Women's Health Commons^™

Performance And Measurement Of A Community-Based Distribution Model Of Family Planning Services In Pakistan, Syed Khurram Azmat, Shirin Ahmed, Waqas Hameed, Mohsina Bilgrami, Ayesha Khan, Adnan Ahmad Khan, Ghulam Mustafa

Community Health Sciences

Introduction: Community-based distribution (CBD) has been successfully applied to family planning (FP) services worldwide. It forms the basis for the large lady health worker (LHW) programme in Pakistan which serves a limited number of women with contraception services. Thus, the concept has seen limited application in Pakistan. We present the outcomes of a CBD model that was implemented in 49 districts across Pakistan by a non-government organization (NGO).
Methods: The Marie Stopes Society (MSS) developed a CBD model around its fixed centres and reached around half a million married women of reproductive age (MWRA) with services. The services provided included …

Iud Discontinuation Rates, Switching Behavior, And User Satisfaction: Findings From A Retrospective Analysis Of A Mobile Outreach Service Program In Pakistan, Syed Khurram Azmat, Waqas Hameed, Ghulam Mustafa, Wajahat Hussain, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: In Pakistan, the uptake rate for the intrauterine device (IUD) is very low at 2.5%. The most popular modern contraceptive methods in Pakistan are female sterilization and use of condoms. The Marie Stopes Society established its mobile outreach service delivery program with the aim of increasing use of modern quality contraceptive services, including the long-term reversible IUD, by women living in hard-to-reach areas. The present study attempts to assess IUD discontinuation rates and associated factors, including switching behavior and level of satisfaction with this type of service delivery.
Methods: Using a cross-sectional approach, we contacted 681 women who had …

Post-Abortion Care In Pakistan: A National Study, Zeba Sathar, Susheela Singh, Zakir Hussain Shah, Gul Rashida, Iram Kamran, Kanwal Eshai

Reproductive Health

The objectives of this Population Council study were twofold: first to collect information on prevailing practices of abortion and post‐abortion care in Pakistan and, second, to gauge changes in the magnitude and quality of abortion‐related complications and care during the last decade (since the 2002 national study of “Unwanted Pregnancy and Post‐abortion Complications in Pakistan”). The study found that the level of post‐abortion family planning (FP) counseling in both public and private health facilities offering PAC services was inadequate. There has been no improvement over the decade in the level of counseling reported, and, even more disappointingly, only half of …

Unmet Need And Unintended Pregnancy: The Bigger Picture, Ian Askew

Reproductive Health

No abstract provided.

Subjective Health Status And Health-Related Quality Of Life Among Women With Recurrent Vulvovaginal Candidosis (Rvvc) In Europe And The Usa, Samuel Aballéa, Florent Guelfucci, Julian Wagner, Amine Khemiri, Jean-Paul Dietz, Jack Sobel, Mondher Toumi

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Recurrent vulvovaginal candidosis (RVVC) is a chronic condition causing discomfort and pain. Health status and health-related quality of life (HRQoL) in RVVC were never previously described using validated questionnaires. The objective of this study is to describe subjective health status and HRQoL and estimate health state utilities among women with RVVC.

Methods

A cross-sectional online survey was conducted among women who reported having suffered four or more yeast infections over the past 12 months, in five European countries (France, Germany, Italy, Spain and the UK) and the USA. Index scores were derived from the EQ-5D, a questionnaire providing …

Quality Of Care And Client Willingness To Pay For Family Planning Services At Marie Stopes International In Burkina Faso, Placide Tapsoba, Dalomi Bahan, Emily Forsyth Queen, Gisele Kaboré, Sally Hughes

Reproductive Health

Many sexual and reproductive health programs operating in a limited-resource setting face a challenging balancing act between making services accessible and affordable to clients, including those most in need, and remaining financially sustainable. To achieve these dual objectives, the Population Council, with Marie Stopes International in Burkina Faso (MSI BF), launched a willingness-to-pay (WTP) study that examined the current situation and numerous pricing options, proposing optimal prices for products and services. The process of implementing the WTP survey was insightful for MSI BF as it provided evidence on client satisfaction with services and willingness to contribute to the cost of …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape And Defilement In Sub-Saharan Africa: A Regional Overview, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

No abstract provided.

Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

Un profil pays a été préparé pour le Sénégal pour compiler et synthétiser les informations disponibles sur la santé de la reproduction, en particulier les grossesses non désirées et par conséquent les besoins non satisfaits en matière de planification familiale. D’importants efforts ont été consentis par l’Etat sénégalais, mais de nombreux obstacles continuent de freiner les progrès réalisés. Un programme national plus cohérent et ciblé est donc nécessaire pour réduire ces obstacles. Dans le même temps, les acteurs non-gouvernementaux devraient poursuivre leurs efforts pour renforcer leur programmation pour produire des effets plus immédiats, tout en assurant une meilleure coordination entre …

Availability, Use And Quality Of Care For Medical Abortion Services—Preliminary Results Of Two Components: Kiis And The Pharmacy Study, Wilson Liambila, Harriet Birungi, Francis Onyango, Brian Mdawida, Vitalis Akora, Thoai Ngo, Kate Reiss

Reproductive Health

No abstract provided.

Silent Uterine Rupture Of Scarred Uterus--An Unusual Presentation As Amniocele, Aisha Syed Wali, Tahira Naru

Department of Obstetrics & Gynaecology

Obstetricians should be aware of the possibility of silent rupture of scarred uterus. Ultrasound has an important role in the diagnosis of silent uterine rupture. A case of silent uterine rupture with foetal demise, that remained undiagnosed for many weeks, is described.

Post-Abortion Care Family Planning Use In Pakistan, Syed Khurram Azmat, Waqas Hameed, Muhammad Ishaque, Ghulam Mustafa, Aftab Ahmed

Community Health Sciences

Introduction: The stagnated CPR and high unmet need for contraception lead to approximately 890,000 induced abortions every year in Pakistan. A fairly recent study from Pakistan also revealed that around 40% of abortions are performed by unskilled workers in backstreet clinics. Considering these grave statistics, it should not come as surprise that unwanted pregnancies are the leading cause of induced abortions in Pakistan. Despite country's inferior situation, there is no data available in Pakistan that unveils the much needed information pertaining to post-abortion care family planning (PAC) use. Thus, this paper attempts to document socio-demographic profile seeking post-abortion care clients; …

Rates Of Iucd Discontinuation And Its Associated Factors Among The Clients Of A Social Franchising Network In Pakistan, Syed Khurram Azmat, Babar Tasneem Shaikh, Waqas Hameed, Mohsina Bilgrami, Ghulam Mustafa, Muhammad Ali, Muhammad Ishaque, Wajahat Hussain, Aftab Ahmed

Community Health Sciences

Background: Modern Intrauterine contraceptive device (IUCD) is very safe, highly effective reversible and inexpensive family planning method which offers 5-10 years of protection against pregnancy. The contraceptive use in Pakistan has been merely 30% for over a decade with IUCD being the least used method. Higher discontinuation rates are documented in developing countries; however no such data is available for Pakistan. Marie Stopes Society (MSS) established a social franchise outlets network branded as 'SURAJ' (Sun) in Pakistan to provide quality family planning services. This study attempts to determine IUCD discontinuation rates and its associated risk factors. Using a semi-structured questionnaire, …

Barriers And Perceptions Regarding Different Contraceptives And Family Planning Practices Amongst Men And Women Of Reproductive Age In Rural Pakistan: A Qualitative Study, Syed Khurram Azmat, Ghulam Mustafa, Waqas Hameed, Muhammad Ali, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: Pakistan ranks as one of the most poorest and most populous in the world with poor reproductive health indicators. This study helps in understanding barriers and perceptions regarding Family Planning (FP), modern contraception, quality of care and free of charge FP services amongst men and women in rural Pakistan.
Methods: Employing purposive sampling and Focus Group Discussion (FGD) technique, this qualitative study was conducted with men and women of reproductive age in Pakistan. A total of eight FGDs were conducted in Sindh and Punjab provinces. Being descriptive in nature, the study provided a thematic analysis of the relevant health …

Attitudes, Beliefs, And Practices Of Providers And Key Opinion Leaders On Emergency Contraception In India, M.E. Khan, Deepthi S. Varma, Isha Bhatnagar, Anvita Dixit, Martha Brady

Reproductive Health

The Population Council undertook this study to assess the knowledge, attitudes, and practices regarding emergency contraception (ECP) among providers in public and private facilities and pharmacies in India. The objectives of the study were to: assess providers' knowledge of ECP's biological mechanism; understand providers' knowledge and attitudes about ECP's safety, effectiveness, and availability as an OTC drug; and identify providers' definitions of “repeated use” and profiling women who are “repeated users” of ECP. This study's findings show that most providers, including doctors and some KOLs, were incorrectly informed about ECP's mechanism of action. Service guidelines are necessary for accurate and …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In Nigeria, Babatunde A.O. Ahonsi, Salisu Mohammed Ishaku, Araoyinbo Idowu, Ayodeji Oginni

Reproductive Health

Despite significant progress in product development, procurement, and distribution in the past few decades, emergency contraception’s (EC) capacity to benefit many women in countries such as Nigeria is hampered by a number of potential barriers, that are not well understood. The Population Council, with support from the International Consortium for Emergency Contraception, documented EC-related knowledge, attitudes, and practices among providers in Nigeria as well as perceptions of key opinion leaders who help shape the policy environment for EC and family planning in general. Findings suggest significant gaps in Nigeria, potentially necessitating continuous training and re-training to help dispel misperceptions and …

Does Cerclage Improve Neonatal Outcomes In A Molar Pregnancy And A Coexistent Fetus? A Case Report, Eduardo Aguin, Victor Aguin, Ligia Cisneros, Tina Aguin, Cosmas Van De Ven, Ray Bahado-Singh

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome.

Case presentation

A patient presented with vaginal spotting around 23 weeks. She has a history of four preterm deliveries. Her cervix was dilated and a cerclage was placed. She presented again with PPROM around 25 weeks. She went into spontaneous preterm labor and delivered a viable fetus that is a healthy girl …

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Increasing Access To Family Planning And Reproductive Health Services Through Community Work: A Case Study Of A Dual Cadre Model In India, Jaleel Ahmad, Isha Bhatnagar, M.E. Khan

Reproductive Health

Before the introduction of Accredited Social Health Activists (ASHAs) in India, mid-level auxiliary nurse midwives (ANMs) were responsible for community health education and services such as antenatal care, delivery, IUCD insertion, and sterilization referrals. The Population Council studied how community extension work and some primary care responsibilities have been shifted to ASHAs, who are tasked with identifying pregnant women; facilitating ANC check-ups; motivating women for institutional deliveries during ANC checkups; and organizing child immunization. Establishing dual worker cadres in India by shifting community extension tasks from ANMs to local ASHAs has been well conceived. Task shifting has allowed ANMs, as …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Critical Issues For Integrating Srh And Hiv/Aids Services To Provide Dual Protection Against Unintended Pregnancy And Hiv/Sti Acquisition, Population Council

Reproductive Health

This document reports on a one-day symposium that was held by the STEP UP (Strengthening Evidence for Programming on Unintended Pregnancy) Research Program Consortium, coordinated by the Population Council. STEP UP generates policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion in Bangladesh, Ghana, India, Kenya, and Senegal. The symposium’s objectives were to review and discuss critical and emerging issues around integrating SRH and HIV and AIDS services to enable dual protection, including new directions in dual protection technology and behaviour change interventions. The meeting also provided an opportunity to discuss the programmatic …

Replication Of The Community Mobilization For Postabortion Care (Commpac) Model In Naivasha District, Rift Valley Province, Kenya: An Evaluation Report, Chi-Chi Undie, Francis Obare, Saumya Ramarao

Reproductive Health

The Population Council’s RESPOND project worked with districts and communities in Kenya to: strengthen service delivery points to provide postabortion care (PAC) services; conduct community mobilization to improve involvement in and knowledge of the prevention and treatment of postabortion complications; build community capacity to address needs related to PAC; and encourage involvement in community action of those most marginalized and most affected by postabortion complications. The program succeeded at increasing knowledge of critical danger signs; enabling providers to effectively offer PAC services; and raising awareness of PAC, among other goals. The intervention was less successful in increasing FP knowledge, current …

Birth Spacing And Family Planning Uptake In Pakistan: Evidence From Falah, Arshad Mahmood

Reproductive Health

The Population Council was the lead implementing agency for the Family Advancement for Life and Health (FALAH) project in Pakistan. The project’s main objectives were to achieve a 10 percent increase in the use of moden contraceptives, to equip 80 service delivery points to provide family planning services, and to ensure birth-spacing understanding and ways to achieve it by three-quarters of the target population. The main conclusion of this research is that a sharp uptake of family planning is possible in a relatively short time, if certain investments are made to ensure better communication and greater access to quality family …

Country Mapping: Kenya, Francis Obare, Wilson Liambila, Harriet Birungi, Eseoise Itombra, Heather Clark, Saumya Ramarao

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and to develop a strategic plan for its introduction. This technical report presents the findings of the assessments in Kenya with specific focus on: (1) the country’s demographic profile; (2) the health systems, health policy, and family planning program context; and (3) stakeholder perspectives regarding the PVR. The findings suggest that the introduction of the PVR would fill a gap in the family planning needs of breastfeeding women in Kenya, and there is strong support from stakeholders …

Country Mapping: Nigeria, Salisu Mohammed Ishaku, Saumya Ramarao

Reproductive Health

The Population Council conducted a three-year acceptability study of the progesterone vaginal ring (PVR) in three sub-Saharan African countries. This technical report presents results from Nigeria, laying out the country’s demographics and high fertility rates; describing the family planning program and policy context; and, finally, revealing the stakeholder support thus far with a discussion on how best to proceed with introduction activities. This country mapping confirms the likelihood that the PVR would be well received in Nigeria and fill a large need in family planning. The PVR is a safe, long-acting, user-controlled product that can be easily inserted and removed …

Country Mapping: Senegal, Babacar Mane, Nafissatou Diop, Nancy Termini Lachance, Saumya Ramarao, Heather Clark

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and its potential introduction. This technical report presents results from assessments undertaken to map the existing landscape of family planning programs and new contraceptive technologies in Senegal in an effort to identify national priorities and assess the level of interest in the PVR among stakeholders and to design appropriate preintroductory activities. This country mapping exercise confirms that Senegal is a promising context for the introduction of the PVR: the government is committed to repositioning family planning and …

Contraceptive Use Dynamics In Pakistan 2008-09, Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This report looks at contraceptive use dynamics in Pakistan, focusing on contraceptive discontinuation, method failure, and contraceptive switching, as well as the reasons for discontinuation. The study found that almost one-third of discontinuations were due to side effects followed by one-fifth of them by the method failure. Side effects were the most common reason for discontinuing modern methods (IUDs and hormonal methods), while failure was the most common reasons for discontinuing barrier and traditional methods (condom, rhythm, withdrawal). Based on the findings of this study, this report suggests that better training of health providers and better information and counseling of …

Attitudes, Beliefs, And Practices Of Key Opinion Leaders (Kol) And Providers About Emergency Contraception (Ec) In Senegal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In 2010, the Reproductive Health Division in Senegal, with support from Population Council, performed an assessment of the emergency contraception (EC) integration process into the national health system through a national forum on EC. This forum revealed that there was a real promotional problem regarding EC in the national health system despite the efforts made. There was widespread lack of public awareness of the product, rumors concerning EC due to the sensitive nature of the product, low inclusion of EC in routine service delivery, especially during initial counseling in family planning awareness campaigns , and a better method of keeping …

Bellagio Consensus: Recommendations For Action To Increase Access To Highly Effective, Long-Acting, Reversible Contraception, Population Council

Reproductive Health

This brief and statement offers recommendations for action to increase access to highly effective, long-acting, reversible contraception (LARCs) and accelerate progress toward meeting the Millennium Development Goal of universal access to reproductive health services.