Women's Health Commons^™

What Do We Know About The Hiv Risk Characteristics Of Adolescent Girls And Young Women In Zambia? Findings From Dreams Implementation Science Research, Population Council

HIV and AIDS

The Population Council is conducting implementation science research in Zambia and other countries across sub-Saharan Africa to build needed evidence to inform community-based, girl-centered HIV-prevention programming. Critical to this process is understanding adolescent girls’ and young women’s (AGYWs’) knowledge, attitudes, sexual behaviors, and characteristics of their sexual partnerships that may put them at risk of HIV acquisition. This results brief summarizes key findings from a cross-sectional survey of 1,915 AGYW, half of whom were 15–19 years old and the other half 20–24 years old, residing in urban districts of Lusaka and Ndola. The findings in this brief were shared at …

Evaluating A Multidisciplinary Integrated Management Team Intervention To Improve Maternal And Child Outcomes And Hiv Service Uptake And Retention In Lesotho, Project Soar

HIV and AIDS

Pregnant and postpartum HIV-positive women face a particularly complex set of barriers to prevention of mother-to-child transmission of HIV (PMTCT) uptake at the policy, health facility, community, and individual levels. They are vulnerable to poor retention in care and adherence to treatment, especially in the first three months after initiation of treatment and the postpartum period. In addition, counseling and support for primary prevention among HIV-negative pregnant women is almost nonexistent in PMTCT programs. This brief describes the IMPROVE study—a multidisciplinary integrated management team intervention to increase maternal and child health and HIV service uptake and retention—that Project SOAR is …

Modeling The Expected Cost-Effectiveness And Impact Of Oral Pre-Exposure Prophylaxis In Uganda And Swaziland, Project Soar

HIV and AIDS

Clinical trials have shown that oral antiretrovirals (ARVs) containing tenofovir/emtricitabine used by HIV-negative individuals to prevent HIV acquisition, called oral pre-exposure prophylaxis (PrEP), are safe and effective in several populations. Prior modeling work has demonstrated that oral PrEP is most cost effective when targeted to populations at very high risk of infection, with risk dependent on a combination of individual behavior and epidemic contexts. This brief describes a study Project SOAR is conducting to assist Uganda and Swaziland in making critical decisions about oral PrEP introduction and scale up by modeling the expected cost effectiveness and impact of oral PrEP …

How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba

Reproductive Health

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this …

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson

Reproductive Health

Both the family planning sector and the environmental sector will be interested in this synopsis of findings from a study of the first four years of the Tuungane integrated population, health, and environment (PHE) project in Tanzania. The objectives of the Tuungane Project are to achieve healthier families, healthier forests, and healthier fisheries, using an integrated, cross-sectoral approach. Analyses of the 2011 baseline and 2016 midline quantitative data, and additional qualitative data from 2016, measured the project’s progress and shed light on the contribution of the project interventions to building resilience, and on the links between family planning and other …

Dynamics Of Injectable Contraceptive Use In India, The Evidence Project

Reproductive Health

This brief describes a research study by the Population Council, with support from USAID/India, whose purpose is to provide evidence that can be used to strengthen the family planning program and meet the needs of reversible contraceptive users who want to prevent pregnancy in India. Understanding the experiences of the small but growing population of women choosing the injectable is important as the Government of India continues to roll out injectable contraceptive methods in the public sector. The report’s key recommendations include: disseminating messaging about potential side effects of the injectable, institutionalizing quality of care in pre-service trainings for all …

Dynamics Of Interval Iud Use In India, The Evidence Project

Reproductive Health

The IUD is an important long-acting, reversible contraceptive method, and an alternative to permanent female sterilization that does not carry the risk of regret. In India, as the government aims to expand the basket of reversible method choice available to women, understanding the experiences of those who use the interval IUD is paramount. This brief describes a study by the Population Council, with support from USAID/India, which found that overall there is room to improve the quality of services clients receive. The report recommends disseminating messaging about potential side effects of the IUD, training frontline health workers on four domains …

Dynamics Of Oral Contraceptive Pill Use In India, The Evidence Project

Reproductive Health

The purpose of this brief is to provide evidence that can be used to strengthen the family planning program in India, particularly for community-based and facility-based distribution of oral contraceptive pills (OCPs), use of which remains low despite their availability. Understanding women’s interactions with frontline health workers while obtaining the method and during follow-up counseling can help the Government of India improve its National Family Planning Program. Based on its findings, the report recommends that all providers, especially frontline health workers, receive training focusing on four domains of quality of care: 1) respectful care, 2) counseling to enable appropriate method …

Dynamics Of Postpartum Iud Use In India, The Evidence Project

Reproductive Health

Evidence suggests that in India, compared to married women in general, postpartum married women have a much higher need for family planning that remains unmet. India’s postpartum IUD (PPIUD) program aims to help postpartum women space pregnancies and prevent mistimed or unwanted births. The majority of PPIUD users in this study were young, educated, and had one child. Most were involved in making the final decision about which family planning method to use after discussions with the provider, and most had spoken with a frontline health worker at least once about family planning methods in the three months preceding birth …

Ending Eclampsia: Phc Ph/E_Plus Model, Charlotte E. Warren

Reproductive Health

Pre-eclampsia and eclampsia (PE/E)—life-threatening high blood pressure and excess protein in the urine after 20 weeks gestation—is a leading cause of pregnancy-related deaths. These deaths are preventable, yet essential medicines and tools to treat this disorder are often unavailable in low-resource settings. The Population Council implemented a two-phase intervention involving training, mentoring, and supervising providers at secondary facilities on detection and management of PE/E patients (Phase 1), and training primary health care (PHC) providers to administer a modified loading dose of magnesium sulphate and refer women to secondary health facilities for monitoring (Phase 2). This brief describes the Population Council’s …

Engaging Community Women's Groups For Improved Uptake Of Antenatal Care Services In Cross River State, Nigeria: An Analysis Of Post-Intervention Findings, Salisu Mohammed Ishaku

Reproductive Health

The Ending Eclampsia project seeks to understand the potential of underutilized and promising interventions that increase access to services, particularly improving community referral systems. This brief reports on a study in Nigeria’s Cross River state that aimed to test the feasibility of women’s group leaders delivering health information for pre-eclampsia and eclampsia (PE/E), referral, and other antenatal care (ANC) services to their peers, to increasing access to quality maternal and newborn health services. Women’s group findings suggest that community engagement is a critical model for information sharing and is an adaptable, acceptable model for increasing PE/E prevention and danger-sign recognition …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Cross River State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Cross River State on post-intervention landscape changes in: programmatic …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Ebonyi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Ebonyi State on post-intervention landscape changes in: programmatic and …

Findings From Post-Intervention Analysis Of Pre-Eclampsia/Eclampsia In Kogi State, Salisu Mohammed Ishaku

Reproductive Health

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Kogi state on post-intervention landscape changes in: programmatic and …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Ebonyi, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Ebonyi …

Reducing Barriers To Accessing Fistula Repair: Implementation Research In Katsina, Pooja Sripad, Emmanuel Nwala, Vandana Tripathi

Reproductive Health

Female genital fistula is preventable and surgically treatable, but women who lack access to quality health care often live with fistula for many years. For every 1,000 births, an estimated 2.11 women develop fistula in Nigeria and despite the establishment of internationally accredited national fistula centers across the country, the majority of women live with unrepaired fistula. The Population Council, in collaboration with EngenderHealth and the Fistula Care Plus project, conducted implementation research to understand whether a comprehensive information, screening, and referral intervention reduces transportation, communication, and financial barriers to accessing preventive care, detection, and treatment of fistula in Katsina …

Three Essays On Maternal And Child Health, Mandar V. Bodas

Theses and Dissertations

This dissertation is a collection of three separate essays on the health of women and children. In the first essay, I along with my co-authors, analyzed the impact of two large, national-level health policies (the Janani Suraksha Yojana (JSY) and the National Rural Health Mission (NRHM)) on maternal health outcomes (proportion of institutional deliveries) in India. We used data from the India Human Development Survey (IHDS) and found that the JSY and the NRHM had a greater impact on institutional deliveries in high-focus states. We also found that the conditions of the public health facilities, did not change after the …

Family Planning And Hiv Interventions Among Women In Low-Income Settings, Steven P. Masiano

Theses and Dissertations

This dissertation examines the effectiveness of interventions related to family planning and the uptake of HIV-related preventive services among women in low-income settings. Women in low-income settings and living with HIV face many barriers to care, including limited access to services for family planning and HIV-related preventive care. At the same time, national, regional, and global efforts are looking for interventions to help control rapid population growth, create an HIV-free generation, and provide adequate preventive care for those living with HIV. This dissertation cuts across these issues and can help to inform debate and policies to address these issues.

This …

Nutritional Status Of Infants At Six Months Of Age Following Maternal Influenza Immunization: A Randomized Placebo-Controlled Trial In Rural Nepal., Joanne Katz, Janet A Englund, Mark C Steinhoff, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Luke C Mullany, Helen Y Chu, Steven C Leclerq, Naoko Kozuki, James M Tielsch

Global Health Faculty Publications

Background

Maternal influenza vaccination has increased birth weight in two randomized trials in South Asia but the impact on infant growth is unknown.

Methods

A randomized placebo-controlled trial of year round maternal influenza immunization was conducted in two annual cohorts in Sarlahi District, southern plains of Nepal, from April 2011 through April 2014. Infants born to women enrolled in the trial had weight, length, and head circumference measured at birth and 6 months of age. The study was powered for the 3 primary trial outcomes but not for stunting and wasting at 6 months of age.

Results

3693 women received …

Impact Of Maternal Vaccination Timing And Influenza Virus Circulation On Birth Outcomes In Rural Nepal., Naoko Kozuki, Joanne Katz, Janet A Englund, Mark C Steinhoff, Subarna K Khatry, Laxman Shrestha, Jane Kuypers, Luke C Mullany, Helen Y Chu, Steven C Leclerq, James M Tielsch

Global Health Faculty Publications

Objective

To describe the effect of maternal vaccination on birth outcomes in rural Nepal, modified by timing of vaccination in pregnancy and influenza virus activity.

Methods

A secondary analysis was conducted using data from two annual cohorts of a randomized controlled trial. A total of 3693 pregnant women from Sarlahi District were enrolled between April 25, 2011, and September 9, 2013. All participants were aged 15–40 years and received a trivalent inactivated influenza vaccine or placebo. The outcome measures included birth weight, pregnancy length, low birth weight (<2500 g), preterm birth, and small‐for‐gestational‐age birth.

Results

Data were available on birth weight for 2741 births and on …

Essential Newborn Care During Humanitarian Crises: Integration Of Low-Cost Interventions, Athena Wong

Independent Study Project (ISP) Collection

Newborn healthcare has long been neglected on the international agenda despite neonatal death making up 44% of all under-five deaths. Neonates are newborns under 28 days of age and are the most vulnerable population with the highest risk of mortality during humanitarian emergencies. The common misconception that neonatal healthcare is very expensive and requires delivery from highly skilled healthcare professionals must be dismissed. There are many low-cost interventions that are highly effective at saving lives, the most notable ones being kangaroo mother care, bag and mask resuscitation, and basic immunizations. The leading causes of neonatal death are prematurity, intrapartum complications, …

Do Marketing Strategies Impact Condom Sales In Uganda?, Meyhar Mohammed

Master's Theses

What attracts people to buy condoms? HIV/AIDS remain one of the biggest health dangers of the world, especially in Sub-Saharan Africa. A lot of efforts have been pursued in the past two decades to drastically reduce prevalence of HIV and increase awareness about preventive mechanisms. In order to prevent relapse of success achieved so far, it is important to recognize transformation of consumer behavior due to growth in social networks, education and awareness over time. There are a lot of behavioral triggers captured by social marketing interventions in the field of public health. In an attempt to investigate the role …

Equity And Community-Based Health Insurance: How Does Insurance Coverage Affect Health Seeking Behavior Among Disadvantaged Groups In India?, Hazel Hering

Independent Study Project (ISP) Collection

The objective of this study is to examine how Community-Based Health Insurance (CBHI) can promote equity by improving health seeking behavior across gender and geography. Using a CBHI scheme from the Self-Employed Women’s Association (SEWA) as a case study, trends in claims filed between October 2016 and March 2017 are compared to the distribution of memberships in order to investigate whether health insurance coverage positively impacts health seeking behavior among disadvantaged groups, and what barriers to access exist when the burden of medical costs are reduced. This study concludes that the number of male and female claims in the sample …

Improving Health Outcomes In Trafficking Survivors Through Core Skills Development In The Workplace: Experience From The Philippines, Melinda A. Gill

Dignity: A Journal of Analysis of Exploitation and Violence

Whilst an emerging body of research documents the adverse physical and mental health outcomes of victims of trafficking following rescue, there is little research or guidance regarding interventions which improve these outcomes. In this article, I describe my experience as physician involved in a computer-based social enterprise for survivors of trafficking and slavery in the Philippines, and outline my evolving understanding of the requirements for health behavior change and improved outcomes. I conclude that while meaningful vocational skills, economic security, and adequate health-related knowledge are foundational, it is necessary to develop core skills to achieve improved health outcomes and that …