Demography, Population, and Ecology Commons^™

Evaluation Of The Long-Term Impact Of The Tostan Programme On The Abandonment Of Fgm/C And Early Marriage: Results From A Qualitative Study In Senegal, Nafissatou J. Diop, Amadou Moreau, Helene Benga

Reproductive Health

In 1998–99, a village empowerment program was implemented in the Thiès/Fatick and Kolda regions of Senegal by the nongovernmental organization Tostan, to mobilize communities to hold public declarations in support of abandoning harmful traditional practices, including female genital mutilation/cutting (FGM/C) and child marriage. The information presented in this report indicates that many did end the practices following a public declaration, however, the lack of follow-up in the field and the absence of support mechanisms pose a large obstacle. Nevertheless, the program achieved significant results: knowledge of life skills resulting in positive changes and a shift in the perception of FGM/C …

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In The Dominican Republic, Gisela Quiterio, Maritza Molina, Marija Miric, Ricardo Vernon, M. Estela Rivero-Fuentes

Reproductive Health

A diagnostic study of the provision and use of contraception in postpartum, postabortion, and prevention of mother-to-child transmission (PMTCT) programs in the Dominican Republic was conducted with funding from USAID. The objectives of the study were to assess the contraceptive knowledge, attitudes, and behaviors of providers and clients; the degree to which information, counseling, and delivery are implemented in postpartum, postabortion, and PMTCT services; the quality of these services; and the readiness of postpartum, postabortion, and PMTCT services to offer contraceptive services. The report finds that family planning services are linked to antenatal, delivery, and postpartum care in most of …

Increasing The Accessibility, Acceptability And Use Of The Iud In Gujarat, India, M.E. Khan, Sitanshu Sekhar Kar, Vikas Kishor Desai, Pratibha Patel, B.P. Itare, Sandhya Barge

Reproductive Health

The USAID-funded FRONTIERS Program of the Population Council, in collaboration with the Department of Health & Family Welfare, Government of Gujarat, and the Center for Operations Research and Training, Vadodara, conducted an operations research study in India to test the hypothesis that by improving the demand for the IUD and simultaneously strengthening the technical competencies and counseling skills of the providers, use of the IUD use would increase. The findings show that demand-generation activities and provision of good-quality IUD services, together with a supportive programmatic environment, when carried out simultaneously showed increased acceptance of the IUD. The intervention could be …

Taking Critical Services To The Home: Scaling-Up Home-Based Maternal And Postnatal Care, Including Family Planning, Through Community Midwifery In Kenya, Annie Mwangi, Charlotte E. Warren

Reproductive Health

With support from USAID, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project supported the scaling up of a community-based model in Kenya that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. To strengthen the sustainability of this approach FRONTIERS engaged a microfinance NGO to develop a training curriculum on basic business skills and financial literacy, and encouraged the community midwives (CMs) to form clusters or informal associations so that they could be trained in business skills. Following these interventions, CMs proved more …

Feasibility, Acceptability, Effect, And Cost Of Integrating Counseling And Testing For Hiv Within Family Planning Services In Kenya, Wilson Liambila, Charlotte E. Warren, Saiqa Mullick, Ian Askew, Rick Homan, Ibrahim Mohammed, Robert Ayisi, Margaret Gitau, Josephine Kibaru, Mary W. Gathitu, Judith Maua, Helton Jilo, Juma Mwangi, John Njoroge, Anthony K. Wanyoro, Peter Mohammed Njuguna, Andrew Mboche

Reproductive Health

FRONTIERS supported the Division of Reproductive Health and the National AIDS and STI Control Program of the Kenya Ministry of Health to design, implement, and compare two models of integrating counseling and testing (CT) for HIV within family planning (FP) services in terms of their feasibility, acceptability, cost, and effect on the voluntary use of CT, as well as the quality of FP services. The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion, and counseling and testing with FP services, and are effective …

Empowering Communities To Make Pregnancy Safer: An Intervention In Rural Andhra Pradesh, Dipa Sinha

Reproductive Health

Recognizing that multiple factors are responsible for adverse pregnancy-related outcomes, a community-based intervention was implemented in Mominpet, in Andhra Pradesh, India in collaboration with the M.V. Foundation, a nongovernmental organization. The intervention focused on improving maternal health outcomes by raising awareness and building family and community support for pregnant women; involving pregnant women’s families, notably their husbands, in pregnancy-related care; and supporting pregnant women to access health services. This report describes the experience and outcomes of the intervention. In particular, it explores the extent to which the intervention was effective in increasing community support for safe motherhood on the one …

Dominican Republic, Haiti, Nicaragua: Promoting Family Planning During The Postpartum Period Can Increase Contraceptive Acceptance, Population Council

Reproductive Health

The World Health Organization recommends that women receive information on family planning (FP) during antenatal care (ANC), immediately after birth, and during postpartum and well-baby care. However, few studies have assessed the effect of information during each of these stages on women’s use of contraceptive methods. Data collected by FRONTIERS in the Dominican Republic, Haiti, and Nicaragua have been analyzed to answer this question. Use of maternal care services, exposure to FP information, and use of postpartum contraception varies among countries. All women interviewed in the Dominican Republic attended ANC services and delivered in a facility; ANC use and institutional …

Assessing Routine Health Information System In Selected Paiman Districts By Using Lot Quality Assurance Sampling (Lqas) Technique, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to the hospital. PAIMAN is compiling data from three data sources and making efforts to improve the functioning of these Health Information Systems (HISs) for efficient management of health services at the district level through generation of quality data and their …

Meeting The Family Planning Needs Of Postpartum Women, Ricardo Vernon

Reproductive Health

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women's reproductive health and fertility needs during the year following delivery. The situation is compounded …

Promoting Healthy Timing And Spacing Of Births In India Through A Community-Based Approach, M.E. Khan, Mary Philip Sebastian, Usha Sharma, Rukma Idnani, Kaushal Kumari, Bharati Maheshwari, Shahid Ashraf

Reproductive Health

The Indian Family Welfare Program, though successful in increasing contraceptive use among couples who have achieved their desired family size, has failed in educating people about the importance and need of using contraceptive methods for spacing births. With its Indian collaborators, the Population Council’s Frontiers in Reproductive Health (FRONTIERS) program undertook a study to test a model to increase use of postpartum contraception among young pregnant women with a parity of 0 or 1. The study showed that the Behavior Change Communication (BCC) model developed to promote Healthy Timing and Spacing of Pregnancy (HTSP) was effective in promoting the lactational …

Assessing The Need And Opportunities For Improved Linkages Between Conditional Cash Transfers And Reproductive Health Programs In Latin America And The Caribbean, Ricardo Vernon, M. Estela Rivero-Fuentes

Reproductive Health

The objective of this project was to document the structure and functioning of conditional cash transfer (CCT) programs in Latin America and the Caribbean, to assess opportunities for improved linkages between CCTs and reproductive health programs, and to explore the role that operations research may have in the improvement of CCT programs. Activities were conducted in the Dominican Republic, El Salvador, Honduras, Jamaica, Nicaragua, and Peru. Operational problems identified by CCT programs included the targeting and selection of beneficiaries, monitoring compliance with conditions for receiving cash transfers, the systems used to provide the transfers, and management weaknesses. Recommendations are made …

Multisectoral Youth Rh Interventions: The Scale-Up Process In Kenya And Senegal, Stephanie Joyce, Ian Askew, Anta Fall Diagne, Nafissatou J. Diop, Humphres Evelia

Reproductive Health

As in many developing countries, young people in Kenya and Senegal (aged 10–20) account for about 25 percent of the population. To ensure their future contribution to their countries, it is of vital strategic importance to safeguard their welfare. Rapid social change in both countries exposes youth to sexual and reproductive health (RH) risks, including unintended pregnancy, sexually transmitted infections including HIV, and sexual violence. Beginning in 1999, the Population Council’s FRONTIERS program conducted operations research studies that tested the feasibility, acceptability, and cost of a public-sector, multisectoral intervention to enhance young people’s RH knowledge and behavior. Study findings showed …

Profile Of Abortion Seekers In Ghana And Their Decision-Making Processes, Philomena Nyarko, Cletus Adohinzin, Saumya Ramarao, Placide Tapsoba, Ayorinde Ajayi

Reproductive Health

In 2006, a consortium of agencies, including the Population Council, came together to provide technical and financial support to the Government of Ghana in the rollout of comprehensive abortion care (CAC) services. The consortium collaborated with the government in expanding women’s access to modern family planning and CAC. The consortium’s program, Reducing Maternal Mortality and Morbidity (R3M), aims to reduce unwanted pregnancy and severe complications and deaths caused by unsafe abortion. The formative research in this report was undertaken to provide a profile of beneficiaries, their needs for information and services, their decision-making process in seeking care, and the quality …

Crude Birth Rates And Contraceptive Use By Racial/Ethnic Group In The U.S., 1990-2000, Victoria Stone

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes crude birth rates and contraceptive use among women in the three primary racial/ethnic groups, White, Black, and Latina, and further examines birth rates by age-specific groups in the United States between 1990 and 2000.

Methods: The data examined here was derived from the NYC Vital Statistics 2002 Report and the Census 2000 SF4 table on Sex by Age by race and Latino nationality. The birth rates were calculated by dividing live birth numbers (Vital Statistics report) by total population count by age and racial/ethnic group (Census 2000 data) and multiplying this number by 1000.

Results: In …

Increasing Women's Use Of The Iud For Family Planning, Ricardo Vernon

Reproductive Health

The intrauterine device (IUD) is highly effective, easy to use, and has few side effects. The device costs the provider about US$2 and offers a duration of protection that makes it the most cost-effective of the temporary methods if used for two years or more. The IUD's many advantages also make it a good alternative for reducing unmet need for long-term contraception around the world. Between 5 and 17 percent of all married women of reproductive age in 53 less developed countries do not want to have more children but are not using a contraceptive method. Because the IUD can …

Adapting Focused Antenatal Care: Lessons From Three African Countries, Harriet Birungi

Reproductive Health

In 2001, the World Health Organization issued guidance on a new model of antenatal care (ANC) called goal-oriented or focused antenatal care (FANC), for implementation in developing countries. The new model reduces the number of required antenatal visits to four, and provides focused services shown to improve maternal outcomes. FANC emphasizes helping women maintain normal pregnancies by identifying existing health conditions, detecting emerging complications, promoting health, preparing for a healthy birth, and educating clients on postpartum care including nutrition, breastfeeding, and family planning. Trials conducted in Argentina, Cuba, Saudi Arabia, and Thailand proved that FANC was safe and was a …

Assessment Of Knowledge And Attitudes Of Married Women On Maternal And Newborn Health (Mnh) In Selected Union Councils Of Project Districts, Pakistan Initiative For Mothers And Newborns (Paiman)

Reproductive Health

The World Health Organization estimates that 585,000 women die from pregnancy-related conditions each year. Pregnancy-related conditions, including dysfunctional labor, hemorrhage, infection, toxemia, and unsafe abortion, are the leading cause of death among women of reproductive age in many developing countries. The Pakistan Initiative for Mothers and Newborns (PAIMAN) is a five-year project funded by USAID. Its goal is to reduce maternal and newborn mortality in Pakistan, through viable initiatives and capacity building of existing programs and structures within health systems and communities to ensure improvements and supportive linkages in the continuum of health care for women from the home to …

Situation Analysis Of The Integration Of Family Planning Services In Postpartum, Postabortion And Prevention Of Mother To Child Transmission Programs In Haiti, M. Estela Rivero-Fuentes, Ricardo Vernon, Michaelle Boulos, Louis-Marie Boulos

Reproductive Health

This report presents the results of a situation analysis of the provision and use of contraception in postpartum, postabortion, and Prevention of Mother-to-Child Transmission of HIV (PMTCT) services in Haiti. FRONTIERS provided the Centre d’Évaluation et de Recherche Appliqueé (Center for Evaluation and Applied Research or CERA) with technical assistance for the data collection, cleaning, and entry processes. The study found that there is a substantial unmet need for family planning services among postpartum women and many missed opportunities to provide these services during the pregnancy-extended postpartum period continuum. Most outpatient services have adequately implemented HIV counseling for pregnant women, …

Creating The Conditions For Scale-Up Of The Men In Maternity Intervention In India, Leila Caleb-Varkey, Anurag Mishra, M.E. Khan

Reproductive Health

The Frontiers in Reproductive Health (FRONTIERS) program conducted an operations research study, called the Men in Maternity (MiM) study, in collaboration with the Employees' State Insurance Corporation of India (ESIC), aimed at involving men in the antenatal and postpartum care of their partners to raise knowledge and use of postpartum contraception and preventive practices against sexually transmitted infections, as well as improving pregnancy outcomes. This report details the MiM scale-up process, which worked well in terms of ESIC assuming ownership of the training component of the program and being able to build capacity for training. However, to further scale up …

Helping Egyptian Women Achieve Optimal Birth Spacing Intervals Through Fostering Linkages Between Family Planning And Maternal/Child Health Services, Nahla G. Abdel-Tawab, Sarah Loza, Amal Zaki

Reproductive Health

The Population Council’s USAID-funded Frontiers in Reproductive Health (FRONTIERS) program, in collaboration with the Egyptian Ministry of Health and Population and the NGO Social Planning, Analysis and Administration Consultants, conducted an operations research study to measure the acceptability and effectiveness of two birth spacing message models in Upper Egypt. Overall, the study found that providing birth spacing messages to low-parity women during antenatal and postpartum care and also to husbands through community awareness activities was feasible and acceptable. As a result, birth spacing messages have been integrated into service delivery guidelines for antenatal and postpartum care, and IEC materials on …

Strengthening Postnatal Care Services Including Postpartum Family Planning In Kenya, Annie Mwangi, Charlotte E. Warren, Nancy Koskei, Holly Blanchard

Reproductive Health

The objectives of this study were to develop and introduce a strengthened postnatal care package into one hospital and four health centers in one district in Kenya, to document the feasibility, acceptability, and quality of care of the strengthened postnatal care, and to evaluate the effectiveness of the postnatal package on women’s reproductive health behaviors. The study was implemented jointly by the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project and by Jhpiego’s ACCESS-FP project, both funded by USAID. A postnatal care–family planning orientation package for providers was developed that incorporated relevant maternal and newborn healthcare services in the postnatal …

Extending Prevention Of Mother-To-Child Transmission Through Postpartum Family Planning In Lesotho, Charlotte E. Warren, Semakaleng Phafoli, Bosielo Majara, Thato Tsukuluet

Reproductive Health

Recognizing the need to improve the care and follow up of mothers and infants in the postpartum period, the Lesotho Ministry of Health and Social Welfare (MOHSW), with technical support from the Frontiers in Reproductive Health (FRONTIERS) of Population Council and funding from PEPFAR/RHAP/USAID, carried out an operations research project to strengthen the existing postpartum care services. This study had a specific focus on strengthening linkages with existing PMTCT follow-up and family planning services during the postpartum period by changing the number, timing, and content of postpartum consultations that a woman and her newborn should receive. The key findings indicated …

Analysis Of The Evolution Of The Practice Of Female Genital Mutilation/Cutting In Burkina Faso, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

This study was undertaken as a collaboration between the Population Council’s Frontiers in Reproductive Health program and the Comité National de Lutte contre la Pratique de l’Excision (CNLPE) within the Ministry of Social Action and National Solidarity in Burkina Faso. The creation of a favorable environment for the campaign against excision in Burkina Faso has facilitated various anti-cutting activities over the past two decades and enabled the achievement of gains, both in terms of awareness and behavior change. However some of the strategies need further readjustment: among the reasons why excision still continues in Burkina Faso is a certain view …

Family Planning And Comprehensive Abortion Care Handbook For Medical Students And House Officers, Population Council

Reproductive Health

The persistently high maternal mortality and morbidity in Ghana is partly due to high rates of unwanted fertility, unsafe abortion, and relatively low use of modern contraception. In 2006, a consortium of agencies, including the Population Council, initiated the Reducing Maternal Mortality and Morbidity program. The program provides financial and technical resources that will enable the government to significantly expand women's access to modern family planning, contraception, and comprehensive abortion care (CAC) to reduce maternal mortality in Ghana. This handbook on FP and CAC was developed as part of the program. It updates a previous document produced more than ten …

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

HIV and AIDS

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

Crude Birth Rates Among New York City’S Racial/Ethnic Groups And Latino Nationalities In 2002, Victoria Stone

Center for Latin American, Caribbean, and Latino Studies

Introduction: This report analyzes crude birth rates among women in the three primary racial/ethnic groups, White, Black, and Latina, and further examines birth rates by age-specific groups in the five boroughs of New York City in 2002. In addition, this report presents the crude birth rates for six Latino nationalities: Mexican, Ecuadorian, Dominican, Colombian, Puerto Rican and Cuban.

Methods: The data examined here was derived from the NYC Vital Statistics 2002 Report and the Census 2000 SF4 table on Sex by Age by race and Latino nationality. The birth rates were calculated by dividing live birth numbers (Vital Statistics report) …

Developing Comprehensive And Evidence-Based Policy And Guidelines For Antenatal And Postnatal Care In Kwazulu-Natal, Prudence Ditlopo, Mantshi Menziwa, Saiqa Mullick, Saumya Ramarao, Janet Dalton, Dolly Nyasulu, Mags Beksinska, Busi Kunene

Reproductive Health

In May 2004, the Maternal Child and Women’s Health department of Kwazulu-Natal (KZN), South Africa requested technical assistance from the Population Council’s USAID-funded FRONTIERS project for developing standardized and comprehensive antenatal and postnatal (ANC/PNC) care policies and guidelines and supportive training and educational materials. The aims and objectives of this project were to: support the development of a comprehensive evidence-based antenatal and postnatal care program in KZN; consolidate lessons learned and evidence around delivery of comprehensive ANC and PNC; revise provincial guidelines to enable comprehensive ANC and PNC services that address PMTCT, partner involvement, syphilis screening, focused visits, and antiretrovirals; …

Obstetric Fistula: Can Community Midwives Make A Difference? Findings From Four Districts In Kenya, Charlotte E. Warren, Annie Mwangi

Reproductive Health

As part of the UNFPA Global Campaign to End Obstetric Fistula, the Population Council and UNFPA built on Kenya’s Community Midwifery Approach to develop a comprehensive community midwifery intervention strategy that aimed at increasing skilled attendants at birth and prevention of obstetric fistula. This report seeks to understand the experiences of women affected by fistula and whether community midwives can contribute to preventing obstetric fistula in rural settings in Kenya. The key recommendations emerging from this report are to: update health facility midwives in maternal and neonatal health (MNH) skills including prevention, treatment, and care of obstetric fistula; train more …

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

HIV and AIDS

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

Malaria In Pregnancy Pilot Projects Nationally Adopted In Kenya And Malawi, Population Council

Reproductive Health

Kenya and Malawi have developed national policies to prevent malaria in pregnancy. Measures to prevent malaria among antenatal clients were shown to be sustainable several years after pilot interventions ended. In Malawi, the approach has been expanded nationwide. In most malaria-endemic areas of Africa, women in their first and second pregnancies have the highest risk of acquiring malaria and, consequently, of malaria-associated anemia and low birth-weight. Two USAID-funded interventions aimed at strengthening the prevention and management of malaria in pregnancy were pilot-tested at the district level in Kenya (1998–2002) and Malawi (1998–2004). As noted in this brief, the goal was …