Maternal and Child Health Commons^™

Building Programs To Address Child Marriage: The Berhane Hewan Experience In Ethiopia, Eunice N. Muthengi, Annabel Erulkar

Poverty, Gender, and Youth

The development of a context-appropriate program to delay marriage in rural Ethiopia took place over many years and in stages. The program that ultimately became known as “Berhane Hewan” was developed by building an evidence base of understanding on the populations being served and developing partnerships between the Population Council and like-minded agencies with complementary expertise. The Berhane Hewan pilot demonstrated that significant impacts can be made on the social, educational, and health status of adolescent girls in a short period of time, through well designed and implemented support programs. However, high levels of exposure to all project components, make …

L'Adolescence Des Filles Au Burkina Faso: Une Clé De Voûte Pour Le Changement Social, Martha Brady, Lydia Saloucou, Erica Chong

Poverty, Gender, and Youth

Although a number of innovative programs have been created to meet their needs, Burkinabé adolescent girls continue to face many threats to their well-being. They still need considerable support and opportunities to improve their social and economic status and health status. This report, using a number of data sources, including Population Council studies and programs, and the Demographic and Health Survey of Burkina Faso, aims to provide a general overview of these young girls’ adolescence—the realities of life and the policy and program initiatives designed for them. The Population Council hopes that this report will make a significant contribution to …

Poverty, Marriage Timing, And Transitions To Adulthood In Nepal: A Longitudinal Analysis Using The Nepal Living Standards Survey, Ashish Bajracharya, Sajeda Amin

Poverty, Gender, and Youth

This working paper examines the influence of household poverty experienced during early childhood on early marriage and outcomes in schooling and workforce participation during adolescence for girls in Nepal. Much of the evidence concerning these relationships is drawn from cross-sectional data that cannot be used, and has not been able, to address causality. This Population Council study uses longitudinal data from the Nepal Living Standards Survey (NLSS), a two-wave panel in which the waves were conducted eight years apart to address these questions. Analyzing the data by household-wealth quintiles reveals surprisingly nonlinear results indicating that these associations are largest for …

The Nature Of Mothers' Work And Children's Schooling In Nepal: The Influence Of Income And Time Effects, Ashish Bajracharya

Poverty, Gender, and Youth

Using nationally representative cross-sectional data from the Nepal Living Standards Survey, this Population Council working paper examines the influence of the nature of mothers’ work on Nepali children’s schooling outcomes. It analyses whether the engagement of mothers (and fathers) in nonagricultural work has significant consequences for their children’s school attendance and grade attainment, compared with these consequences when parents’ work is in traditional subsistence agriculture. Results indicate that children of parents who both work in the nonagriculture sector are significantly more likely to have attended or currently be attending school and have higher grade attainment, compared with children whose parents …

Planning And Implementing An Essential Package Of Sexual And Reproductive Health Services: Guidance For Integrating Family Planning And Sti/Rti With Other Reproductive Health And Primary Health Services, Katherine Williams, Charlotte E. Warren, Ian Askew

Reproductive Health

The second goal of the United Nations Population Fund’s (UNFPA’s) 2008–11 Strategic Plan is “Universal access to reproductive health by 2015 and universal access to comprehensive HIV prevention by 2010 for improved quality of life.” UNFPA identified a number of outcomes that will contribute to achieving this goal. Through an extensive search of the published literature and collation of unpublished literature on programmatic experiences with developing and implementing integrated packages of SRH services, the Population Council gathered a body of evidence from which this guidance for UNFPA staff and national counterparts has been developed. UNFPA identified two priority areas: integrating …

Manual On Financial Mechanism For The Health Facilities: Introducing Pay-For-Performance Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Laila Rahman, Dipak Kumar Shil, Md. Mamun-Or Rashid, Ismat Ara Hena, Md. Noorunnabi Talukder, Farhana Akter, Anup Kumar Dey, Ripa Ali, Joynal Abedin, Mursheda Rahman, Md. Ataur Rahman, Md. Julkarnayeen, Arifur Rahman, Md. Abdur Rab Sardar

Reproductive Health

The Population Council initiated an operations research study to test two Pay-for-Performance (P4P) strategies to improve maternal, newborn, and child health (MNCH) services in Bangladesh in 2010. The P4P study is being implemented as part of the two ongoing MNCH and maternal and newborn health (MNH) projects of the United Nations Children’s Fund (UNICEF) implemented by the Directorate General of Health Services, Government of Bangladesh. The study has been testing two strategies. The first introduces incentives tied with performance for motivating service providers to improve the quantity as well as quality of services, and enable poor pregnant women, and mothers …

Facility Assessment Report: Introducing Pay-For-Performance (P4p) Approach To Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen, Md. Akteruzzaman, Md. Sohel Rana, Ripa Ali

Reproductive Health

Under the leadership of the Directorate General of Health Services, the Population Council in collaboration with James P. Grant School of Public Health, BRAC University and with support from UNICEF is testing an innovative service delivery model to provide financial incentives to institutions to enhance their performance on maternal, newborn, and child health (MNCH) services in three districts of Bangladesh as part of GOB-UNICEF’s ongoing MNCH/MNH projects. A comparative analysis on the availability and condition of physical and human assets across 16 health facilities will inform what is needed in a facility in terms of inputs and processes. This report …

Future Of Family Planning Program In Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Bangladesh experienced large population growth in the past, but due to a successful family planning program, the total fertility rate (TFR) declined rapidly until the mid-nineties. Over the last decade, the country experienced a slow pace in fertility decline with a small increase in the contraceptive prevalence rate (CPR). This slow pace in fertility decline is causing serious concern for reaching replacement level fertility by 2015. CPR increased seven-fold from 1975 to 2000, but there was no significant increase from 2000-09, demonstrating the weakness of present program efforts. This raises concern among researchers, policymakers, and program managers about the prospect …

Urban Family Planning Program Of Bangladesh: Issues And Challenges, Ubaidur Rob, Md. Noorunnabi Talukder, A.K.M. Zafar Ullah Khan

Reproductive Health

Extremely inadequate government primary health care (PHC) structure exists in cities in Bangladesh. Nongovernmental organizations (NGOs) play an important role in providing basic health and family planning services to a limited proportion of the urban population. However, NGO programs are time-bound and subject to the availability of development assistance. Bangladesh has one of the highest rates of growth of urban populations among developing countries. For this teeming urban population, there is no structured family planning service. To ensure continuous family planning services in urban areas it is critical to develop a sustainable primary health care structure with the thrust on …

Workshop Report: Introducing Pay-For-Performance (P4p) Approach And Increase Utilization Of Maternal, Newborn, And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Ismat Ara Hena, Farhana Akter, Mohammad Ataur Rahman, Md. Julkarnayeen

Reproductive Health

In Bangladesh, improving skilled birth attendance at delivery and access to facility-based obstetric and newborn care are vital to improving maternal and neonatal health. The health system in Bangladesh faces a critical challenge on the supply side: unavailability of quality services at public health facilities, due to inadequately motivated providers, vacant positions, and provider absenteeism. As well, salaries of public-sector providers do not depend on quality of work or quantity of services provided. Paying an incentive to facilities based on a performance benchmark has the potential of increasing the quantity and quality of maternal, neonatal, and child health (MNCH) care. …

Emergency Contraception: Idea To Program, Saumya Ramarao, John Townsend, Sarah Raifman

Reproductive Health

This report summarizes the role of the Population Council in generating evidence, providing technical leadership, and demonstrating at scale that emergency contraception (EC) can be easily integrated into national family planning programs and other reproductive health services. Since the 1990s, the Population Council, along with other partners, has contributed to the changes seen in the provision and availability of EC, now available in over 140 countries around the world. While much progress has been made in the campaign for access to EC, the Council is committed to improving existing methods of service delivery and to leading advocacy efforts and research …

Adolescent Girls In Urban Ethiopia: Vulnerability And Opportunity, Abebaw Ferede, Annabel Erulkar

Poverty, Gender, and Youth

In 2008, the Population Council undertook a survey of out-of-school, adolescent girls (aged 10 to 19) in slum areas of urban Ethiopia—a population that is highly vulnerable to HIV infection. The survey serves as a baseline for HIV prevention programs designed and implemented jointly by the Ministry of Youth and Sports, Regional Bureaus of Youth and Sports, and the Population Council. This study provided valuable direction for programmers interested in supporting adolescent girls, particularly early adolescent (10 to 14 years old) and out-of-school girls who are highly vulnerable and in need of dedicated attention. Special efforts are needed to support …

Itinéraires Thérapeutiques Des Adolescentes Pendant La Grossesse, L'Accouchement Et La Période Post-Partum Dans La Zone D'Intervention Du Projet, Gisele Kaboré, Aicha Tamboura/Diawara, Assita Nacanabo Diallo, Abdoulaye Karama

Poverty, Gender, and Youth

Le Population Council a réalisé une étude sur « les itinéraires thérapeutiques des adolescentes pendant la grossesse, l’accouchement et la période post-partum » dans cinq régions du Burkina Faso. Il s’agissait d’une étude qualitative, exploratoire qui a permis d’identifier et de décrire les itinéraires thérapeutiques des adolescentes en grossesse et post-partum en vue de déceler les obstacles liés à la fréquentation des centres de santé dans le suivi de la grossesse, de l’accouchement assisté et des soins aux nouveau-nés. Les résultats de l’étude montrent que, d’une manière générale, les adolescentes mariées ou non ont recours aux soins traditionnels à domicile …

Hazards And Gender In Children's Work: An Egyptian Perspective, Nadia Zibani

Poverty, Gender, and Youth

Girls and boys can and do work. They work for a variety of reasons related to poverty or failures in educational systems, and they work to support themselves and their families or to learn skills for future careers. The types of work carried out by children often differ according to the gender of the child. Additionally, the hazards they face in their work can also be differentiated on the basis of gender. The present study attempts to develop a better understanding of the gender aspects of children’s work with a particular focus on the gender-differentiated hazards that exist therein. This …

Understanding Pregnancy-Related Morbidity And Mortality Among Young Women In Rajasthan, K.G. Santhya

Poverty, Gender, and Youth

Pregnancy and childbearing continue to occur in adolescence for considerable proportions of women in India. The dangers of childbearing for adolescent girls, whose bodies have not physically matured, are widely acknowledged. Yet, little is known about whether morbidity and mortality experiences vary within the subgroup of adolescent girls, whether such experiences differ between adolescent and adult women of similar parity, and whether treatment-seeking behaviors and the delays experienced in seeking treatment differ between adolescent and adult mothers. To begin to fill this gap, the Population Council undertook an exploratory study of the pregnancy-related morbidity and mortality experiences of women who …

Making Pregnancy Safe For Women In Rajasthan: Targeting The Most Vulnerable, K.G. Santhya

Poverty, Gender, and Youth

As recently as 2005–06, almost two out of three women in Rajasthan, India were married before age 18 years (of those aged 20–24). Moreover, half of currently married girls aged 15–19 years in the state had already begun childbearing. The dangers of childbearing among adolescent girls, whose bodies have not physically matured, are widely acknowledged, as are the links between poverty and unsafe pregnancy. Yet, less is known about whether morbidity and mortality experiences vary within the subgroup of adolescent girls, whether such experiences differ between adolescent and adult women of similar parity, and whether treatment-seeking behaviors and the delays …

Female-Initiated Prevention: Integrating Female Condoms Into Hiv Risk-Reduction Activities In Kenya, Population Council, Liverpool Vct Care & Treatment

Poverty, Gender, and Youth

The Female Condom (FC) is the only female-initiated prevention product on the market today that provides simultaneous protection against STIs, including HIV, and unintended pregnancy. However, the FC remains limited in supply, not widely available, and underutilized in many settings. Improvements in FC programming are essential to achieve increased uptake and public health impact, and to pave the way for future women’s HIV prevention products. The Population Council’s Female-Initiated Prevention Methods project aimed to stimulate action and generate evidence around FC access through innovative program experimentation. The study was conducted to understand the challenges and opportunities these different access models …

Implementation Of Maternal Health Financial Scheme In Rural Bangladesh, Md. Moshiur Rahman, Ubaidur Rob, Tasnima Kibria

Reproductive Health

The maternal mortality ratio in Bangladesh has declined from more than 600 per 100,000 live births in 1980 to 322 in 2004, yet it is still unacceptably high. Economic barriers are an important factor in deterring pregnant women from seeking services at health facilities. To achieve the country’s Millennium Development Goal of reducing the maternal mortality ratio to 143 by 2015, the Population Council conducted an operations research study to test the feasibility and effectiveness of introducing an innovative model of health care financing to increase utilization of maternal health services by poor, rural women. As this report notes, “Voucher …

Manual For Designing Community Based Interventions For Preventing Postpartum Hemorrhage (Pph) Using Misoprostol: Standardized Pilot-Test Training Manual, Saumya Ramarao, Tekle-Ab Mekbib, Sarah Raifman

Reproductive Health

This manual is a comprehensive, standardized, step-by-step guide for Population Council staff to use when designing and implementing community-based pilot interventions for the prevention of postpartum hemorrhage using misoprostol. The introduction and background section provide basic information about maternal mortality, normal and abnormal pregnancy, and postpartum hemorrhage. This section also describes prevailing methods of prevention and treatment for postpartum hemorrhage, active management of the third stage of labor, and use of misoprostol for the prevention and control of postpartum hemorrhage. The second half of the manual focuses on how to develop a protocol for an intervention study on misoprostol. It …

Crude Birth Rates Among New York City’S Racial/Ethnic Groups And Latino Nationalities In 2002, Victoria Stone

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes crude birth rates among women in the three primary racial/ethnic groups, White, Black, and Latina, and further examines birth rates by age-specific groups in the five boroughs of New York City in 2002. In addition, this report presents the crude birth rates for six Latino nationalities: Mexican, Ecuadorian, Dominican, Colombian, Puerto Rican and Cuban.

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) …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Manual For Building Capacity Of Trainers And Program Managers In Emergency Contraception, Sharif M.I. Hossain, M.E. Khan, Mary Philip Sebastian, Sohini Roychowdhury

Reproductive Health

This manual equips trainers with appropriate knowledge on emergency contraceptive pills (ECPs). Emergency contraception (EC) refers to any method of contraception that can be used by a woman to prevent an unwanted pregnancy within three days of unprotected intercourse or a contraceptive accident such as condom leakage. This manual discusses ECPs and the provision of related services. After a day’s training, trainers have the knowledge and skills necessary to train service providers and workers on ECPs. The manual is divided into four sessions. The first provides an overview of the demographic and reproductive health (RH) situation in South and South …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga

Reproductive Health

In 1998–99, a village empowerment program was implemented in the Thiès/Fatick and Kolda regions of Senegal by the nongovernmental organization Tostan, to mobilize communities to hold public declarations in support of abandoning harmful traditional practices, including female genital mutilation/cutting (FGM/C) and child marriage. The information presented in this report indicates that many did end the practices following a public declaration, however, the lack of follow-up in the field and the absence of support mechanisms pose a large obstacle. Nevertheless, the program achieved significant results: knowledge of life skills resulting in positive changes and a shift in the perception of FGM/C …

Analysis Of The Evolution Of The Practice Of Female Genital Mutilation/Cutting In Burkina Faso, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

This study was undertaken as a collaboration between the Population Council’s Frontiers in Reproductive Health program and the Comité National de Lutte contre la Pratique de l’Excision (CNLPE) within the Ministry of Social Action and National Solidarity in Burkina Faso. The creation of a favorable environment for the campaign against excision in Burkina Faso has facilitated various anti-cutting activities over the past two decades and enabled the achievement of gains, both in terms of awareness and behavior change. However some of the strategies need further readjustment: among the reasons why excision still continues in Burkina Faso is a certain view …

Malaria In Pregnancy Pilot Projects Nationally Adopted In Kenya And Malawi, Population Council

Reproductive Health

Kenya and Malawi have developed national policies to prevent malaria in pregnancy. Measures to prevent malaria among antenatal clients were shown to be sustainable several years after pilot interventions ended. In Malawi, the approach has been expanded nationwide. In most malaria-endemic areas of Africa, women in their first and second pregnancies have the highest risk of acquiring malaria and, consequently, of malaria-associated anemia and low birth-weight. Two USAID-funded interventions aimed at strengthening the prevention and management of malaria in pregnancy were pilot-tested at the district level in Kenya (1998–2002) and Malawi (1998–2004). As noted in this brief, the goal was …

Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi

Reproductive Health

In 2001, the World Health Organization issued guidance on a new model of antenatal care (ANC) called goal-oriented or focused antenatal care (FANC), for implementation in developing countries. The new model reduces the number of required antenatal visits to four, and provides focused services shown to improve maternal outcomes. FANC emphasizes helping women maintain normal pregnancies by identifying existing health conditions, detecting emerging complications, promoting health, preparing for a healthy birth, and educating clients on postpartum care including nutrition, breastfeeding, and family planning. Trials conducted in Argentina, Cuba, Saudi Arabia, and Thailand proved that FANC was safe and was a …

Multisectoral Youth Rh Interventions: The Scale-Up Process In Kenya And Senegal, Stephanie Joyce, Ian Askew, Anta Fall Diagne, Nafissatou J. Diop, Humphres Evelia

Reproductive Health

As in many developing countries, young people in Kenya and Senegal (aged 10–20) account for about 25 percent of the population. To ensure their future contribution to their countries, it is of vital strategic importance to safeguard their welfare. Rapid social change in both countries exposes youth to sexual and reproductive health (RH) risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Beginning in 1999, the Population Council’s FRONTIERS program conducted operations research studies that tested the feasibility, acceptability, and cost of a public-sector, multisectoral intervention to enhance young people’s RH knowledge and behavior. Study findings showed …

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

Reproductive Health

The South African government wishes to expand availability and use of counseling and testing (C&T) for HIV. One option is to integrate C&T into well-attended services, such as family planning (FP). In 2004, the Population Council began a three-year study with the Department of Health in North West Province. The study tested the feasibility, acceptability, and cost of two models for integrating HIV prevention services within established FP programs, and evaluated their quality against standard practice. In the testing-model clinics, providers provided C&T services at the same consultation; in the referral-model clinics, providers offered HIV counseling and referred clients to …

Increasing Women's Use Of The Iud For Family Planning, Ricardo Vernon

Reproductive Health

The intrauterine device (IUD) is highly effective, easy to use, and has few side effects. The device costs the provider about US$2 and offers a duration of protection that makes it the most cost-effective of the temporary methods if used for two years or more. The IUD's many advantages also make it a good alternative for reducing unmet need for long-term contraception around the world. Between 5 and 17 percent of all married women of reproductive age in 53 less developed countries do not want to have more children but are not using a contraceptive method. Because the IUD can …