Maternal and Child Health Commons^™

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In Haiti, M. Estela Rivero-Fuentes, Ricardo Vernon, Michaelle Boulos, Louis-Marie Boulos

Reproductive Health

This report presents the results of a situation analysis of the provision and use of contraception in postpartum, postabortion, and Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in Haiti. FRONTIERS provided the Centre d’Évaluation et de Recherche Appliqueé (Center for Evaluation and Applied Research or CERA) with technical assistance for the data collection, cleaning, and entry processes. The study found that there is a substantial unmet need for family planning services among postpartum women and many missed opportunities to provide these services during the pregnancy-extended postpartum period continuum. Most outpatient services have adequately implemented HIV counseling for pregnant women, …

Promoting Healthy Timing And Spacing Of Births In India Through A Community-Based Approach, M.E. Khan, Mary Philip Sebastian, Usha Sharma, Rukma Idnani, Kaushal Kumari, Bharati Maheshwari, Shahid Ashraf

Reproductive Health

The Indian Family Welfare Program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has failed in educating people about the importance and need of using contraceptive methods for spacing births. With its Indian collaborators, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program undertook a study to test a model to increase use of postpartum contraception among young pregnant women with a parity of 0 or 1. The study showed that the Behavior Change Communication (BCC) model developed to promote Healthy Timing and Spacing of Pregnancy (HTSP) was effective in promoting the lactational …

Increasing The Accessibility, Acceptability And Use Of The Iud In Gujarat, India, M.E. Khan, Sitanshu Sekhar Kar, Vikas Kishor Desai, Pratibha Patel, B.P. Itare, Sandhya Barge

Reproductive Health

The USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health & Family Welfare, Government of Gujarat, and the Center for Operations Research and Training, Vadodara, conducted an operations research study in India to test the hypothesis that by improving the demand for the IUD and simultaneously strengthening the technical competencies and counseling skills of the providers, use of the IUD use would increase. The findings show that demand-generation activities and provision of good-quality IUD services, together with a supportive programmatic environment, when carried out simultaneously showed increased acceptance of the IUD. The intervention could be …

Creating The Conditions For Scale-Up Of The Men In Maternity Intervention In India, Leila Caleb-Varkey, Anurag Mishra, M.E. Khan

Reproductive Health

The Frontiers in Reproductive Health (FRONTIERS) program conducted an operations research study, called the Men in Maternity (MiM) study, in collaboration with the Employees' State Insurance Corporation of India (ESIC), aimed at involving men in the antenatal and postpartum care of their partners to raise knowledge and use of postpartum contraception and preventive practices against sexually transmitted infections, as well as improving pregnancy outcomes. This report details the MiM scale-up process, which worked well in terms of ESIC assuming ownership of the training component of the program and being able to build capacity for training. However, to further scale up …

Promoting Healthy Weight In The Preschool Years: A Portfolio And Planning Guide To Address Barriers In Primary Care, Margaret Miller, Renee Campbell-Pope, Lydia Hearn

Research outputs pre 2011

The rapidly rising incidence of overweight and obesity in Australia, particularly among young children has led to an urgent need for effective prevention. Recent figures indicate that 15% of preschool children in Australia are overweight, and a further 6% are obese1,2, with rates rising steadily especially among children from lower socioeconomic groups.

Family, childcare, primary health care, early childhood education and the community are influential environments for young children3-7 with the potential to engage in an integrated approach to promote healthy weight and development of healthy eating and active lifestyle habits during the pre-school years5,8,9.

In 2006, the Child Health …

A Cohort Study Of Reproductive And Hormonal Factors And Renal Cell Cancer Risk In Women, Gc Kabat, Stephanie A. Navarro Silvera, Ab Miller, Te Rohan

Department of Public Health Scholarship and Creative Works

We examined the association of reproductive and hormonal factors with renal cell cancer risk in a cohort study of 89 835 Canadian women. Compared with nulliparous women, parous women were at increased risk (hazard ratio (HR) 1.78, 95% confidence interval (CI) 1.02–3.09), and there was a significant gradient of risk with increasing levels of parity: relative to nulliparous women, women who had X5 pregnancies lasting 4 months or more had a 2.4-fold risk (HR 1⁄4 2.41, 95% CI 1⁄4 1.27–4.59, P for trend 0.01). Ever use of oral contraceptives was associated with a modest reduction in risk. No associations were …

Community-Based Approaches To Prevention Of Mother-To-Child Transmission Of Hiv: Findings From A Low-Income Community In Kenya, Susan Kaai, Carolyn Baek, Scott Geibel, Peter Omondi, Benson Ulo, Grace Muthumbi, Carol Nkatha, Naomi Rutenberg

HIV and AIDS

The Horizons program, in partnership with International Medical Corps and Steadman Research Services International, conducted an intervention study in Kibera, an urban slum in Nairobi, Kenya to determine what effect three different community-based activities had on utilization of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants and peer counselors as PMTCT promoters. Data from the study showed that there were positive trends during the study period in most of the PMTCT indicators, including knowledge of MTCT, …

Continuum Of Care For Hiv-Positive Women Accessing Programs To Prevent Parent-To-Child Transmission: Findings From India, Vaishali Sharma Mahendra, Rupa Mudoi, Archana Oinam, Venkat Pakkela, Avina Sarna, Sucheta Panda, Ashok Rau, L. Birendrajit Singh, Naomi Rutenberg

HIV and AIDS

This study examined the efforts of PPTCT programs in different cities in India to offer women a continuum of care, and shows that the programs have both strengths and shortcomings. The government launched a national treatment program that offers antiretroviral therapy (ART) to HIV-positive women, children below 15 years of age, and men. However, since the start-up of the ART program there have been concerns about limited access to and utilization of these services by women and children. To address these shortcomings, the PPTCT programs studied should strengthen their referral systems to public and private treatment and family planning services, …

Key Findings From An Evaluation Of The Mothers2mothers Program In Kwazulu-Natal, South Africa, Carolyn Baek, Vuyiswa Mathambo, Sibongile Mkhize, Irwin Friedman, Louis Apicella, Naomi Rutenberg

HIV and AIDS

The Horizons program of Population Council, in collaboration with Health Systems Trust, completed the first evaluation of mothers2mothers (m2m) as part of its introduction in KwaZulu-Natal Province, South Africa. It is the first external evaluation that provides quantitative evidence about the role of the well-known m2m program in complementing services to prevent mother-to-child transmission of HIV (PMTCT). m2m is a peer support program that aims to provide education and psychosocial support to HIV-positive pregnant women and new mothers, help women access existing health care, and follow up with mothers and babies to ensure they receive appropriate medical care after delivery. …

The Role Of Schools In Promoting Sexual And Reproductive Health Among Adolescents In Developing Countries, Cynthia B. Lloyd

Poverty, Gender, and Youth

This Population Council working paper reviews the state of knowledge about relationships between schooling and adolescent reproductive health. With the spread of mass schooling and the growing share of adolescents who attend school, the opportunities for synergies between health and education policies and programs are growing. Data on cross-country variations in health conditions on the one hand, and variations in attendance and attainment patterns and school systems on the other hand, provide a framework for assessing alternative approaches to the promotion of adolescent sexual and reproductive health in different contexts. Disappointing findings from recent school-based reproductive health interventions in poor …

Premarital Sex And Schooling Transitions In Four Sub-Saharan African Countries, Ann E. Biddlecom, Richard Gregory, Cynthia B. Lloyd, Barbara Mensch

Poverty, Gender, and Youth

Using data from the 2004 National Survey of Adolescents conducted in Burkina Faso, Ghana, Malawi, and Uganda, this Population Council working paper investigates the timing of two key transitions in adolescence—school exit and premarital sex—among those who remain enrolled in school at the beginning of adolescence (age 12). Girls appear more vulnerable to dropout once they become sexually mature and once they engage in premarital sex. While girls were found to be less likely than boys, at any given age and controlling for other covariates, to have had premarital sex (except in Ghana), school enrollment and the timing of school …

Ethnic Differentials In Parental Health Seeking For Childhood Illness In Vietnam, Bussarawan Teerawichitchainan, James F. Phillips

Poverty, Gender, and Youth

The recent introduction of user fees for Vietnam’s primary healthcare services has generated concern that economic policies may adversely affect health-seeking behavior and health outcomes of the poor, particularly among impoverished families who are members of socially marginalized minority groups. This Population Council working paper examines this debate by analyzing parental recall of illness and care-seeking for sick children under age 5 recorded by the 2001–02 Vietnam National Health Survey. Ethnic differentials are evident in all geographic and income levels, although adverse effects of minority status are most pronounced among poor households in remote areas. Results suggest that social equity …

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, …

Increasing Use Of The Iud Through Community And Clinic Based Education Activities In Rural Honduras, Ivo Flores Flores, Elida Rosa Aguilar Fonseca, Rosa Merlen Flores, Ricardo Vernon, Jorge Solorzano, Suyapa Pavon, Marco Tulio Falck, Alba Lidia Sanchez

Reproductive Health

This document presents the results of an operations research project implemented by the Ministry of Health in Honduras with technical and administrative assistance from the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program, ASHONPLAFA, and EngenderHealth, and funding from USAID. The project tested a strategy to inform communities about the availability of the IUD in nearby health centers and about the method’s most salient attributes. The main conclusion is that communication of messages about a specific contraceptive method, while also communicating messages about other contraceptive methods, through printed materials (flyers, brochures, and posters) and interpersonal messages (individual talks and counseling) …

Strengthening Financial Sustainability Through Integration Of Voluntary Counseling And Testing Services With Other Reproductive Health Services, Rumeli Das, Kaushik Biswas, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

In West Bengal, India, the Child in Need Institute (CINI) operated an HIV/AIDS voluntary confidential counseling and testing center and a reproductive health clinic at separate locations. Concerns about lack of service coordination as well as cost and revenue considerations led CINI to integrate the two services. CINI conducted an operations research study to examine the impact of integration on utilization and revenues. The objective of the study was to examine whether integration of services would yield an increase in clients served and improve the financial position of the program. The study found that integrating services was associated with increased …

Provision Of Emergency Contraceptive Services Through Paraprofessionals In India, Shiv Kumar, Chander Shekhar, N.K. Gupta, Malabika Roy, M.E. Khan, Mary Philip Sebastian, Rukma Idnani, Ardash Bhargava, Vinita Salvi

Reproductive Health

In 2004, with funding for technical assistance provided by USAID, the Indian Council of Medical Research funded and collaborated with the Frontiers in Reproductive Health (FRONTIERS) program of the Population Council on a two-year study to assess the usefulness and effectiveness of using paraprofessionals in educating and providing emergency contraception (ECP) services to potential users. Based on the findings and advocacy efforts, the Indian Ministry of Health and Family Welfare introduced ECP as an over-the-counter medication beginning in September 2005. This made it possible for paraprofessionals in the National Family Planning Program to provide ECP services, making the method widely …

Assessing The Feasibility, Acceptability And Cost Of Introducing Postabortion Care In Health Centres And Dispensaries In Rural Tanzania, Monica Wanjiru, Ian Askew, Nzoya Munguti, Saumya Ramarao, Rick Homan, Reheme Kahando, John M. Pile

Reproductive Health

The EngenderHealth ACQUIRE Project has been supporting the Tanzanian Ministry of Health (MOH) since early 2005 to decentralize the management of postabortion care (PAC) services to primary healthcare facilities (health centers and dispensaries), with the intention of bringing services closer to women who are unable to access them at district hospitals. Findings from this study were provided to the MOH and ACQUIRE to address issues arising from introduction of the intervention; and in September 2006, to assess the feasibility, cost, and effectiveness of the intervention. Findings show that the intervention appears to have broadened service providers’ range of clinical skills …

La Ley De Maternidad Gratuita En Intag: Su Aplicación, Educación Y Uso, Stephanie Lewis

Independent Study Project (ISP) Collection

The country of Ecuador has a high rate of infant and maternal mortality, as well as problems with malnutrition. The Minister of Public Health responded to these problems with a law to provide the public with different types of free medical attention. The Minister’s hope is to reduce these problems with the law. The law is called the Law of Free Motherhood and Attention for Infants (Ley de Maternidad Gratuita y Atención a la Infancia), and includes free attention and vitamins for pregnant women, free birth and post-birth care, and vitamins, attention and vaccinations for children under 5 years of …

Orphans And Vulnerable Youth In Bulawayo, Zimbabwe: An Exploratory Study Of Psychosocial Well-Being And Psychosocial Support, Laelia Gilborn, Louis Apicella, Jonathan Brakarsh, Linda Dube, Kyle Jemison, Mark Kluckow, Tricia Smith, Leslie M. Snider

HIV and AIDS

This Population Council Horizons report presents findings from an exploratory study by the Regional Psychosocial Support Initiative and Catholic Relief Services’ Support to Replicable, Innovative Village/Community-level Efforts Program of vulnerable youth living in and around Bulawayo, Zimbabwe. It describes their demographic characteristics, exposure to stress and trauma, and psychosocial well-being. The report also highlights the relationships between psychosocial well-being outcomes and exposure to stress and trauma, and the differences in psychosocial well-being between males and females, orphaned and nonorphaned youth, and younger and older adolescents. The report concludes with program and research implications.

Exploring Current Practices In Pediatric Arv Rollout And Integration With Early Childhood Programs In South Africa: A Rapid Situation Analysis, Desiree Michaels, Brian Eley, Lewis Ndhlovu, Naomi Rutenberg

HIV and AIDS

This Horizons program report describes the status of pediatric HIV treatment in selected sites in South Africa, identifies gaps in service delivery, and proposes recommendations for strengthening services and expanding children’s access to treatment. The study provides much needed information on critical issues of pediatric HIV care, especially regarding health service and contextual issues surrounding the expansion of access to treatment for HIV-infected children, and key factors that facilitate sustainability of treatment by young children. The aims of the study were to identify successful program strategies in pediatric HIV treatment in South Africa and to determine priority knowledge gaps to …

Correlates Of Inter-Birth Intervals: Implications Of Optimal Birth Spacing Strategies In Mozambique, Saumya Ramarao, John Townsend, Ian Askew

Reproductive Health

The Optimal Birth Spacing Initiative (OBSI) was created under the auspices of USAID to place optimal birth spacing on the global leadership priority agenda. As part of this initiative, Advance Africa documented a pilot intervention to introduce the new spacing message in Mozambique. The FRONTIERS program of the Population Council collaborated with Advance Africa providing technical input, and assistance in the conceptualization of intervention design and evaluation. This paper was written to inform Advance Africa’s efforts in Mozambique and includes a short review of correlates of birth intervals; a presentation of results from analysis of Mozambique-DHS 1997 data that identify …

Correlates Of In-Home Smoking Behavior Of Parents With Newborns, James Kyung Jo

Loma Linda University Electronic Theses, Dissertations & Projects

Secondhand smoke has been shown to have adverse health effects on young children. It is associated with various health effects such as respiratory infections, Sudden Infant Death Syndrome (SIDS), and asthma. Because of the dangers secondhand smoke poses to young children, there is a need for educating parents about the dangers of secondhand smoke as well as determining factors associated with secondhand smoke exposure among children. Understanding these factors may be first step toward developing strategies to reduce ETS exposure.

The study examined correlates of in-home smoking behavior of parents with newborns by analyzing 657 respondents who filled out the …

Improving Access To Long-Term Contraceptives In Rural Guatemala Through The Ministry Of Health, Edwin Montufar, Carlos Morales, Ricardo Vernon, Carlos Brambila, Jorge Solorzano

Reproductive Health

The purpose of this study was to test a model to train nurse auxiliaries at health centers and posts in Guatemala and to determine whether these providers could deliver adequate, cost-effective services. The training model consisted of: a) selection of nurse auxiliaries; b) two-day group training; c) on-the-job training, including work with actual clients at the trainees’ work centers; and d) certification of trainees who had conducted at least five quality insertions under supervision. This study has shown that nonprofessional health providers can effectively provide quality IUD services in Guatemala. The main recommendation derived from the project is to scale …

Systematic Screening As A Strategy To Increase Services Integration And Revenues In Honduras, Ricardo Vernon, James R. Foreit, Fiorella Mancini, Suyapa Pavon, Jheisy Torres

Reproductive Health

This operations research study, undertaken by the Honduras Family Planning Association (Asociación Hondureña de Planificación de Familia—ASHONPLAFA), tested the effectiveness of systematic screening to increase the number of services and revenue per visit in a reproductive health program. Despite monitoring plans, provider compliance with the intervention was low; the overall proportion of clients screened was less than 11 percent, and the frequency of screening varied greatly by clinic contact point. Although the study did not show an increase in the mean number of services per client, the negative results could reasonably be attributed to lack of implementation of the intervention. …

Nursing Staff Dynamics And Implications For Maternal Health Provision In Public Health Facilities In The Context Of Hiv/Aids, Loveday Penn-Kekana, Duane Blaauw, Khin San Tint, Desiree Monareng, Jane Chege

Reproductive Health

This study, carried out in Limpopo, KwaZulu-Natal, and Mpumalanga provinces in South Africa, aimed to document nursing staff dynamics in maternal health services, and to explore the factors associated with these dynamics. The study found that a high percentage of nursing staff working in public facilities were demotivated, burnt out, and were considering leaving the facility where they were working. A range of factors, both financial and nonfinancial, were associated with nurses considering going overseas: inadequate pay, poor promotion, feeling unsupported by management, and having bad relationships at work were all associated with lack of organizational commitment. As a result …

Feasibility Of Introducing A Comprehensive Package Of Antenatal Care Services In Rural Public Clinics In South Africa, Jane Chege, Ian Askew, Nzwakie Mosery, Mbali Ndube-Nxumalo, Busi Kunene, Mags Beksinska, Janet Dalton, Ester Snyman, Wilem Sturm, Preshny Moodley

Reproductive Health

The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, …

Review Of Field Experiences: Integration Of Family Planning And Pmtct Services, Naomi Rutenberg, Carolyn Baek

HIV and AIDS

The Population Council and its research partners have been addressing several key questions about prevention of mother-to-child HIV transmission (PMTCT) services and how well they function in field settings. The World Health Organization asked the Population Council to provide a review of field experiences regarding the integration of family planning and PMTCT services. This report provides conclusions and recommendations as input into a WHO/UNFPA-sponsored consultative meeting on "The linkages between reproductive health and HIV/AIDS: Family planning and prevention of mother-to-child transmission."

Succession Planning In Uganda: Early Outreach For Aids-Affected Children And Their Families, Horizons Program, Makerere University Department Of Sociology, Plan Uganda

HIV and AIDS

This publication reports on an intervention study that evaluated the effectiveness of a succession planning (SP) program in Uganda. Unlike most other programs for AIDS-affected children, succession planning reaches children and their families while their HIV-positive parents are still living and in a position to plan for their children’s long-term well-being. Research carried out by the Department of Sociology at Makerere University (Kampala) and the Population Council Horizons program suggests that succession planning is a promising approach: despite AIDS-related stigma and cultural resistance to acknowledging illness and death, qualitative research indicates that the approach met with a high degree of …

Involving Men In Maternity Care In India, Leila Caleb-Varkey, Anurag Mishra, Anjana Das, Emma Ottolenghi, Dale Huntington, Susan E. Adamchak, M.E. Khan, Rick Homan

Reproductive Health

The Men in Maternity study investigated the feasibility, acceptability, and cost of a new, more comprehensive model of maternity care that encouraged husbands’ participation in their wives’ antenatal and postpartum care. The study was conducted in India, in collaboration with the Employees’ State Insurance Corporation (ESIC), Delhi Directorate at their primary health facilities called dispensaries. The study found that men accompanied their wives to the clinics and participated actively in the intervention. There were significant changes in family planning knowledge and behaviors of both men and women; although there was little acknowledgement of STI risk, knowledge and use of dual …

Informing The Medical Community In Guatemala About Emergency Contraception, Edgar Kestler, Lilian Ramirez

Reproductive Health

The general purpose of this project was to increase the awareness of and access to emergency contraception (EC) among the medical community in Guatemala. Specific project objectives included: 1) training three physicians as trainers in all aspects of EC; 2) adapting and disseminating scientific literature and informational materials about the method and about EC programs in Latin America and worldwide; and 3) training at least 250 participants about the characteristics of emergency contraception, its mechanisms of action, and counseling techniques. The project concluded with several lessons for improving dissemination and policy, including: the dissemination workshops had a positive effect on …