Family, Life Course, and Society Commons^™

Anneau Vaginal À Progestérone: Aussi Sûr Pour Maman Que Pour Bébé, Population Council

Reproductive Health

Cette fiche d'information fournit des informations de base sur l'innocuité et l'efficacité de l'anneau contraceptif vaginal à la progestérone (AVP). Son effet contraceptif fonctionne en renforçant les effets inhibiteurs de l'allaitement maternel sur l'ovulation, et en étendant l'aménorrhée post-partum. L'AVP est un contraceptif sûr et efficace pour les mamans, leurs bébés et leurs partenaires sexuels. Cette méthode étend largement le gamme de contraceptifs à la disposition des femmes qui allaitent.

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This fact sheet provides basic information on the safety and effectiveness of the progesterone vaginal contraceptive ring. It works as a contraceptive by reinforcing the inhibitory effect of breastfeeding …

Confronting Disrespect And Abuse During Childbirth In Kenya: The Heshima Project, Population Council

Reproductive Health

No woman should be hit, yelled at, or abused in any way during childbirth. However, laboring women in Kenya and elsewhere may experience inhumane treatment in hospitals and clinics. This abuse is a key yet overlooked reason why only four in ten pregnant women in Kenya deliver at health facilities. To increase the number of women delivering in health facilities and thereby reduce maternal deaths, governments, health systems, and practitioners need sound evidence documenting the disrespect and abuse that women experience. Through the Heshima Project, the Population Council is changing how health systems and women think about quality maternity care …

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report …

Achieving Mdgs 4 And 5 In Punjab: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Punjab government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Punjab—about 16 percent of the deaths in this age group are pregnancy-related. Approximately 6,000 women die each year in Punjab due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The good …

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

Reproductive Health

The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Facility-Based Workshops” is to orient service providers on the RMC concept along with a set of evidence-based interventions to promote RMC. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to RMC and the RMC Resource Package. Demonstrate knowledge and use of Values Clarification and Attitude Transformation (VCAT) theory and practice. Discuss selected evidence-based strategies that reduce disrespect and abuse. Discuss participants’ …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Mexico, Karla Berdichevsky, Claudia Diaz, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To help accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate the indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. …

Achieving Mdgs 4 And 5 In Balochistan: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Balochistan government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Balochistan—about 35 percent of the deaths in this age group are pregnancy-related. Approximately 3,000 women die each year in Balochistan due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The maternal …

Achieving Mdgs 4 And 5 In Khyber Pakhtunkhwa: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Khyber Pakhtunkhwa (KP) government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in KP—about 27 percent of the deaths in this age group are pregnancy-related. Approximately 1,700 women die each year in KP due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. …

Achieving Mdgs 4 And 5 In Sindh: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Sindh government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Sindh—about 24 percent of the deaths in this age group are pregnancy-related. Approximately 2,800 women die each year in Sindh due to pregnancy-related causes despite some recent improvement in reproductive health indicators. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family …

Induced Abortions And Unintended Pregnancies In Pakistan, 2012, Population Council

Reproductive Health

The 2012–13 PDHS (Pakistan Demographic and Health Survey) shows that gains in contraceptive prevalence over the past decade have been small, and unmet need has remained high. Using data from a 2012 national study on post-abortion care, we estimate 2.2 million abortions occurred in Pakistan in 2012, and an annual abortion rate of 50 per 1,000 women. A previous study estimated an abortion rate of 27 for 2002. Even accounting for an underestimation of abortion incidence (private sector abortion services could not be included) in the prior study, the abortion rate in Pakistan has likely increased substantially between 2002 and …

Maternal Health Commodity Landscaping Exercise: A Snapshot Of The Bangladesh Program, Sharif M.I. Hossain, Saumya Ramarao, Ismat Ara Hena, Ubaidur Rob

Reproductive Health

Despite consistent efforts of the government and national stakeholders, every year in Bangladesh over 5,000 mothers and thousands of children die. Most of these deaths would be preventable with increased access to quality services including existing medicines and other health commodities. The United Nation’s Commission on Life-Saving Commodities for Women and Children suggests that an important cause of these deaths is lack of access and appropriate use of 13 life-saving commodities. This document describes an effort by the Population Council to assess the country’s policies, guidelines, and availability for these 13 life-saving commodities as well as engaging with key stakeholders …

Prioritizing Family Planning For Achieving Provincial Maternal Child Health And Development Goals, Zeba Sathar, Muhammad Asif Wazir, Maqsood Sadiq

Reproductive Health

This report presents an argument for prioritizing family planning to achieve the maternal, child, and development goals of four major provinces in Pakistan, using the latest available provincial data, especially the Pakistan Demographic and Health Survey 2012-13. The analysis is based on provincial projections generated by the Population Council. Opportunities for enhancing family planning are identified, and the number of maternal, infant, and child lives that could be saved in each province through an accelerated family planning program is estimated. The analysis establishes that none of the provinces are on track to meet Millennium Development Goals 4 or 5. The …

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 …

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 …

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 …

Shaping Demand And Practices To Improve Family Health Outcomes: Findings From A Quantitative Survey, Volume 3: Bihar, M.E. Khan, France Donnay, Usha Kiran Tarigopula, Kumudha Aruldas

Reproductive Health

This report provides findings of a study undertaken to generate comprehensive information on eight target behaviors that have direct bearing on family health in rural Bihar. Behaviors include: 1) Increasing the proportion of deliveries that occur in a facility and mothers who have access to basic emergency obstetric care; 2) Increasing the proportion of safe deliveries at home; 3) Increasing the uptake of preventive postnatal-care services for newborns and mothers; 4) Increasing the practice of skin-to-skin care/Kangaroo Mother Care for newborns; 5) Increasing the practice of early and exclusive breastfeeding of infants during the first six months of life; 6) …

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 …

Providing Maternal And Newborn Health Services: Experiences Of Auxiliary Nurse Midwives In Rajasthan, K.G. Santhya, Shireen J. Jejeebhoy

Poverty, Gender, and Youth

To better understand the experiences of auxiliary nurse-midwives (ANMs) in providing maternal and newborn health services and to obtain their perspectives on Janani Suraksha Yojana (JSY), the Population Council undertook an exploratory study of ANMs in two districts of the north-western state of Rajasthan, India. Findings show that the vast majority of the ANMs were aware of best practices related to the immediate care of the newborn. Nevertheless, the findings also suggested a number of priority areas for action, including increased investment in training, encouraging provision of services on a more regular basis, making special efforts to enable ANMs to …

Training Manual On The Use Of Magnesium Sulphate In The Management Of Severe Pre-Eclampsia And Eclampsia [Trainee Version], Federal Ministry Of Health, Population Council

Reproductive Health

This training manual provides detailed, descriptive, and practical instructions and tips necessary to respond to obstetric emergencies (severe pre-eclampsia and eclampsia). The manual is an integral part of the collaborative efforts between the Federal Ministry of Health and the MacArthur Foundation to scale up the use of magnesium sulphate in the management of severe pre-eclampsia and eclampsia in Nigerian health facilities. Magnesium sulphate has been established as the gold standard in the management of severe pre-eclampsia and eclampsia, but lack of knowledge and necessary skill have been identified as some of the factors responsible for its limited use in Nigeria. …

Incentivizing Providers To Improve Maternal, Newborn And Child Health Services In Bangladesh: Pay-For-Performance Model Refinement And Advocacy (P4p Mra) Final Report, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, A.K.M. Zafar Ullah Khan, Riad Mahmud, Azizul Alim, Ismat Ara Hena, Farhana Akter, Anup Kumar Dey

Reproductive Health

An operations research project by the Directorate General of Health Services (DGHS) of the Ministry of Health and Family Welfare, Government of Bangladesh tested the feasibility of a pay-for-performance (P4P) approach, which offered financial incentives to reward service providers for meeting and exceeding specified performance targets for maternal, newborn, and child health services. In response to the encouraging findings, the DGHS implemented a follow-up project, with technical assistance from Population Council and UNICEF, to utilize the experiences and findings of the P4P OR project. Despite it short duration, implementation of the revised P4P scheme induced improvements in service volume and …

Strengthening The Delivery Of Comprehensive Reproductive Health Services Through The Community Midwifery Model In Kenya, Wilson Liambila, Francis Obare, Chi-Chi Undie, Harriet Birungi, Shiphrah Kuria, Ruth Wayua Muia, Assumpta Matekwa

Reproductive Health

The overall objective of this project was to strengthen the delivery of family planning/reproductive health and HIV (FP/RH/HIV) services at the community level. The interventions included revision of existing guidelines and protocols for the community midwifery approach, training of providers, provision of equipment and supplies, and creating awareness on the use of community referral cards. In addition, cost analysis of community midwives’ services and willingness-to-pay assessments for various reproductive health services among current and potential users of community midwifery services were undertaken. The results showed that the community midwifery model improved clients’ access to a comprehensive package of RH/HIV including …

Scaling Up The Integration Of Tuberculosis Screening Into Reproductive Health Services, Aphia Ii Or Project In Kenya

Reproductive Health

The Population Council’s APHIA II Operations Research and Kenya’s Ministry of Health implemented a pilot project in five facilities across Nairobi Province in 2010 with the aim of improving access to care and treatment for tuberculosis (TB) for women during postnatal care (PNC) services. As tuberculosis persists in Kenya, integration of screening and referrals within postnatal care services will increase case detection and treatment for those infected. Integration of TB screening is likely to be scaled up throughout PNC and maternal and child health services in Kenya. Strong linkages between health services, training, and supervision, and simple provider tools will …

Strengthening The Delivery Of Comprehensive Reproductive Health Services At The Community Level In Kenya, Population Council

Reproductive Health

The Population Council APHIA II Operations Research Project collaborated with the Ministry of Public Health and Sanitation to improve the quality of services offered by community-based midwives in two districts in Western Kenya, to prepare them to offer more comprehensive maternal services through antenatal, obstetric, postpartum, and newborn care. The study found that community midwives can tremendously increase clients’ access to essential maternal health services and other reproductive health services. Therefore Ministry of Health and its partners should scale up community midwives’ activities to enable more women access these services. Furthermore, information campaigns are needed to promote the range of …

A P4p Model For Increased Utilization Of Maternal, Newborn And Child Health Services In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Laila Rahman, Ismat Ara Hena, A.K.M. Zafar Ullah Khan

Reproductive Health

In Bangladesh, maternal health programs are not yet reaching the desired level of facility-based obstetric care service. Most deliveries are conducted by untrained persons at home, demonstrating inequity in access to recommended maternal health care services and underutilization of existing obstetric and newborn care services. Suboptimal performance by providers is a key barrier to improving availability and quality of maternal, newborn, and child health (MNCH) services. To increase use of facility-based services, an operations research study of “pay-for-performance” (P4P) incentives for providers and subsidization of consumer costs was initiated in 2010. The study, part of the Government of Bangladesh–United Nations …