from community leaders, parents, and youth. Positive findings from the study convinced the three ministries and USAID to institutionalize and scale up selected elements from the pilot project. In 2003, FRONTIERS and PATH began providing technical assistance aimed at mainstreaming and expanding cost-effective …

Tuko Pamoja: A Guide For Peer Educators, Program For Appropriate Technology In Health (Path)

Reproductive Health

This guide was developed by Program for Appropriate Technology in Health (PATH) and is part of the Kenya Adolescent Reproductive Health Project’s Tuko Pamoja (We Are Together) series. Based on KARHP’s Adolescent Reproductive Health and Life Skills Curriculum, the guide is designed to help facilitate dialogue between adults and young people on issues related to adolescent reproductive health. It can be used to help peer educators share information and lead discussions with their peers on physical and emotional changes during adolescence, staying healthy, planning for the future, making good decisions, and preventing pregnancy and HIV and AIDS. The information can …

Grandir En Harmonie: Document De Références, Population Council

Reproductive Health

Ce document de référence fournit des informations pour accompagner les animateurs du curriculum « Grandir en harmonie » en santé de la reproduction. Il s’adresse principalement aux pairs éducateurs et aux assistants d’adolescent(e)s pour les aider à préparer les adolescents(e) à aborder la sexualité en connaissance de cause, de manière responsable et dans le respect des valeurs de leur communauté. Son contenu peut également être adapté pour les jeunes de 20 à 24 ans. Le document couvre des sujets tels que : lʼadolescence; les valeurs; le genre; les mutilations génitales féminines; comprendre son corps; le tabagisme, l’alcoolisme et la toxicomanie; …

Grandir En Harmonie: Guide De L'Utilisateur, Population Council

Reproductive Health

Ce guide de l’utilisateur fournit des informations pour aider les animateurs du programme « Grandir en harmonie » à jouer efficacement leur rôle d’éducateur pair. Le guide décrit la mission, les tâches et la cible des activités à faire avec les adolescent(e)s/jeunes. Ces activités leur permettent de renforcer leurs capacités à prendre des décisions afin de mieux se réaliser maintenant et dans le futur. Le guide aide les animateurs avec l’organisation, la méthodologie et le matériel de soutien pour les sessions.

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This user’s guide provides information to help “Growing in Harmony” curriculum facilitators effectively carry out their role of …

Grandir En Harmonie: Curriculum D'Animation Des Pairs-Éducateurs Et Des Aides-Ados Ou Jeunes Écoutant, Population Council

Reproductive Health

« Grandir en harmonie » est un curriculum d’animation en santé de la reproduction a l’intention des pair éducateurs et des aides-adolescent(e)s, principalement, pour préparer les adolescent(e)s à aborder la sexualité en connaisance de cause, de manière responsable et dans le respect des valeurs de leur milieu. Son contenu peut aussi être utilisé par les jeunes de 20 à 24 ans, mais avec des méthodes appropriées (panel, thé-débat, etc.). D’autre types d’utilisateurs l’ont expérimenté et ont trouvé que c’était une ressource utile pour la conduite de leurs activités: aides-adolescent(e)s, enseignants, prestataires de santé et autres encadreurs de jeunes. Leurs remarques …