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Articles 511 - 540 of 548
Full-Text Articles in Maternal and Child Health
Special Studies Program Of The Pilot Health Project: West Bank And Gaza, Mahmoud Shaheen, Laila Nawar, Dale Huntington, Sahar Hegazi
Special Studies Program Of The Pilot Health Project: West Bank And Gaza, Mahmoud Shaheen, Laila Nawar, Dale Huntington, Sahar Hegazi
Reproductive Health
The Special Studies Program was implemented as part of the Pilot Health Project in the West Bank and Gaza to provide small grants to Palestinian researchers, research organizations, and advanced graduate students to conduct research that examines critical reproductive health topics related to maternal and child health care, including family planning. The research implemented under the Special Studies Program covered a range of topics including male involvement in reproductive health, clients' satisfaction with family planning programs, the relationship between early marriage and the delivery of premature infants, factors affecting compliance for iron supplementation, and diabetes mellitus during pregnancy. The research …
Greater Investments In Children Through Women's Empowerment: A Key To Demographic Change In Pakistan?, Valerie L. Durrant, Zeba Sathar
Greater Investments In Children Through Women's Empowerment: A Key To Demographic Change In Pakistan?, Valerie L. Durrant, Zeba Sathar
Poverty, Gender, and Youth
Women’s status has received considerable attention as a significant factor in demographic behavior and outcomes in South Asia however, little research has addressed the links between women’s status and their investments in children. In this paper, we empirically investigate how women’s status on multiple levels is associated with demographic outcomes. Using data from the Pakistan Status of Women and Fertility Survey in rural Punjab, we confirm that empowered women, or those with higher status, are better able to make positive investments in their children, thus increasing their children’s chances of survival during infancy and increasing their likelihood of ever attending …
Assessing The Potential Demand For And Effectiveness Of Integrating Sti/Hiv Management Services With Zimbabwe National Family Planning Council's Clinic-Based Family Planning Services, Baker Ndugga Maggwa, Ian Askew, Hazel M.B. Dube, Caroline S. Marangwanda, Sithokozille Simba, Ahmed Latif
Assessing The Potential Demand For And Effectiveness Of Integrating Sti/Hiv Management Services With Zimbabwe National Family Planning Council's Clinic-Based Family Planning Services, Baker Ndugga Maggwa, Ian Askew, Hazel M.B. Dube, Caroline S. Marangwanda, Sithokozille Simba, Ahmed Latif
Reproductive Health
HIV/AIDS is a threat to individual lives and the national economies of many sub-Saharan African countries, despite efforts to contain its spread. The region also suffers from high levels of other reproductive tract infections (RTIs), some of which increase the risk of sexual transmission of HIV. The control of RTIs is therefore seen not only as an important reproductive health care strategy, but as a key strategy in reducing the spread of HIV/AIDS. Most national health care programs in the region are actively seeking cost-effective ways of implementing an RTI management program that would reduce and prevent RTIs and HIV. …
Quality Of Care And Utilisation Of Mch And Fp Services At Kenyan Health Facilities, Lewis Ndhlovu
Quality Of Care And Utilisation Of Mch And Fp Services At Kenyan Health Facilities, Lewis Ndhlovu
Reproductive Health
Quality of services is playing an increasingly important role in many family planning (FP) programs. In 1995, a national Situation Analysis Study of 254 health facilities was conducted in Kenya to assess the status and quality of FP services in the country. An in-depth survey of a subsample of 28 health facilities was conducted the following year. From these facilities, 1,834 women were interviewed about their experiences with services at facilities when they sought antenatal, child health, and FP services. The goal of the survey was to examine the links between quality of care in FP services and contraceptive behavior. …
Strengthening Reproductive Health Services In Africa Through Operations Research, Population Council
Strengthening Reproductive Health Services In Africa Through Operations Research, Population Council
Reproductive Health
The health status of women, men, and children in sub-Saharan Africa remains the poorest in the world. Moreover, virtually every country in the region is suffering mediocre economic growth or economic decline, thereby reducing the ability of their health care systems to respond adequately, and increasing dependence on external donor assistance. In terms of reproductive health (RH), the region is faced with high levels of unwanted fertility; high levels of maternal, child, and infant morbidity and mortality; and an almost exponential growth in HIV prevalence. Access to and quality of RH services remains poor in most countries, thereby maintaining unmet …
Reproductive Decisionmaking In The Context Of Hiv/Aids In Ndola, Zambia, Naomi Rutenberg, Ann E. Biddlecom, Frederick A.D. Kaona
Reproductive Decisionmaking In The Context Of Hiv/Aids In Ndola, Zambia, Naomi Rutenberg, Ann E. Biddlecom, Frederick A.D. Kaona
Reproductive Health
Family planning (FP) programs are increasingly being considered as a logical focal point for STD and HIV/AIDS prevention services because they serve large numbers of women at risk, address the sensitive issue of sexual behavior and fertility control, and the methods for preventing unwanted pregnancy and disease can be the same. FP programs, by providing contraceptive methods, are currently one of the few sources of assistance in the sub-Saharan African region for preventing perinatal transmission of HIV, while the promotion of barrier methods contributes to the prevention of heterosexual transmission. Given this potential, research is needed to understand how the …
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 …
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 …
La Familia En La Mira: Nuevas Perspectivas Sobre Madres, Padres E Hijos, Judith Bruce, Cynthia B. Lloyd, Ann Leonard, Patrice L. Engle, Niev Duffy
La Familia En La Mira: Nuevas Perspectivas Sobre Madres, Padres E Hijos, Judith Bruce, Cynthia B. Lloyd, Ann Leonard, Patrice L. Engle, Niev Duffy
Poverty, Gender, and Youth
A pesar de la retórica de los últimos años que lamenta la pérdida de la "familia tradicional," las familias jamás se han podido encajonar en modelo único. "Familia" puede referirse a la gente que se ha vinculado entre sí por matrimonio o parentesco, o a los que pretenden descender de antecesores comunes. Las personas pueden formar y extender familias, ya sea mediante la adoptación o crianza de niños, o definiendo como familiares a gente no emparentada o mediante el establecimiento de sociedades consensuales. Las familias son tan adaptables como diversas, pues se reconfiguran a sí mismas en el transcurso de …
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 …
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 …
Youth Talk About Sexuality: A Participatory Assessment Of Adolescent Sexual And Reproductive Health In Lusaka, Zambia, Tamara Fetters, Evans Mupela, Naomi Rutenberg
Youth Talk About Sexuality: A Participatory Assessment Of Adolescent Sexual And Reproductive Health In Lusaka, Zambia, Tamara Fetters, Evans Mupela, Naomi Rutenberg
Reproductive Health
Thirty-six percent of Zambia’s 9 million inhabitants are between 10 and 19 years of age, and most adolescents are sexually active by their mid-teens. Pregnant teenagers have an elevated risk of maternal mortality and complications related to birth. In 1990, at Lusaka’s University Teaching Hospital, self-induced abortion accounted for up to 30 percent of maternal mortality, and one-quarter of these deaths occurred in women under 18 years. Sexually transmitted infections (STIs) are a major health problem for adolescents, yet only a small proportion protect themselves from pregnancy and STIs. There are many barriers to improving the situation, including opposition by …
Follow-Up Household Survey In Agra District, Jayanti Tuladhar, R.B. Gupta, V.S. Sridhar, Tilak Mukherjee
Follow-Up Household Survey In Agra District, Jayanti Tuladhar, R.B. Gupta, V.S. Sridhar, Tilak Mukherjee
Reproductive Health
This follow-up household survey in Agra District, India, was conducted with funding from USAID under the Population Council’s Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project. The main objective of this study, as noted in this report, is to assess changes in the program indicators of family welfare activities, including some of the selected reproductive health indicators, from 1995 (before method-specific targets were withdrawn) and 1997 (30 months after targets were withdrawn). The study’s objectives are to detect changes in FP knowledge and use among currently married women in rural areas; detect changes in level of …
Follow-Up Household Survey In Sitapur District, Jayanti Tuladhar, R.B. Gupta, B.P. Thiagrajan, Tausif Alam Khan, Hemlata Sadhwani
Follow-Up Household Survey In Sitapur District, Jayanti Tuladhar, R.B. Gupta, B.P. Thiagrajan, Tausif Alam Khan, Hemlata Sadhwani
Reproductive Health
This follow-up household survey in Sitapur, India, was conducted with funding from USAID under the Population Council's Asia and Near East Operations Research and Technical Assistance (ANE OR/TA) Project. The main objective of the study, as noted in this report, is to assess changes in the program indicators of family welfare activities, including some of the selected reproductive health indicators, from 1994–95 (before the method-specific targets were withdrawn) and 1997 (30 months after the targets were withdrawn). The study has the following immediate objectives: detect changes in family planning (FP) knowledge and use among currently married women in rural areas; …
Monitoring Of Macro-Level Family Planning Quality Of Care Indicators, Meiwita B. Iskandar
Monitoring Of Macro-Level Family Planning Quality Of Care Indicators, Meiwita B. Iskandar
Reproductive Health
The success of population development in Indonesia can be seen partly from success in reducing population growth. Population growth has declined from 2.32 percent (1971–80) to 1.98 percent (1980–90), and then to 1.66 percent (1990–95). The continued slowing of population growth is expected to bring expanded opportunities for economic development and improved quality of life. The success of family planning (FP) programs cannot be judged solely on reduction of population growth but should also be judged in terms of quality of care (QOC) and success in helping women achieve their reproductive goals. The Indonesian National Family Planning Coordinating Board (BKKBN) …
Towards Safe Womanhood: Supporting Safe Motherhood Initiatives And Women's Participation In Development, Meiwita B. Iskandar
Towards Safe Womanhood: Supporting Safe Motherhood Initiatives And Women's Participation In Development, Meiwita B. Iskandar
Reproductive Health
Improvement in a woman’s quality of life is a prerequisite for development of human resources, because the quality of children’s physical and mental development is inextricably tied to the health and welfare of women as future mothers. If a mother is well protected during the pregnancy, birth, and postpartum period, the risk of illness and other problems in fetuses and newborn babies will be reduced. On the other hand, if a woman does not survive the pregnancy, birth, and postpartum period, her fetus or newborn will also be threatened. This paper provides a situation analysis of pregnant women, women in …
Technical Assistance To Enhance The Institutionalization Of Operations Research Within The Philippines Family Planning Program, Population Council
Technical Assistance To Enhance The Institutionalization Of Operations Research Within The Philippines Family Planning Program, Population Council
Reproductive Health
This technical assistance project supports the goal of the Asia Near East Operations Research and Technical Assistance (ANE OR/TA) project of helping strengthen family planning (FP)/reproductive health (RH) operations research (OR) capabilities in the Philippines. During the extension period of the ANE OR/TA project, four OR studies were implemented in the Philippines dealing with cross-cutting issues, including a study to assess the feasibility of integrating RTI management within FP/MCH programs; an intervention study dealing with improving quality of care via expanded FP counseling; an intervention to address high unmet need in Pangasinan Province; and an intervention study to increase male …
The Life Saver: The Mother Friendly Movement In Indonesia, Abdullah Cholil, Meiwita B. Iskandar, Rosalia Sciortino
The Life Saver: The Mother Friendly Movement In Indonesia, Abdullah Cholil, Meiwita B. Iskandar, Rosalia Sciortino
Reproductive Health
The focus of this book is the Mother Friendly Movement in Indonesia, a collective effort to reduce maternal mortality. The idea of documenting the Mother Friendly Movement or Gerekan Sayang Ibu (GSI) was originally suggested by Her Excellency Mien Sugandhi, the State Minister for the Role of Women, Republic of Indonesia, in the belief that the Indonesian experience in reducing maternal mortality would be relevant to other countries struggling with the same problem. The authors were entrusted with producing an illustrated monograph on the pilot projects implemented in eight districts from June to December 1997. Besides extensively monitoring these activities, …
Male Involvement Through Reproductive Health Awareness In Bukidnon Province, The Philippines: An Intervention Study, Lita Palma-Sealza, Marilou P. Costello, Chona R. Echavez
Male Involvement Through Reproductive Health Awareness In Bukidnon Province, The Philippines: An Intervention Study, Lita Palma-Sealza, Marilou P. Costello, Chona R. Echavez
Reproductive Health
Recent years have been characterized by an increasing consensus that, in order to support women's goals and aspirations, health programs directed to the improvement of women's and children's health must consider men's perspectives. Although family planning (FP) is often viewed as the woman's responsibility, men have an important role in decisions of whether FP will be practiced and which method will be used. Even though gender relations in the Philippines are often characterized as being relatively egalitarian, there are several reasons for believing that male involvement in FP is highly relevant for this country. Studies indicate that not only are …
Improving Quality Of Care In Fp/Rh Of Selected Communities Of Pangasinan Province: An Intervention Study, Zelda C. Zablan, Josefina V. Cabigon, Luzviminda Muego, Marilou P. Costello, Chona R. Echavez
Improving Quality Of Care In Fp/Rh Of Selected Communities Of Pangasinan Province: An Intervention Study, Zelda C. Zablan, Josefina V. Cabigon, Luzviminda Muego, Marilou P. Costello, Chona R. Echavez
Reproductive Health
This intervention study was designed to improve the quality of family planning (FP) services within the Integrated Family Planning and Maternal Health Program of the Pangasinan Population and Family Planning Program in the Philippines. It addresses high unmet need and studies the feasibility of enhancing quality of services by training service providers in fixed clinics and orienting outreach workers on the method of identifying women who have unmet need for FP. Four municipalities were chosen from the 47 municipalities comprising the province of Pangasinan and randomly assigned to experimental and control groups. Four indicators were used to match the chosen …
Dual Protection In An Integrated Community-Based Program: A Case Study Of Tanzania Family Health/Ministry Of Health Project In Mbeya, Grace Mbekem, Jane Chege
Dual Protection In An Integrated Community-Based Program: A Case Study Of Tanzania Family Health/Ministry Of Health Project In Mbeya, Grace Mbekem, Jane Chege
Reproductive Health
One of the most pressing challenges for health programs in most sub-Saharan African countries is effectively addressing the increasing prevalence of HIV/AIDS. Recent evidence suggests that controlling sexually transmitted diseases (STDs) through undertaking preventive measures, early diagnosis, and treatment significantly slows the spread of HIV/AIDS. In regard to STI/HIV, Maternal and Child Health (MCH) and Family Planning (FP) clients are described as “low risk” groups. However, in a number of sub-Saharan African countries, the reported levels of STDs are significantly high enough to justify use of limited resources to target this group for STD services. MCH/FP programs have begun to …
Counseling The Husbands Of Postabortion Patients In Egypt: Effects On Husband Involvement, Patient Recovery And Contraceptive Use, Nahla G. Abdel-Tawab, Dale Huntington, Ezzeldin Osman Hassan, Hala Youssef, Laila Nawar
Counseling The Husbands Of Postabortion Patients In Egypt: Effects On Husband Involvement, Patient Recovery And Contraceptive Use, Nahla G. Abdel-Tawab, Dale Huntington, Ezzeldin Osman Hassan, Hala Youssef, Laila Nawar
Reproductive Health
An ANE OR/TA Project qualitative study conducted in 1995 probed into women’s perceptions of abortion in Egypt, and the stress that postabortion patients experience during recovery. That study drew attention to the important role husbands can play in their wives’ recovery and subsequent use of contraception. This study was designed to test the effects of involving husbands in the postabortion medical-care process. Overall, the study indicates that providing counseling to husbands of postabortion patients is feasible, as the majority of husbands either accompanied their wife on admission or at discharge from the hospital. However, administrative changes are needed to enhance …
Situation Analysis Of Lgu Health Centers For Integrating Rti Management Within The Philippines Fp/Mch Program, Jesus Encena, Carmeli Marie Chaves, Marilou P. Costello, Chona R. Echavez
Situation Analysis Of Lgu Health Centers For Integrating Rti Management Within The Philippines Fp/Mch Program, Jesus Encena, Carmeli Marie Chaves, Marilou P. Costello, Chona R. Echavez
Reproductive Health
A Situation Analysis (SA) was conducted in seven local government health centers as part of a larger project studying the feasibility of integrating RTI services within the existing Family Planning/Reproductive Health Program of the Department of Health (DOH). The SA was part of a series of baseline activities conducted by the Family Planning Operations Research and Training Project as part of its study on Integrating RTI Management in Local Government Unit Health Centers. It was conducted by Population Council, Manila, for the DOH. Participating health centers were located in a large and highly urbanized community, a medium-sized city, and two …
Implant Users: Over Five Years After Insertion (Further Analysis Of Previous Study Data), Jayanti Tuladhar, Joedo Prihartono
Implant Users: Over Five Years After Insertion (Further Analysis Of Previous Study Data), Jayanti Tuladhar, Joedo Prihartono
Reproductive Health
This secondary analysis report presents the characteristics of a subgroup of 235 women who are overdue in getting Norplant® implants removed after five years, factors related to the risk of nonremoval after five years, and issues related to accessing information about removal of implants. The main source of data for the present study is the “Norplant Implants® Assessment Study: Insertion, Use, and Removal” carried out in Indonesia in April 1996. This study consisted of a representative sample of 2,979 current and former Norplant users who had an insertion from April 1, 1987, to March 31, 1991, five or more years …
Iron Supplementation: Knowledge, Perceptions, And Usage Among Pregnant Women In Rural India, Jayanti Tuladhar, John Townsend, Nazir Haider, Leila Caleb-Varkey
Iron Supplementation: Knowledge, Perceptions, And Usage Among Pregnant Women In Rural India, Jayanti Tuladhar, John Townsend, Nazir Haider, Leila Caleb-Varkey
Reproductive Health
In India, severe anemia has been one of the causes of high maternal mortality and death of newborns and infants due to low birthweight. The prevalence of anemia among women ages 15–44 is extremely high. The Government of India has provided iron and folic acid tablets (IFA) as a prophylaxis against nutritional anemia among pregnant women as part of the Child Survival and Safe Motherhood program and will continue to do so in the Reproductive and Child Health package. This paper presents findings of both qualitative and quantitative research conducted among pregnant women to investigate the extent of distribution and …
Dmpa Provision In Pss Clinics In Uttar Pradesh: Costs And Prices, Saumya Ramarao, John Townsend, Leila Caleb-Varkey, Sudha Tiwari, Sneh Vishwanath, Harbans Singh
Dmpa Provision In Pss Clinics In Uttar Pradesh: Costs And Prices, Saumya Ramarao, John Townsend, Leila Caleb-Varkey, Sudha Tiwari, Sneh Vishwanath, Harbans Singh
Reproductive Health
The injectable contraceptive DMPA was introduced in the private sector in India in 1993, contingent on completion of a post-marketing surveillance study of users. The commercial price of a dose of DMPA is about Rs. 150-180, exclusive of the fees of the medical provider. This price puts it beyond the reach of most Parivar Seva Sanstha (PSS) clients in need of safe and effective family planning (FP) services in Uttar Pradesh. Since April 1996, an experiment has been underway with three PSS clinics in Uttar Pradesh to study the effect of price on demand for DMPA. The study seeks to …
Clinic-Based Investigation Of The Typology And Self-Reporting Of Fgm In Egypt, Population Council
Clinic-Based Investigation Of The Typology And Self-Reporting Of Fgm In Egypt, Population Council
Reproductive Health
This clinic-based study of female genital mutilation (FGM) was designed and carried out by the Egypt Fertility Care Society to gather detailed information on the types of FGM practiced in Egypt. The study involved interviews with clinic clients to elicit information about their experience and attitudes concerning FGM, and gynecological examinations by specially trained OB/GYN physicians. In all, 93% of the women in this study were found to have some type of FGM. The study's findings were incorporated in the final report of the 1995 Egyptian Demographic and Health Survey, with the aim of contributing to the scientific understanding of …
Quality Of Family Planning Programme In India: A Review Of Public And Private Sector, Dileep V. Mavalankar
Quality Of Family Planning Programme In India: A Review Of Public And Private Sector, Dileep V. Mavalankar
Reproductive Health
Increasing attention has been paid to quality of care (QOC) in family planning (FP) during the last few years, and there have been several initiatives to strengthen QOC in FP in the developing world. This paper reviews the quality of the FP program in India’s public and private sectors, and examines six elements: choice of methods, information given to clients, technical competence, interpersonal relations, continuity of care and follow-up, and appropriate constellation of services. Overall, the paper finds that not much attention has been paid to QOC and hence the level is quite low. Evidence and observations indicate that QOC …
A Model Of Costs Of Rti Case Management Services In Uttar Pradesh, Saumya Ramarao, John Townsend, M.E. Khan
A Model Of Costs Of Rti Case Management Services In Uttar Pradesh, Saumya Ramarao, John Townsend, M.E. Khan
Reproductive Health
The Government of India has adopted a Reproductive and Child Health (RCH) approach as the basis of its new family welfare policy. One component of RCH is management of reproductive tract infections (RTIs). The Population Council's Asia and the Near East Operations Research and Technical Assistance (ANE OR/TA) Project, in collaboration with the State of Uttar Pradesh, Ministry of Health and Family Welfare, is conducting a study on the feasibility and cost of providing RTI case management at the primary-care level. The estimated annual cost of RTI case management at the district level would be about US$64,000. From the analysis, …
Indonesia: Utilization Of Completed Operations Research Studies, Meiwita B. Iskandar, Subadra Indrawati
Indonesia: Utilization Of Completed Operations Research Studies, Meiwita B. Iskandar, Subadra Indrawati
Reproductive Health
In the past eight years, many operations research (OR) programs were implemented in Indonesia to increase the availability, accessibility, and acceptability of services desired by family planning (FP) users. OR has also been employed to improve quality and sustainability by studying the performance, efficiency, and effectiveness of services delivered by providers. Nonetheless, relatively little is known about the true effects of OR studies in identifying and solving program problems in order to support the planning and coordinating of a particular program. Measuring utilization of OR results is not simple. In 1989, USAID signed its last bilateral assistance agreement with the …