Women's Health Commons^™

Repositioning Postnatal Care In A High Hiv Environment: Swaziland, Charlotte E. Warren, Rachel Shongwe, Allen Waligo, Mohammed Mahdi, Goldy Mazia, Indira Narayanan

HIV and AIDS

This Horizons report from the Swaziland Ministry of Health and Social Welfare discusses findings from an intervention which aimed to reposition postnatal care within the context of a high HIV prevalence environment. The objectives were to determine if changes to the sexual and reproductive health guidelines on postnatal care would result in the timely and quality provision of key components of essential maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirms that the introduction …

If You Build It, Will They Come? Kenya Healthy Start Pediatric Hiv Study: A Diagnostic Study Investigating Barriers To Hiv Treatment And Care Among Children, Karusa Kiragu, Katie D. Schenk, Julie Murugi, Avina Sarna

HIV and AIDS

In Kenya the proportion of eligible HIV-positive children receiving ART treatment is only 11 percent. This study explored and documented possible barriers in the community to accessing pediatric HIV testing and treatment, to guide the development of new interventions to encourage uptake. The study identified barriers such as cost, use of traditional healers, low knowledge of treatment options, attitudinal barriers, stigma, unique treatment issues, and dissatisfaction with available services. Additionally, healthcare workers missed opportunities to provide services and cited numerous service-side challenges. The study recommends prioritizing community awareness, mobile clinics, strengthening capacity of healthcare workers, supporting family-based HIV testing, and …

Highlighting Marital Hiv Risk And Promoting Premarital Vct In Nyanza Province, Kenya, Ben Ochieng, Annabel Erulkar

Reproductive Health

This report describes a project undertaken in Kenya by the Population Council, in collaboration with PATH and Kendu Adventist Hospital, whose objectives were: 1) to design and implement educational strategies to raise awareness of the risks of HIV and early marriage; 2) to promote voluntary counseling and testing (VCT) for couples; and 3) to support and empower newly married girls through community-based clubs. The report notes that the strong technical support and leadership provided by the partners led to successful implementation of most project activities. The partnership enabled scarce resources to be shared, and has ensured that the comparative advantages …

Taller Regional De Utilización De Resultados De Investigación Operativa Para Incrementar El Acceso, La Calidad E Integración De Los Servicios Anticonceptivos En América Latina Y El Caribe, M. Estela Rivero-Fuentes, Antonieta Martin

Reproductive Health

En octubre de 2007, el programa Fronteras de la Salud Reproductiva (FRONTERAS) realizó un taller regional de tres días en La Antigua, Guatemala, para difundir los resultados de sus proyectos de investigación operativa. Durante el taller, los participantes escucharon los avances en la metodología anticonceptiva y escucharon las estrategias efectivas que probó FRONTERAS para incrementar el acceso al DIU y la vasectomía; la integración de la planificación familiar con los servicios posparto, postaborto y PTMI. Los investigadores habloaron sobre los resultados de los estudios, los gerentes de los programas explicaron cómo se usaban los instrumentos y se habló de la …

Development Of A Quality Assurance Procedure For Reproductive Health Services For District Public Health Systems: Implementation And Scale-Up In The State Of Gujarat, M.E. Khan, Anurag Mishra, Vivek Sharma, Leila Caleb-Varkey

Reproductive Health

This project was carried out in India, in two districts each in Gujarat and Maharashtra states. It confirmed that quality assurance (QA) checklists and an implementation manual, developed by the USAID-funded Frontiers in Reproductive Health (FRONTIERS) Program of the Population Council in collaboration with UNFPA/India, are useful and effective tools that the Ministry of Health and Social Welfare (MOHFW) can use to monitor the quality of services provided by health facilities. It also demonstrated that this QA mechanism can be easily institutionalized at the district level management. One key lesson has been the critical role that the commitment of state …

Regional Workshop To Use The Findings From Operations Research To Increase The Access, Quality And Integration Of Contraceptive Services In Latin America And The Caribbean, M. Estela Rivero-Fuentes, Antonieta Martin

Reproductive Health

In October 2007, the Frontiers in Reproductive Health (FRONTIERS) program held a three-day regional workshop in La Antigua, Guatemala, to disseminate results of its operations research projects. During the workshop, participants received contraceptive technology updates, and learned about effective strategies tested by FRONTIERS to increase access to the IUD and vasectomy; and about integration of family planning with postpartum, postabortion, and PMTCT. Researchers discussed study results, program managers explained how they were used, and practitioners talked about implementing the interventions—a combination of perspectives that successfully transmitted the message that the interventions were not difficult to apply, could have a great …

Introduction Of Quality Of Care And A Gender Perspective In Reproductive Health Service Organizations In Latin America And The Caribbean, Patricia Riveros, Antonieta Martin, Ricardo Vernon

Reproductive Health

In 2005 and with the technical assistance of the Frontiers in Reproductive Health (FRONTIERS) Program, the Integrated Health Coordination Program (PROCOSI), a Bolivian network of 33 nongovernmental organizations, designed and tested a set of four guidelines to help organizations deliver high-quality reproductive health services with a gender perspective. The guidelines were: 1) to present a strategy to certify organizations as “gender sensitive” healthcare providers; 2) to present the knowledge staff members should know to be certified; 3) to describe procedures to collect and analyze the data to evaluate implementation of the strategy; and 4) to describe how to assess strategy …

Adequacy Of Communicating Results From Screening Mammograms To African American And White Women, Beth Jones, Kam Reams, Lisa Calvocoressi, Amy B. Dailey, Stanislav V. Kasl, Nancy M. Liston

Health Sciences Faculty Publications

Objective. We examined whether African American women were as likely as White women to receive the results of a recent mammogram and to self-report results that matched the mammography radiology report (i.e., were adequately communicated). We also sought to determine whether the adequacy of communication was the same for normal and abnormal results.

Methods. From a prospective cohort study of mammography screening, we compared self-reported mammogram results, which were collected by telephone interview, to results listed in the radiology record of 411 African American and 734 White women who underwent screening in 5 hospital-based facilities in Connecticut between October 1996 …

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, …

Day Of Dialogue—Insights And Evidence From Product Introduction: Lessons For Microbicides, Martha Brady, C. Elizabeth Mcgrory

HIV and AIDS

This report summarizes key issues and themes emerging from a Population Council Day of Dialogue held in March 2007. The Council convened this meeting of experts in the fields of product development, introduction, and social marketing; clinical trials; and reproductive health and HIV/AIDS in order to identify key features that can be used to guide efforts to introduce microbicides.

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, …

Study Of The Effectiveness Of Training Malian Social And Health Agents In Female Genital Cutting Issues And In Educating Their Clients, Nafissatou J. Diop, Fatoumata Traore, Habibatou Diallo, Ousmane Traore, Aissa Haidara Toure, Youssouf Diallo, Madina Sangare, Fatoumata Tandia, Keita Attaher Toure

Reproductive Health

This report documents findings of a study to assess the education and training of social and healthcare workers in Mali regarding female genital cutting (FGC). After two decades of campaigning against FGC in Mali, the results are not satisfactory when compared to the levels of human and financial investment. The Mali Division of Family and Community Health, with technical support from the Population Council, conducted this research to highlight certain issues related to the practice of FGC in Mali, in particular health consequences and the role health personnel can play in eradicating the practice. The continued prevalence of FGC among …

Contributing Towards Efforts To Abandon Female Genital Mutilation/Cutting In Kenya: A Situation Analysis, Humphres Evelia, Maryam Sheikh Abdi, Carolyne Njue, Ian Askew

Reproductive Health

The Kenyan Ministry of Gender, Sports, Culture and Social Services, with support from UNFPA/Kenya, commissioned the Population Council to conduct a situation analysis of female genital mutilation/cutting (FGM/C) programs in Kenya, with the overall objective of documenting the current status of and trends in FGM/C programming and to help identify crucial elements that need to be prioritized for support. Results show marked declines in prevalence nationally between generations, suggesting a decline in the practice as well as trends toward “medicalization” in recent years. The practice still continues for different reasons, such as rite of passage, for marriageability, controlling sexuality, religious …

Developing And Testing Strategies For Increasing Awareness Of The Iud As A Contraceptive Option, Ricardo Vernon, M.E. Khan, Harriet Birungi, Ian Askew, William Stones

Reproductive Health

A workshop was held in England in 2004 to identify the most promising interventions for increasing access to the IUD and to generate protocols for small-scale operations research projects to be undertaken in selected countries. Participants were academics, policymakers, program staff, and service providers from Bangladesh, Ghana, Guatemala, Honduras, India, Kenya, and Nepal. The workshop objectives were to review international experiences with approaches to increase access to and use of the IUD; identify factors explaining the decline in IUD use in many countries; identify factors favoring client demand for IUD; review barriers to effective IUD service delivery; identify issues of …

Technical Assistance To The Institute Of Reproductive Health, Georgetown University In Researching Introduction Strategies For The Standard Days Contraceptive Method (Sdm), Saumya Ramarao, James R. Foreit

Reproductive Health

The Institute of Reproductive Health (IRH), Georgetown University tested the impact of introducing the standard days contraceptive method (SDM) with the technical assistance (TA) of Population Council staff. FRONTIERS technical assistance had the immediate effect of allowing IRH to carry out evaluations of the SDM in Asia and Latin America. The IRH studies also produced important lessons learned on strategies for the introduction of natural methods. IRH staff responsible for the India and Ecuador projects learned specific skills in cost-analysis and research instrument design.

Effect Of Introducing An 'Afternoon Pay Clinic' On Service Utilization And Cost Recovery (Nepal), Mahendra Pd. Shrestha, Rajesh Swar, Pradeep Panda, M.E. Khan, Rick Homan

Reproductive Health

An operations research study was initiated with financial and technical assistance from the FRONTIERS program to examine whether introducing an afternoon clinic at the Chhetrapati Family Welfare Center (CFWC) in Nepal with a substantially higher registration fee could improve cost recovery by adding more to program revenues than to program costs. The study showed, however, that premium pricing of afternoon services generated very little additional demand for services. Even with a premium price, the afternoon clinic could reach its cost recovery goal only if the volume of afternoon clients were to increase significantly. However, client perceptions about the ability of …

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 …

Reproductive Health Update Trainings For Health Workers In North Eastern Province, Garissa, Kenya Ministry Of Health, Population Council

Reproductive Health

The Somali community living in Kenya has practiced the severest form of female genital mutilation/cutting (FGM/C), infibulation, for centuries. To understand the context within which the practice takes place, and how its complications are managed, FRONTIERS undertook a diagnostic study in North Eastern Province and in the Eastleigh area of Nairobi. The study found that the health system is ill equipped to serve women who have been cut, and particularly infibulated women who are pregnant and delivering, stemming from an overall weakness in the availability and quality of maternal and neonatal heath services. Specific recommendations could strengthen these services so …

Strategies For Encouraging The Abandonment Of Female Genital Cutting In West Africa: Experiences From Senegal, Burkina Faso, And Mali, Nafissatou J. Diop, Ian Askew

Reproductive Health

This article explores efforts to encourage abandonment of female genital cutting (FGC) in Senegal, Burkina Faso, and Mali. The strategy of encouraging traditional practitioners to stop performing FGC is not effective as community-level support for the practice remains high. Training health staff significantly improved healthcare providers' levels of knowledge about FGC and its complications. Consequently, it was recommended that such training be incorporated into preservice medical training. The use of community-based strategies like the Village Education Program (VEP) showed the most promise, as their multifaceted approach addresses knowledge, attitudes, actions, and communal support in an integrated manner. The way forward …

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 …

Analyse De L'Evolution De La Pratique De L'Excision Au Burkina Faso: L'Environment Institutionel, Politique Et Programmatique De La Lutte Contre La Pratique De L'Excision, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

La présente analyse du projet Frontiers du Population Council fait un tour historique des événements majeurs de la lutte contre la pratique de l’excision au Burkina Faso avant d’aborder les conventions internationales auxquelles le pays a adhéré ainsi que les textes nationaux adoptés en ce qui concerne les droits de l’homme, spécifiquement le droit des femmes et des enfants. Elle analyse également l’application de la loi à travers l’évolution des cas de condamnation depuis l’adoption de la loi. Enfin, elle s’intéressera à quelques programmes d’intervention mis en place en identifiant les acquis et les limites. Ce travail fait partie d’une …

Predictors Of Intention To Use Contraception, Given Alcohol Consumption, Among Women In Southeast Alaska, Donna Louise Hebbeler

Loma Linda University Electronic Theses, Dissertations & Projects

Fetal alcohol exposure is a serious public health problem and is 100% preventable. Traditionally, FASD prevention programs and research recommendations have targeted peri-conceptual or pregnant women. Another approach to the prevention of FASD involves preventing pregnancy in women who use alcohol. The purpose of this cross sectional study was to identify factors that predicted women’s intention to use contraception using the theory of planned behavior (TPB), to determine if predictors of the theoretical constructs varied in women depending on alcohol use, and to examine interactions between alcohol use and TPB constructs. Qualitative data was gathered to triangulate with the quantitative …

Motivated Breast Cancer Screening Behavior And Its Cultural Antecedents, Patricia M. Flynn

Loma Linda University Electronic Theses, Dissertations & Projects

Discrepancies in breast cancer screening behavior exist among various ethnic groups in the United States (Jacobs & Lauderdale, 2001), with Latino American women reporting particularly low screening rates in comparison to Anglo American women (ACS, 2002). Research indicates that behavior is in part influenced by aspects of culture and relevant psychological processes (Betancourt & Lopez, 1993; Betancourt & Fuentes, 2001). This study was designed to investigate the relations among cultural values, attributions regarding the causes for not screening, related emotions, expectancy that screening leads to early detection and value incentive of early detection as determinants of breast cancer screening intention …

Systematic Screening To Integrate Reproductive Health Services In India, N.P. Das, Urvi Shah, Varsha Chitania, Pratibha Patel, M.E. Khan, Anurag Mishra, James R. Foreit

Reproductive Health

This study, conducted in large public clinics and small health posts in the city of Vadodara, India, tested the effectiveness of a systematic screening technique in integrating reproductive health services at the provider level. The objective was to determine if women screened during clinic visits received more services, appointments, and referrals per visit than women who were not screened. Results show that in experimental group clinics the number of services per visit increased while control clinics experienced a slight decrease; the effect of systematic screening was smaller in health posts than in clinics. In experimental posts, services per visit increased …