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PubMedDate not supplied

Breaking the mold: expanding options for reproductive health awareness: the CARE experience.

The early years of the CARE family planning and reproductive health program were geared primarily toward modern methods of contraception and providing services. However, new and fresh opportunities to address reproductive health awareness and natural family planning are now emerging as important options. In these programs, coordination and collaboration with other sectors such as food and nutrition, children's health and natural resource management, combined with more sophisticated approaches for assessing need and reaching communities with information, has resulted in more people being reached than ever before with appropriate options and opportunities for reproductive health awareness and care. There are examples of CARE projects from India, Peru and Nepal where activities which feature working across development sectors and engaging communities to address their individual and collective RH needs are featured. Ways to disseminate information about reproductive health are being broadened to include creative combinations of interpersonal, mass and folk media', whether it be an informal one-to-one counseling session with flipcharts, a community mobilization event, a multi-media campaign, or any combination thereof. Likewise, the target audience need not always be the women of reproductive age, not should the RH messengers always be the medical and public health professionals. What is critical in all of these instances is to craft strategies based on appropriate research and need, continuously monitor progress, refine approaches as necessary, track results and evaluate the process and impact of interventions leading to behavior change. The challenge is not insignificant, but the rewards to be reaped through the improved programs are clearly worth striving for.

Awareness↗

PubMed1999

Filling the gap. JICA Reproductive Health Project. Nghi Loe district.

Our district, which is composed of 33 communes, is economically poor with unacceptably low health conditions. Many health problems could not be adequately addressed due to the lack of needed resources and technology. But the Japan International Cooperation Agency project, which was started in 1997, has been effectively assisting us in improving the health situation, especially in reproductive health. We highly appreciate the support, which has helped us to disseminate health information to the general public, especially pregnant women. Health workers such as midwives and assistant doctors have been able to improve their skills after attending the training courses. The provision of equipment and instruments has been of great help. We would not have been able to procure them on our own budget, even over the next 10 years. One of our major concerns is the big gap in the health conditions among communes. The health conditions of people in the mountainous area are lower compared to the people in communes in and near the center of the district. The difference exists not only in the health field, but also education and economic fields. To fill the gap, we are encouraging the advanced communes to continue to develop their programs while giving much stronger assistance to the less advanced communes.

Asia↗

PubMed2005

Focus on women: linking HIV care and treatment with reproductive health services in the MTCT-Plus Initiative.

Despite important advances in expanding access to antiretroviral therapy in the countries most heavily affected by HIV/AIDS, there has been little consideration of the connections between HIV prevention, care and treatment programmes and reproductive health services. In this paper, we explore the integration of reproductive health services into HIV care and treatment programmes. We review the design and progress of the MTCT-Plus Initiative, which provides HIV care and treatment services to HIV positive women as well as their HIV positive children and partners. By emphasising the long-term follow-up of families and the provision of comprehensive care across the spectrum of HIV disease, MTCT-Plus highlights the potential synergies in linking reproductive health services to HIV care and treatment programmes. While HIV care and treatment programmes in resource-limited settings may not be able to integrate all reproductive health services into a single service delivery model, there is a clear need to include basic reproductive health services, such as access to appropriate contraception and counselling and management of unplanned pregnancies. The integration of these services would be facilitated by greater insight into the reproductive choices of HIV positive women and men, and into how health care providers influence access to reproductive health services of people with HIV and AIDS.

Africa South of the Sahara↗

PubMed2001

Reproductive health differences among Latin American- and US-born young women.

Investigations of reproductive health within Latinos living in the United States suggest that sexual behaviors and contraception use practices vary by ethnicity and between foreign- and US-born adolescents. This article compares high-risk sexual behaviors and reproductive health among foreign-born Latinas, US-born Latinas, and US-born non-Latinas aged 15-24 years. We recruited 361 females from reproductive health clinics in the San Francisco Bay Area of California between 1995 and 1998; these women completed an interview that assessed sexual risk behaviors and history of pregnancy, abortion, and sexually transmitted infections. Current chlamydial and gonococcal infections were detected through biological testing. Among participants aged 15-18 years, US-born Latinas were more likely to have been pregnant (odds ratio [OR] comparing US-born Latinas and US-born non-Latinas = 3.9, 95% confidence interval [CI] 1.3, 11.4), whereas among respondents aged 19-24 years, foreign-born Latinas were more likely to have been pregnant than US-born Latinas (OR = 11.3, 95% CI 1.0, 130.8) and US-born non-Latinas (OR = 64.2, 95% CI 9.9, 416.3). US-born Latinas were most likely to have had an abortion (OR comparing US-born Latinas and US-born non-Latinas = 2.0, 95% CI 0.9, 4.7). They were also most likely to have chlamydial infection at study enrollment (8.2% prevalence compared to 2.2% and 1.0%for foreign-born Latinas and US-born non-Latinas, respectively; P =.009). Reproductive health differences between foreign and US-born females and within the US-born population warrant further examination and highlight the need for targeted prevention.

Abortion, Legal↗

PubMed1994

A comprehensive reproductive health program in the workplace.

This paper summarizes the reproductive health component of the AT&T Bell Laboratories occupational health program. The comprehensive R&D Reproductive Health Program is a collaborative effort between the Health Services Group and the Environmental Health & Safety Center. It provides a tailored curriculum to occupational health nurses and physicians so that they may respond to employee questions and concerns with detailed information and with referrals to appropriate subject-matter experts. Expanding on the typical regulatory approaches of hazard communication and right-to-know, the program encourages employees of both sexes to learn about workplace, environmental, and lifestyle aspects of reproductive and developmental health.

Chemical Industry↗

PubMed1999

The use of reproductive health information material in the rural clinics of Umtata district.

Though it appears that there has been a long history of development, distribution and dissemination of reproductive health information materials, impediments still exist in the health information, communication and education systems in South Africa. The aim of the study was to contribute towards improvement of the development, distribution and utility of reproductive health information material both in the Eastern Cape province and nationally. In-depth understanding of complexities surrounding development, distribution and utility of educational material is key to the provision of information to communities. The objectives were to describe the availability and examine the content, target groups, language and utility of reproductive health information materials. Qualitative study using non probability sampling was done. Ten rural clinics were conveniently selected. In-depth interviews, focus groups and a checklist were used to collect data. Reproductive health information materials found were mostly posters, there were no pamphlets, material on some reproductive health aspects was not available, inconsistently distributed and not updated. It was concluded that posters are available in the rural clinics of Umtata district judging from the results there is a need to improve the quality of reproductive health information material.

Ambulatory Care Facilities↗

PubMed2000

Women and reproductive health in a graying world.

Gender differences in longevity suggest that the health problems in both developed and developing countries will largely be the problems of older women. As life expectancy increases, the important causes of death and ill health change. Older women's health issues and reproductive health needs are different from those of younger women. Biological susceptibility to various conditions also differs between the sexes. Monitoring of differences in incidence can better direct preventive efforts and contribute to improving the quality of life for aging women worldwide.

Age Factors↗

PubMed2002

Reproductive health in Mongolia: results from three provinces and one urban district.

The purpose of this study was to obtain data for facilitating the planning, monitoring and evaluation of reproductive health services in Mongolia. The survey was carried out in 17 randomly selected health facilities where health professionals were graded on their reproductive health knowledge and also in 64 adjacent households where 162 women of childbearing age were interviewed for their comments on reproductive health services and to obtain their reproductive health knowledge/behaviour. We rated the reproductive healthcare delivery system, using the methodology of Kielmann et al. The results from the women's interviews are encouraging and show a high acceptance of and satisfaction with family planning services.

Adolescent↗

PubMed1995

Reproductive health in young women with cystic fibrosis: knowledge, behavior and attitudes.

PURPOSE: The improved life-expectancy in cystic fibrosis (CF) results in the fact that the majority of affected young women now survive to face the same reproductive health decisions as other women, in addition to those that specifically relate to CF. The aim of this study was to assess the reproductive health knowledge of women with CF, to investigate the range of their reproductive health problems, and to review their reproductive health attitudes and behaviors. METHODS: Women aged 18 years and over attending CF services in the state of Victoria, Australia were invited to complete a reproductive health questionnaire. Comparison subjects (n = 76) were enrolled from 2 primary care practices. RESULTS: Fifty-five women participated (89%), with a median age of 22 years (range 18-50). There was no significant difference in marital status between the two groups and a similar proportion were sexually active, yet women with CF were less likely to use contraception. A majority of women with CF believed that fertility was reduced, and there was poor knowledge of the potentially deleterious effect of pregnancy. A relatively high proportion were planning to become pregnant in the near future. Twenty-two percent had tried to conceive, with a success rate of 67%. CONCLUSIONS: Women with CF are currently lacking important information about reproductive health that potentially has a major impact on their health and their lives.

Adolescent↗

PubMedDate not supplied

Men in Australia Telephone Survey (MATeS): a national survey of the reproductive health and concerns of middle-aged and older Australian men.

BACKGROUND: The Men in Australia Telephone Survey (MATeS) describes the prevalence of self-reported reproductive health disorders as well as related concerns and health behaviours among middle-aged and older Australian men. METHODS: A representative sample population (n=5990) of Australian men (>or=40 years) was obtained by contacting a random selection of households with unbiased sampling, stratified by age and state. A 20-min computer-assisted telephone interview was done to assess reproductive health and related knowledge and beliefs, sociodemographic factors, general health, and lifestyle factors. FINDINGS: A response rate of 78% (5990/7636) was achieved. 34% (1627/4737) of men surveyed reported one or more reproductive health disorder, all of which were most common in the oldest age group. Age-standardised prevalence of significant lower urinary tract symptoms was 16%, erectile dysfunction was 21%, and prostate disease was 14%. About 50% of participants reported having had a prostate cancer test whereas only 30% (300/1012) of men with erectile dysfunction sought medical help. Willingness to seek medical help for erectile dysfunction was related to age and ethnic origin. Although men aged 40-69 years expressed a moderate or high level of concern about prostate cancer and loss of erectile function, concern about reproductive health was less in the oldest age group (>or=70 years). INTERPRETATION: The high prevalence of reproductive health disorders and associated concerns in middle-aged and older Australian men draws attention to the need to develop appropriate services and education strategies specifically directed to improving reproductive health in these men.

Adult↗

PubMed2004

Changing men's involvement in reproductive health and family planning.

The shift in focus on men's reproductive health was influenced by the 1994 Cairo (ICPD) Action Plan to promote gender equality and equity, empower women, and improve family health in society. Changing and improving the way in which men are involved in reproductive health can only have a positive impact on women's, men's, and children's health. Educating and counseling men about contraceptive choices is essential if they are to be supportive of women's reproductive health. Research on new male contraceptive methods must continue if the bias of women shouldering the major responsibility for contraception is to be eliminated.

Attitude to Health↗

PubMed1996

Primary reproductive health care in Tanzania.

The introduction of community based reproductive health care programmes in Tanzania integrated within primary health care (PHC) programmes is discussed. These programmes should address safe motherhood, fertility awareness and sexually transmitted diseases (STDs), including AIDS. It is argued that the proposed primary reproductive health care programmes will only be sustainable if community participation is achieved, and if combined with improved woman and child health programmes. Sensitized communities, who have learned how to prioritize the problems identified and the appropriate actions to take, will have to be linked at the local level with well trained and supervised health workers, having proper equipment and supplies. A limited number of measurable indicators should give feedback on progress at any given time to both communities and health workers on mutually agreed objectives. The requirements demanded for these programmes add to the difficulties of a health service which experiences already considerable financial and other constraints. Major improvement in the financial support will be needed to raise quality and confidence in the health care system. Supplementation of domestic resources by considerable long-term external donor assistance is essential for filling the resource gap. Further, a more efficient and effective use of resources is required. This makes substantial health system reform and reallocation of public spending important, as well as consistent and coordinated support for district health systems.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Reproductive health, criminal activity, and abuse among 10- to 15-year-old females enrolled in medicaid.

OBJECTIVE: To quantify the degree of abuse or criminal behavior among young females presenting for reproductive health care services. METHODS: An evaluation was conducted among Alaskan females age 10 through 15 years enrolled in Medicaid. Subjects were identified who had experienced reproductive health outcomes. The Medicaid file was linked to a Child Protective Services database and a Juvenile Justice database to identify episodes of abuse by a caretaker and criminal behavior. RESULTS: Of 21,350 Alaskan females aged 10-15 years enrolled in Medicaid during 1999-2003, 841 (3.9%) presented for reproductive health care, 2,930 (14%) were referred to Child Protective Services and 1,858 (8.7%) were referred to Juvenile Justice for criminal activity. Among the subjects with a reproductive health-related claim, 39% were referred to Child Protective Services while 31% were referred to Juvenile Justice at some point during the study period. Reproductive health care was strongly associated with referral to Child Protective Services (adjusted odds ratio [aOR] 2.9, 95% confidence interval [CI] 2.5-3.4), substantiated sexual abuse (aOR 2.3, 95% CI 1.7-3.2), and referral to Juvenile Justice (aOR 2.9, 95% CI 2.5-3.4). These associations remained regardless of the type of reproductive health care, including contraceptive management. CONCLUSION: Females aged 10-15 years enrolled in Medicaid who present for any type of reproductive health care are at increased risk of abuse by a caretaker and criminal behavior. Clinicians caring for low-income females should consider routine screening for sexual activity and the experience of violence. LEVEL OF EVIDENCE: II-2.

Adolescent↗

PubMed2006

Differential use of adolescent reproductive health programs in Addis Ababa, Ethiopia.

PURPOSE: Adolescent reproductive health programs in Africa have largely remained as small-scale pilot programs, however, there is increasing interest in bringing programs to scale. Evaluations have focused on individual programs and few have gathered population-based information on the reach of program models and the profile of adolescents who utilize services, versus those who do not. This study examines the coverage and utilization of existing adolescent programs in Addis Ababa, Ethiopia. METHODS: Population-based surveys were undertaken among over 1000 adolescents aged 10 to 19 years in slum areas of Addis Ababa, Ethiopia. An inventory of youth programs including youth centers and peer education programs was compiled in the study area. RESULTS: Eight peer education programs and six youth centers were operating in the study area. Twenty percent of boys and only 7% of girls had visited a youth center in the last year; 27% of boys and 15% of girls had had contact with a peer educator. Older adolescents, especially boys, were more likely to utilize programs. Girls who work long hours and who are isolated are less likely to access and benefit from programs. CONCLUSIONS: Greater segmentation of the adolescent population is needed in the design and content of adolescent reproductive health programs. In addition, programmers should pay attention to the specific circumstances of young people in local settings, particularly vulnerable, hard-to-reach sub-groups of adolescents, including girls.

Adolescent↗

PubMedDate not supplied

The reproductive health awareness (RHA) model: a qualitative perspective.

The Reproductive Health Awareness model developed by Georgetown University Institute for Reproductive Health is responsive to the elements of quality of care articulated by Judith Bruce in 1989. The model encourages self-choice regarding family planning options, informed choice and flexibility to change family planning options with changing circumstances, and inclusion of men and the family. Providers utilizing the model must know the stages of behavior change and how to program care based on the client's knowledge and readiness, and how to communicate with clients such that they are facilitating care rather than prescribing it.

Awareness↗

PubMed2006

Women's reproductive health and depression: a community survey in the Gambia, West Africa.

BACKGROUND: Depression is the commonest mental illness in developing countries and impoverished women are most at risk. Formal mental health services in these situations are rare. Depression commonly co-presents with physical symptoms or else is unspectacular, so the condition often goes unrecognised. To strengthen the prevention and management of depression, information is required on easily recognisable correlates of depression. This study explored associations between depression and reproductive health conditions in rural African women of reproductive age. METHODS: A community-based reproductive health survey among rural women aged 15-54 years in The Gambia, West Africa, included screening with a modified Edinburgh Depression Scale (EDS), a reproductive health questionnaire and a gynaecological examination. Depression was then assessed clinically and data for 565 women were used to estimate the prevalence of depression and examine associations with reproductive health conditions and demographic factors. RESULTS: The weighted prevalence of depression was 10.3% (95% CI 8.3-12.7). Being depressed was most significantly associated with widowhood or divorce (adjusted Odds Ratio (aOR) 8.42, 2.77-25.57), infertility (3.69, 1.42-9.65) and severe menstrual pain (3.94, 1.52-10.27). There were significant differences between ethnic groups. Being in the postpartum period was not associated with an increased likelihood of depression. CONCLUSION: This study points to the importance of reproductive potential and reproductive health in maintaining women's mental well-being across different strata of a rural and resource-poor society. It could provide an initial focus for the management of women with depression as well as directing future research in reproductive health and psychiatry.

Adolescent↗

PubMed2002

Changes in male reproductive health and effects of endocrine disruptors in Scandinavian countries.

Male reproductive health has deteriorated in many ways during the last decades. The incidence of testicular cancer has rapidly increased in Europe and European-derived populations. Sperm concentrations have declined and sperm motility and morphology have worsened in many areas. Both adverse trends have been shown to be associated with year of birth. Older birth cohorts have better reproductive health than the younger generations. Incidences of cryptorchidism and hypospadias have also increased according to several studies. The reasons for secular trends are unknown, but the rapid pace of the change points to environmental causes. Endocrine disrupting chemicals have been hypothesized to influence male reproductive health.

Cryptorchidism↗

PubMed2005

Women's perceptions of reproductive health in three communities around Beirut, Lebanon.

The aim of this study was to elicit definitions of the concept of reproductive health among women in three communities around Beirut, Lebanon, as part of the reproductive health component of a larger Urban Health Study. The communities were characterised by poverty, rural-urban mobility and heterogeneous refugee and migrant populations. A random sample of 1,869 women of reproductive age completed a questionnaire, of whom a sub-sample of 201 women were randomly selected. The women's understanding of good reproductive health included three major themes, which were expressed differently in the three communities. Their understanding included good physical and mental health, and underscored the need for activities promoting health. Their ability to reproduce and raise children, practise family planning and birth spacing, and go through pregnancy and motherhood safely were central to their reproductive duties and their social status. Finally, they saw reproductive health within the context of economic status, good marital relations and strength to cope with their lives. These findings point to the need to situate interventions in the life course of women, their health and that of their husbands and families; the importance of reproduction not only from a health services point of view, but also as regards women's roles and responsibilities within marriage and their families; and taking account of the harsh socio-economic conditions in their communities.

Adolescent↗