Women's Health Commons^™

The Role Of Abortion In The Last Stage Of Fertility Decline In Vietnam, Bussarawan Teerawichitchainan, Sajeda Amin

Poverty, Gender, and Youth

Vietnam’s rapid fertility decline can be explained by very high rates of contraceptive use and induced abortion, but despite the overall decline, fertility rates vary considerably across the country’s 54 ethnic groups. To explore the prospects for further fertility decline through use of abortion among high-fertility minority populations, this study analyzes unique data from the Vietnam National Health Survey to examine ethnic differentials in prevalence and determinants of abortion and contraception, using a new classification system for ethnicity. The report concludes that providing improved abortion services alone is unlikely to reduce fertility among high-fertility minority groups. Service provision needs to …

Making Pregnancy Safe For Women In Rajasthan: Targeting The Most Vulnerable, K.G. Santhya

Poverty, Gender, and Youth

As recently as 2005–06, almost two out of three women in Rajasthan, India were married before age 18 years (of those aged 20–24). Moreover, half of currently married girls aged 15–19 years in the state had already begun childbearing. The dangers of childbearing among adolescent girls, whose bodies have not physically matured, are widely acknowledged, as are the links between poverty and unsafe pregnancy. Yet, less is known about whether morbidity and mortality experiences vary within the subgroup of adolescent girls, whether such experiences differ between adolescent and adult women of similar parity, and whether treatment-seeking behaviors and the delays …

Toward Fgm-Free Villages In Egypt: A Mid-Term Evaluation And Documentation Of The Fgm-Free Village Project, Ghada Barsoum, Nadia Rifaat, Omaima El-Gibaly, Nihal Elwan, Natalie Forcier

Poverty, Gender, and Youth

This Population Council report is a mid-term evaluation and documentation of the process and approach of the FGM-Free Village Model in Egypt. The objective of this report is to create a knowledge base of information to support policy dialogue on female genital mutilation (FGM) and to assist in transferring knowledge about the model to other communities across Egypt and other countries where FGM is practiced. Impact evaluation at the community level shows the significant impact of the project in changing views and attitudes toward FGM among intervention groups. However, it also shows that FGM is an entrenched generational problem that …

Female-Initiated Prevention: Integrating Female Condoms Into Hiv Risk-Reduction Activities In Kenya, Population Council, Liverpool Vct Care & Treatment

Poverty, Gender, and Youth

The Female Condom (FC) is the only female-initiated prevention product on the market today that provides simultaneous protection against STIs, including HIV, and unintended pregnancy. However, the FC remains limited in supply, not widely available, and underutilized in many settings. Improvements in FC programming are essential to achieve increased uptake and public health impact, and to pave the way for future women’s HIV prevention products. The Population Council’s Female-Initiated Prevention Methods project aimed to stimulate action and generate evidence around FC access through innovative program experimentation. The study was conducted to understand the challenges and opportunities these different access models …

Enquête Sur La Contraception D'Urgence (Cu) Au Niveau Des Pharmacies, Nafissatou J. Diop, Babacar Mane, Ousseynou Faye, Cheikh Ibrahima Niang, Thiaba Thiaw, Aissatou Sano Coly, Fatou Mbow, Youmane Niang Faye

Reproductive Health

No abstract provided.

Operational Research For The Introduction Of An Adolescent Health Package In The Context Of Cervical Cancer Prevention, Marieke G. Van Dijk, Katherine Wilson, Claudia Diaz, Sandra G. Garcia

Reproductive Health

This report provides findings from a WHO/PAHO/UNFPA meeting that took place in Mexico City in 2009. Participants discussed a proposed operational research study on adolescent health and cervical cancer prevention that would help support countries that have already made or will soon make a policy decision to introduce the HPV vaccine. Adolescents typically have little contact with health services, particularly for immunization programs. Since new HPV vaccines target adolescent girls, the introduction of HPV vaccines may provide an opportunity for adolescents to engage more with health services and this may create openings to offer packages of adolescent health services that …

Mainstreaming Ec In Africa: The Ec Facilitative Re-Granting Program—Final Narrative Report, Jill Keesbury, Wilson Liambila, Youmane Niang Faye, Victoria Rumbold

Reproductive Health

Since 2006, ECafrique has been working to build the capacity of African nongovernmental organizations to design, implement, and evaluate successful emergency contraception (EC) mainstreaming projects. Through a process of “facilitative regranting,” ECafrique annually awarded nine grants ranging from $25,000 to $30,000 to organizations from across Anglophone and Francophone Africa. The program’s objectives were to increase access to EC across Africa by supporting projects intended to introduce, scale up, or mainstream the method, and build the capacity of African NGOs to design, implement, and evaluate successful EC mainstreaming projects. Each grantee participated in an international proposal development workshop and received individualized …

Acceptability And Promotion Strategies For Lng-Ius In Ghana: A Public Health Assessment, Philomena Nyarko, Cletus Adohinzin, Placide Tapsoba, Selina F. Esantsi, John Townsend, Nicholas Kanlisi, Ekua Ed-Nighpense, Gloria Quansah Asare

Reproductive Health

In response to concerns about the side effects of the IUD, the commonly known reversible, long-term method in Ghana, and to curb the shift from long-term to short-term methods, the Ghana Health Service decided to expand women’s contraceptive method choices by introducing the Levonorgestrel-releasing Intrauterine System (LNG-IUS), a hormonal IUD, into the contraceptive method mix. The LNG-IUS is a uterine contraceptive that provides effective long-term protection up to five years. Even though the product has been certified as safe and effective, it was necessary to ensure that it satisfies client’s needs and meets provider expectations. The Population Council, in collaboration …

Special Needs Of In-School Hiv Positive Young People In Uganda, Francis Obare, Harriet Birungi, Anne Katahoire, Hannington Nkayivu, Aggrey David Kibenge

Reproductive Health

Since 2006, the Population Council has pioneered operations research in collaboration with local partners in Uganda to promote the sexual and reproductive health and rights of young people aged 10–19 years infected with HIV. Key findings show that many young people perinatally infected with HIV want to be in school to avoid social isolation, and about 70 percent of them attend school. However, there has been limited understanding of how the education sector should support this vulnerable group of learners. The objective of this study was to explore the special needs of HIV-positive young people in primary and secondary schools …

Standards Required In Maintaining The Chain Of Evidence In The Context Of Post Rape Care Services: Findings Of A Study Conducted In Kenya, Carol Ajema, Emily Rogena, Hadley Muchela, Buluma Bwire, Nduku Kilonzo

Reproductive Health

Sexual violence (SV) is a serious societal problem that creates significant challenges to local communities in their attempt to create an overall plan for meeting the medical, emotional, physical safety, and legal needs of SV survivors. It is important to understand the existing links between the health sector and police as a basis for addressing the complexities surrounding SV. Appropriate management of SV survivors requires a standardized clinical evaluation, an effective interface with law enforcement for the handling of forensic evidence, and coordination of the continuum of care. From the public health perspective, the issues to be addressed revolve around …

Improving The Health Care Response To Gender-Based Violence: Phase Ii, Meiwita P. Budiharsana, Mai Quoc Tung

Reproductive Health

In 2009, the Population Council/Vietnam in collaboration with the Hanoi Health Service carried out an evaluation survey among Duc Giang Hospital staff to assess the extent to which awareness and perceptions of gender-based violence (GBV) had changed since the project commenced in 2005. The survey also assessed the extent to which the response of the hospital and Women’s Center for Counseling and Health had been strengthened, and made recommendations on changes to improve the situation. Overall, this project has been effective in raising awareness and willingness to integrate GBV screening into health services. The project conducted its training program at …

Manual For Designing Community Based Interventions For Preventing Postpartum Hemorrhage (Pph) Using Misoprostol: Standardized Pilot-Test Training Manual, Saumya Ramarao, Tekle-Ab Mekbib, Sarah Raifman

Reproductive Health

This manual is a comprehensive, standardized, step-by-step guide for Population Council staff to use when designing and implementing community-based pilot interventions for the prevention of postpartum hemorrhage using misoprostol. The introduction and background section provide basic information about maternal mortality, normal and abnormal pregnancy, and postpartum hemorrhage. This section also describes prevailing methods of prevention and treatment for postpartum hemorrhage, active management of the third stage of labor, and use of misoprostol for the prevention and control of postpartum hemorrhage. The second half of the manual focuses on how to develop a protocol for an intervention study on misoprostol. It …

Sexual Violence: Setting The Research Agenda For Kenya, Catherine Maternowska, Jill Keesbury, Nduku Kilonzo

Reproductive Health

This research agenda is the result of a stakeholders’ meeting held in Nairobi on June 11–12, 2008, that identified, developed, and prioritized areas for research on sexual violence in Kenya. The meeting was convened by the Population Council, Liverpool VCT, Care & Treatment, and the International Centre of Reproductive Health, Kenya. Kenya’s research agenda is premised on the need to generate the evidence required to impact policy formulation and services strengthening. Knowledge gaps that form the basis of key research areas identified include the need to: 1) Understand the nature, contexts, and prevalence of sexual violence; 2) Document and evaluate …

Multi-Sectoral Approaches To Preventing Sexual Assault And Domestic Violence: A Collective Force To Stop The Violence, Population Council

Reproductive Health

The Multi-Sectoral Approaches to Preventing Sexual Assault and Domestic Violence Symposium took place May 6–7, 2009, in Gauteng, South Africa. The symposium aimed to: increase awareness of sexual assault and domestic violence and its relationship to HIV and AIDS among decision-makers; promote evidence-based programming for practitioners; advocate for increased preventative measures and service delivery around sexual and gender-based violence (SGBV) in the public and private sectors; facilitate networking, strengthen and develop partnerships, and create opportunities for ongoing collaboration between key stakeholders; and inspire a coordinated plan of action for prevention that supports the government’s 365-day plan. South Africa has some …

Ecp Handbook: Introducing And Mainstreaming The Provision Of Emergency Contraceptive Pills In Developing Countries, Sharif M.I. Hossain, M.E. Khan, Ricardo Vernon, Jill Keesbury, Ian Askew, John Townsend, Victoria Rumbold

Reproductive Health

For many women, emergency contraceptive pills (ECPs) offer an opportunity to prevent unintended pregnancy following contraceptive method failure, rape, or unprotected sex. Access to this safe, effective option remains an essential element of women’s quality reproductive health care. However, ECPs remain inaccessible across much of the world, particularly in developing countries where limited commodity supplies, provider competency, public awareness, and misinformation routinely coalesce to restrict availability. While ECPs have been introduced on a pilot basis in many countries, their effective integration into both the public and private sectors has lagged. Successful interventions are guided by the principle that provision of …

Improving The Quality Of Family Planning And Reproductive Tract Infection Services For Urban Slum Populations: Demand-Based Reproductive Health Commodity Project, Md. Noorunnabi Talukder, Ubaidur Rob, Md. Mafizur Rahman

Reproductive Health

Quality of care has been a neglected dimension of family planning (FP) services for a long time in Bangladesh. Furthermore, effective programs are yet to be implemented to address the imbalance in contraceptive method mix. As outlined in this report, efforts were made through an operations research project to improve the quality of FP and reproductive tract infection (RTI) services provided by NGO clinics in selected slums in Bangladesh. The capacity of these NGO clinics to offer high-quality services to slum neighborhoods was strengthened by training service providers, strengthening service delivery points, and improving counseling services to ensure client satisfaction. …

The Refentse Model For Post-Rape Care: Strengthening Sexual Assault Care And Hiv Post-Exposure Prophylaxis In A District Hospital In Rural South Africa, Julia C. Kim, Ian Askew, Lufuno Muvhango, Ntabozuko Dwane, Tanya Abramsky, Stephen Jan, Ennica Ntlemo, Jane Chege, Charlotte Watts

Reproductive Health

The Refentse study aimed to develop a nurse-driven, post-rape care model that could be integrated into existing reproductive health/HIV services within a rural South African hospital, and to evaluate the impact of this model on the quality of care delivered. Following the intervention, there were significant improvements in the quality of clinical history and examination, and the provision of pregnancy testing, emergency contraception, STI treatment, HIV counseling and testing, post-exposure prophylaxis (PEP), trauma counseling, and referrals. The report concludes that it is possible to improve sexual assault services including PEP within a rural South African hospital at modest cost, using …

An Assessment Of Sexual And Gender Based Violence In Wajir District, North Eastern Kenya, Gladys K. Mwangi, Guyo W. Jaldesa

Reproductive Health

A 2006 baseline survey conducted by CARE Kenya indicated that sexual and gender-based violence (SGBV) is widespread throughout Kenya’s North Eastern Province. Other findings revealed that high levels of stigma and gender imbalances are associated with sexual violence and female genital mutilation (FGM) and that a coordinated approach to responding to the service needs of survivors is missing. As noted in this report, there is limited awareness of the legal mechanisms available to survivors. The Population Council’s study in Wajir District ascertained the need for and possible components of an integrated and comprehensive services model that could meet the needs …

Concepts Of Contraception For Adolescents With Obesity: Pathways Of Judicial Moderation, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …

Increased Strength And Physical Performance With Eccentric Training In Women With Impaired Glucose Tolerance: A Pilot Study, Robin L. Marcus, Paul C. Lastayo, Leland E. Dibble, Laura Hill, Donald A. Mcclain

Human Movement Studies & Special Education Faculty Publications

Background: Menopause is associated with both a loss of muscle mass and a worsening of insulin sensitivity (IS). Although eccentric resistance exercise (ECC) can effectively improve muscle mass over time, a single bout of ECC can worsen IS. This study assessed the effect of repeated ECC on IS, muscle mass, and function in postmenopausal women with impaired glucose tolerance (IGT).

Methods: Sixteen PM women (aged 56 years +/- 6.4) with IGT were randomly assigned to a 12-week, knee extensor ECC program (n = 10) or a nonexercise control group (CON) (n = 6). Participants underwent hyperinsulinemic-euglycemic clamps, dual-energy …

Elevated Corticotropin-Releasing Hormone In Human Pregnancy Increases The Risk Of Postpartum Depressive Symptoms, Ilona S. Yim, Laura M. Glynn, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Curt A. Sandman

Psychology Faculty Articles and Research

Postpartum depression (PPD) is common and has serious implications for the mother and her newborn. A possible link between placental corticotropin-releasing hormone (pCRH) and PPD incidence has been discussed, but there is a lack of empirical evidence.