Women's Health Commons^™

Introducing Contraceptive Methods In Low-Resource Settings: New Opportunities In Senegal, Population Council

Reproductive Health

This factsheet outlines the Delivering Contraceptive Vaginal Rings project, awarded by USAID to the Population Council in October 2013 to foster the introduction of two contraceptive methods. The objectives of this project are to: 1) improve availability and affordability of a three-month Progesterone Vaginal Ring for postpartum breastfeeding women, and 2) facilitate regulatory approval and introduction of a one-year contraceptive vaginal ring containing Nestorone® and ethinyl estradiol—a long-acting method for non-breastfeeding women that is in the late stages of development. The factsheet identifies milestones achieved and new opportunities in Senegal to implement activities in the year ahead.

A Systematic Review Of The Treatment And Management Of Pre-Eclampsia And Eclampsia In Nigeria, Karen Kirk, Ishita Chattopadhyay

Reproductive Health

Throughout the development of a pregnancy, there are many opportunities when pre-eclampsia and eclampsia (PE/E) can be prevented, detected, and managed; based on the literature, certain gaps exist along this continuum of care. To fully appreciate the enormity of the problem at the country level, the Population Council conducted a systematic review of published papers on PE/E in Nigeria from 2000–15 in order to understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E. In order to have the most impact, this report recommends a multi-level set of interventions that increase community awareness of symptoms …

Formative Research On Assessing Barriers To Fistula Care And Treatment In Nigeria, Charlotte E. Warren, Rachel Agbonkhese, Salisu Mohammed Ishaku

Reproductive Health

This report documents results of a systematic study of peer-reviewed and “grey” literature which identified studies relevant for understanding barriers to accessing obstetric fistula (OF) care in developing countries. To more comprehensively and holistically understand these barriers in Nigeria and potential enabling factors for alleviation, this study explored the perspectives of those involved in both identifying fistula and accessing care, such as family members and other community stakeholders including patriarchs, matriarchs, community leaders, and other opinion leaders. It also examines the cultural patterns, myths, and perspectives related to OF and how they influence women’s willingness and capacities to access surgical …

Barriers To Fistula Repair In Uganda: A Formative Study, Population Council

Reproductive Health

This brief describes a formative research study conducted in Uganda by the Population Council, building on the results of a systematic review, to better understand the barriers and enabling factors for fistula repair care delivery and access. Understanding how Ugandan women living with fistula decide to seek care, identify and reach medical centers, and receive adequate and appropriate care is integral and continues to influence the design of a larger implementation pilot. This study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results show that while it is difficult to measure the relative influence …

Fact Sheet—How Does Quality Of Care Relate To A Rights-Based Approach To Family Planning Programs?, Jan Kumar

Reproductive Health

Because policymakers are challenged by numerous, overlapping definitions of quality of care, with uncertainty about which to adopt, there is a need for common understanding of each construct and its contribution to family planning (FP). This factsheet describes several definitions of quality in health care that are widely accepted. It concludes that improving and assuring quality of care is a legal, ethical, and practical imperative, and is instrumental in achieving outcomes that benefit women, children, and programs. If donors embrace, fund, and hold governments accountable to the fullness of a rights-based approach for FP with an explicit focus on assuring …

Measuring Quality Of Care: A Review Of Previously Used Methodologies And Indicators, Katherine Tumlinson

Reproductive Health

Despite successful efforts to increase financial and geographic access to family planning services in many parts of the developing world, large numbers of women with a desire to delay or limit future pregnancies are not using contraceptive methods. Several multi-country, large-scale facility surveys incorporate indicators for measuring the quality of family planning service delivery. These facility surveys use data collection tools such as facility audits, provider and client questionnaires, and third party observation guides. A limited body of research indicates that the validity of these tools is low, however, while large variations in analytical approaches inhibit use of existing literature …

Fact Sheet—Measuring Quality Of Care: A Review Of Methodologies And Indicators, Katherine Tumlinson

Reproductive Health

Broad support for the promotion of high-quality service delivery in family planning (FP) programs is rooted in the publication in 1990 of a formal framework outlining its essential elements. This framework, developed by Judith Bruce of the Population Council, defines FP service delivery quality through six critical elements: choice of methods, information provided to clients, interpersonal relations, provider competence, follow-up mechanisms, and appropriate range of services offered. This factsheet argues that despite widespread endorsement of the Bruce framework and development of standardized data collection instruments, obstacles to accurate measures of quality of care remain. It concludes that further discussion within …

Adolescents In Bangladesh: Programmatic Approaches To Sexual And Reproductive Health Education And Services, Sigma Ainul, Ashish Bajracharya, Laura Reichenbach

Reproductive Health

There is a gap in knowledge and understanding of effective adolescent sexual and reproductive health (ASRH) programming in Bangladesh, especially programming at scale. Initiatives to address ASRH have been implemented at different times by both the Government of Bangladesh and NGOs, but these activities have often been fragmented and are not well documented or evaluated, making it difficult to know what worked well and what did not. This policy brief presents selected findings from a comprehensive review and analysis of ASRH programming in Bangladesh, carried out by the Population Council’s Evidence Project, with financial support from USAID/Bangladesh, as part of …

Evaluation De La Mise En Oeuvre Et Des Réalisations De L’Approche 3d Au Sein Du Plan D’Action National De Planification Familiale (Panpf) Au Sénégal—Technical Brief, Population Council

Reproductive Health

Leader dans le domaine de la Planification Familiale (PF) en Afrique de l’Ouest francophone, le Sénégal a entrepris diverses initiatives pour atteindre ses objectifs, dont l’élaboration du Plan d’Action National de Planification Familiale (PANPF) 2012–15, basé sur l’Approche 3D (Démocratisation, Démédicalisation, Décentralisation). Au moment où il arrivait à terme, et que l’élaboration d’un nouveau plan était envisagée, il était nécessaire de documenter l’approche, sa mise en œuvre, et ses réalisations. Le Population Council a mené cette étude en collaboration avec la Direction de la Santé de la Reproduction et de la Survie de l’Enfant du Ministère de la Santé et …

Scaling Up Family Planning In Zambia—Part 1: Assessment And Feasibility Of Maintaining An Innovative Program, Benjamin Bellows, Mary Nambao, Luigi Jaramillo, Roz Fanaiayan, Mardieh Dennis, Karen Hardee

Reproductive Health

To support the Government of Zambia in addressing its reproductive health challenges and in meeting its goals for 2020, the United Kingdom Department for International Development funded a four-year effort to support public sector contraceptive expansion under the Scaling Up Family Planning (SUFP) Project, led by Abt Associates. Launched in 2012, and with a focus on hard-to-reach areas and youth and expanding access to long-acting reversible contraceptives, SUFP was a technical assistance program designed to strengthen the ability of the public sector to provide services to meet the country’s FP2020 goals. SUFP focused on capacity building, infrastructure strengthening, behavior change …

Scaling Up Family Planning In Zambia—Part 2: The Cost Of Scaling Up Family Planning Services, David Collins, Colin Gilmartin

Reproductive Health

This costing study is Part 2 of a broader implementation research study designed to establish the feasibility of integrating successful interventions and lessons from the Scaling Up Family Planning (SUFP) project into Zambia’s health system at the conclusion of the project, and to contribute to the global learning on scaling up family planning services. The main contribution of the costing study was to examine the cost implications in determining the scope and pace of scale up. Challenges experienced during the project reportedly included lack of equipment and limited space in some facilities, government staff shortages, and irregular access to supplies …

Understanding Demand For Family Planning And Reproductive Health Services Through The Indian National Health Insurance Scheme In Uttar Pradesh, Arupendra Mozumdar, Kumudha Aruldas, Aparna Jain, Laura Reichenbach, Robin Keeley, M.E. Khan

Reproductive Health

The Indian National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), was launched by the Ministry of Labour and Employment in 2008 to promote equitable access to health services through the private and public sectors. This scheme is intended to offer economically disadvantaged families living below the poverty line in urban and rural areas access to a pre-specified package of health services including: general surgery, general medical care, pediatric care, gynecological care, family planning (FP) and other reproductive health (RH) services, dental, ophthalmology, urology, neurosurgery, and oncology. Almost eight years into the program, this is an opportune time to examine …

Utilization Of National Health Insurance For Family Planning And Reproductive Health Services By The Urban Poor In Uttar Pradesh, India, Arupendra Mozumdar, Kumudha Aruldas, Aparna Jain, Laura Reichenbach, Robin Keeley, M.E. Khan

Reproductive Health

In 2008, the Government of India launched the National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in both urban and rural areas to access a range of private health services. The available evidence suggests several limitations and barriers that may affect the utilization of RSBY services and warrants a more in-depth examination of the contexts of family planning/reproductive health (FP/RH) services. The Population Council, under the Evidence project, conducted a study among the urban poor to: 1) determine RSBY awareness and barriers to enrollment; 2) identify barriers and facilitating factors to …

Delivering Contraceptive Vaginal Rings To Breastfeeding Women, Population Council

Reproductive Health

The Progesterone Vaginal Ring (PVR) is a user-controlled contraceptive that helps breastfeeding women safely and effectively space, delay, or limit their next pregnancy. The Population Council and partners developed the PVR to help address the unmet need for contraception among breastfeeding women. The ring provides a convenient option that adds choices for new mothers and promotes optimal infant nutrition and health. This two-page brief provides fast facts for advancing nutrition and infant health with the PVR.

Building A National Pro-Choice Alliance In Mexico: Evaluation Of The Alliance Media Campaign To Promote Access To Safe, Free, And Legal Abortion Services, Population Council

Reproductive Health

The Population Council and Alliance partners designed a legal abortion media campaign aimed at informing women in Mexico City of their legal right to a safe, free elective abortion during the first 12 weeks of pregnancy. The impetus for the campaign was the apparent lack of knowledge regarding the legality of abortion in Mexico City among low-income, marginalized women of reproductive age combined with the inadequate number of Mexico City Ministry of Health facilities equipped to provide services to women living in an expansive metropolitan area such as Mexico City. This brief presents results of an evaluation that show that …

A Model For Providing 24-Hour Normal Delivery Services At Union Health And Family Welfare Centers In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, A.K.M. Zafar Ullah Khan, Forhana Rahman Noor, Afsana Fatema Noor

Reproductive Health

In rural areas of Bangladesh, emergency obstetric care services are available at the upazila level and above. At lower levels, Union Health and Family Welfare Centers (UHFWCs) located in the proximity of women’s homes provide normal delivery services. Recently, the Directorate General of Family Planning (DGFP) undertook an initiative to provide 24-hour normal delivery services in newly upgraded UHFWCs. The Population Council, with financial support from UKaid is providing technical assistance to the DGFP to implement an operations research study to test the effectiveness of this model. This brief presents an overview of the project, describes the implementation of project …

Understanding Married Women's Vulnerability To Hiv Infection In Egypt: An Exploratory Study, Doaa Oraby, Nahla G. Abdel-Tawab

Reproductive Health

This study examines the behavioral, sociocultural, economic, programmatic, and legal factors that aggravate Egyptian women’s vulnerabilities to HIV/AIDS. The study concludes that in low-prevalence settings like Egypt, targeted interventions are the most strategic and cost-effective: for example, HIV awareness-raising with a special focus on the preventive role of consistent, correct condom use, and creating a cadre of peers that could provide psychosocial support and HIV counseling to migrant workers. Furthermore, premarital and antenatal care programs should include HIV awareness-raising and provider-initiated counseling and testing after screening of women to identify those at risk for HIV infection. Concurrently, efforts should be …

The Health Exception, Monica E. Eppinger

All Faculty Scholarship

The abortion doctrine laid out in Roe v. Wade permits a procedure necessary to preserve the life or the health of the pregnant woman, setting out what has come to be called the “life exception” and the “health exception.” This Article investigates the background and antecedents of the health exception, identifying three periods of formation and change up to the drafting of the Model Penal Code in 1959. It argues that theories of health lie at the heart of legal doctrine, shaping common-law treatment of abortion and persisting in nineteenth- and twentieth-century statutes. This account reveals origins of a health …

Hiv Risk And Psychological Distress Among Female Entertainment Workers In Cambodia: A Cross-Sectional Study, Carinne M. Brody, Pheak Chhoun, Sovannary Tuot, Khuondyla Pal, Siyan Yi

Background: In Cambodia, there has been an increase in entertainment work as a result of the breakdown of the traditional brothel-based sex industry, presenting new challenges to addressing the health issues and needs of people working in the entertainment industry. This study aims to identify factors associated with psychological distress among female entertainment workers (FEWs) in Cambodia.

Methods: A two-stage cluster sampling method was used to randomly select 657 FEWs from entertainment establishments in Phnom Penh and Siem Reap in April and May 2014 for interviews using a structured questionnaire. Psychological distress was measured using the General Health …

Are Text Messages A Feasible And Acceptable Way To Reach Female Entertainment Workers In Cambodia With Health Messages? A Cross-Sectional Phone Survey, Carinne M. Brody, Sukhmani Dhaliwal, Sovannary Tuot, Michael Johnson, Khuondyla Pal, Siyan Yi

Background: Despite great achievements in reducing the prevalence of HIV, eliminating new HIV infections remains a challenge in Cambodia. Entertainment venues such as restaurants, karaoke bars, beer gardens, cafes, pubs, and massage parlors are now considered important venues for HIV prevention efforts and other health outreach interventions.

Objective: The purpose of this study was to explore phone use and texting practices of female entertainment workers (FEWs) in order to determine if text messaging is a feasible and acceptable way to link FEWs to health services.

Methods: This cross-sectional phone survey was conducted in May 2015 with 97 …

El Rol De Los Servicios Sociales En El Acompañamiento De Mujeres Durante El Proceso De Interrupción Legal Del Embarazo En Un Hospital Público En La Provincia De Buenos Aires / The Role Of Social Services In The Accompaniment Of Women During The Process Of Legally Terminating A Pregnancy In A Public Hospital In The Province Of Buenos Aires, Judy Rivière

Independent Study Project (ISP) Collection

El acceso a la Interrupción Legal del Embarazo (ILE) sigue siendo limitado para muchas mujeres en Argentina. En la mayoría de los hospitales públicos, no se hace la ILE. Este tema es todavía muy polémico y tiene implicaciones diferentes, no solo en el nivel provincial, sino también en el nivel municipal. En las instituciones donde se hacen interrupciones del embarazo, los profesionales de la salud tienen mirada abierta que incluyen factores biopsicosociales. Por eso, las trabajadoras sociales, que miran la salud desde la perspectiva de determinantes sociales, tienen un rol importante en la facilitación del acceso a la ILE para …

Análisis De Las Políticas Públicas De Prevención Del Cáncer De Cuello Uterino Vinculadas Al Control Del Virus Del Papiloma Humano (Vph) En Argentina / An Analysis Of Argentina’S Public Health Prevention Strategies Of Cervical Cancer Related To The Control Of The Human Papiloma Virus (Hpv), Caroline Seman

Independent Study Project (ISP) Collection

El objetivo general de este estudio es analizar las políticas públicas de prevención del cáncer de cuello uterino (CCU) basadas en la incorporación de nuevas tecnologías como el test de VPH (Virus del Papiloma Humano) y la vacuna contra el VPH en Argentina. Los objetivos específicos son 1) describir la implementación del test de VPH y la campaña de vacunación obligatoria contra el VPH como estrategias de prevención primaria del CCU a nivel nacional: 2) identificar los factores que las facilitan y las obstaculizan. El CCU es el segundo cáncer más diagnosticado en las mujeres de Argentina. Desde el año …

Enteric Fever: A Slow Response To An Old Plague, Carlos Franco- Paredes, M. Imran Khan, Esteban Gonzalez- Diaz, Jose I. Santos- Preciado, Alfonso J. Rodriguez Morales, Eduardo Gotuzzo

Centre of Excellence in Women and Child Health

Man is irremediably embedded in nature with complex interactions with all living organisms. Historically, the establishment of contemporary human societies has been influenced by our coexistence with other microorganisms living in highly interconnected habitats and ecologies. As a result, with the progression from unicellular to multicellular life, bacteria have coexisted with humans. In this biological journey, while there are important benefits provided by bacterial guests to the human host living in complex relationships and becoming part of their microbiome, some organisms are able to cause a wide spectrum of diseases. Among the large Enterobacteriaceae family, the genus Salmonella, a …

Status Of Paratyphoid Fever Vaccine Research And Development, Laura B. Martin, Raphael Simon, Calman A. Maclennan, Sharon M. Tennant, Sushant Sahastrabuddhe, M. Imran Khan

Centre of Excellence in Women and Child Health

Salmonella enterica serovars Typhi and Paratyphi (S. Paratyphi) A and B cause enteric fever in humans. Of the paratyphoid group, S. Paratyphi A is the most common serovar. In 2000, there were an estimated 5.4 million cases of S. Paratyphi A worldwide. More recently paratyphoid fever has accounted for an increasing fraction of all cases of enteric fever. Although vaccines for typhoid fever have been developed and in use for decades, vaccines for paratyphoid fever have not yet been licensed. Several S. Paratyphi A vaccines, however, are in development and based on either whole cell …

Nontyphoidal Salmonella Disease: Current Status Of Vaccine Research And Development, Sharon M. Tennant, Calman A. Maclennan, Raphael Simon, Laura B. Martin, M. Imran Khan

Centre of Excellence in Women and Child Health

Among more than 2500 nontyphoidal Salmonella enterica (NTS) serovars, S. enterica serovar Typhimurium and S. enterica serovar Enteritidis account for approximately fifty percent of all human isolates of NTS reported globally. The global incidence of NTS gastroenteritis in 2010 was estimated to be 93 million cases, approximately 80 million of which were contracted via food-borne transmission. It is estimated that 155,000 deaths resulted from NTS in 2010. NTS also causes severe, extra-intestinal, invasive bacteremia, referred to as invasive nontyphoidal Salmonella (iNTS) disease. iNTS disease usually presents as a febrile illness, frequently without gastrointestinal symptoms, in both adults and children. Symptoms …

Measuring Self-Reported Exercise, Motivation To Exercise, And Sexism In Women, Sydney C. Jensen

All Master's Theses

The harmfulness and pervasiveness of benevolent sexism is not a well disseminated issue, despite the belief that women are treated with equality in today’s society. The current study was designed to investigate whether exercise type and motivation to exercise would predict participants’ self-reported benevolent and hostile sexism, particularly in light of gender-related stereotypes about physical activity. A sample of 79 females completed an online survey that included questions about demographic characteristics, primary exercise type (i.e., cardiovascular exercise, weight-lifting, or hobbies), average number hours spent engaging in their primary exercise weekly, exercise motivations, and finally the Ambivalent Sexism Inventory which served …

Gender And Sexual Health: Applying Gender Role Theory To Men And Women’S Intention To Engage In Sexual Health Information Seeking Behaviors, Ariella R. Tabaac

Theses and Dissertations

The purpose of the present study is to examine the pathways between gender and behavioral intention to engage in sexual HISB through application of the Theory of Planned Behavior (TPB). It was found that feminine and masculine gender role stress differentially influence perceived behavioral control and behavioral attitudes, and that intention to engage in HISB was higher among women than men. Attitudes and PBC significantly predicted behavioral intention in this model. Further, women in the sample were more likely to search for sexual health information, with online sources being the most frequently reported resource. Additionally, past HISB was a significant …

Socioeconomic Factors Associated With Cataract-Related Blindness Treatment In Women In Rural Regions Of Andhra Pradesh, Kiranpreet Kaur 4198353

UROP Posters

Despite efforts of Vision 2020 in India, the Andhra Pradesh Eye Disease Study (APEDS) extrapolated, in 2000, approximately 18.7 million blind people in India and also, projected an increase to 31.6 million blind people by 2020. Within the state Andhra Pradesh itself, preventable corneal blindness increased to 1.84% from 1.5% in the late 1980s.

Numerous public health studies have been conducted to outline factors that cause and preclude treatment of avoidable corneal blindness in the India. Conclusively, the escalation of corneal blindness can be largely attributed to personal, social, and economic barriers in utilizing available eye-care services. However, due to …

Conducting Qualitative Interviews By Telephone: Lessons Learned From A Study Of Alcohol Use Among Sexual Minority And Heterosexual Women, Laurie Drabble, Karen Trocki, Brenda Salcedo, Patricia Walker, Rachael Korcha

Faculty Publications

This study explored effective interviewer strategies and lessons learned based on collection of narrative data by telephone with a subsample of women from a population-based survey, which included sexual minority women. Qualitative follow-up, in-depth life history interviews were conducted over the telephone with 48 women who had participated in the 2009–2010 National Alcohol Survey. Questions explored the lives and experiences of women, including use of alcohol and drugs, social relationships, identity, and past traumatic experiences. Strategies for success in interviews emerged in three overarching areas: (1) cultivating rapport and maintaining connection; (2) demonstrating responsiveness to interviewee content, concerns; and (3) …

Creating A Community Of Practice To Prevent Suicide Through Multiple Channels: Describing The Theoretical Foundations And Structured Learning Of Pc Cares, Lisa Wexler, Diane Mceachern, Gloria Difulvio, Cristine Smith, Louis F. Graham, Kirk Dombrowski

Department of Sociology: Faculty Publications

It is critical to develop practical, effective, ecological, and decolonizing approaches to indigenous suicide prevention and health promotion for the North American communities. The youth suicide rates in predominantly indigenous small, rural, and remote Northern communities are unacceptably high. This health disparity, however, is fairly recent, occurring over the last 50 to 100 years as communities experienced forced social, economic, and political change and intergenerational trauma. These conditions increase suicide risk and can reduce people’s access to shared protective factors and processes. In this context, it is imperative that suicide prevention includes—at its heart— decolonization, while also utilizing the “best …