Maternal and Child Health Commons^™

Autonomy, Intimate Partner Violence, And Maternal Health-Seeking Behavior: Findings From Mixed-Methods Analysis In Nigeria, Pooja Sripad, Charity Ndwiga, Charlotte E. Warren

Reproductive Health

Gendered norms and discriminatory practices often limit women’s decision-making power, which over time can lead to social norms that systematically subordinate women. Aspects of empowerment were explored in a global evaluation of Demographic and Health Survey data that measured how gendered social norms influenced maternal health-seeking behaviors. Analysis specifically explored associations of women’s autonomy and acceptability of intimate partner violence against women (IPVAW) on antenatal care use and facility delivery in 63 low- and middle-income countries. Service utilization is positively associated with increased autonomy and negatively associated with increased acceptability of IPVAW, but variability exists across countries and regions. In …

Exploring Barriers And Opportunities For Pre-Eclampsia And Eclampsia Prevention And Management In Ethiopia, Pooja Sripad, Hussein Ismail, Amy Dempsey, Karen Kirk, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project is a five-year cooperative agreement between the United States Agency for International Development (USAID) and the Population Council, in partnership with the Federal Ministry of Health Ethiopia, which seeks to expand access to quality underutilized interventions and commodities for the prevention and treatment of pre-eclampsia/eclampsia (PE/E). This report presents qualitative findings from formative research conducted to: 1) assess the policy and health systems environment related to PE/E prevention and management, 2) identify potential bottlenecks in the supply chain, 3) investigate PE/E knowledge, attitudes, and practices at policy, health system, and community levels, 4) describe the barriers …

Addressing Barriers To Quality Of Underutilized Commodities And Services For Prevention And Management Of Pre-Eclampsia And Eclampsia In Kenya, Charity Ndwiga, Pooja Sripad, Charlotte E. Warren

Reproductive Health

The Ending Eclampsia Project seeks to increase access to quality, underutilized interventions and commodities for the prevention, detection, and management of pre-eclampsia and eclampsia (PE/E), including promoting correct use of antihypertensive drugs and magnesium sulphate (MgSO4). This final report details the findings of a qualitative study that explored health system bottlenecks that prevent access to quality maternal and newborn health care in two Kenyan counties, Kakamega and Kitui, with a specific focus on PE/E. The study explored policy implementation gaps in Kenya’s newly devolved county government structure, to:1) assess the policy and health system environment for PE/E diagnosis, referral, and …

Retrospective Cohort Study: Clinical Presentation And Outcomes Of Pre-Eclampsia And Eclampsia At Kenyatta National Hospital, Nairobi, Kenya, Charity Ndwiga, Alfred Osoti, Pooja Sripad, George Odwe, Omondi Ogutu, Charlotte E. Warren

Reproductive Health

Pre-eclampsia has two distinct subtypes: early onset pre-eclampsia, which occurs before 34 weeks of gestation, and late onset pre-eclampsia, which occurs after 34 weeks. Few studies examine and compare early and late onset pre-eclampsia in a low- and middle-income country setting. This study’s goal was to establish a profile of patients with hypertensive disorders in pregnancy, especially pre-eclampsia and eclampsia, over a two-year period. At Kenya’s national referral hospital, clinical presentation at admission was examined, as was management of complications, along with maternal and newborn health outcomes in the hospital’s maternity unit, to ascertain any differences in health outcomes for …

The Nia Project: Baseline Report, Eunice N. Muthengi, Emily Farris, Karen Austrian

Poverty, Gender, and Youth

The onset of puberty and menarche is a particularly vulnerable time for girls, when external pressures are exacerbated by their lack of knowledge of their bodies, their rights, and the implications of their decisions, and by their inability to manage puberty and adolescence safely and comfortably with appropriate menstrual health and hygiene management (MHM) products. Although several programs have previously been developed to address girls’ MHM needs globally, few have been evaluated, and where evidence does exist the results have been mixed. In collaboration with ZanaAfrica, the Population Council is evaluating the Nia Project, a set of interventions for adolescent …

The Nia Project: Baseline Survey Instruments, Karen Austrian

Poverty, Gender, and Youth

This document includes all of the Nia Project baseline survey instruments used to collect data in Kenya, providing a multidimensional description of a sample of the participating girls and the schools they attend. The Project is one of the first randomized controlled trials to explore the role of sanitary pad distribution and reproductive health education—individually and in combination—to improve girls’ educational and sexual and reproductive health outcomes. The study collected data from 3,489 girls from 140 schools in three rural Kilifi subcounties: Magarini, Kaloleni, and Ganze.

The Nia Project—Brief, Eunice N. Muthengi, Emily Farris, Karen Austrian

Poverty, Gender, and Youth

This brief provides highlights from the Nia Project conducted in Kenya. The study found that while gaps exist in girls’ capabilities, particularly knowledge and attitudes related to menstruation and reproductive health, the Nia Project has the potential to bridge those gaps. The Project is one of the first randomized controlled trials to explore the role of sanitary pad distribution and reproductive health education—individually and in combination—to improve girls’ educational and sexual and reproductive health outcomes. The findings of this study will make a critical contribution to filling an evidence gap in the field of menstrual health and hygiene management, and …

Measuring Disrespect And Abuse To Promote Respectful Maternity Care, Population Council

Reproductive Health

The Heshima project developed several study instruments to measure disrespect and abuse throughout the study’s formative, baseline, and endline stages. The quasi-experimental implementation research design applied a mixed methods approach to understanding the meaning and factors that drive disrespect and abuse in maternity settings in Kenya. These tools allowed the project to measure the prevalence of disrespect and abuse in this setting, as well as the changes affected by the project.

The Heshima project involved a complex set of multi-level interventions that sought to curb disrespectful and abusive practices during childbirth and promote dignified and respectful maternity care. The evidence …

Risk Factors For Pre-Eclampsia And Eclampsia In Belize, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Belize.

Risk Factors For Pre-Eclampsia And Eclampsia In Cambodia, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Cambodia.

Risk Factors For Pre-Eclampsia And Eclampsia In Guatemala, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Guatemala.

Risk Factors For Pre-Eclampsia And Eclampsia In Nepal, Population Council

Reproductive Health

Each day around the world, 830 women die from pregnancy- and childbirth-related causes. The second most common cause (after postpartum hemorrhage) is a hypertensive disorder during pregnancy, such as pre-eclampsia and eclampsia (PE/E)—life-threatening, pregnancy-induced high blood pressure and excess protein in urine—which can lead to seizures and other fatal complications. One in four preterm infants dies as a result of its mother’s PE/E. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. This factsheet provides a graphic overview of the data surrounding this issue with a specific focus on Nepal.

Understanding Adolescent And Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth Friendly Service Programming, Aparna Jain, Hussein Ismail, Elizabeth Tobey, Annabel Erulkar

Reproductive Health

To meet the unique sexual and reproductive health needs of its large adolescent and youth population, Ethiopia’s government has expanded and institutionalized youth-friendly services (YFS) at all levels of the health system. To help inform and improve these efforts, the Evidence Project, in collaboration with USAID/Ethiopia and the Ethiopian Federal Ministry of Health, conducted a study on adolescents’ and young people’s use of and opinions on YFS. Results showed that young people were satisfied overall with the health services they received, regardless of whether it was basic health services or YFS. Awareness and use of YFS was low, but many …

Using Data To Target And Scale-Up Girls' Support Programs And Child Marriage Prevention, The Evidence Project

Reproductive Health

Though child marriage is declining globally, it is estimated that over 100 million girls under age 18 will be married in the next decade. A 2012 review of child marriage interventions in developing countries found that the most effective approaches in delaying child marriage were those that offered incentives, such as conditional cash transfers or provision of school materials, and those that empower girls directly through interventions such as girls’ groups and training. The Berhane Hewan program in Ethiopia (meaning ‘Light for Eve’ in Amharic) was one of the earliest to test child marriage prevention interventions in sub-Saharan Africa. The …

Harmonizing National Abortion And Pregnancy Prevention Laws And Policies For Sexual Violence Survivors With The Maputo Protocol, Jill Thompson, Chi-Chi Undie, Avni Amin, Ronald Johnson, Rajat Khosla, Ian Askew, Leopold Ouedraogo, Triphonie Nkurunziza, Sarah Rich, Elizabeth Westley, Melissa Garcia

Reproductive Health

In April 2016, the Population Council, the World Health Organization (WHO), and the International Consortium for Emergency Contraception (ICEC) convened a three-day regional technical meeting aimed at helping participating countries meet their obligations under the Maputo Protocol to protect and promote the reproductive health rights of women and girls, with a special emphasis on survivors of sexual and intimate partner violence. Participants included representatives from six countries in sub-Saharan Africa—Botswana, Ethiopia, Kenya, Malawi, Rwanda, and Zambia—as well as international and regional experts on reproductive health, law, and human rights. Presentations and discussions focused primarily on the prevention and management of …

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Bangladesh, Karen Kirk, Amy Dempsey

Reproductive Health

By 2015, at the conclusion of the Millennium Development Goals, Bangladesh had achieved a reduction in maternal deaths, however, despite the progress, there are still between 5,000 and 6,000 maternal deaths every year, with 20 percent the result of pre-eclampsia and eclampsia (PE/E). To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E at the national level, Ending Eclampsia conducted a systematic review of papers in Bangladesh published between 2000 and 2015 specifically looking at issues around the quality of care, gaps in the evidence, and barriers to accessing PE/E services. The main …

Access To Reproductive Health And Hiv Services Among Young Mothers In Tanzania, Francis Obare, Annette Almeida, George Odwe, Jamilla Mwanga, Chi-Chi Undie, Maurice Hiza, Feddy Mwanga

Reproductive Health

This report presents findings from a Population Council study that examined the experiences of young mothers in Tanzania with accessing reproductive health and HIV services during pregnancy, delivery/pregnancy termination, and the postpartum period. The overall objective of the study was to generate evidence on access to reproductive health and HIV services among young mothers aged 12–19 years in Tanzania in order to inform programming and actions to better meet their needs. It specifically examined their experiences with accessing reproductive health (safe motherhood and contraception) and HIV (testing and counseling, PMTCT, antiretroviral therapy, and early infant diagnosis) services as well as …

Adolescent Friendly Health Corners (Afhcs) In Selected Government Health Facilities In Bangladesh: An Early Qualitative Assessment, Sigma Ainul, Iqbal Ehsan, Tasmiah Tanjeen, Laura Reichenbach

Reproductive Health

With high rates of early marriage, especially among girls, a significant proportion of adolescents in Bangladesh need sexual and reproductive health services (SRH), including contraceptive information. To address this gap and ensure that adolescents throughout the country, including unmarried adolescents, have access to SRH services through public health facilities, the Maternal and Child Health Services Unit of the Directorate General of Family Planning, with financial and technical assistance from development partners, has begun establishing Adolescent Friendly Health Corners (AFHCs) at selected government facilities at district and union levels. The Evidence Project/Population Council was asked to assess the implementation of the …

Charity: A Health Volunteer Success Story, Amy Dempsey

Reproductive Health

Results from Ending Eclampsia’s landscape analysis of seven states in Nigeria served as the catalyst for a training with Community Health Extension Workers (CHEWs) in Nigeria. Researchers conducted observations of client–provider interactions during antenatal care (ANC) visits and assessed healthcare providers’ knowledge of proven risk factors for pre-eclampsia, including chronic hypertension, previous history of PE/E, obesity, pre-existing diabetes or diabetes in pregnancy, advanced maternal age, sickle cell diseases, and connective tissue diseases. The training’s objective was to teach CHEWs how ANC providers can prevent pregnancy-related complications like pre-eclampsia and eclampsia (PE/E). Following the training the CHEWs felt that they can …

Contribution Of Contraceptive Discontinuation To Unintended Births In 36 Developing Countries, Population Council

Reproductive Health

High contraceptive discontinuation results in millions of women having an unmet need for contraception. This Population Council study using data from 36 Demographic and Health Surveys shows that contraceptive discontinuation also results in millions of unintended pregnancies and births. This brief recommends attention to issues related to quality of care, such as counseling, to ensure that each woman has the method she needs/wants and uses it correctly. This will help women avoid contraceptive discontinuation and associated unmet need and unintended fertility right from the beginning. As programs become more successful, quality of care will become key to expanding contraceptive use …

Enhancing Access To Post-Rape Care For Child Survivors In The Context Of Police And Health Services In Zambia: A Feasibility Assessment Of A Police Response Model, Nachela Chelwa, Kshipra Hemal, George Msipu Phiri, Michael Mbizvo, Chi-Chi Undie

Reproductive Health

This study builds on previous interventions by the Population Council and the Zambia Police Service to mitigate unintended pregnancy and HIV among survivors of sexual violence by involving trained police in task-sharing interventions. These previous efforts have involved police providing emergency contraceptive pills and HIV post-exposure prophylaxis to survivors reporting to police stations, in addition to referrals to health facilities. The objective of the current study was to assess the feasibility of implementing a transportation intervention within police stations, coupled with training and sensitization for police officers to perform their government-mandated roles in post-rape care. This intervention was developed as …

Enhancing Frontline Health Workers' Abilities To Improve Mnch Services In Bauchi State Through Task Shifting/Sharing, Sylvia Adebajo, Ekechi Okereke, Friday Joseph

Reproductive Health

Frontline health workers (FLHWs), including nurses, midwives, community health extension workers, and community health officers, are healthcare providers with the greatest access to clients and patients, and provide initial care to persons in need of health services. In 2014, Nigeria’s 57th National Council on Health approved a task-shifting and sharing (TSS) policy for essential healthcare services as a promising strategy for improving access and efficiency in Nigeria’s health system. Subsequently, FLHWs in Nigeria have been trained for new roles and functions traditionally reserved for mid- or high-level cadres, to optimize available providers and their capacities. This brief reviews the strategy …

Enhancing Frontline Health Workers' Abilities To Improve Mnch Services In Cross River State Through Task Shifting/Sharing, Sylvia Adebajo, Ekechi Okereke, Friday Joseph

Reproductive Health

There is a shortage of qualified and skilled health professionals providing cost-effective maternal, newborn, and child health (MNCH) services in Cross River State, Nigeria. Frontline health workers (FLHWs) have the potential to learn new skills as part of a task-shifting and sharing (TSS) policy. This brief highlights the results of the TSS policy in Cross River state: village health workers identify and refer pregnant women in their communities to antenatal clinics and provide oral medications; community health workers perform initial case management and ensure quick referrals to secondary facilities for specialized care; nurses and midwives deliver MNCH interventions that are …

Exploring The Association Between Fgm/C And Early/Child Marriage: A Review Of The Evidence, Jamlick Karumbi, David Gathara, Jacinta Muteshi-Strachan

Reproductive Health

Female genital mutilation/cutting (FGM/C) has been frequently linked to marriageability and thought to be associated with child marriage, yet there is remarkably little rigorous research to clarify the relationship between these two practices to inform discussions and responses. Furthermore, trends are also shifting in the timing of FGM/C from adolescence to early childhood, and the implications this might have on the links between early/child marriage and FGM/C are not well understood. This review of current available evidence aims to assess the association between FGM/C and early/child marriage in contexts where both practices are carried out. The social and cultural norms …

Exploring The Association Between Fgm/C And Fistula: A Review Of The Evidence, Pooja Sripad, Charity Ndwiga, Kaji Tamanna Keya

Reproductive Health

Female genital mutilation/cutting (FGM/C) and fistula are both conditions that have a range of health, socioeconomic, and lifestyle causes and consequences for women globally. There have been sparse empirical and conceptual efforts to look at how these two conditions manifest and relate to one another. This rigorous review of the literature aims to fill this research gap by assessing the state of evidence on the association of FGM/C and fistula and conceptually mapping this association within broader social, political, and health-systems contexts. Based on the findings, the authors of this report have developed a conceptual mapping framework to situate the …

Female Genital Cutting In Somaliland: Baseline Assessment, Katy Newell-Jones

Reproductive Health

This report summarizes research findings into the prevalence and attitudes around female genital cutting (FGC) in 20 communities across five regions of Somaliland. There was a specific focus on young people, who accounted for 47 percent of the interviewees, and also on the role of schools in promoting abandonment of cutting. This research found that the prevalence of FGC in the five regions studied is 98.9 percent across all age groups in city, semi-city, and village communities. The findings indicate that decisionmaking in relation to FGC has less to do with having accurate knowledge, and more to do with the …

Female Genital Mutilation/Cutting In Kenya: Is Change Taking Place? Descriptive Statistics From Four Waves Of Demographic And Health Surveys, Bettina Shell-Duncan, David Gathara, Zhuzhi Moore

Reproductive Health

Nationally representative survey data on female genital mutilation/cutting (FGM/C) in Kenya are available from four waves of Demographic and Health Surveys. These survey data provide a rich and detailed picture of when, where, and how FGM/C has been carried out, and trends in changes in the practice. National prevalence data from successive waves of surveys show a steady decrease in the prevalence of FGM/C among women aged 15–49. While the data reported here are descriptive, they provide useful insights on the progress of FGM/C abandonment at national and subnational levels. These findings are useful for policymakers in steering discussions on …

Female Genital Mutilation/Cutting In Nigeria: A Scoping Review, Blessing U. Mberu

Reproductive Health

This report’s overarching objective is the examination of key trends in the evidence base of female genital mutilation and cutting (FGM/C) and gaps in knowledge for Nigeria, building on a scoping review of peer-reviewed and "grey" literature along with quantitative analysis of relevant data. What is clear from prevalence levels identified over the last 15 years is how widespread different types of FGM/C are, in Nigeria’s different ethno-geographical zones, and the little change that has taken place over time, despite increased international, and renewed national, political commitment to eradicate the practice. The findings show that much work remains to be …

Florence: A Midwife Success Story, Amy Dempsey

Reproductive Health

Ebonyi State is one of three states in Nigeria where the Ending Eclampsia project provides trainings, mentoring, and supportive supervision focused specifically on pre-eclampsia/eclampsia (PE/E) detection, prevention, and treatment measures. This brief reports on the success of one nurse/midwife who attended an Ending Eclampsia–led training on proper detection of pre-eclampsia, administration of the magnesium sulphate for severe cases, and referral of PE/E patients to secondary facilities for management. When there are gaps in providers’ skill sets, partners like Ending Eclampsia, UNICEF, and UNFPA help to bring them up to standard by providing supportive supervision and on-the-job trainings that span a …

Knowledge And Practices For Pre-Eclampsia And Eclampsia Care In Bangladesh, Kanij Sultana, Amy Dempsey

Reproductive Health

The Bangladesh Maternal Mortality Survey revealed that pre-eclampsia and eclampsia (PE/E) is the second most common direct cause of maternal deaths—between 1,000 and 1,200 maternal deaths (20 percent) each year. Early detection and treatment during antenatal care visits are instrumental in reducing deaths from PE/E. In Bangladesh, however, primary healthcare providers have limited knowledge of the condition, and in many cases are unaware of how to detect, manage, and treat it. This research brief presents the findings of a landscape analysis that was conducted to better understand service providers’ maternal health knowledge, attitudes, and practices, particularly around PE/E.