Demography, Population, and Ecology Commons^™

Kenya Country Profile: A Status Check On Unintended Pregnancy In Kenya, Joyce Mumah, Jessica Brinton, Caroline W. Kabiru, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Kenya’s mothers are dying at an alarming rate: a woman giving birth in Kenya has a 1 in 38 chance of dying due to inadequate reproductive health services. In response, in 2014 Kenya’s First Lady Margaret Kenyatta launched the Beyond Zero campaign to create awareness and raise funds to tackle maternal mortality and morbidity and improve child health. This brief offers six policy and programmatic recommendations to address significant sexual and reproductive health challenges highlighted throughout the report. These recommendations take into account the policy context in Kenya, which is evolving at a rapid rate in part because of the …

Improving Family Planning Services In Public Health Facilities To Reach More Women, Caroline W. Kabiru, Jessica Brinton, Joyce Mumah, Carol Mukiira, Chimaraoke O. Izugbara

Reproductive Health

Although Kenya has made significant progress in ensuring its citizens’ right to reproductive health, many Kenyans still lack access to or fail to use contraceptives, in part because of the lack of quality family planning (FP) services. Through the STEP UP research program, the African Population and Health Research Center developed a comprehensive country profile report that outlines the status, causes, and consequences of unintended pregnancy in Kenya. One of the most prominent findings was how important public health facilities are to reducing unmet need for FP. In order to solidify gains achieved and make further progress, concerted commitment from …

Reducing Unsafe Menstrual Regulation Through Medication In Bangladesh, Ubaidur Rob, Ismat Ara Hena, Nargis Sultana, Md. Irfan Hossain, Reena Yasmin, Tapash Ranjan Das, Farid Uddin Ahmed

Reproductive Health

The Population Council and Marie Stopes Bangladesh, in collaboration with the Directorate General of Family Planning and with funding from the World Health Organization, tested the feasibility of introducing menstrual regulation with medication (MRM) in Bangladesh and assessed the acceptability of providing MRM using the combination drug regimen mifepristone and misoprostol in urban and rural public health facilities. As reported in this policy brief, the study demonstrates that it is feasible and safe to introduce MRM in rural and urban public health facilities. Given the choice, almost two-thirds of women preferred MRM to manual vacuum aspiration and women receiving MRM …

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

Reproductive Health

Dans le cadre du programme de recherche « Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) », le Population Council a élaboré un Rapport du Profil Pays pour comprendre les grossesses non désirées au Sénégal. Ils ont mené une revue de la littérature, analysé des données d'enquêtes disponibles, et a mené des entretiens pour discuter plus en détail de certains aspects avec quelques parties prenantes clés. Le Profil Pays a été discuté lors d’un atelier de deux jours à Dakar regroupant les principaux acteurs du gouvernement aux niveaux central et régional, des organisations non-gouvernementales, et des acteurs de la …

Understanding Unintended Pregnancy In Senegal: Country Profile Report, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

As part of the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) research program, the Population Council has developed a Country Profile Report to understand unwanted pregnancies in Senegal. The Population Council conducted a literature review, analyzed available survey data, and conducted interviews to discuss some aspects in more detail with a number of key stakeholders. The Country Profile was discussed at a two-day workshop in Dakar bringing together key government actors at the central and regional levels, nongovernmental organizations, and civil society actors. The report is composed of six chapters, summarized in this evidence brief.

La Planification Familiale Postpartum Au Burkina Faso - Résumé En Français, Step Up Research Programme Consortium

Reproductive Health

Ce résumé décrit une étude sur la planification familiale post-partum (PFPP) au Burkina Faso. L’étude avait pour but: de donner un aperçu de la disponibilité et la qualité des services prénatals, du post-partum, et de planification familiale au niveau des soins primaires, et d’évaluer la mesure dans laquelle ils fournissent des services efficaces de PFPP; d’évaluer l'accessibilité des services PFPP; d’explorer l’effet de facteurs sociaux, économiques, et culturels sur la demande et l'adoption de la PFPP; d’estimer l’impact, la pertinence, et la mise en œuvre de la politique nationale et des protocoles cliniques par rapport à la PFPP; et d’identifier …

International Seminar On Promoting Postpartum And Post-Abortion Family Planning: Challenges And Opportunities, Iussp Scientific Panel On Reproductive Health

Reproductive Health

The IUSSP Scientific Panel on Reproductive Health, in collaboration with the Population Council, India, and the Department of Reproductive Health and Research, World Health Organization held a seminar on “Promoting postpartum and post-abortion family planning: Challenges and opportunities” in Cochin, India, November 2014. The seminar brought together 24 scientists, policymakers, and program managers to present and discuss a range of issues relating to postpartum and post-abortion family planning. This report summarizes the papers presented at the seminar which sought to answer several key questions pertaining to postpartum and post-abortion contraception. Several conclusions drawn from the evidence are presented and research …

Knowledge And Provision Practices Of Misoprostol Among Pharmacies In Senegal, Ramatoulaye Ndao, Babacar Mane, Eva Burke, Nafissatou Diop, Kate Reiss, Thoai Ngo, Katharine Footman, Maaike Van Min

Reproductive Health

In developing countries, postpartum hemorrhage and complications related to unsafe abortions are direct causes of maternal death. In Senegal, actions have been undertaken by the government to reduce this burden and significant advances have been made in these areas in recent years. However, progress is still necessary to achieve the Millennium Development Goals for the reduction of the maternal mortality rate to the target numbers by 2015. The objective of the study was to understand the knowledge about, availability of, and practices in the provision of misoprostol at pharmacies in Dakar, Senegal, to ensure correct delivery of the product. Pharmacists …

Prevalence Of Unintended Pregnancy And Needs For Family Planning Among Married Adolescent Girls Living In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Sabiha Chowdhuri, Bidhan Krishna Sarker, Noushin Islam, Anisuddin Ahmed

Reproductive Health

This STEP UP research report examined the prevalence and basic underlying factors of unintended pregnancy among married adolescent girls in five urban slums in Dhaka, Bangladesh. The specific objectives of the study were to: 1) document the prevalence of unintended pregnancy among married adolescent girls aged 15–19 years living in urban slums of Dhaka; 2) identify the factors associated with or which contribute to unintended pregnancy among urban married adolescent girls; 3) estimate the proportion of married adolescent girls who have an unmet need for family planning (FP) services; and 4) explore the barriers to access and effective use of …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape: A Review Of Policies, Programmes And Country Experiences In Sub-Saharan Africa, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

This study examined how pregnancy prevention and management services (specifically, the provision of emergency contraception, pregnancy testing and counseling, and termination or referral for termination of pregnancy services) feature within post-rape care services in sub-Saharan Africa. The study drew on a range of sources via a desk review, as well as on information provided through key informant interviews. The existence of numerous national guidelines in the region demonstrates countries’ desire to respond to this public health and legal challenge. However, if left in their current state, the gaps and inconsistencies observed across most national guidelines contribute to a violation of …

Coping With Unintended Pregnancies: Narratives From Adolescents In Nairobi's Slums, Joyce Mumah, Caroline W. Kabiru, Chimaraoke O. Izugbara, Carol Mukiira

Reproductive Health

This qualitative study examined the challenges faced by adolescents in Kenya with regard to unintended pregnancies and how adolescents in urban slum settlements manage and cope with unintended pregnancies. The study’s findings suggest that high levels of unintended pregnancy among young people in Kenya’s urban slums are linked to myths and misconceptions about contraception. Other findings underscore the fact that many young people lack access to contraception and reproductive health services; indicate that unintended pregnancies are linked to sexual violence; and highlight the need for government to manage the high levels of school dropout as a result of an unintended …

Unintended Pregnancy And Abortion In India: Country Profile Report, Mary Philip Sebastian, M.E. Khan, Daliya Sebastian

Reproductive Health

A review of literature and analysis of large surveys were carried out with funding from the STEP UP consortium led by Population Council to build a coherent body of robust research-based evidence on the situation in India in the context of unmet need for family planning (FP) and safe abortion services. The study found that there is insufficient training of different cadres of health staff in the public health system on abortion provision, post-abortion care, FP counseling of young couples, emergency contraception, and IUD insertion/removal. Despite service delivery guidelines in India expecting providers to provide FP counseling during antenatal visits, …

Second Consultation On Developing Standards For Identifying Evidence-Based Practices In Reproductive Health, Step Up Research Programme Consortium

Reproductive Health

The STEP UP consortium and the High Impact Practices initiative, together with other partners, supported three consultation meetings to inform the use of appropriate standards of evidence for recommending best practices in reproductive health (RH). The second consultation, reported here, brought together researchers and funders to review the research designs and methodologies that can be used to generate evidence on the impact of FP/RH interventions and on their implementation; the mechanisms and structures through which such evidence is reviewed and translated into recommendations; and the implications for organizing and funding evidence generation to maximize its quality and utility. Drawing from …

Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew

Reproductive Health

This research report presents a country profile of Kenya, and looks at differential access to and quality of family planning (FP) and abortion/post-abortion services to assess their current situation, as well the various financing and delivery mechanisms for these crucial services. Since 2000, Kenya has passed several new sexual and reproductive health (SRH) and population-related policies, including a new population and development policy that addresses rapid population growth. Results of this country profile highlight the need for further research on: 1) innovative ways through which SRH information can be brought to schools; 2) FP/SRH indicators in people living with disabilities; …

Postpartum Family Planning In Burkina Faso, Marina Daniele

Reproductive Health

This is a formative study aiming to identify the main barriers to the provision and uptake of quality postpartum family planning (PPFP) services at the supply, access, demand, and policy levels in Burkina Faso. This study reveals that there are substantial shortfalls in the availability of quality PPFP at all these levels. Most of the difficulties observed in the provision of PPFP services are due to the failure to translate largely sound policies and guidelines into practice. This study contributes to identifying priority areas and makes recommendations for improvement in order to respond to unmet need for family planning in …

Promoting Respectful Maternity Care: A Training Guide For Facility-Based Workshops—Participant's Guide, Charity Ndwiga, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Alice Maranga, Christine Ochieng, Mary Wanjala, Beatrice Chelang'at, Anne Njeru, Annie Gituto, George Odhiambo, Faith Mbehero, Lucia Maina, Jeremiah Maina

Reproductive Health

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. Workshop objectives outlined in the Participant’s Guide: Outline current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to respectful maternity care and …

Promoting Respectful Maternity Care: A Training Guide For Community-Based Workshops—Community Facilitator's Guide, Charity Ndwiga, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Alice Maranga, Christine Ochieng, Mary Wanjala, Beatrice Chelang'at, Anne Njeru, Annie Gituto, George Odhiambo, Faith Mbehero, Lucia Maina, Jeremiah Maina

Reproductive Health

This guide was produced as part of the Respectful Maternity Care (RMC) Resource Package. The Resource Package was designed to support health facility managers, health care providers, and communities in confronting disrespect and abuse (D&A) during facility-based childbirth and to promote respectful maternity care. The Resource Package includes a facilitator’s guide (facility-based workshops), facilitator’s guide (community-based workshops), participant’s guide, community flipchart, tools, and program briefs. The Community Facilitator’s Guide, designed to be used by facilitators to promote respectful maternity care at the community level, can be adapted to educate a variety of stakeholders in community settings (i.e., Community Health Extension …

Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Community-Based Workshops, Population Council

Reproductive Health

The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Community-Based Workshops” is to orient community-health workers on the RMC concept. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal health in relation to RMC. Discuss rights-based approaches related to RMC. Discuss selected strategies that reduce disrespect and abuse (D&A). Discuss the role of the community in promoting RMC. Demonstrate knowledge and use of the Alternative Dispute Resolution mechanism. Develop action plans to support the implementation of RMC interventions at the community level. Summary: D&A deters facility-based childbirth and Skilled …

Maternal And Newborn Health Behaviors In Rural Uttar Pradesh: Findings From Learning Phase Baseline Survey 2013, M.E. Khan, Praween Kumar Agrawal, Avishek Hazra, Anvita Dixit, Isha Bhatnagar, Jaleel Ahmad, D.N. Ahmad

Reproductive Health

The Uttar Pradesh Community Mobilization Project (2011–16) aims to develop and scale up evidence-based interventions to improve reproductive, maternal, neonatal, and child health and nutrition health behaviors by an average of 10 percentage points among marginalized populations in Uttar Pradesh, India. The goal is to reduce neonatal mortality by improving maternal and child health behaviors through developing and scaling up a package of family health interventions and strengthening the management of Behavior Change Communication using self-help groups as the platform. The project is being carried out in two phases—a learning phase covering 10 blocks and a scale-up phase covering 100 …

The Characteristics Of Women Seeking Funding From The Dc Abortion Fund, Karin Elizabeth Bleeg

GW Research Days 2013

Objectives: To determine whether the population DCAF serves, based on current research, are those most in need of its financial services. Describe the population that DCAF is supports by age, race and ethnicity, poverty, educational attainment, union status, contraceptive method used, referral source, and number of prior pregnancies.

Methods: An adapted version of The Guttmacher Institute's National Patient Survey will be used to collect data from women who contact DCAF for financial assistance for their abortion (n=150). The data will be collected for one month and then analyzed in SPSS.

Results: Between January and March 2013 approximately 400 women contacted …

Status Report On The Sexual And Reproductive Health Of Adolescents Living In Urban Slums In Kenya, Donatien Beguy, Joyce Mumah, Salome Wawire, Kanyiva Muindi, Lindsey Gottschalk, Caroline W. Kabiru

Reproductive Health

This report highlights the sexual and reproductive health (SRH) challenges faced by adolescents living in slums in Nairobi, Kenya, as well as the perceptions and strategies that adolescents adopt to deal with each of these challenges. The results point to the fact that there is a range of experiences among adolescents with regard to knowledge, attitudes, and behaviors. Age, education, and marital status were often strongly associated with certain adolescent sexual and reproductive health experiences, highlighting the fact that targeted programs are needed to reach adolescents with SRH services at different stages of need. Consistent and persistent poverty reduction strategies …

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

Reproductive Health

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

Insights Into Unmet Need In Kenya, Kazuyo Machiyama, John C. Cleland

Reproductive Health

Results from this study demonstrate that most women having unmet need for family planning in Kenya were aware of the two main contraceptive methods and a supply source, but many of the poorest, least educated women and those living in North Eastern Province were disadvantaged in this regard. Targeted expansion of access/information is a priority to meet the need of the disadvantaged populations. Kenya has one of the longest records of successful family planning programs in Africa, but this report has revealed some major defects, in particular excess reliance on two hormonal methods. Major future progress may well depend on …

The Contracting World Of Girls At Puberty: Violence And Gender-Divergent Access To The Public Sphere Among Adolescents In South Africa, Kelly Hallman, Nora Kenworthy, Judith A. Diers, Nick Swan, Bashi Devnarain

Poverty, Gender, and Youth

This Population Council working paper describes a participatory mapping project undertaken with single-sex groups of grade 5 and grade 8–9 children in urban and rural KwaZulu-Natal, South Africa. At grade 5, female self-defined community areas were equal to or larger in size than those of males in both sites. However, wide gender divergence in access to the public sphere was found among grade 8–9 children. Although curtailed spatial access, especially in urban areas, is intended to protect post-pubescent girls, grade 8–9 girls reported most spaces in their small navigable areas unsafe. Reducing girls’ access to the public sphere does not …

Assessment Of The Availability And Use Of Maternal Health Supplies In The Primary Health Care System In Amhara Region, Ethiopia, Sarah Raifman, Sisay Mellese, Kelemua Hailemariam, Ian Askew, Annabel Erulkar

Reproductive Health

Maternal mortality in Ethiopia remains among the highest in the world. A UN Commission Report in 2012 identified 13 life-saving commodities—defined as medicines, medical devices, and health supplies—that effectively address avoidable causes of death during pregnancy and childbirth that, if more widely accessed and properly used, could significantly reduce preventable deaths among women. This assessment, conducted by the Population Council, evaluates the availability of these life-saving commodities that are essential for basic emergency obstetric and neonatal care, and safe and clean delivery services within primary health care in Ethiopia. The report concludes that Ethiopia’s pharmaceutical procurement and supply system is …

Do Public Health Services In Egypt Help Women Exercise Their Reproductive Rights?, Nahla G. Abdel-Tawab

Reproductive Health

These slides present results from a Population Council study conducted in Egypt aimed at identifying factors that prevent Egyptian couples from attainment of their reproductive goals using a rights-based, gender-sensitive analysis of family planning service demand and supply. The analysis focused on six aspects of clients’ rights: clinic/provider readiness, accessibility and affordability, privacy and confidentiality, choice and autonomy, informed decisionmaking, and the right to complain. The presentation concludes with recommendations for closing gaps that exist with regard to protection of clients’ rights to autonomy, choice, informed decisionmaking, privacy, and confidentiality.

Feasibility Of Routine Screening For Intimate Partner Violence In Public Health Care Settings In Kenya, Chi-Chi Undie, Catherine Maternowska, Margaret Mak'anyengo, Ian Askew

Reproductive Health

This Population Council study tested the feasibility of implementing intimate-partner violence (IPV) screening protocols in healthcare settings in Kenya where sexual and gender-based violence service referrals could be executed. Providers drawn from these sites were trained to routinely screen for IPV and to refer IPV-positive clients identified through this process for further care. This study demonstrates that providers, given the training, are willing and able to incorporate IPV screening into their practice—one that they perform in a severely resource-constrained context. Likewise, the findings indicate that incorporating IPV screening questions into client intake forms in a variety of public healthcare settings …

Scaling Up Advocacy For Gender-Based Violence And Child Sexual Abuse In The East, Central And Southern Africa Region: Technical Exchange And Meeting, East Central And Southern African Health Community

Reproductive Health

The East, Central and Southern Africa (ECSA) Health Community, which prioritizes gender-based violence and child sexual abuse as regional health concerns, partnered with the Population Council to convene a pre-conference Expert Committee meeting of the Research, Information and Advocacy Programme. The conference marked a major milestone in the ECSA Health Community’s commitment to promote and support region-wide sharing and utilization of health research and policy information among its member states. This report summarizes the deliberations of the two-day workshop and the recommendations for implementing an advocacy plan to address this important facet of the region’s development agenda.

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

Reproductive Health

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

Cost Estimation For Scale-Up Of Voucher Services In Kenya, Shubhra Kumar, Smita Sanghrajka, Benjamin Bellows

Reproductive Health

This document reports on the Government of Kenya’s Output-Based Aid (OBA) vouchers program—an affordable strategy to meet the international and national objectives for improved maternal and reproductive health. To help achieve the global Millennium Development Goals related to maternal and child health, the Kenyan government has launched several initiatives including this Vision 2030 flagship program which harmonizes global and national objectives by improving access and enhancing equity in health service delivery. The report finds that the three maternal health MDG indicators—maternal mortality rate, rate of institutional deliveries, and contraceptive prevalence—can all be improved substantially by scaling up the OBA program. …