International Public Health Commons^™

Understanding Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth-Friendly Service Programming, The Evidence Project

Reproductive Health

In Ethiopia, significant attention has been given to improving youth sexual and reproductive health (SRH) services, including the establishment of youth-friendly services (YFS). Yet high rates of child marriage, unmet need for family planning, and adolescent childbearing persist, particularly in rural areas where over 84 percent of the population lives. Reaching rural youth with timely SRH information and services that are relevant to their varying ages and life stages remains a challenge. The Evidence Project is examining the coverage and reach of public and NGO-supported youth SRH services in several rural regions of Ethiopia. As this activity brief notes, the …

Utilization Of National Health Insurance For Family Planning And Reproductive Health Services By The Urban Poor In Uttar Pradesh, India, The Evidence Project

Reproductive Health

In 2008, the Government of India launched the National Health Insurance program, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in urban and rural areas to access a range of private health services. Enrolled families can access packages of services from RSBY-participating private hospitals, including family planning (FP) and other reproductive health (RH) services. Despite the availability of insurance coverage, poor families’ utilization of RSBY for FP/RH services is believed to be negligible. The Evidence Project is conducting a study in three cities in Uttar Pradesh to better understand the factors affecting utilization of RSBY …

The Raise Health Initiative For Workers, Companies, And Communities, The Evidence Project

Reproductive Health

RAISE Health is an initiative to improve the health of factory and farm workers (women and men) in developing countries through changes in global and corporate policies and workplace practices. Effective management of workplace health is good for companies and workers alike, resulting in better health and morale, better labor-management relations, empowerment of women, and better use of company health investments. Worker health is typically one of the most neglected areas in business operations. As this activity brief notes, RAISE Health is a major activity of the USAID-funded Evidence Project. The goal of the initiative is to utilize the existing …

Standard Days Method Of Contraception: Evidence On Use, Implementation, And Scale Up, Kelsey Wright, Hiba Iqteit, Karen Hardee

Reproductive Health

In 2002, an article in Contraception reported on a trial for a new method of contraception, the Standard Days Method (SDM). SDM is a fertility awareness-based family planning (FP) method that identifies the eighth through nineteenth days of a woman’s menstrual cycle as the fertile window. SDM users abstain or use barrier methods during their fertile periods to prevent pregnancy. The trial established a first-year method failure rate of 5 per 100 woman years with correct use, and 12 per 100 women for typical use. Over the decade since the publication of the original efficacy trial, the Georgetown University Institute …

Rights-Based Family Planning: 10 Resources To Guide Programming, Jan Kumar, Karen Hardee

Reproductive Health

The FP2020 goal of providing FP services to 120 million more women and girls that emerged from the 2012 London Summit on Family Planning refocused attention on the need to ensure that FP programs respect, protect, and fulfill human rights. The current challenge is how to operationalize human rights in existing FP programs and new projects. This resource guide reviews ten key resources available to guide programming—FP2020: Rights and Empowerment Principles for Family Planning; Ensuring Human Rights in the Provision of Contraceptive Information and Services, Ensuring Human Rights Within Contraceptive Service Delivery: Implementation Guide; Voluntary Family Planning Programs that Respect, …

Anneau Vaginal À La Progesterone: Appel A L'Action Pour Combler Les Ecarts Importants Dans La Planification Familiale Postnatal, Population Council

Reproductive Health

L’anneau vaginal à la progestérone (AVP) est une méthode efficace et sûre de contraception pour les femmes qui allaitent. C’est une médecine prioritaire de la liste des produits médicaux essentiels de l’OMS et elle est inclue parmi les critères médicaux éligibles pour les personnels de la planification familiale. Développé par le Population Council, l’AVP est un anneau intra-vaginal qui donne une option contraceptive aux femmes qui allaitent au moins quatre fois par jour dès la quatrième semaine après l’accouchement. L’AVP apporte une nouvelle option pour réduire les besoins non-satisfaits des nouvelles mères, permet aux femmes d’espacer leurs grossesses sans problème, …

Progesterone Vaginal Ring: A Call-To-Action To Fill Critical Gaps In Post-Partum Family Planning, Population Council

Reproductive Health

The progesterone vaginal ring (PVR) is a safe and effective method of contraception for lactating women. It is a priority medicine on the WHO’s Essential Medicines List and is included in the Medical Eligibility Criteria for family planning providers. Developed by the Population Council, the PVR is an intravaginal ring that provides women who breastfeed at least four times a day with a contraceptive option as early as four weeks after giving birth. The PVR provides a new option to reduce unmet need among new mothers, allow women to safely space their pregnancies, and improve the health of women and …

Willingness To Pay For Contraceptive Vaginal Rings In Senegal, Babacar Mane, Fatou Mbow, Deepa Rajamani, Nafissatou Diop, Saumya Ramarao

Reproductive Health

Contraceptive vaginal rings are an innovative category of products that have not been introduced into any sub-Saharan African country. As a result, there is little experience to guide the introductory pricing for the PVR and the one-year NES/EE CVR when it becomes available. The evidence generated by this consumer willingness to pay, and provider/procurer study has shed light on critical aspects of PVR introduction in Senegal. In general, the results generated here complement and reinforce findings from an acceptability study of the PVR and stakeholder discussions that have been occurring over the past three years. Results confirm that contraceptive vaginal …

L’Anneau Vaginal À Progestérone: Résultats De L’Étude D’Acceptabilité Au Sénégal, Babacar Mane, Papa Chimere Diaw, Nafissatou Diop, Fatou Mbow, Heather Clark, Saumya Ramarao, Deepa Rajamani

Reproductive Health

Le Gouvernement du Sénégal s’est engagé dans une politique volontariste de repositionnement de la planification familiale à travers l’adoption d’un Plan d’Action National de Planification Familiale. Pour mieux adresser les besoins de contraception des femmes et réduire les taux d’abandon, le Population Council a initié le développement d’une gamme d’anneaux vaginaux; le premier produit développé était l’anneau vaginal à progestérone ou AVP, conçu pour les femmes qui allaitent en vue de prolonger la période d’aménorrhée lactationnelle et ainsi promouvoir l’espacement des naissances. Avec l’appui de la Fondation Bill & Melinda Gates, le Population Council a entrepris des activités de pré-introduction …

Progesterone Vaginal Ring: Results Of An Acceptability Study In Nigeria, Salisu Mohammed Ishaku, Afolabi Kayode, Godwin Unumeri, Ayodeji Oginni, Adekunle Adeyemi, Deepa Rajamani, Heather Clark, Naomi Rijo, Saumya Ramarao

Reproductive Health

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. The PVR was first registered in Chile and Peru in 1998 for use by postpartum women and has since been expanded to other Latin American countries. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Nigeria as part of a larger project that was also conducted in Kenya …

Progesterone Vaginal Ring: Results Of An Acceptability Study In Kenya, Francis Obare, Wilson Liambila, Chi-Chi Undie, Harriet Birungi, Shiphrah Kuria, Heather Clark, Deepa Rajamani, Saumya Ramarao

Reproductive Health

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Kenya as part of a larger project that was also conducted in Nigeria and Senegal. The specific objectives of the study were to assess the factors influencing the acceptability of the method among clients, their spouses, providers, community members, …

Anneau Vaginal À Progestérone: Aussi Sûr Pour Maman Que Pour Bébé, Population Council

Reproductive Health

Cette fiche d'information fournit des informations de base sur l'innocuité et l'efficacité de l'anneau contraceptif vaginal à la progestérone (AVP). Son effet contraceptif fonctionne en renforçant les effets inhibiteurs de l'allaitement maternel sur l'ovulation, et en étendant l'aménorrhée post-partum. L'AVP est un contraceptif sûr et efficace pour les mamans, leurs bébés et leurs partenaires sexuels. Cette méthode étend largement le gamme de contraceptifs à la disposition des femmes qui allaitent.

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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 …

Gender Considerations Along The Hiv Treatment Cascade: An Evidence Review With Priority Actions, Melanie Croce-Galis, Jill Gay, Karen Hardee, What Works Association, Population Council

Reproductive Health

This treatment brief provides policymakers and program implementers with evidence about the impact of gender dynamics on treatment access and adherence and the gender-related gaps in treatment research and programming. It also includes priority actions that can be taken to better address gender within treatment programming and raises questions for implementation science in order to achieve the global 90-90-90 goal. This brief draws from What Works for Women and Girls: Evidence for HIV Interventions and uses the WHO treatment cascade framework to identify and analyze major gender considerations in providing antiretroviral therapy to those living with HIV in low- and …

Proposed Indicators To Measure Adherence To And Effects Of Rights-Based Family Planning: Resource Guide, Kelsey Wright, Karen Hardee

Reproductive Health

At the London Summit on Family Planning in 2012, the goal of expanding access to FP programs by 120 million additional women and girls by 2020 was established. This goal calls attention to the need for FP information and services to be delivered in ways that are voluntary and respect human rights. While human rights have been codified and affirmed in declarations, conventions, and treaties, operationalizing rights in FP programs is still in an early stage of development. With the recent emergence of global numeric benchmarks for FP programs, there is the risk that the focus will move away from …

Education Sector Response To Early And Unintended Pregnancy: A Policy Dialogue In Homa Bay County, Kenya, Chi-Chi Undie, Ian Mackenzie, Harriet Birungi, Stephen Barongo, Diosiana Ahindukha, Caleb Omondi

Reproductive Health

In collaboration with the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) Research Programme Consortium, the Population Council implemented a project to increase the demand for secondary school education in Homa Bay County, Kenya—an area characterized by high, unintended teenage pregnancy and female school drop-out rates. To foster awareness of the school re-entry policy, the Population Council collaborated with the Homa Bay County Department of Education (Ministry of Education) to convene a policy dialogue for all principals of public, day, girls-only, and co-educational secondary schools in the area. The policy dialogue helped to create visibility around the issue of …

Creating Conditions For Scale Up: Technical Assistance As An Implementation Research Uptake Strategy, Ian Askew

Reproductive Health

No abstract provided.

The Influence Of Participating In An International Clinical Experience During Baccalaureate Nursing Education On Interprofessional Collaboration And Teamwork For New Registered Nurses, Sherylyn Watson

Nursing Faculty Publications

An increased focus on interprofessional collaboration and teamwork in the healthcare professions had placed demands on nursing education to identify evidence based instructional strategies that bolster the interprofessional competency in prelicensure nursing education. One approach in addressing the call was to explore current educational opportunities for their effectiveness in developing interprofessional collaboration and teamwork. The popular trend in nursing education was to offer international clinical experiences that provide nursing care to impoverished people of developing countries. The current literature on these experiences had primarily focused on short-term outcomes that demonstrate personal growth of the individual, exposing opportunity for research concentrating …

An O'Neill Institute Briefing Paper: Ebola, The World Health Organization, And Beyond: Toward A Framework For Global Health Security, Lawrence O. Gostin, Eric A. Friedman, Daniel Hougendobler

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic has demonstrated that the world remains ill-prepared to respond to infectious disease outbreaks. A host of institutions are now reviewing what went wrong, and new institutions are being considered, including an African Centers for Disease Control and Prevention and World Bank-initiated Pandemic Emergency Facility. The World Health Organization itself failed in one of its core functions by allowing a preventable infectious disease to spiral out of control in the world’s poorest region. The 68th World Health Assembly (WHA), held in May 2015, provided an opportunity for the Organization to reflect on what went wrong and …

A Retrospective And Prospective Analysis Of The West African Ebola Virus Disease Epidemic: Robust National Health Systems At The Foundation And An Empowered Who At The Apex, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic is a pivotal moment for the global health system. Just as the depth of the crisis ultimately spurred an unprecedented response, the failures of leadership demand innovative reforms. This analysis offers a template for these reforms, responding to the profound harms posed by fragile national health systems, delays in the international response, deficient resource mobilization, ill-defined responsibilities, and insufficient coordination. The scope of the reforms must address the failures evident in the Ebola response, as well as entrenched weaknesses that enabled the epidemic to reach its heights, transforming the existing inchoate, organically developed global health …

3 Critical Challenges For Global Health Security, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

International institutions are poised to make one of the most momentous decisions about the future of global health security since the formation of the World Health Organization (WHO) in 1948.

By the end of this year, 5 global commissions will have published major critiques of global health preparedness, all spurred by the Ebola epidemic, which exposed deep flaws in the international system.

Discovering A Gold Mine Of U.S. Government Information: Exploring The Hathitrust Catalog And Its Rich Veins, Bert Chapman

Libraries Faculty and Staff Presentations

The Hathitrust Catalog provides researchers at member institutions with exponentially expanded access to historical U.S. Government information resources. This presentation describes how researchers can use this resource to conduct substantive research using government information resources on public policy issues such as Internal Revenue Service program problems, infectious diseases such as Ebola, and U.S. foreign relations with the former Soviet Union/Russian Federation.

Is The United States Prepared For Ebola?, Lawrence O. Gostin, James G. Hodge Jr., Scott Burris

Georgetown Law Faculty Publications and Other Works

The West African Ebola epidemic is a humanitarian crisis and a threat to international security. It is not surprising that isolated cases have emerged in Europe and North America, but a large outbreak in the United States, with its advanced health system, is unlikely. Yet the handling of the first domestically diagnosed Ebola case in Dallas, Texas, raised concerns about national public health preparedness. What were the critical health system vulnerabilities revealed in Dallas, and how can the country respond more effectively to novel diseases in a globalized world?

Ebola: A Crisis In Global Health Leadership, Lawrence O. Gostin, Eric A. Friedman

Georgetown Law Faculty Publications and Other Works

At the core of the present Ebola crisis in West Africa is a lack of global health leadership. WHO should be the global health leader, following its constitutional charge, yet it is significantly under-resourced, having a direct effect on its rapid response capacity. The Organization's response to this crisis has been constantly behind, from low funding appeals to its delay in declaring this outbreak to be a Public Health Emergency of International Concern under the binding International Health Regulations (2005) (IHR). The IHR themselves have proven insufficient, as countries have failed to cooperate in building the public health capacities that …

Public Health In The Age Of Ebola In West Africa, Michael T. Osterholm, Kristine A. Moore, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The Ebola epidemic, with its fast-growing toll and real potential for spreading into much of Africa, including major cities, has the makings of a “Black Swan” event. Such events, using the term coined by Nassim Nicholas Taleb, are: 1) unpredictable, outside the realm of regular expectations; 2) have a major impact, and; 3) are rationalized after the fact as being explainable and predictable.

We have learned from this outbreak the potential for an infectious disease to be politically, economically, and socially destabilizing, and that what kills us may be very different from what frightens us or substantially affects our social …

Breaking Barriers: The Influence Of Socioeconomic Status On Obesity Among Women In Salvador, Bahia, Brazil, Christina Camoriano

Independent Study Project (ISP) Collection

Obesity in Brazil has grown rapidly within the past decade, however research is conflicting in terms of who carries the burden of this disease- the economic elite or the poor. Despite the lack of clarity towards the current distribution of obesity, many studies have come to the conclusion that in developing countries, obesity is growing more rapidly among those of lower socioeconomic status.¹¹ Therefore, the purpose of my research study is to examine how socioeconomic status influences the dietary and exercise habits of lower and lower-middle income women who are obese. This study is relevant because it seeks to …

Structural Factors That Increase Hiv/Sti Vulnerability Among Indigenous People In The Peruvian Amazon, E. Roberto Orellana, Isaac E. Alva, Cesar P. Cárcamo, Patricia J. García

School of Social Work Faculty Publications and Presentations

We examined structural factors—social, political, economic, and environmental—that increase vulnerability to HIV among indigenous people in the Peruvian Amazon. Indigenous adults belonging to 12 different ethnic groups were purposively recruited in four Amazonian river ports and 16 indigenous villages. Qualitative data revealed a complex set of structural factors that give rise to environments of risk where health is constantly challenged. Ferryboats that cross Amazonian rivers are settings where unprotected sex—including transactional sex between passengers and boat crew and commercial sex work—often take place. Population mobility and mixing also occurs in settings like the river docks, mining sites, and other resource …

Agency Of The South Sudanese: Compensating For Health Care In Mungula Refugee Settlement, Lauren Schmidt

Independent Study Project (ISP) Collection

In reaction to the endemic violence, which has forced many South Sudanese to flee their homes and seek refuge within Uganda’s borders, the researcher spent the practicum interning with the Uganda Red Cross Society (URCS) in Mungula refugee settlement, under academic advisor Steven Mawa. As the organization is the leading health provider in the settlement, the researcher gained insight into the provision of social services to the population, which allowed an extensive study on the ability of the South Sudanese to compensate for shortages in care and various complications associated with doing so.

The researcher sought to entertain these inquiries …

The Ebola Epidemic: A Public Health Emergency Of International Concern, Lawrence O. Gostin, Daniel Lucey, Alexandra Phelan

Georgetown Law Faculty Publications and Other Works

On August 8, 2014, the World Health Organization (WHO) Director-General Margaret Chan declared the West Africa Ebola crises a “public health emergency of international concern,” triggering powers under the 2005 International Health Regulations (IHR).

The most affected West African states have attempted classic public health measures with varied success, including quarantine and isolation, social distancing, risk communication, and travel restrictions. These have involved a trade off between population health and human rights; sometimes to the disadvantage of both. At the same time, the countries’ health systems and human resources are fragile, impeding an effective response.

Beyond the public health and …

Virus Sharing, Genetic Sequencing, And Global Health Security, Lawrence O. Gostin, Alexandra Phelan, Michael A. Stoto, John D. Kraemer, K. Srinath Reddy

Georgetown Law Faculty Publications and Other Works

The WHO’s Pandemic Influenza Preparedness (PIP) Framework was a milestone global agreement designed to promote the international sharing of biological samples to develop vaccines, while that ensuring poorer countries would have access to those vaccines. Since the PIP Framework was negotiated, scientists have developed the capacity to use genetic sequencing data (GSD) to develop synthetic viruses rapidly for product development of life-saving technologies in a time-sensitive global emergency—threatening to unravel the Framework. Access to GSD may also have major implications for biosecurity, biosafety, and intellectual property (IP).

By rendering the physical transfer of viruses antiquated, GSD may also undermine the …

Ebola: Towards An International Health Systems Fund, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

The current outbreak of Ebola virus disease (EVD) in West Africa is spiraling out of control, but it never had to happen. What can the international community do now to bring the epidemic under control, and how can we prevent the next one?

The counties most affected by Ebola (Guinea, Liberia, and Sierra Leone), rank among the lowest in global development, lacking essential public health infrastructure. If the affected countries had adequate public health systems, they probably would have contained Ebola within rural settings, avoiding the first outbreak in major urban areas.

More than 130 health workers have died from …