Maternal and Child Health Commons^™

Assessing Integration Methodology (Aim): A Handbook For Measuring And Assessing The Integration Of Family Planning And Other Reproductive Health Services, M. Estela Rivero-Fuentes, Saumya Ramarao, Ricardo Estrada, Charlotte E. Warren, Saiqa Mullick, Ian Askew, Harriet Birungi, John Townsend, Susana Medina

Reproductive Health

Several international statements over the past two decades have endorsed the integration of family planning (FP) services with other reproductive health (RH) services as a means of expanding availability and access for potential users. Many rationales underlie the move toward integrating FP with other services. First is that it provides benefits to the client and the program. Moreover, there is the expectation that the costs to the health system of configuring two or more services will cost less than providing them independently. However, there is still little empirical evidence available about integration of services. Over time, a number of methodologies …

Financial Capacity Building For Ngo Sustainability, John H. Bratt, Rick Homan, Barbara Janowitz, James R. Foreit

Reproductive Health

While demand for family planning and reproductive health services is increasing worldwide, a number of recent trends threaten the financial sustainability of donor-supported NGOs that provide these services. First, the U.S. Agency for International Development has seen its funding for population assistance decline since 1995. A second reason is the growth of government-funded programs that provide these services for low-income clients, which reduced the need for NGOs to focus programs entirely on the poor. Health-sector reform has created opportunities for NGOs via public–private partnerships in some countries, but sustained public-sector support is unlikely given limited economic growth in domestic economies …

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …

Study Of Sexually Transmitted Infections Among Urban Men In Pakistan: Identifying The Bridging Population, Ali M. Mir, Laura Reichenbach, Abdul Wajid, Mumraiz Khan

Reproductive Health

Pakistan currently has low levels of HIV infection, however the country is considered at high potential risk for an HIV epidemic. In major cities there are large concentrations of individuals whose behaviors make them extremely vulnerable to the rapid spread of HIV and of classical sexually transmitted infections (STIs), including male and female sex workers, men who have sex with men, and injecting drug users. HIV can spread to the general population through individuals who have contact with both high-risk groups and the general heterosexual population (the “bridging population”). Identifying the bridging population and bridging behaviors among urban men and …

Assessment Of Knowledge And Attitudes Of Married Women On Maternal And Newborn Health (Mnh) In Selected Union Councils Of Project Districts, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The World Health Organization estimates that 585,000 women die from pregnancy-related conditions each year. Pregnancy-related conditions, including dysfunctional labor, hemorrhage, infection, toxemia, and unsafe abortion, are the leading cause of death among women of reproductive age in many developing countries. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan, through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Crude Birth Rates And Contraceptive Use By Racial/Ethnic Group In The U.S., 1990-2000, Victoria Stone

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes crude birth rates and contraceptive use among women in the three primary racial/ethnic groups, White, Black, and Latina, and further examines birth rates by age-specific groups in the United States between 1990 and 2000.

Methods: The data examined here was derived from the NYC Vital Statistics 2002 Report and the Census 2000 SF4 table on Sex by Age by race and Latino nationality. The birth rates were calculated by dividing live birth numbers (Vital Statistics report) by total population count by age and racial/ethnic group (Census 2000 data) and multiplying this number by 1000.

Results: In …

Kenya: Integrating Services For Fp And Hiv Improves Quality And Hiv Testing, Population Council

Reproductive Health

The Kenyan government’s reproductive health policy highlights service integration and quality of care. While integrating counseling and testing (C&T) for HIV into family planning (FP) can potentially increase the range of services to clients at risk from sexually transmitted infections (STIs) including HIV, few studies have documented the feasibility, effects, or costs of such integration. From 2005–07, the Population Council worked with the Kenyan Ministry of Health to test the feasibility of two models for integrating C&T into existing FP services. Both models featured client education on HIV prevention during FP visits. Providers were trained to routinely use the Balanced …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Familialism, Social Support, And Stress: Positive Implications For Pregnant Latinas, Belinda Campos, Christine Dunkel Schetter, Cleopatra M. Abdou, Calvin J. Hobel, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

This study examined the association of familialism, a cultural value that emphasizes close family relationships, with social Support, stress, pregnancy anxiety, and infant birth weight. Foreign-born Latina (n = 31), U.S.-born Latina (n = 68), and European American (n = 166) women living in the United States participated in a prospective study of pregnancy in which they completed measures of familialism, social support, stress, and pregnancy anxiety during their second trimester. As expected, Latinas scored higher on familialism than European Americans. Familialism was positively correlated with social support and negatively correlated with stress and pregnancy anxiety in the overall sample. …

The Experience Of Married Adolescent Girls In Northern Nigeria, Annabel Erulkar, Mairo Bello

Poverty, Gender, and Youth

Programs for young people in sub-Saharan Africa have been directed largely toward unmarried adolescents, neglecting the fact that a large proportion of adolescents—especially girls—are married in some settings. Early marriage is a common feature of girls’ adolescence in Northern Nigeria, yet few programs are in place to support this sizable and vulnerable group. To suggest directions for future programming, Adolescent Health and Information Projects (AHIP) and the Population Council examined the lives of married and unmarried girls in two geopolitical regions of Nigeria, North West and North East. The study, as described in this report, consisted of secondary analysis of …

Changing Transitions To Adulthood In Vietnam's Remote Northern Uplands: A Focus On Ethnic Minority Youth And Their Families [Vietnamese], Bussarawan Teerawichitchainan, Hac Van Vinh, Nguyen Thi Phuong Lan

Poverty, Gender, and Youth

Ethnic minorities, who tend to live in remote mountainous areas, account for 15 percent of Vietnam’s 84 million total population and, according to a recent estimate, 61 percent of them are poor. Evidence suggests that despite recent efforts by the Government of Vietnam to promote poverty reduction in remote areas, a majority of ethnic minorities have not yet experienced positive change, contrary to their Kinh (ethnic Vietnamese) neighbors who have enjoyed substantial improvement in living standards. To identify program interventions that promote healthy human development and, in turn, positively affect Vietnam’s economic growth, it is crucial to have a comprehensive …

Girls' Adolescence In Burkina Faso: A Pivot Point For Social Change, Martha Brady, Lydia Saloucou, Erica Chong

Poverty, Gender, and Youth

As closer attention is paid to the lives of adolescents in sub-Saharan Africa, girls are found to be clearly disadvantaged, compared with their male counterparts. Burkinabé girls are frequently married at a young age, and more than one-third of married girls find themselves in polygamous unions as second or third wives, married to much older men. Understanding and recognizing girls’ realities is an important first step in planning appropriate and meaningful interventions for them. Girls who are unmarried, “promised,” engaged, or married face different constraints and merit different program approaches. This report by the Population Council aims to fill gaps …

Changing Transitions To Adulthood In Vietnam's Remote Northern Uplands: A Focus On Ethnic Minority Youth And Their Families, Bussarawan Teerawichitchainan, Hac Van Vinh, Nguyen Thi Phuong Lan

Poverty, Gender, and Youth

Ethnic minorities, who tend to live in remote mountainous areas, account for 15 percent of Vietnam’s 84 million total population and, according to a recent estimate, 61 percent of them are poor. Evidence suggests that despite recent efforts by the Government of Vietnam to promote poverty reduction in remote areas, a majority of ethnic minorities have not yet experienced positive change, contrary to their Kinh (ethnic Vietnamese) neighbors who have enjoyed substantial improvement in living standards. To identify program interventions that promote healthy human development and, in turn, positively affect Vietnam’s economic growth, it is crucial to have a comprehensive …

Leave No Woman Behind, Ethiopia: Baseline Report, Annabel Erulkar, Tekle-Ab Mekbib, Helen Amdemikael, Garry Conille

Poverty, Gender, and Youth

“Leave No Woman Behind, Ethiopia” is an experimental project being implemented in rural areas of Ethiopia’s Amhara region. The project uses the mobilization of women into groups and adult literacy as an entry point for reproductive health education and referrals. Measurement of the program’s impact is being undertaken using a quasi-experimental research design including baseline and endline surveys in six Kebele Associations in rural Amhara. This report presents findings from the baseline survey conducted among more than 3,000 girls and women aged 10–45 in rural Amhara region. The results cover a broad range of topics including education, work, livelihoods, social …

Avances En La Atención Postaborto En América Latina Y El Caribe: Investigando, Aplicando Y Expandiendo, Deborah L. Billings, Ricardo Vernon

Reproductive Health

This work by the Population Council and Ipas documents the intellectual, financial, and managerial effort that many organizations and institutions in Latin America and the Caribbean have made to achieve the objective of improving the quality and effectiveness of postabortion care services. This volume is a contribution to the preparation of directors, owners, and service providers, and to the creation and implementation of policies and programs based on scientific evidence, which will benefit women and the services themselves. Its five sections include an overview; results from country studies, and information about providers and program components; clinical care with various technologies, …

Safe Motherhood Applied Research And Training (Smart) Report 1: Project Overview, Gul Rashida, Peter C. Miller

Reproductive Health

Maternal mortality in Pakistan is believed to be quite high, at about 350–500 maternal deaths per 100,000 live births. Reducing maternal mortality is one of the major objectives of the Government of Pakistan. Interventions required to address maternal mortality include safe motherhood, which means a woman’s ability to have a safe and healthy pregnancy and delivery. The Safe Motherhood Applied Research and Training (SMART) project was an operations research project designed to develop and test interventions to reduce maternal and neonatal mortality in a predominantly rural district of Pakistan. The vast majority of maternal deaths are attributed to delays in …

In Our Own Hands: Swaa-Ghana Champions The Female Condom, Kathleen Cravero, Michelle Skaer, Victoria Ebin, Martha Brady

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the vital role played by the Ghana branch of the Society for Women and AIDS in Africa (SWAA) in introducing the female condom, the only female-controlled method for protection from HIV. By addressing issues of gender inequity and communication within relationships, SWAA used the female condom to empower women to regain control of their bodies. Also in this issue are profiles of three other approaches to programming for the female condom from Brazil, South Africa, and Zimbabwe.

Safe Motherhood Applied Research And Training (Smart) Report 2: The Interventions, Abdul Wajid, Zakir Hussain Shah, Ashfa Hashmi, Zeba Tasneem, Lubna Shireen

Reproductive Health

The Safe Motherhood Applied Research and Training (SMART) project, an operations research project designed to develop and test interventions to reduce maternal, perinatal, and neonatal mortality and morbidity in predominantly rural districts of Pakistan, was a three-year project (2003 to 2006) funded by the European Union. The study area was in the district of Dera Ghazi Khan; the control area was in the district of Layyah. The project focused on three areas to accomplish its goals: empowering women to seek appropriate and timely general, maternal, and newborn care; supporting methods that encourage men to play a positive and active role …

Safe Motherhood Applied Research And Training (Smart) Report 3: Changes In Knowledge And Behavior Of Women And Families, Muhammad Shafique Arif, Peter C. Miller, Nayyer Munir, Irfan Masood

Reproductive Health

The Safe Motherhood Applied Research and Training (SMART) project was conceived as an operations research project designed to test the effectiveness of two different strategies for improving maternal and neonatal health in Pakistan. To evaluate the results of this test, several types of evaluative research were conducted, including qualitative studies of various types, health systems assessments, evaluations of specific components, and household surveys. The household surveys are the subject of this report, which is Report 3 (Changes in knowledge and behavior of women and families) in a series of six. The surveys are two types: a large-scale, before-after household survey …

Safe Motherhood Applied Research And Training (Smart) Report 4: Knowledge And Behaviour Of Service Providers, Zakir Hussain Shah, Saima Pervaiz

Reproductive Health

The Safe Motherhood Applied Research and Training (SMART) project was an operations research project designed to develop and test interventions to reduce maternal, perinatal, and neonatal mortality and morbidity in predominantly rural districts of Pakistan. The study area was in the district of Dera Ghazi Khan; the control area was in the district of Layyah. The project focused on three areas: empowering women to seek appropriate and timely general, maternal, and newborn care; supporting methods that encourage men to play a positive and active role in decision-making and seeking care for their families in matters relating to maternal and newborn …

Technical Assistance To Organizations In Guinea Seeking To Reduce Female Genital Cutting, Nafissatou J. Diop

Reproductive Health

This reports details the technical assistance the Population Council’s FRONTIERS program provided to WHO’s Africa Bureau to implement a project addressing medicalization of female genital cutting (FGC), and to support Tostan in replicating its program in Guinea. Technical assistance had several aims: to improve the effectiveness of strategies to abandon FGC in Guinea, to assist WHO in developing and implementing a project to reduce FGC medicalization by health providers, to build the capacity of Guinean organizations to appropriately monitor and evaluate their FGC-related activities, and to enable the Comité de Lutte contre les Pratiques Traditionnelles portant Atteinte aux Femmes (CPTAFE) …

Female Genital Cutting Among The Somali Of Kenya And Management Of Its Complications, Guyo W. Jaldesa, Ian Askew, Carolyne Njue, Monica Wanjiru

Reproductive Health

The Somali community living in Kenya (and in their native Somalia) has practiced the severest form of female genital cutting (FGC)—infibulation—for centuries. To understand the context within which the practice takes place, and how its complications are managed, the Population Council’s Frontiers in Reproductive Health Program undertook a diagnostic study that confirmed that FGC is a deeply rooted and widely supported cultural practice. Several closely related reasons are used to sustain the practice: religious obligation, family honor, and virginity as a prerequisite for marriage; an aesthetic preference for infibulated genitalia was also mentioned. The study also found that the health …

Integrating Adolescent Livelihood Activities Within A Reproductive Health Program For Urban Slum Dwellers In India, Dale Huntington, Mary Philip Sebastian, Barbara Mensch, Wesley H. Clark, Aditya Narain Singh, Sohini Roychowdhury, M.E. Khan, Nirmala Selvam, Bella C. Patel, Sandhya Barge, Y.P. Gupta, Lovleen Johri, Gita Biswas, Manohar Shenoy

Reproductive Health

The Population Council’s Frontiers in Reproductive Health (FRONTIERS) program and Policy Research Division, in collaboration with CARE India, conducted an operations research study in Allahabad, Uttar Pradesh to examine the feasibility and impact of adding livelihood counseling and training, savings formation activities, and follow-up support to an ongoing reproductive health program for adolescents. The short-term objective of the study was to foster development of alternative socialization processes for adolescent girls that encourage positive sexual and reproductive health behaviors. The study also aimed to produce a replicable model for CARE and other agencies to use in adding livelihood activities to adolescent …

Youth Behavioral Risks And Psychosocial Resources In Peru's Alternative-Development Zones, Federico R. Leon, Mary L. Claux

Reproductive Health

Alternative-development programs are being offered to the population of seven regions of central-eastern Peru involved in coca cropping. The youth of these regions are above the national average in risk of pregnancy and sexually transmitted infections, use of alcohol and drugs, and violence against women. This study sought to identify and describe protective factors expected to function as counterforces to such risks; develop reliable indicators and provide a baseline concerning the risk behaviors and protective factors; compare youth by gender, developmental stage, urbanization, and geography to determine whether segmented interventions are required; and recommend specific intervention strategies. The results of …

Culturally Appropriate Information, Education And Communication Strategies For Improving Adolescent Reproductive Health In Cusco, Peru, Marco Florez-Arestegui Cornejo, Rosalinda Barreto Silva

Reproductive Health

The project Culturally Appropriate Information, Education and Communication Strategies for Improving Adolescent Reproductive Health in Cusco, Peru was designed in response to the evident lack of information and education on adolescent reproductive health in the country and, in particular, in the rural areas of the department of Cusco. Research revealed that a great need for sexual and reproductive health information still exists among indigenous adolescents in the rural areas of the region and that sexual education programs have to be sustainable. This report recommends that the Ministry of Education train more teachers in sexual and reproductive health topics, taking into …

Medicalization Of Female Genital Cutting Among The Abagusii In Nyanza Province, Kenya, Carolyne Njue, Ian Askew

Reproductive Health

This study sought to understand the role that health providers play in the medicalization of female genital cutting (FGC) among the Abagusii community in western Kenya, among whom the practice continues to be almost universal. Interviews with service providers and their clients revealed an overwhelming belief that FGC fulfills a traditional cultural obligation among the Abagusii, and that it limits a woman’s sexual desire and confers respect on girls. New approaches are needed within this community to present FGC as violating human rights and national laws, as well as threatening girls’ and women’s health. The study recommends measures such as …

Female Circumcision In Indonesia. Extent, Implications And Possible Interventions To Uphold Women's Health Rights, Meiwita P. Budiharsana, Lila Amaliah, Budi Utomo

Reproductive Health

In Indonesia, the practice of female circumcision (FC) has long existed, but information concerning where and how it is carried out has been limited. The specific aims of the study conducted by the Population Council Jakarta were to provide research-based information on FC customary practices and their socio-cultural determinants, and if possible, to assess any long-term physical and psychological consequences. Study findings indicate that in general Muslim communities support the continuation of FC practice, because they perceive it as both a societal custom and a religious duty. The report strongly recommends that key donor agencies pressure the Ministry of Health …

Renforcement Des Capacites Villageoises: Comment 23 Villages S'Initient Aux Droits Humains Et Abandonnent La Pratique De L'Excision Au Burkina Faso, Nafissatou J. Diop, Edmond Bagde, Djingri Ouoba, Molly Melching

Reproductive Health

This document is a summary of the process followed in implementing a community-based education program in Burkina Faso. The Population Council initiated a collaboration between two NGOs, Tostan in Senegal and Mwangaza Action in Burkina Faso, to replicate the program for improving women’s reproductive health and contributing to the end of female genital cutting (FGC). In Burkina Faso, the participants (men and women) held discussions to analyze the problems faced by their communities and to find appropriate solutions. Many positive changes occurred in the participating villages: the communities now promote reproductive health and human rights and work to improve public …

Replication Of The Tostan Programme In Burkina Faso: How 23 Villages Participated In A Human Rights-Based Education Programme And Abandoned The Practice Of Female Genital Cutting In Burkina Faso, Nafissatou J. Diop, Edmond Bagde, Djingri Ouoba, Molly Melching

Reproductive Health

This document is a summary of the process followed in implementing a community-based education program in Burkina Faso. The Population Council initiated a collaboration between two NGOs, Tostan in Senegal and Mwangaza Action in Burkina Faso, to replicate the program for improving women’s reproductive health and contributing to the end of female genital cutting (FGC). In Burkina Faso, the participants (men and women) held discussions to analyze the problems faced by their communities and to find appropriate solutions. Many positive changes occurred in the participating villages: the communities now promote reproductive health and human rights and work to improve public …