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Articles 121 - 150 of 726
Full-Text Articles in Women's Health
Results From Systematic Literature Review On Pe/E In Nigeria, Amy Dempsey, Karen Kirk
Results From Systematic Literature Review On Pe/E In Nigeria, Amy Dempsey, Karen Kirk
Reproductive Health
Pre-eclampsia and eclampsia (PE/E), hypertensive disorders of pregnancy, are consistently cited as a leading cause of maternal and newborn morbidity and mortality in Nigeria. A recent, nationwide cross-sectional survey found that PE/E contributes to 28.2 percent of national maternal deaths. The other main contributors to maternal mortality are hemorrhage and pregnancy-related infection or sepsis. To fully understand the key challenges, gaps, and interventions related to the prevention and treatment of PE/E, the Ending Eclampsia project conducted a systematic review of papers on PE/E in Nigeria published between 2000–15. The methods, results, and recommendations are discussed in this brief.
Workplace Health And The Garment Sector In Cambodia, Bunmey Yat, Carolyn Rodehau, David Wofford, Ashish Bajracharya
Workplace Health And The Garment Sector In Cambodia, Bunmey Yat, Carolyn Rodehau, David Wofford, Ashish Bajracharya
Reproductive Health
In Cambodia, there has been considerable investment in improving the well-being of factory workers. Understanding the key stakeholders and their roles in improving worker health is essential for policy change and ensuring that interventions achieve sustainable, long-term impact in and around the workplace. This policy brief presents selected findings from a stakeholder and situational analysis undertaken by the Cambodia Worker Health Coalition (WorkerHealth) to understand the stakeholder landscape and policy environment for women’s health in the garment industry in Cambodia, with the objective of identifying leading stakeholders and their relationships, as well as strategies and opportunities for collaboration. Collaboration and …
Uganda Retail Audit: Analysis And Report, The Evidence Project
Uganda Retail Audit: Analysis And Report, The Evidence Project
Reproductive Health
This brief presents results of a retail audit, carried out in January 2016, that was commissioned as part of PATH’s work under the USAID-funded Evidence Project to conduct a landscape assessment of the feasibility of a Total Market Approach (TMA) in Uganda. This project also involved key informant interviews with stakeholders on their attitudes toward TMA principles and the collection of a Uganda Market Research Summary of existing family planning knowledge. The approach is based on an understanding that equitably meeting the diverse needs of different population segments requires increased coordination across sectors, including the public, private for-profit, and not-for-profit …
Addressing Intimate Partner Violence And Power In Relationships In Hiv Testing Services: Results Of An Intervention Piloted In Nairobi, Kenya, Nicole Haberland, Charity Ndwiga, Katharine Mccarthy, Margaret Makanyengo, Rose Kosgei, Cecilia Choi, Julie Pulerwitz, Sam Kalibala
Addressing Intimate Partner Violence And Power In Relationships In Hiv Testing Services: Results Of An Intervention Piloted In Nairobi, Kenya, Nicole Haberland, Charity Ndwiga, Katharine Mccarthy, Margaret Makanyengo, Rose Kosgei, Cecilia Choi, Julie Pulerwitz, Sam Kalibala
HIV and AIDS
The overarching goal of this study was to pilot an approach to HIV testing services (HTS) that addresses intimate partner violence (IPV) and sexual relationship power (SRP) inequalities, and explores the intervention’s potential for improving uptake and retention of antiretroviral therapy and prevention of mother-to-child transmission services. The project was implemented in Kenyatta National Hospital’s (KNH) antenatal care (ANC) clinic, and examined intermediate indicators of effect, as well as operational issues around incorporating attention to IPV in hospital procedures, especially in high-volume, high-need settings like KNH’s. The findings from this study suggest that providing some minimal IPV/SRP counseling to all …
Barriers To Fistula Repair In Nigeria: A Formative Study, Population Council
Barriers To Fistula Repair In Nigeria: A Formative Study, Population Council
Reproductive Health
A formative research study was conducted in Nigeria to better understand the barriers and enabling factors for fistula repair care delivery and access. This brief presents results from a literature review conducted to identify and understand the delays in accessing and receiving treatment and corresponding barriers, to document interventions that help to overcome barriers, and to specify gaps in the literature that require further research. The report concludes that women’s concern over healing and reintegration reflects their expectation that the holistic approach of hospitals will bring them back to normal life incorporating physical, sexual, psychosocial, and economic rehabilitation. Awareness, financial, …
Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Sukkur, Population Council
Landscape Analysis Of The Family Planning Situation In Pakistan—District Profile: Sukkur, Population Council
Reproductive Health
This district profile of Sukkur is part of the Landscape Analysis of the Family Planning Situation in Pakistan. The factsheet provides a detailed picture of use of antenatal and delivery care services; use of family planning; other socioeconomic indicators; availability of health facilities, pharmacies, and lady health workers; distribution of public static and private facilities by cadre; provision of specific family planning methods by sector; and presence and provision of family planning services/products. The factsheet concludes with a review of consumers’ perspectives on barriers to use of family planning and a chart listing district-specific donors, projects, and implementing partners. The …
Formative Research On Factors Influencing Access To Fistula Care And Treatment In Uganda, Pooja Sripad, Charlotte E. Warren
Formative Research On Factors Influencing Access To Fistula Care And Treatment In Uganda, Pooja Sripad, Charlotte E. Warren
Reproductive Health
This formative research builds upon the results of a systematic review by the Population Council for better understanding of the barriers and enabling factors for fistula repair care and access in Uganda. The study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results reveal the nuances of women’s experiences, along with the additional perspectives of their spouses, family members, community stakeholders, and fistula camp care providers including nurses/counselors, surgeons, and facility and district managers. Barriers and enablers to fistula repair care are clustered around the following factors: psychosocial, cultural, social, financial, transportation, facility shortages, …
Adolescent Girls Empowerment Programme: Research And Evaluation Mid-Term Technical Report—Executive Summary, Karen Austrian, Paul C. Hewett, Erica Soler-Hampejsek, Fiammetta Bozzani, Jere R. Behrman, Jean Digitale
Adolescent Girls Empowerment Programme: Research And Evaluation Mid-Term Technical Report—Executive Summary, Karen Austrian, Paul C. Hewett, Erica Soler-Hampejsek, Fiammetta Bozzani, Jere R. Behrman, Jean Digitale
Poverty, Gender, and Youth
The Adolescent Girls Empowerment Programme (AGEP) was an ambitious project directed toward changing girls’ lives in a significant and meaningful way across areas of education, sexual and reproductive health, marriage and fertility, and experience of violence. This Executive Summary of the project’s findings shows that, overall, the AGEP cohort data, and lessons they have generated from the AGEP are rich, nuanced, and important for informing the next generation of programs for adolescents in Zambia and elsewhere. Even though the study is still under way, and the full longer-term effects of AGEP remain to be seen, the information presented in this …
Adolescent Girls Empowerment Programme: Research And Evaluation Mid-Term Technical Report, Karen Austrian, Paul C. Hewett, Erica Soler-Hampejsek, Fiammetta Bozzani, Jere R. Behrman, Jean Digitale
Adolescent Girls Empowerment Programme: Research And Evaluation Mid-Term Technical Report, Karen Austrian, Paul C. Hewett, Erica Soler-Hampejsek, Fiammetta Bozzani, Jere R. Behrman, Jean Digitale
Poverty, Gender, and Youth
The Adolescent Girls Empowerment Programme (AGEP) was a social, health, and economic asset-building program targeting vulnerable adolescent girls aged 10–19. The Population Council, in partnership with the Young Women’s Christian Association of Zambia, successfully implemented the AGEP program from late 2013 to early 2016. The results presented in this midterm report have implications for recommendations on future programming for adolescent girls in Zambia and elsewhere and should be coupled with burgeoning evidence from AGEP and the literature to adapt programming for vulnerable adolescent girls in order to improve impact. While the underlying root causes of girls’ vulnerabilities are interrelated, it …
Adolescent Girls Initiative-Kenya: Qualitative Report, Eunice N. Muthengi, Karen Austrian, Amanda Landrian, Benta Abuya, Joyce Mumah, Caroline W. Kabiru
Adolescent Girls Initiative-Kenya: Qualitative Report, Eunice N. Muthengi, Karen Austrian, Amanda Landrian, Benta Abuya, Joyce Mumah, Caroline W. Kabiru
Poverty, Gender, and Youth
The Adolescent Girls Initiative-Kenya (AGI-K) is currently delivering multisectoral interventions, targeting violence prevention, education, health, and wealth creation, to adolescent girls aged 11–14 in two marginalized areas of Kenya. This report provides a brief overview of the research design and intervention components being delivered in AGI-K, and presents findings from the first round of qualitative data collection intended to highlight the strengths and weaknesses of the implementation processes thus far. The findings provide important information about the perceived effects of the program from a diverse set of respondents. Overall, beneficiaries, their parents/guardians, and other key stakeholders value the program and …
Adolescent Sexual And Reproductive Health Situation: Insights From The 2014 Kenya Demographic And Health Survey, Francis Obare, George Odwe, Harriet Birungi
Adolescent Sexual And Reproductive Health Situation: Insights From The 2014 Kenya Demographic And Health Survey, Francis Obare, George Odwe, Harriet Birungi
Reproductive Health
The 2015 Kenya National Adolescent Sexual and Reproductive Health Policy recognized the importance of addressing adolescent sexual and reproductive health (SRH) needs for achieving the country’s development goals. Although estimates from the 2014 Kenya Demographic and Health Survey (DHS) show the country registered improvements in key reproductive, maternal, and child health outcomes, adolescent outcomes likely remain poor given the challenges associated with adequately addressing their sexual and reproductive health needs. This report presents findings of further analysis of the 2014 Kenya DHS on key SRH outcomes among adolescent girls and boys 15 to 19 years old in Kenya. Understanding the …
Adolescent Girls Empowerment Program (Agep): Savings Account, Population Council
Adolescent Girls Empowerment Program (Agep): Savings Account, Population Council
Poverty, Gender, and Youth
Through the Adolescent Girls Empowerment Program (AGEP), the Population Council and partners implemented a social, health, and economic asset-building program for over 10,000 vulnerable adolescent girls aged 10–19 years in Zambia. The AGEP intervention was comprised of three major components: 1) safe spaces groups in which girls met once a week over the course of two years for training on sexual and reproductive health, life skills, and financial education; 2) a health voucher that girls could use at contracted private and public facilities for a package of general wellness and sexual and reproductive health services; and 3) a savings account …
Adolescent Girls Empowerment Programme In Zambia: Qualitative Evaluation Report, Zoe Duby, Chipo Natasha Zulu, Karen Austrian
Adolescent Girls Empowerment Programme In Zambia: Qualitative Evaluation Report, Zoe Duby, Chipo Natasha Zulu, Karen Austrian
Poverty, Gender, and Youth
The Adolescent Girls Empowerment Program (AGEP) reaches over 10,000 vulnerable girls 10–19 years old in five urban and five rural sites spread across four provinces in Zambia. The program works to build adolescent girls’ social, health, and economic assets, providing them with key skills and opportunities to help them transition from adolescence to adulthood in a healthy way. This report presents these valuable insight into the views and experiences of girls who were involved in the AGEP program, as well as the perceptions of program mentors, the girls’ parents, and community leaders. In addition, these findings highlight the areas in …
Addressing Adolescent Girls' Vulnerability To Hiv/Aids: Lessons From The Meri Life Meri Choice Project, Sunil Mehra, Rajesh R. Singh, Vandana Nair, K.G. Santhya, A.J. Francis Zavier
Addressing Adolescent Girls' Vulnerability To Hiv/Aids: Lessons From The Meri Life Meri Choice Project, Sunil Mehra, Rajesh R. Singh, Vandana Nair, K.G. Santhya, A.J. Francis Zavier
Poverty, Gender, and Youth
This report details findings from an assessment of the Meri Life Meri Choice (MLMC) project in India, implemented by MAMTA—Health Institute for Mother and Child, with the support of the Elton John AIDS Foundation. The MLMC project sought to reduce the vulnerability of rural adolescent girls to HIV by enhancing their knowledge about sexual and reproductive matters and equipping them with skills that enable them to address vulnerability to HIV; increasing their utilization of sexual and reproductive health services from the public sector; and developing a supportive environment that enables adolescent girls to adopt protective actions to reduce vulnerability to …
Building Girls' Protective Assets: A Collection Of Tools For Program Design, Population Council
Building Girls' Protective Assets: A Collection Of Tools For Program Design, Population Council
Poverty, Gender, and Youth
Adolescent girls have become a key target population for empowerment, health, and development initiatives in low- and middle-income countries. This collection of tools is intended for organizations that are committed to extending their programs to reach excluded subpopulations of girls and young women—whether they are the poorest girls in the poorest communities, the 10–14-year-old girls who are out of school and not living with either parent, or another subpopulation of young girls who are likely to miss out. The collection contains tools and exercises to help programmers translate evidence on “what works” into girl-centered programming. The resources in this collection …
Methodology: Reaching The Most Vulnerable Adolescent Girls, Population Council
Methodology: Reaching The Most Vulnerable Adolescent Girls, Population Council
Poverty, Gender, and Youth
The objective of the Adolescent Girls Empowerment Programme (AGEP) is to provide vulnerable adolescent girls with needed social, health, and economic assets that they can draw upon to overcome their vulnerabilities and expand their opportunities. As a component of the AGEP evaluation, a household census was conducted in 2013 in the areas where the program was to be implemented. The census revealed that a significant percentage of adolescent girls aged 10–19 contend with multiple levels of socioeconomic vulnerability that include—but are not limited to—geographic remoteness, social isolation, living without parents, living in low-income households, and not attending school. The analysis …
Ending The Medicalization Of Female Genital Mutilation/Cutting In Egypt, Sarah Ghattass, Nahla G. Abdel-Tawab, Salma Abou Hussein
Ending The Medicalization Of Female Genital Mutilation/Cutting In Egypt, Sarah Ghattass, Nahla G. Abdel-Tawab, Salma Abou Hussein
Reproductive Health
This policy brief examines the extent of medicalization of female genital mutilation/cutting (FGM/C) in Egypt, the characteristics of girls who were cut by medical personnel, factors that may have contributed to increased medicalization, and potential interventions that could influence both physicians and the public to completely abandon the practice. The data show that younger cohorts of women, those from higher wealth quintiles, higher levels of education, and living in urban regions are more likely to have been cut by medical personnel. More importantly, the analysis shows that despite medicalization being more common among young women with the above-mentioned characteristics, it …
Evidence To End Fgm/C: Research To Help Girls And Women Thrive, Population Council
Evidence To End Fgm/C: Research To Help Girls And Women Thrive, Population Council
Reproductive Health
This factsheet describes a new Population Council–led research program, funded by the United Kingdom’s Department for International Development, which will join the UNFPA-UNICEF Joint Programme on FGM/C: Accelerating Change and the Girl Generation in the Campaign to End Female Genital Mutilation/Cutting (FGM/C) within One Generation. The program will generate high-quality evidence to influence strategic investment, policy, and programming to end FGM/C. This five-year program will work in 6–9 sub-Saharan African countries to dramatically expand the body of evidence on the most effective approaches to ending FGM/C. The research program will be organized around four themes: building the picture of where, …
Pharmacy Workers In Kenya Need Training And Support On Medical Abortion Information And Referrals To Prevent Unsafe Service Provision, Jesse Njunguru, A. Finnie, Katharine Footman, Wilson Liambila, Kate Reiss
Pharmacy Workers In Kenya Need Training And Support On Medical Abortion Information And Referrals To Prevent Unsafe Service Provision, Jesse Njunguru, A. Finnie, Katharine Footman, Wilson Liambila, Kate Reiss
Reproductive Health
Despite the centrality of pharmacists in the provision of abortion services in Kenya, little is known about their medical abortion (MA) knowledge, attitudes, or practices. This policy brief reports on a study that set out to bridge this gap in the evidence. The report concludes that comprehensive training for pharmacy workers could improve the quality of MA provision and referrals, and help pharmacy workers identify opportunities to simultaneously provide clients with information on contraception and STI prevention. Such efforts would be in line with current Kenyan government policies to reduce the public health burden caused by the prevalence of unsafe …
Kenya: Helping Adolescent Mothers Remain In School Through Strengthened Implementation Of School Re-Entry Policies, Esther Lwanga Walgwe, Nancy Termini Lachance, Harriet Birungi, Chi-Chi Undie
Kenya: Helping Adolescent Mothers Remain In School Through Strengthened Implementation Of School Re-Entry Policies, Esther Lwanga Walgwe, Nancy Termini Lachance, Harriet Birungi, Chi-Chi Undie
Reproductive Health
By applying robust evidence, securing the support of decisionmakers, and engaging stakeholders, STEP UP enabled national and local decisionmakers to better understand the consequences of unintended pregnancy for adolescent girls’ schooling in Homa Bay County, Kenya. STEP UP is playing an important role in informing the implementation of policies within the Kenyan educational sector that will improve educational opportunities for school-age mothers. Through early stakeholder engagement, strong partnerships, the support of implementers and policymakers, effective communication and dissemination strategies, decisionmaker capacity, and the dedication of the adolescent mothers themselves, evidence generated by STEP UP was successfully utilized by key stakeholders. …
Senegal: The Impact Of A Study On Misoprostol Use And Knowledge Among Pharmacists, Eva Burke, E. Robinson, Nafissatou Diop, Kate Reiss, Katharine Footman, Maaike Van Min, Barbara Reichwein, Ian Askew
Senegal: The Impact Of A Study On Misoprostol Use And Knowledge Among Pharmacists, Eva Burke, E. Robinson, Nafissatou Diop, Kate Reiss, Katharine Footman, Maaike Van Min, Barbara Reichwein, Ian Askew
Reproductive Health
The availability of misoprostol is a key part of improving maternal health in low- and middle-income countries. In Senegal, where the drug is not widely available, pharmacies are one of the few places women can access it. STEP UP conducted a study to understand misoprostol knowledge and provision in these pharmacies. The Ministry of Health’s (MoH) commitment to training public providers and pharmacists on all products on the essential medicines list is a promising step toward bettering the health of women in Senegal. Marie Stopes International (MSI) Senegal continues to work to build the capacity of healthcare providers in the …
Acceptability And Feasibility Of Introducing Strengthened School-Based Sexual And Reproductive Health Information And Services In Accra, Ghana, Terence Adda-Balinia, Philip Teg-Nefaah Tabong, Maya Teye, Philip Baba Adongo, Placide Tapsoba, Harriet Birungi
Acceptability And Feasibility Of Introducing Strengthened School-Based Sexual And Reproductive Health Information And Services In Accra, Ghana, Terence Adda-Balinia, Philip Teg-Nefaah Tabong, Maya Teye, Philip Baba Adongo, Placide Tapsoba, Harriet Birungi
Reproductive Health
An initial study conducted by Population Council under the Strengthening Evidence for Programming on Unintended Pregnancies (STEP UP) project in 2012 assessed the knowledge and reproductive health needs of adolescents living in selected slums in Brong Ahafo and Greater Accra regions with the view of informing an improvement in adolescent sexual health (ASRH) programming in Ghana. The study concludes that stakeholders generally believed there was the need for enhanced adolescent sexual and reproductive health services in school as the present system of delivering these services were not sufficiently addressing ASRH needs. The use of trained psychologists and health workers was …
The Consumer Perspective: A Consultation With Senior Health Officials From Developing Countries On Standards Of Evidence For Reproductive And Maternal Health Care, The Evidence Project, Step Up Research Programme Consortium
The Consumer Perspective: A Consultation With Senior Health Officials From Developing Countries On Standards Of Evidence For Reproductive And Maternal Health Care, The Evidence Project, Step Up Research Programme Consortium
Reproductive Health
The Population Council (through the STEP UP consortium and the Evidence Project) and the High Impact Practices (HIP) Collaboration, together with other partners, held a series of three consultative meetings around the topic of standards of evidence in reproductive and maternal health. This report details the third and final meeting held in Bellagio, Italy in February 2016. The meeting brought together developing-country decisionmakers to vet, from the research “consumer” perspective, the recommendations that emerged from the second consultation and to elicit further recommendations on how to better generate and package evidence to meet the needs of decisionmakers. Also in attendance …
Understanding Fertility Regulation Strategies Among Educated Women In Accra, Cicely Marston, Alicia Renedo, Gertrude Nyaaba, Kazuyo Machiyama, Placide Tapsoba
Understanding Fertility Regulation Strategies Among Educated Women In Accra, Cicely Marston, Alicia Renedo, Gertrude Nyaaba, Kazuyo Machiyama, Placide Tapsoba
Reproductive Health
In Ghana fertility is declining, especially among urban educated women, yet according to the Ghana DHS, use of modern family planning methods fell between 2003 and 2014 in Greater Accra, particularly among better-educated and urban women. Recent studies have shown strong resistance to hormonal methods, reportedly because of fear of side effects. This study aimed to understand fertility regulation strategies among educated women in Accra using a qualitative, exploratory approach. Use of different methods was bound up in women’s modern identities and their attempts to meet the demands of modern urban life (get a good education and a professional, well-paid …
Root Causes And Persistent Challenges In Accelerating The Abandonment Of Fgm/C, Jacinta Muteshi-Strachan
Root Causes And Persistent Challenges In Accelerating The Abandonment Of Fgm/C, Jacinta Muteshi-Strachan
Reproductive Health
No abstract provided.
The Fgm/C Research Programme, Jacinta Muteshi-Strachan
The Fgm/C Research Programme, Jacinta Muteshi-Strachan
Reproductive Health
No abstract provided.
A State-Of-The-Art Synthesis On Female Genital Mutilation/Cutting: What Do We Know Now?, Bettina Shell-Duncan, Reshma Naik, Charlotte Feldman-Jacobs
A State-Of-The-Art Synthesis On Female Genital Mutilation/Cutting: What Do We Know Now?, Bettina Shell-Duncan, Reshma Naik, Charlotte Feldman-Jacobs
Reproductive Health
Efforts to end female genital mutilation/cutting (FGM/C) are a rising priority on many national and global agendas. Thus it is imperative to have a clear understanding of the scale and scope of the practice, and where it occurs, as well as the dynamics of change and the broader context surrounding it. This state-of-the-art synthesis offers a snapshot of the most recent data available as of July 2016 and the most relevant contextual information on key FGM/C issues in clear, nontechnical language that can help inform policymakers, donors, program planners, and other key stakeholders. The data point to “hot spot” geographic …
Considerations On The Use And Interpretation Of Survey Data On Fgm/C, Bettina Shell-Duncan
Considerations On The Use And Interpretation Of Survey Data On Fgm/C, Bettina Shell-Duncan
Reproductive Health
This technical brief was written as an addendum to the trends presented in the “State of-Art-Synthesis of Female Genital Mutilation/Cutting: What Do We Know Now?” published in October 2016. This brief describes important sources of reliable data that have been generated in recent years, to provide accurate information on FGM/C practices and attitudes. The majority of these data are derived from cross-sectional survey research, and the brief notes the strengths and limitations of this research approach which should be borne in mind when using and interpreting these data. Table 1 summarizes nationally representative data on FGM/C available from a number …
Health Impacts Of Female Genital Mutilation/Cutting: A Synthesis Of The Evidence, Samuel Kimani, Jacinta Muteshi-Strachan, Carolyne Njue
Health Impacts Of Female Genital Mutilation/Cutting: A Synthesis Of The Evidence, Samuel Kimani, Jacinta Muteshi-Strachan, Carolyne Njue
Reproductive Health
The Africa Coordinating Centre for the Abandonment of Female Genital Mutilation/Cutting, with support from the Population Council, sought to synthesize the evidence on the health impacts of female genital mutilation/cutting (FGM/C), identify recommended interventions, and compile and analyze the existing reference materials. The goal of this review is to inform the development of a comprehensive set of training guidelines and materials for frontline healthcare providers so they can manage the care of women and girls who have undergone FGM/C, prevent the practice at the community level, and accelerate abandonment of FGM/C practices. This analysis underscores the health impacts associated with …
Routine Screening For Intimate Partner Violence: A Guide For Trainers, Odongo Odiyo, Chi-Chi Undie, Margaret Mak'anyengo
Routine Screening For Intimate Partner Violence: A Guide For Trainers, Odongo Odiyo, Chi-Chi Undie, Margaret Mak'anyengo
Reproductive Health
This the first regional document devoted to building the capacity of providers to respond to intimate partner violence (IPV). The training guide is a follow-on initiative to the 6th Best Practices Forum in Health of the East, Central and Southern Africa (ECSA) Health Community, held in August 2012. This Forum brought to the fore research findings from the region centering on the acceptability and feasibility of IPV screening, and culminated in the passage of a resolution by Health Ministers that prescribes the integration of gender-based violence screening into healthcare settings in the ECSA region. This training guide responds to this …