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Full-Text Articles in International Public Health
Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan
Improving Quality Of Care In India's Family Welfare Programme: The Challenge Ahead, Michael A. Koenig, M.E. Khan
Reproductive Health
This book on family planning in India includes detailed empirical data and analysis of the various dimensions of quality of care in different regions of the country. Focus areas include: women’s perceptions of the care they receive; observations of provider-client interactions; barriers to quality of service delivery; existing interregional variations; contraceptive choice and interpersonal relations; technical quality of care; and the effect of the target system on the work style of outreach staff. All elements of the quality-of-care framework elaborated by Judith Bruce are well documented and their relationships to broader program constraints are clearly identified. The overall impression one …
The Tostan Story: Breakthrough In Senegal Ending Female Genital Cutting, Population Council
The Tostan Story: Breakthrough In Senegal Ending Female Genital Cutting, Population Council
Reproductive Health
In Senegal, elements of the Tostan education program were fundamental to the ending of the practice of female genital cutting (FGC) which has persisted for centuries, despite outside efforts to abolish such a dangerous and harmful operation. This paper is an attempt by those who lived through these events to share the experience with others. At a time when there has been little reduction in the numbers of women ending FGC in 28 African countries, when different programs and strategies have rarely succeeded in making an impact on the number of women still practicing FGC despite laws abolishing the tradition, …
Indonesia: Analysis Of Conflicting Crisis-Related Research Results, Michelle Gardner, Lila Amaliah
Indonesia: Analysis Of Conflicting Crisis-Related Research Results, Michelle Gardner, Lila Amaliah
Reproductive Health
This report aims to explain the discrepancies in crisis-related research results in Indonesia, and to recommend methodologies to enhance future crisis-related monitoring and surveillance. The discussion aims to identify where the discrepancies are in the readily available data, and how these discrepancies can be explained. The report does not attempt to clarify the impact that the economic crisis is having on the health status of women and children in Indonesia. Recommendations are made to deal with the following findings: Aggregation of data may hide important crisis impacts; attribution of identified changes to the economic crisis may be misleading; differences in …
Mexico: Training Health Providers On Domestic Violence, Susan Pick, Lydia Miranda
Mexico: Training Health Providers On Domestic Violence, Susan Pick, Lydia Miranda
Reproductive Health
This project was designed to disseminate, expand use, and promote institutionalization of a program to train healthcare professionals to address domestic violence. The program was developed and implemented by the Instituto Mexicano de Investigación de Familia y Población (IMIFAP), a nongovernmental organization that promotes reproductive health. IMIFAP designed an 18-hour workshop, entitled “Health Services Respond to Domestic Violence,” to sensitize health professionals to domestic violence issues and develop strategies for recognizing and managing cases of domestic violence. Following the workshop, strong and significant increases in knowledge about domestic violence and its management in primary healthcare services were found. Workshop participants …
Mexico: Informing Service Providers And Factory Workers About Emergency Contraception, Ricardo Vernon
Mexico: Informing Service Providers And Factory Workers About Emergency Contraception, Ricardo Vernon
Reproductive Health
The goal of this project was to inform physicians, pharmacists, and female factory workers about emergency contraception (EC) through mailings of booklets and posters. These materials were developed in a previous operations research project conducted by the Instituto Mexicano de Investigación de Familia y Población and supported by the Population Council INOPAL III project with funding from USAID. The study found that recipients generally liked the print materials and welcomed information about EC. Within three weeks of receiving the materials, many reported that they had taken immediate action to make EC available and/or to educate others about EC. This project …
Mexico: Protecting Informed Consent, Elsa Santos, Silvia Elena Llaguno, Ricardo Vernon
Mexico: Protecting Informed Consent, Elsa Santos, Silvia Elena Llaguno, Ricardo Vernon
Reproductive Health
The objective of this three-month project in Mexico was to disseminate information among key audiences about: 1) the right of women to choose contraceptive methods in a free and informed manner; and 2) the laws and institutions available to help redress any violations of this right. Four publications on these topics, developed by a previous project funded by Population Council/INOPAL III, were reproduced and distributed to 2,750 people in the following target audiences: women of reproductive age; reproductive health service providers; national and state commissions of human rights, complaints offices in public hospitals, feminist and human rights organizations; and legal …
Peru: Providers' Compliance With Quality Of Care Norms, Federico R. Leon
Peru: Providers' Compliance With Quality Of Care Norms, Federico R. Leon
Reproductive Health
Peru's Ministry of Health (MOH) introduced changes in its family planning service delivery strategy and set quality-of-care goals purported to ensure informed choice of methods and respect for the users’ reproductive intentions and rights. This study was designed to assess the extent to which providers comply with the guidelines in their daily routine. The study found that among the strongest elements of care are interpersonal relationships and free choice of methods. However, shortcomings were observed in screening for contraindications and information given to the client. The report includes a number of recommendations, including offering providers IEC materials, training, and supervision …
Reproductive Health Indicators: Moving Forward, Kelly Blanchard, Batya Elul, Saumya Ramarao
Reproductive Health Indicators: Moving Forward, Kelly Blanchard, Batya Elul, Saumya Ramarao
Reproductive Health
This report is designed to help researchers, program managers, policymakers, and advocates sift through and evaluate which potential indicators might be useful in a particular programmatic context. It was initially prepared as a background manuscript for a Population Council meeting on reproductive health indicators held in Cairo in March 1998. The manuscript has since been modified to incorporate ideas and comments expressed at that meeting, as well as to include input from other Population Council colleagues.
Implementing A Reproductive Health Agenda In India: The Beginning, Saroj Pachauri
Implementing A Reproductive Health Agenda In India: The Beginning, Saroj Pachauri
Reproductive Health
At the International Conference on Population and Development (ICPD) in 1994, the nations of the world agreed to give special attention to girls’ education, women’s health, infant survival, and women’s empowerment, and to provide comprehensive reproductive health (RH) services to enable couples to achieve their reproductive goals. The government of India launched a reproductive and child health program in October 1997. This book begins a review of the processes underway to operationalize the program. It brings together several important initiatives at various stages of development and examines key policy and program issues based on empirical research and field experience. The …
Comparing Alternative Products In The Provision Of Emergency Contraception, John P. Skibiak, Yusuf Ahmed, M. Ketata
Comparing Alternative Products In The Provision Of Emergency Contraception, John P. Skibiak, Yusuf Ahmed, M. Ketata
Reproductive Health
This report is the third in a series of summaries produced in connection with the operations research project “Enhancing Access to Family Planning Services through the Introduction of Emergency Contraception.” Launched in September 1997, the project explores the many issues surrounding the introduction and delivery of emergency contraception services in a developing country context. The study compares the introduction of two different emergency contraception pills—the combined oral contraceptive PC-4, introduced in Zambia in 1997, and the progestin-only contraceptive Postinor-2, introduced by this study in the following year. Client histories showed only minor differences in the attitudes of emergency contraception users …
Community-Based Aids Prevention And Care In Africa: Results Of Four Action-Research Interventions In East And Southern Africa, Ann Leonard, Esther Muia
Community-Based Aids Prevention And Care In Africa: Results Of Four Action-Research Interventions In East And Southern Africa, Ann Leonard, Esther Muia
HIV and AIDS
The Community Counseling Aides (CCA) project operating with support from the National AIDS Control Programme (NACP) in Uganda, is a government initiative being carried out in collaboration with local communities. As the Ministry of Health seeks to develop local capacity to support and operate these efforts at the community level, it has identified the need to improve the skills of local project staff so that they may begin to assume the responsibility for monitoring and evaluating their own program performance. This is part of an overall strategy on the part of the Ugandan Government to decentralize control and allocation of …
Integrating Sti/Hiv Services Into Existing Mch/Fp Programs, Baker Ndugga, Ian Askew
Integrating Sti/Hiv Services Into Existing Mch/Fp Programs, Baker Ndugga, Ian Askew
Reproductive Health
The presence of certain STIs increases the risk of the sexual transmission of HIV. Thus, controlling STIs can reduce the incidence of HIV. Almost all women in the East and Southern African regions attend MCH/FP clinics regularly, and recent surveys have shown that the prevalence levels of many STIs, including HIV, can be high for women seeking FP and antenatal services, even though they are frequently asymptomatic. MCH/FP services are provided by medically trained staff with many of the same skills needed for managing STIs. Consequently, several MCH/FP programs have started looking for ways to integrate STI management strategies, such …
Reproductive Health Operations Research, 1995–1998, James R. Foreit, Federico R. Leon, Ricardo Vernon, Timothy D.N. King, Deborah L. Billings, A.B Friedman, Janie Benson
Reproductive Health Operations Research, 1995–1998, James R. Foreit, Federico R. Leon, Ricardo Vernon, Timothy D.N. King, Deborah L. Billings, A.B Friedman, Janie Benson
Reproductive Health
This book presents in-depth reports on promising new interventions that have been developed and important programmatic changes that have been achieved by operations research in Latin America between 1995 and 1998. The INOPAL III project has made advances in five areas including access and quality of services, integration of family planning and other reproductive health services, financial sustainability, post-abortion care, and emergency contraception. Each of these topics are represented by at least three studies conducted in two or more countries. The operations research projects discussed under each topic are not replications of a single study. They use different research designs …
Emergency Contraception In Zambia: Setting A New Agenda For Research And Action, Yusuf Ahmed, M. Ketata, John P. Skibiak
Emergency Contraception In Zambia: Setting A New Agenda For Research And Action, Yusuf Ahmed, M. Ketata, John P. Skibiak
Reproductive Health
This report summarizes the activities and findings of the first phase of the operations research study, “Enhancing Access to Family Planning Services through the Introduction of Emergency Contraception.” Launched in September 1997, the study was designed to explore a broad range of issues relating to emergency contraception within a developing country context. With financial and technical support from the United States Agency for International Development, the World Health Organization, the Canadian Public Health Association, and the British Department for International Development (DFID), the study consists of an initial exploratory exercise and a subsequent research phase. The report is divided into …
Youth Centres In Ghana: Assessment Of The Planned Parenthood Association Of Ghana Programme, Evam Kofi Glover, Annabel Erulkar, Joana Nerquaye-Tetteh
Youth Centres In Ghana: Assessment Of The Planned Parenthood Association Of Ghana Programme, Evam Kofi Glover, Annabel Erulkar, Joana Nerquaye-Tetteh
Reproductive Health
The sexual and reproductive health of adolescents has become a major public concern, particularly with the advent of HIV/AIDS. Many organizations have tried to find strategies to reach youth with reproductive health (RH) information and services through various service delivery models. One such model has been the multipurpose youth center approach. Multipurpose youth centers typically include recreational or vocational services as entry points for RH and family planning (FP) information and services. There is some evidence in a variety of African settings (notably Kenya and Zimbabwe) suggesting that these centers are underutilized and not cost-effective. As a result, the Planned …
Peru Logistics Chain Analysis, Jeanne Noble, James R. Foreit
Peru Logistics Chain Analysis, Jeanne Noble, James R. Foreit
Reproductive Health
The inventory module of situation analysis, developed by the Population Council, has been adapted to help generate indicators of logistics system functioning suggested by the Evaluation Project and to provide an analytical framework that permits more accurate estimations of the frequency, location, and patterns of logistics problems. In 1996, the module was implemented in southern Peru. In 1997, the same module was implemented in the province of Santa and two provinces of Huancavelica. Comparable information was obtained from 149 service delivery points (SDPs) in four departments. Data include inventories of contraceptive supplies and materials required for safe delivery of contraception; …
An Assessment Of The Zimbabwe Family Planning Programme: Results From The 1996 Situation Analysis Study, Lewis Ndhlovu, Hazel M.B. Dube, Caroline S. Marangwanda
An Assessment Of The Zimbabwe Family Planning Programme: Results From The 1996 Situation Analysis Study, Lewis Ndhlovu, Hazel M.B. Dube, Caroline S. Marangwanda
Reproductive Health
Within the past ten years, the Zimbabwe National Family Planning Council (ZNFPC) has conducted two major studies for assessing the availability and quality of reproductive health services. The two studies, generally referred to as Situation Analysis studies, were conducted in 1991 and 1996. The 1996 survey collected data from 192 health facilities spread throughout Zimbabwe. During this exercise, an inventory of physical facilities, equipment, and educational materials was taken. In addition, 758 provider–client interactions of new and revisit clients were observed. Exit interviews were conducted with service providers, and with family planning and maternal and child health clients. In this …
Needs And Risks Facing The Indonesian Youth Population, Desti Murdijana
Needs And Risks Facing The Indonesian Youth Population, Desti Murdijana
Reproductive Health
Youth are the leaders of tomorrow, but right now they face a formidable collection of problems that will determine the quality of their future lives and the lives of us all. Education, jobs, substance abuse, violence, sexuality, and marriage are examples of adolescent issues that demand special attention from researchers, youth activists and advocates, parents, and policymakers. In attempting to address these complex issues, we must be willing to confront ignorance, controversy, and cultural obstacles. Clear and focused policy and strategies must play a basic role in tackling these issues facing Indonesian adolescents. This paper provides a concise situation analysis …
The Impact Of Monetary Crisis And Natural Disasters On Women's Health And Nutrition, Meiwita B. Iskandar
The Impact Of Monetary Crisis And Natural Disasters On Women's Health And Nutrition, Meiwita B. Iskandar
Poverty, Gender, and Youth
This paper analyzes the short-term effects of the monetary crisis and natural disasters in Indonesia on women's health and nutritional status, and activities to monitor and address these problems. The monetary crisis which was announced in January 1998 hit the highest monthly inflation rate of 13 percent in February. Natural disasters that have plagued Indonesia since early 1997, including droughts and forest fires, have been projected to cause famines and an increased likelihood of infant and adult mortality. The economic crisis also directly impacts millions of workforce members threatened by the downsizing of thousands of businesses and factories, in the …
Incentive Schemes For School Attendance In Rural Bangladesh, Sajeda Amin, Gilda Sedgh
Incentive Schemes For School Attendance In Rural Bangladesh, Sajeda Amin, Gilda Sedgh
Poverty, Gender, and Youth
This paper examines the impact of two incentive schemes on school attendance in rural Bangladesh: a food-for-education program for poor primary school children and a female secondary school scholarship scheme. The data come from an in-depth village study, before and after the programs went into effect. Both programs provide direct financial incentives to families to send their children to and keep them in school. The data also allow for an assessment of an informal school program sponsored by BRAC, a national non-governmental institution, at the study sites. School enrollment in the target population increased more rapidly than would have been …
Ethnicity And Child Mortality In Sub-Saharan Africa, Martin Brockerhoff, Paul C. Hewett
Ethnicity And Child Mortality In Sub-Saharan Africa, Martin Brockerhoff, Paul C. Hewett
Poverty, Gender, and Youth
Analysis of recent survey data reveals large differentials in child mortality among ethnic groups in countries throughout sub-Saharan Africa. These disparities correspond with the prominence of specific ethnic groups in the national political economy. In many countries where heads of state since independence have come from one or two ethnic groups-as in Côte d’Ivoire, Kenya, and Niger-these groups have experienced levels of early child mortality at least one-third lower than those of other groups. In other countries where there have been several transitions in state control, as in Ghana and Uganda, descendants of precolonial kingdoms such as Ashanti and Buganda …
The Uncharted Passage: Girls' Adolescence In The Developing World, Barbara Mensch, Judith Bruce, Margaret E. Greene
The Uncharted Passage: Girls' Adolescence In The Developing World, Barbara Mensch, Judith Bruce, Margaret E. Greene
Poverty, Gender, and Youth
Adolescence is a formative time of transition to adulthood. What happens between the ages of 10 and 19 shapes how girls and boys live out their lives as women and men—not only in the reproductive arena, but in the social and economic realm as well. Yet, despite its impact on human development, adolescence has been sidelined as a research and policy subject in developing countries. While all adolescents deserve our attention, the needs of adolescent girls in the developing world are particularly pressing. This monograph focuses on these girls, presenting statistics to examine the social and economic context of their …
Covert Contraceptive Use: Prevalence, Motivations, And Consequences, Ann E. Biddlecom, Bolaji M. Fapohunda
Covert Contraceptive Use: Prevalence, Motivations, And Consequences, Ann E. Biddlecom, Bolaji M. Fapohunda
Poverty, Gender, and Youth
This paper examines women’s covert use of contraceptives, that is, use without the knowledge of their husbands. Covert use may highlight conflict between husbands and wives about family planning, or it may reflect behaviors that spouses find difficult to discuss together. This study addresses three questions: 1) How is covert use measured in different settings? 2) How prevalent is it? and 3) What are the factors underlying covert use? We examine these questions by drawing on existing studies and detailed survey and qualitative data collected in 1997 in an urban setting in Zambia from married women and a subsample of …
Women's Lives And Rapid Fertility Decline: Some Lessons From Bangladesh And Egypt, Sajeda Amin, Cynthia B. Lloyd
Women's Lives And Rapid Fertility Decline: Some Lessons From Bangladesh And Egypt, Sajeda Amin, Cynthia B. Lloyd
Poverty, Gender, and Youth
In some of the more traditional parts of the world, fertility is falling steadily, sometimes rapidly, in environments where women’s lives remain severely constrained. The recent experiences of Bangladesh and Egypt, both predominantly Muslim countries, are illustrative in this regard. Since the late 1970s, rural and urban areas in both countries have experienced steady declines in fertility, with recent declines in rural Bangladesh similar to those in rural Egypt, despite lower levels of development and higher rates of poverty. This paper provides an in-depth exploration of the demographic transition in these two societies as seen through the dual lens of …
The Impact Of An Integrated Micro-Credit Programme On Women's Empowerment And Fertility Behavior In Rural Bangladesh, Fiona Steele, Sajeda Amin, Ruchira Tabassum Naved
The Impact Of An Integrated Micro-Credit Programme On Women's Empowerment And Fertility Behavior In Rural Bangladesh, Fiona Steele, Sajeda Amin, Ruchira Tabassum Naved
Poverty, Gender, and Youth
This paper examines the impact of participation in women’s savings and credit groups organized by Save the Children USA on women’s empowerment, contraceptive use, and fertility in a rural area of Bangladesh. The data are drawn from a panel survey conducted in 1993, shortly before the groups were formed, and in 1995 after interventions began. This quasi-experimental design enables us to identify the characteristics of women who chose to join savings groups. The findings show that those who joined tend to more educated and more socially independent than are women who did not. Thus, to control for selection bias, preintervention …
Migration, Sexual Behavior And Hiv Diffusion In Kenya, Martin Brockerhoff, Ann E. Biddlecom
Migration, Sexual Behavior And Hiv Diffusion In Kenya, Martin Brockerhoff, Ann E. Biddlecom
Poverty, Gender, and Youth
The association of migration with the spread of AIDS in sub-Saharan Africa is well documented, yet the social and behavioral mechanisms underlying this relationship remain poorly understood. Using data from the 1993 Kenya Demographic and Health Survey, this paper examines whether migrants are more likely than nonmigrants to have multiple recent sexual partners and not to use condoms with those partners. Results indicate that migation is a critical factor in high-risk sexual behavior and that its importance varies by gender and by the direction of movement. Independent of marital and cohabitation status, social milieu, awareness of AIDS, and other crucial …
Fertility And Reproductive Preferences In Post-Transitional Societies, John Bongaarts
Fertility And Reproductive Preferences In Post-Transitional Societies, John Bongaarts
Poverty, Gender, and Youth
Conventional theories have little to say about the level at which fertility will stabilize at the end of the transition although it is often assumed that replacement fertility of about 2.1 births per woman will prevail in the long run. However, fertility has dropped below the replacement level in virtually every population that has moved through the demographic transition. If future fertility remains at these low levels populations will decline in size and age rapidly.This paper attempts to contribute to the understanding of levels and trends of post-transitional fertility by examining the causes of discrepancies between reproductive preferences and observed …
The Onset Of Fertility Transition In Pakistan, Zeba Sathar, John B. Casterline
The Onset Of Fertility Transition In Pakistan, Zeba Sathar, John B. Casterline
Poverty, Gender, and Youth
Recent trends in fertility and contraceptive prevalence indicate that the marital fertility transition in Pakistan, which has been anticipated for three decades, has begun in the 1990s. Before that decade, the total fertility rate had exceeded 6 births per woman for at least three decades, and fewer than 10 percent of married women practiced contraception. The most recent survey data, collected in 1996- 97, show a total fertility rate of 5.3 births per woman and a contraceptive prevalence rate of 24 percent. Underlying this development are macroeconomic trends that have led to widespread economic distress at the household level, and …
The Changing Social Environment For Adolescents In Kassena-Nankana District Of Northern Ghana: Implications For Reproductive Behavior, Barbara Mensch, Daniel Bagah, Wesley H. Clark, Fred N. Binka
The Changing Social Environment For Adolescents In Kassena-Nankana District Of Northern Ghana: Implications For Reproductive Behavior, Barbara Mensch, Daniel Bagah, Wesley H. Clark, Fred N. Binka
Poverty, Gender, and Youth
This study reports on a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, a rural isolated area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus groups with adolescents, parents, chiefs and traditional leaders, teachers, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of reproductive-aged women conducted by the Navrongo Health Research Centre. The social environment faced by adolescent boys and girls in the Kassena-Nankana District and its links to reproductive behavior are described. …
The Impact Of Family Planning Household Service Delivery On Women's Status In Bangladesh, James F. Phillips, Mian Bazle Hossain
The Impact Of Family Planning Household Service Delivery On Women's Status In Bangladesh, James F. Phillips, Mian Bazle Hossain
Poverty, Gender, and Youth
Since 1982, the Maternal and Child Health and Family Planning Extension Project has compiled longitudinal panel data on rural women’s contact with household service providers who visit homes to discuss family planning and offer services to women on request. This study tests the hypothesis that home-based services reinforce customs of purdah (female seclusion) by sustaining the dependency and isolation of the women served by the program. Results show that household services improve women’s status. This effect is largely attributable to the impact of outreach on effective fertility regulation. Findings do not support the hypothesis that household service delivery is detrimental …