International Public Health Commons^™

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 …

Peer Mentoring: An Effective Strategy For Integrating Hiv And Srh Services, Integra Initiative

Reproductive Health

Mentoring is an innovative approach to improving provider skills without compromising service delivery by harnessing the potential of existing providers. In Kenya, a peer-mentorship approach was designed and tested to improve service providers’ skills, knowledge, and capacity to provide high-quality integrated HIV and SRH services. A central component was to understand providers’ opinions on mentoring, so as to build a practical and sustainable mentorship model. The “Steps to Integration” series provides a guide on how to integrate HIV and SRH services based on findings from the Integra Initiative, managed by the International Planned Parenthood Federation in partnership with the London …

Srh And Hiv Service Integration And Stigma, Integra Initiative

Reproductive Health

Stigma is frequently faced by people living with HIV and those who they are associated with, and is frequently followed by discrimination. The “Steps to Integration” series provides a guide on how to integrate HIV and SRH services based on findings from the Integra Initiative, managed by the International Planned Parenthood Federation in partnership with the London School of Hygiene & Tropical Medicine and the Population Council. Issue 3 of the series explores the experience of stigma among clients living with HIV in a variety of settings, both service-based (when seeking family planning, antenatal, and postnatal care services) and facility-based …

Integration Of Sexual And Reproductive Health And Hiv Services, Integra Initiative

Reproductive Health

In sub-Saharan Africa, there is a high rate of unintended pregnancy, particularly among HIV-positive women, and the majority of HIV infections are sexually transmitted or transmitted as a result of pregnancy, childbirth, and breastfeeding. Yet many health facilities do not provide integrated HIV and SRH services. Integration has the potential to increase access and uptake of health services, increase job satisfaction among providers, more effectively distribute facility workloads, and reduce facility costs. The Integra Initiative represents an effort to respond to the need for high-quality evidence on the feasibility, effectiveness, cost, and impact of different models for delivering integrated HIV …

Male Utilization In Integrated Srh And Hiv Services, Integra Initiative

Reproductive Health

Worldwide, men are less likely to seek sexual and reproductive health (SRH) and HIV services than women. This is due to the way in which SRH and HIV services are organized and promoted as well as rigid gender norms and harmful perceptions of what it means to be a man, with far reaching consequences on health and well-being. The “Steps to Integration” series provides a guide on how to integrate SRH and HIV services based on findings from the Integra Initiative, managed by International Planned Parenthood Federation in partnership with the London School of Hygiene & Tropical Medicine and the …

Delivering Contraceptive Vaginal Rings: Review Of Postpartum And Postnatal Care Programs In Nigeria, Godwin Unumeri, Salisu Mohammed Ishaku

Reproductive Health

Postpartum family planning is a major component of postpartum care services. The Population Council is working to introduce an additional method of contraception in Nigeria—the Progesterone Contraceptive Vaginal Ring (PCVR). The PCVR is administered vaginally but acts systemically to inhibit ovulation. The PCVR contains natural progesterone and is meant for breastfeeding women to augment lactational amenorrhea. As the Council conducts a series of activities as a prelude to eventual introduction of the PCVR in sub-Saharan Africa, including Nigeria, the detailed evaluation of the postpartum program environment is very important. Understanding the prevailing postpartum and postnatal care landscapes will be crucial …

Delivering Contraceptive Vaginal Rings: Review Of Postpartum Service Packages In Kenya, Wilson Liambila, Saumya Ramarao, Heather Clark

Reproductive Health

The postnatal period is a critical phase in the lives of mothers and newborn babies. Most maternal and infant deaths occur during this time, yet this is the most neglected period for the coverage and provision of quality care. The building blocks of the WHO health systems model were applied in describing the status and health system structures that support the provision of postpartum and postnatal care (PNC) services in Kenya. Many opportunities exist for facilitating the delivery of the Population Council’s Progesterone Contraceptive Vaginal Rings (PCVR) within PNC services in Kenya, such as integration with other primary health care …

Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew

Reproductive Health

This research report presents a country profile of Kenya, and looks at differential access to and quality of family planning (FP) and abortion/post-abortion services to assess their current situation, as well the various financing and delivery mechanisms for these crucial services. Since 2000, Kenya has passed several new sexual and reproductive health (SRH) and population-related policies, including a new population and development policy that addresses rapid population growth. Results of this country profile highlight the need for further research on: 1) innovative ways through which SRH information can be brought to schools; 2) FP/SRH indicators in people living with disabilities; …

Coping With Unintended Pregnancies: Narratives From Adolescents In Nairobi's Slums, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara, Carol Mukiira

Reproductive Health

This qualitative study examined the challenges faced by adolescents in Kenya with regard to unintended pregnancies and how adolescents in urban slum settlements manage and cope with unintended pregnancies. The study’s findings suggest that high levels of unintended pregnancy among young people in Kenya’s urban slums are linked to myths and misconceptions about contraception. Other findings underscore the fact that many young people lack access to contraception and reproductive health services; indicate that unintended pregnancies are linked to sexual violence; and highlight the need for government to manage the high levels of school dropout as a result of an unintended …

Measuring The Impact Of Contraceptive Use On Unintended Pregnancy And Other Health Outcomes, Step Up Research Programme Consortium

Reproductive Health

This brief describes several statistical models that have been developed to estimate the number of health outcomes that will be averted because of contraceptive use. Concerns have been expressed that this range of approaches—which overlap in the impacts they estimate, but sometimes use different inputs, mathematical algorithms, and assumptions, and may produce different results—may be confusing for policymakers, managers, and donors who want to measure or evaluate these impacts. To address these concerns, the STEP UP consortium convened two expert meetings to review the estimation methods used; come to consensus on methodologies and assumptions, where possible; and provide guidance to …

Status Report On The Sexual And Reproductive Health Of Adolescents Living In Urban Slums In Kenya, Donatien Beguy, Joyce Mumah, Salome Wawire, Kanyiva Muindi, Lindsey Gottschalk, Caroline W. Kabiru

Reproductive Health

This report highlights the sexual and reproductive health (SRH) challenges faced by adolescents living in slums in Nairobi, Kenya, as well as the perceptions and strategies that adolescents adopt to deal with each of these challenges. The results point to the fact that there is a range of experiences among adolescents with regard to knowledge, attitudes, and behaviors. Age, education, and marital status were often strongly associated with certain adolescent sexual and reproductive health experiences, highlighting the fact that targeted programs are needed to reach adolescents with SRH services at different stages of need. Consistent and persistent poverty reduction strategies …

Introducing Medical Mr In Bangladesh: Mrm Final Report, Ismat Ara Hena, Ubaidur Rob, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council Bangladesh, in collaboration with the Directorate General of Family Planning and Marie Stopes Bangladesh, with funding from the World Health Organization and the DFID-supported STEP UP project, conducted an 18-month operations research study from January 2012 to June 2013. This operations research tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed accessibility of the combination regimen of mifepristone and misoprostol in urban and rural health facilities. Based on this study’s results, the feasibility of introducing MRM services in Bangladesh is clear, and women receiving MRM were satisfied with their overall quality of …

Positive Action For Hiv In Schools In Kenya, Francis Obare, Harriet Birungi, Monica Wanjiru, Sheila Bayley, John Kiunjuri, Mary Omondi, Rob Burnet, Bridget Deacon

Reproductive Health

The objective of this study was to test the feasibility of using comic books, role models, and edutainment to communicate HIV and AIDS messages to in-school young people in Kenya, with a view to improving their knowledge about the epidemic, enhancing communication about it, and promoting positive attitudes and behavior among them. The study was implemented by the Population Council in eight secondary schools in Nairobi, as part of the APHIA II Operations Research Project in collaboration with the AIDS Control Unit in the Ministry of Education, Well Told Story, and the National AIDS/STI Control Programme. The study found that …

Expanding Access To Comprehensive Reproductive Health And Hiv Information And Services For Married Adolescent Girls In Nyanza Province, Chi-Chi Undie, Harriet Birungi, Francis Obare, Ben Ochieng, Wilson Liambila, Erick Oweya, Ian Askew, Rob Burnet, Bridget Deacon, Aisha Mohamed

Reproductive Health

The objectives of this operations research study, conducted by the Population Council’s APHIA II Operations Research Project in Kenya, were to: 1) identify and design a set of interventions that promote the uptake of comprehensive reproductive health (RH)/family planning (FP) and HIV prevention services and information among married adolescent girls; and 2) expand access to comprehensive RH/FP and HIV prevention services and information among this population. The study demonstrated that the combined use of interactive media and community health worker visitation, health information provision, and referrals, is an effective means of reinforcing RH/FP and HIV messages, and of increasing access …

Sexual And Reproductive Health Needs Of Adolescents Living With Hiv In Kenya, Harriet Birungi, Francis Obare, Jane Harriet Namwebya, Ibrahim Mohammed, Margaret Gitau, Margaret Makumi

Reproductive Health

The objective of this study was to assess the sexual and reproductive health needs of adolescents living with HIV in Kenya with a view to identifying and developing interventions that integrate these needs within the existing HIV/AIDS treatment, care, and support programs in the country. The study was a result of collaboration between Population Council, APHIA II Rift Valley and Coast (Family Health International), the National AIDS and STI Control Programme, and APHIA II Nairobi and Central (Pathfinder International). Major findings indicate that many of the adolescents living with HIV are vulnerable, and that programmatic gaps exist in addressing the …

Ten Years Of The Kenya Adolescent Reproductive Health Project: What Has Happened?, Humphres Evelia, Monica Wanjiru, Francis Obare, Harriet Birungi

Reproductive Health

This evaluation by the Population Council’s APHIA II Operations Research Project sought to find out whether the adolescent sexual and reproductive health (ASRH) and HIV/AIDS activities in Kenya had been sustained over a 10-year period when the project was replicated and scaled up to cover seven provinces in the country. The evaluation had three main objectives: 1) to determine the extent to which activities of the Kenya Adolescent Reproductive Health Program (KARHP) have continued at national, provincial, and district levels; 2) to determine whether desired sexual and reproductive health outcomes (knowledge, behavior, and practices) have been sustained among in- and …

Using Youth-Friendly Communication Approaches To Communicate Hiv/Aids With Young People Is Feasible And Acceptable, Population Council

Reproductive Health

HIV remains a major concern in Kenya among all segments of the population, including adolescents. New ways of delivering HIV information and services are therefore needed, especially to reach young people and encourage them to take up counselling and testing to know their sero-status. The APHIA II Operations Research Project collaborated with the Ministry of Education, Well Told Story, and the National AIDS and STD Control Programme to implement a project to enhance communication in schools about HIV and create demand for early counseling and testing. The project also sought to create a supportive environment in schools for young people …

Mainstreaming Ec In Africa: The Ec Facilitative Re-Granting Program—Final Narrative Report, Jill Keesbury, Wilson Liambila, Youmane Niang Faye, Victoria Rumbold

Reproductive Health

Since 2006, ECafrique has been working to build the capacity of African nongovernmental organizations to design, implement, and evaluate successful emergency contraception (EC) mainstreaming projects. Through a process of “facilitative regranting,” ECafrique annually awarded nine grants ranging from $25,000 to $30,000 to organizations from across Anglophone and Francophone Africa. The program’s objectives were to increase access to EC across Africa by supporting projects intended to introduce, scale up, or mainstream the method, and build the capacity of African NGOs to design, implement, and evaluate successful EC mainstreaming projects. Each grantee participated in an international proposal development workshop and received individualized …

Operational Research For The Introduction Of An Adolescent Health Package In The Context Of Cervical Cancer Prevention, Marieke G. Van Dijk, Katherine Wilson, Claudia Diaz, Sandra G. Garcia

Reproductive Health

This report provides findings from a WHO/PAHO/UNFPA meeting that took place in Mexico City in 2009. Participants discussed a proposed operational research study on adolescent health and cervical cancer prevention that would help support countries that have already made or will soon make a policy decision to introduce the HPV vaccine. Adolescents typically have little contact with health services, particularly for immunization programs. Since new HPV vaccines target adolescent girls, the introduction of HPV vaccines may provide an opportunity for adolescents to engage more with health services and this may create openings to offer packages of adolescent health services that …

Special Needs Of In-School Hiv Positive Young People In Uganda, Francis Obare, Harriet Birungi, Anne Katahoire, Hannington Nkayivu, Aggrey David Kibenge

Reproductive Health

Since 2006, the Population Council has pioneered operations research in collaboration with local partners in Uganda to promote the sexual and reproductive health and rights of young people aged 10–19 years infected with HIV. Key findings show that many young people perinatally infected with HIV want to be in school to avoid social isolation, and about 70 percent of them attend school. However, there has been limited understanding of how the education sector should support this vulnerable group of learners. The objective of this study was to explore the special needs of HIV-positive young people in primary and secondary schools …

Enquête Sur La Contraception D'Urgence (Cu) Au Niveau Des Pharmacies, Nafissatou J. Diop, Babacar Mane, Ousseynou Faye, Cheikh Ibrahima Niang, Thiaba Thiaw, Aissatou Sano Coly, Fatou Mbow, Youmane Niang Faye

Reproductive Health

La Division de la santé de la reproduction (DRH) avec l’aide du Population Council a mené ces dernières années un programme de recherche opérationnelle sur la contraception d’urgence (CU). L’objectif de cette recherche a été de fournir des informations de base à utiliser dans l’élaboration d’une stratégie pour la promotion de l’utilisation de la CU au Sénégal. Des études ont montré qu’un accès rapide à une méthode de CU entraînerait une réduction significative de l’étendue des grossesses non désirées et des avortements chez les femmes. Cependant, malgré le fait que l’OMS ait recommandé l’intégration de la CU dans les programmes …

Improving The Health Care Response To Gender-Based Violence: Phase Ii, Meiwita P. Budiharsana, Mai Quoc Tung

Reproductive Health

In 2009, the Population Council/Vietnam in collaboration with the Hanoi Health Service carried out an evaluation survey among Duc Giang Hospital staff to assess the extent to which awareness and perceptions of gender-based violence (GBV) had changed since the project commenced in 2005. The survey also assessed the extent to which the response of the hospital and Women’s Center for Counseling and Health had been strengthened, and made recommendations on changes to improve the situation. Overall, this project has been effective in raising awareness and willingness to integrate GBV screening into health services. The project conducted its training program at …

Kenya's Fertility Transition: Trends, Determinants And Implications For Policy And Programmes, Ian Askew, Alex C. Ezeh, John Bongaarts, John Townsend

Reproductive Health

In Africa, fertility rates in the 1990s declined less rapidly than had been projected, and in a few cases the fertility transition appears to have stalled. This development has serious implications for future population growth because projected population size is sensitive to minor variations in current fertility trends. The 16 countries with three DHS surveys in sub-Saharan Africa can be divided into three subgroups: stalled transitions, insignificant declines, and significant declines. Half of the 16 countries experienced a stall, and an additional two experienced insignificant declines. The Population Council prepared a series of demographic and policy analyses that drew from …

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, …

Acceptability And Promotion Strategies For Lng-Ius In Ghana: A Public Health Assessment, Philomena Nyarko, Cletus Adohinzin, Placide Tapsoba, Selina F. Esantsi, John Townsend, Nicholas Kanlisi, Ekua Ed-Nighpense, Gloria Quansah Asare

Reproductive Health

In response to concerns about the side effects of the IUD, the commonly known reversible, long-term method in Ghana, and to curb the shift from long-term to short-term methods, the Ghana Health Service decided to expand women’s contraceptive method choices by introducing the Levonorgestrel-releasing Intrauterine System (LNG-IUS), a hormonal IUD, into the contraceptive method mix. The LNG-IUS is a uterine contraceptive that provides effective long-term protection up to five years. Even though the product has been certified as safe and effective, it was necessary to ensure that it satisfies client’s needs and meets provider expectations. The Population Council, in collaboration …

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.

Youth Reproductive Health: Investing In The Future, Frontiers In Reproductive Health

Reproductive Health

Youth—young people aged 10–24—constitute about a quarter of the world's population. Nearly three-quarters of these young people live in the developing world, and they suffer a disproportionate share of unplanned pregnancies, STIs including HIV, and other reproductive health (RH) problems. Research undertaken by FRONTIERS has shed light on numerous aspects of youth RH, including the information needs of young people, married adolescents, and parents and guardians. Findings from over 20 studies on youth RH provide important lessons about which interventions are effective, what kind of impact is possible, and what approaches have limited impact. This paper focuses on engaging all …

Improving Communication Between Parents And Adolescents On Reproductive Health And Hiv/Aids, Nafissatou J. Diop, Alioune Diagne

Reproductive Health

Cette recherche opérationnelle avait pour but d’évaluer la fonctionnalité et l’efficacité d’un modèle d’intervention destiné à prendre en charge les besoins d’informations des adolescent(e)s en matière de santé de la reproduction et cela à travers le renforcement et l’amélioration de la communication entre les parents et les enfants/adolescent(e)s. Les résultats ont montré la faisabilité de mettre en place un programme qui est spécifiquement destiné à améliorer le niveau et la qualité de la communication entre les parents/tuteurs et les adolescent(e)s sur les questions de SR/VIH/SIDA et cela malgré le caractère encore sensible de cette question dans le contexte socioculturel sénégalais. …

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 …

Tuko Pamoja: Adolescent Reproductive Health And Life Skills Curriculum, Path, Population Council

Reproductive Health

As they move through adolescence, young people begin to have different kinds of relationships with their peers, family members, and adults; good communication and other skills can help ensure that these relationships are satisfying and mutually respectful. Young people need to learn to manage new feelings about sexuality to make responsible decisions about their health, reproduction, and parenthood. This manual, the second edition of the Kenya Adolescent Reproductive Health Curriculum, is for teachers; community, religious, and youth group leaders; health care professionals; and anyone working with young people. The curriculum is designed to delay sexual debut and promote sexual and …