International Public Health Commons^™

Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips

Poverty, Gender, and Youth

The recent introduction of user fees for Vietnam’s primary healthcare services has generated concern that economic policies may adversely affect health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This Population Council working paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under age 5 recorded by the 2001–02 Vietnam National Health Survey. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Results suggest that social equity …

Child Marriage In The Context Of The Hiv Epidemic, Judith Bruce

Poverty, Gender, and Youth

As the HIV epidemic has matured, in many settings it has become a disease of young women. In sub-Saharan Africa, 75 percent of the 6.2 million young people aged 15–24 living with HIV are female. At the same time, child marriage, though on the decline, persists. In parts of Africa, large numbers of girls are at risk of child marriage, and many millions of young wives were married as children. To better understand these twin phenomena—child marriage and the HIV epidemic—the Population Council adopted a multilevel approach. One level of investigation examines the effect of child marriage on the epidemic, …

The Changing Context Of Sexual Initiation In Sub-Saharan Africa, Barbara Mensch

Poverty, Gender, and Youth

The magnitude of the AIDS epidemic in sub-Saharan Africa puts young women at particularly high risk for HIV infection and calls for a better understanding of reproductive behavior, including sexual initiation and premarital sex. An increase in premarital sex is an inevitable consequence of later marriage in the developing world, if for no other reason than that the period during which girls are sexually mature and unmarried is prolonged when marriage is postponed. A recent Population Council project investigated the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries. After documenting the decline in …

Reducir La Exclusión Social Des Las Niñas, Kelly Hallman, Eva Roca

Poverty, Gender, and Youth

En todo el mundo, las niñas son sistemáticamente excluidas de la participación en la vida social, económica y política. La ausencia de niñas en estos terrenos tiene consecuencias, no solo para las mismas jóvenes sino también para la sociedad en su totalidad, ya que se exacerba la pobreza y se perpetúan las disparidades de salud, educación y éxito económico. A nivel internacional, esta marginación dificulta o hace imposible que algunos países logren objetivos en toda la sociedad, como los Objetivos de Desarrollo del Milenio, considerados por las Naciones Unidas como parámetros para reducir la pobreza. Desde hace algunos años, el …

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 …

Mainstreaming Emergency Contraception In Ethiopia's Public Sector: Final Project Report, Jill Keesbury, Hailegiorgis Aytenfisu, Spike Bradford

Reproductive Health

The Ethiopian Ministry of Health, the Ethiopian Society of Obstetricians and Gynecologists, and ECafrique launched a two-year project in 2004 to mainstream emergency contraception (EC) in the country’s public sector. The project aimed at improving reproductive health care among young women and reducing the country’s abortion rate by expanding access to EC. Overall, its goal was to demonstrate the feasibility of integrating EC within the public sector’s broader contraceptive mix and was guided by the following objectives: to scale-up and promote public sector EC services in five of Ethiopia’s most populated regions; to document the characteristics and use patterns of …

The Resolution Of Unintended Pregnancy Among Female Students At The University Of Ghana, Legon, Angela El-Adas

Reproductive Health

Little has been done to investigate the knowledge, attitudes, and practices of university students regarding unintended pregnancy likely because their middle-class status precludes their being considered a “deprived population.” Female students in tertiary institutions of higher learning are at an age and in a social context that makes them extremely susceptible to unintended pregnancy and the consequences of unsafe abortions. It is necessary to take steps to reduce the incidence of unwanted pregnancy and unsafe abortions among this group of “high risk” women. This study sought to investigate the extent of knowledge that female students at the University of Ghana, …

Kenya: Mobilize Health Care Providers To Advocate Against Fgm/C, Frontiers In Reproductive Health

Reproductive Health

Female genital mutilation/cutting (FGM/C) is illegal in Kenya. The practice has declined slightly, yet it is nearly universal among the Abagusii, a relatively affluent ethnic group residing in the Nyanza province in western Kenya. Half of cut women reported that they had been cut by a health worker, however providers express willingness to advocate against the practice. This study, launched in 2004 by the Population Council’s FRONTIERS Program, examined the role of health providers in FGM/C in Kenya’s Abagusii community. As noted in this brief, the objectives were to understand the motivations behind the medicalization of FGM/C and determine the …

Bolivia: Marketing And Economic Analyses Help Ngos Develop Strategies For Sustainability, Frontiers In Reproductive Health

Reproductive Health

Many nongovernmental organizations (NGOs) face reduced funding for reproductive health services and are seeking ways to assess and enhance their ability to generate income to cover their service costs. In 2004, following a workshop on financial sustainability presented by the Population Council’s FRONTIERS Program, three Bolivian NGOs—Prosalud; the Center for Research, Education, and Services (CIES); and the Association of Rural Health Programs (APSAR)—developed operations research studies to improve their financial sustainability. The Prosalud and CIES studies included a cost-recovery study, a study measuring clients’ willingness to pay for services, and a market segmentation study to compare the NGOs’ services with …

Bangladesh: Rh Curriculum Enhances Vocational Students' Knowledge And Behavior, Frontiers In Reproductive Health

Reproductive Health

In 2004, the Population Council’s FRONTIERS Program and the Bangladesh Ministry of Youth and Sports collaborated on an intervention to introduce reproductive health education into government-run vocational-training courses. The training, offered to males and females aged 15–30, includes livestock husbandry, electronics, and secretarial work. The intervention built upon the positive results of the 1999 Bangladesh Youth Reproductive Health Study, which introduced a life-skills curriculum into secondary schools. The interactive reproductive health curriculum was modified to suit older adolescents and youth attending courses at vocational training centers. Topics included reproductive biology, family planning, pregnancy, sexually transmitted infections, critical thinking, and negotiation …

South Africa: Improve Facility Management To Increase Nurse Retention, Frontiers In Reproductive Health

Reproductive Health

South Africa’s medical infrastructure is relatively well developed, but its maternal mortality rate remains high and numerous studies document poor maternal care. Shortages in nursing staff are a major factor in quality-of-care problems on maternity wards. A Population Council FRONTIERS study of antenatal care in rural clinics in Kwa-Zulu Natal showed that between one-third and one-half of providers interviewed had worked at their clinics for less than a year. In 2004, FRONTIERS followed up on the Kwa-Zulu Natal study to document factors affecting the tenure, motivations, and working conditions of maternal-health nursing staff in three South African provinces. The study …

South Africa: Youth Centers: A Costly Way To Provide Reproductive Health Services, Frontiers In Reproductive Health

Reproductive Health

Numerous reproductive health programs sponsor youth centers, which provide recreation and job-skills training as a means of attracting young people to seek reproductive health services or information. However, the productivity, cost, and cost-effectiveness of this approach are not clearly documented. In 2000, FRONTIERS conducted a cost analysis as part of a larger study on the effectiveness of three different youth center models in South Africa. The study focused on 8 of the 12 centers included in the larger study, chosen to be representative of each model. All the selected centers offered clinical services, seven also offered reproductive health information or …

Guatemala: On-Site Training And Outreach Increases Demand For And Provision Of Vasectomy, Frontiers In Reproductive Health

Reproductive Health

About one-third of Guatemalan women use modern contraceptives and half of these use female sterilization. Despite the strong demand for permanent methods, vasectomy is used by less than 1 percent of all couples. An ineffective service introduction model contributes to the low use of vasectomy. In the traditional model, doctors are sent to a hospital (often abroad) where a relatively high number of vasectomies are performed, and the trainee performs at least five supervised vasectomies. In their home practice, however, trained doctors frequently find a low demand and, unable to routinely perform vasectomies, soon lose their enthusiasm and surgical skills. …

How Much Will It Cost To Scale Up A Reproductive Health Pilot Project?, Barbara Janowitz, John H. Bratt, Rick Homan, James R. Foreit

Reproductive Health

Most service-delivery interventions begin as pilot projects. When a pilot study of an intervention is successful, managers begin to think about scaling up the project to new areas. Cost is a critical factor influencing the extent and pace of scale-up. This brief explains how to adapt and modify cost information obtained from a pilot project to estimate scale-up costs. The brief shows why the costs of a pilot project alone are not sufficient to predict costs of scale-up and gives examples of how costs are influenced by factors like economies and diseconomies of scale, resource substitution, and intervention modification. The …

Achieving Synergies In Prevention Through Linking Sexual And Reproductive Health And Hiv Services, Ian Askew

Reproductive Health

Integration, linkages, and synergies are widely used terms among those interested in strengthening the relationship between sexual and reproductive health services and HIV prevention. These conference proceedings explore the terms conceptually and review the wide range of combinations of SRH and HIV prevention services that have been linked or integrated. Several different combinations have proven feasible and acceptable in pilot situations, but there remains a lack of evidence as to their effectiveness in changing behaviors, including preventing HIV transmission. There is also limited experience with scaling up successful models and a need to move beyond a focus on services to …

Hiv/Aids Programming And Sexuality Of Young People Perinatally Infected With Hiv, Harriet Birungi

Reproductive Health

These conference proceedings draw on preliminary data from an ongoing project implemented by TASO Uganda and the Population Council that contributes to the promotion of sexual and reproductive health rights of young people aged 10–19 years perinatally infected with HIV. The key argument is that HIV/AIDS programming in Uganda and elsewhere in Africa will need to acknowledge that the population of young people perinatally infected with HIV is growing and to specifically target that population. HIV/AIDS programming will also address the sexual desires of young people perinatally infected with HIV by providing them with information and practical support to understand …

Mainstreaming And Scaling Up The Kenya Adolescent Reproductive Health Project, Ian Askew, Humphres Evelia

Reproductive Health

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research (OR) projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in two districts of Western Province in Kenya and was known as the Kenya Adolescent Reproductive Health Project (KARHP). The project supported a public sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH. Implemented jointly with PATH, this OR project demonstrated that such an intervention could be implemented by the public sector, that it was acceptable to communities, that its influence …

Mainstreaming Adolescent Reproductive Health In Senegal: Enhancing Utilization Of The Findings From The Youth Reproductive Health Project, Nafissatou J. Diop, Anta Fall Diagne

Reproductive Health

From 1999–2003, FRONTIERS implemented a Global Agenda program of operations research projects to address the reproductive health (RH) needs of adolescents in four countries—Bangladesh, Kenya, Mexico, and Senegal. The project was implemented in urban areas of Saint-Louis and Louga, in northwestern Senegal, and was known as Improving the Reproductive Health of Youth in Senegal. The project supported a public-sector, multisectoral intervention to enhance young people’s knowledge and behavior regarding HIV prevention and RH, and systematically tested its feasibility, acceptability, effectiveness, and cost. The intervention had a significant positive impact on young people’s awareness and understanding of RH issues. The pilot …

Assessment: Frontiers Small Grants Program, Koli Banik

Reproductive Health

This report reviews the Small Grants Program (SGP) implemented by FRONTIERS. It assesses the SGP’s areas of achievements and challenges, and explores the feasibility of using this approach to build capacity in operations research. The report provides ideas for implementing a successful SGP that can deliver high-quality, relevant, and timely information for program design. Although capacity building was not an objective in the FRONTIERS SGP, it did produce some increased capacity after two years. As was found with other small grants programs, the FRONTIERS experience suggests that considerable resources are required to produce good quality research and final products. Program …

Exploring The Choices Of Contraception And Abortion Among Married Couples In Tret, Rural Punjab, Pakistan, Muhammad Shafique Arif, Iram Kamran

Reproductive Health

In Pakistan, the contraceptive prevalence rate is 28 percent, unmet need for family planning services is 33 percent, and unwanted pregnancies are on the rise. A national study showed a fairly high induced abortion rate of 29 per 1,000 married women of reproductive age, and 1 out of 6 pregnancies resulted in induced abortion. This study explored how contraception and induced abortion are perceived as options for avoiding unwanted births by Pakistani men and women, to what extent they deliberately choose one over the other, and the language they use to talk about reproductive behavior decision-making. As noted in this …

Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Bagh District, Munir Afridi, Saman Naz, Nayyer Munir

Reproductive Health

The Primary Healthcare Revitalization, Integration, and Decentralization in Earthquake-affected Areas (PRIDE) program is designed to improve primary health-care services and health outcomes for populations in Bagh and Mansehra districts in northern Pakistan that were affected by the devastating earthquake that struck on October 8, 2005. The project aims to strengthen the financial and human resource management capacities of district health authorities and primary health-care providers. Access to and quality of primary health-care services will be improved through an essential package of health services and improved skills of primary health-care personnel. Community demand for quality services will be improved through an …

Knowledge, Practice, And Coverage (Kpc) Survey: Baseline Report, Mansehra District, Munir Afridi, Saman Naz, Nayyer Munir

Reproductive Health

The Primary Healthcare Revitalization, Integration, and Decentralization in Earthquake-affected Areas (PRIDE) program is designed to improve primary health-care services and health outcomes for populations in Bagh and Mansehra districts in northern Pakistan that were affected by the devastating earthquake that struck on October 8, 2005. The project aims to strengthen the financial and human resource management capacities of district health authorities and primary health-care providers. Access to and quality of primary health-care services will be improved through an essential package of health services and improved skills of primary health-care personnel. Community demand for quality services will be improved through an …

Contributing Towards Efforts To Abandon Female Genital Mutilation/Cutting In Kenya: A Situation Analysis, Humphres Evelia, Maryam Sheikh Abdi, Carolyne Njue, Ian Askew

Reproductive Health

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious …

From Pilots To Regional Programs: Expanding Contraceptive Choice And Improving Quality Of Care In Zambia's Copperbelt, Jill Keesbury

Reproductive Health

Between 2002 and 2005, the Pilots to Regional Programs (PRP) initiative was implemented in eight rural and periurban districts of Zambia’s Copperbelt region. Implemented by the Zambian Ministry of Health/Central Board of Health in collaboration with the Copperbelt Provincial Health Office and with technical assistance from the Population Council, the PRP initiative had two objectives: to expand contraceptive choice and increase the availability of high-quality reproductive health services, and to field-test a model for scaling up reproductive health interventions. The resulting project was structured around three activities: (1) expanding the method mix, (2) training healthcare workers, and (3) linking the …

Increasing Dual Protection Among Rickshaw Pullers In Bangladesh, Ismat Bhuiya, Mizanur Rahman, Ubaidur Rob, M.E. Khan, K.M. Zahiduzzaman

Reproductive Health

The main objective of this study, conducted in six urban clinics of Dhaka, Bangladesh was to increase contraceptive use among rickshaw pullers, with special emphasis on condom use. The study tested two strategies to increase access to family planning and reproductive health (RH) information and services: a) an educational campaign together with improved availability of condoms; and b) an educational campaign alone. Findings show that rickshaw pullers’ knowledge on contraceptive methods increased significantly in both the experimental sites compared to the control site. Use of any contraceptive method increased significantly in the experimental sites, and condom use increased significantly in …

Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon

Reproductive Health

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed …

Strengthening Financial Sustainability Through Integration Of Voluntary Counseling And Testing Services With Other Reproductive Health Services, Rumeli Das, Kaushik Biswas, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

In West Bengal, India, the Child in Need Institute (CINI) operated an HIV/AIDS voluntary confidential counseling and testing center and a reproductive health clinic at separate locations. Concerns about lack of service coordination as well as cost and revenue considerations led CINI to integrate the two services. CINI conducted an operations research study to examine the impact of integration on utilization and revenues. The objective of the study was to examine whether integration of services would yield an increase in clients served and improve the financial position of the program. The study found that integrating services was associated with increased …