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PubMed1995

First Federal Appeals Court finds anti-violence law constitutional.

In a unanimous decision issued on February 13, (1995) a three-judge panel of the U.S. Court of Appeals for the Fourth Circuit upheld the dismissal of two anti-choice challenges to the Freedom of Access to Clinic Entrances Act (FACE). The first mid-level federal bench to rule on FACE's validity, the appeals court held that the law "strikes a balance among competing rights holders. It protects those who seek or provide reproductive health services without suppressing robust debate about abortion. Those opposed to abortion or any other reproductive health service retain the freedom to express their deeply-held moral or religious views in a peaceful, non-obstructive way." In mid-June of last year in American Life League v. Reno, U.S. District Court Judge Leonie Brinkema in Alexandria, Virginia, found that FACE did not violate abortion opponents' First Amendment rights. In open court the next month, Judge Brinkema dismissed Woodall v. Reno, which was filed by an abortion opponent in concert with Concerned Women for America. The cases were consolidated on appeal. Attorneys for the plaintiffs have indicated that they will seek U.S. Supreme Court review. Every other federal court to rule on FACE since its May 1994 enactment has also found the measure constitutional.

Abortion, Induced↗
PubMed1995

Reproductive health care delivery. Patterns in a changing market.

Providers of reproductive health services, including clinics and office-based physicians, face new challenges as the American health system progresses toward managed care. Although services for low-income women are often subsidized, the average out-of-pocket payments for reproductive health services are the same for women with incomes below and above 200% of the poverty level. Although many women, especially those classified as low income, use clinics, most say that they would prefer to receive care in a private physician's office and in a place where they can get general health care as well. Multivariate analyses indicate the importance of type of insurance and source of primary health care in affecting a woman's selection of her reproductive health care provider. Specialized providers such as family planning clinics need to consider how they can blend with managed care plans.

Adult↗
PubMed2006

Lactobacillus vaginal microbiota of women attending a reproductive health care service in Benin city, Nigeria.

OBJECTIVE: The objective of this study was to determine whether Lactobacillus species found in African women differ substantially to those of white decent, described in previous studies. The vaginal microbiota play an important role in female health, and when the naturally dominant lactobacilli are displaced resulting in bacterial vaginosis (BV), the host is more at risk of acquiring sexually transmitted diseases, including HIV. METHODS: Vaginal samples were collected from 241 healthy, premenopausal Nigerian women, which were then Gram-stained for Nugent scoring. Microbial DNA was extracted, amplified using polymerase chain reaction (PCR) and Lactobacillus primers, and processed by denaturing gradient gel electrophoresis (DGGE). Lactobacillus species were identified by DNA sequencing and BLAST algorithm. RESULTS: Of the samples, 207 (85.8%) had PCR products for lactobacilli, whereas 34 (14.2%) showed absence of lactobacilli, which correlated to the BV Nugent scores. On sequencing of amplicons, 149 subjects (72%) had sequence homologies to lactobacilli. Most women (64%) were colonized by L. iners as the predominant strain, similar to previous findings in Canadian and Swedish women. L. gasseri was found in 7.3% samples, followed by L. plantarum, L. suntoryeus, L. crispatus, L. rhamnosus, and other species. CONCLUSION: The findings indicate that even with geographic, racial, and other differences, the predominant vaginal Lactobacillus species is similar to species in women from Northern countries.

Adolescent↗
PubMed2006

Poor uptake of reproductive health screening services by female renal transplant recipients.

Women with functioning renal transplants are a high-risk group for de novo malignancies and other gynaecological health problems. The objective of this study was to assess patients' awareness of gynaecological issues, and to assess uptake of cervical and breast cancer screening services. A structured questionnaire on family planning, menopausal issues and knowledge/use of cervical and breast cancer screening was administered to 64 female renal transplant recipients. 58 (91%) responded to the questionnaire. Mean age at first transplantation was 35 years (range 11 - 69). 84% were aware as to why they should have regular cervical smears. 15 (26%) had, however, never had a smear and only 9 (16%) were having yearly smears. 12 of 28 postmenopausal women entered the menopause under the age of 41 years, but only 5 of these had received Hormone Replacement Therapy. Breast self examination is practiced by 71%, but only 26% have had mammograms. These figures suggest that female renal transplant patients are not adequately screened for cervical and breast cancer. The results also indicate a need for further education regarding family planning issues and menopausal health concerns. We conclude that formal gynaecological review should be routinely available for women with renal transplants.

Adult↗
PubMed1999

Planning reproductive health in conflict: a conceptual framework.

A conceptual framework for planning reproductive health services for refugees is presented for use by those involved in planning field activities. Secondary sources of data are recommended to describe pre-existing patterns and trends in reproductive health status and likely determinants of any change in status, for populations which have been subsequently affected by conflict. The interaction between these patterns and the conflict itself is then analyzed, taking into account the shift in health status and service availability as the conflict progresses through various recognized phases. The potential impact of conflict is thus hypothesized in order to make initial plans for incorporating reproductive health services into standard relief packages. Two case studies are presented: Rwanda demonstrates the use of the framework in a relatively short but dramatic conflict, for which there was also substantial prior evidence on reproductive health status; Cambodia is used, in contrast, to demonstrate the use of the framework in a much more complex conflict which has been occurring over the last 20 years.

Cambodia↗
PubMed2005

Availability of services for emergency contraceptive pills at high school-based health centers.

CONTEXT: School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex. METHODS: In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data. RESULTS: Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified. CONCLUSIONS: School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.

Adolescent↗
PubMed2004

Real and perceived threats to reproductive health: a way forward.

Ten years ofter the International Conference on Population and Development finds the reproductive health community under threat from at least three sources: global initiatives, reforms of the health sector, and new financial modalities from donors and lenders. These challenges, however, mainly reflect the complete system failure in many low-income countries in providing basic reproductive health services to women, especially those who are poor and socially vulnerable. The reproductive health community can do a lot more to address the system failures and potential threats and take advantage of opportunities offered. The starting point should be an internal look at how the reproductive health community has performed in helping low-income countries. Understanding these changes and opportunities in the health sector is another important step, but understanding will only be effective if representatives of the reproductive health community in low-income countries are armed with the skills and tools needed to engage in health sector reforms, to take advantage of global initiatives and to effectively influence the implementation of new holistic forms of aid.

Developing Countries↗
PubMed2005

Barriers to and attitudes towards promoting husbands' involvement in maternal health in Katmandu, Nepal.

Couple-friendly reproductive health services and male partner involvement in women's reproductive health have recently garnered considerable attention. Given the sensitive nature of gender roles and relations in many cultures, understanding the context of a particular setting, potential barriers, and attitudes towards a new intervention are necessary first steps in designing services that include men. In preparation for a male involvement in antenatal care intervention, this qualitative study specifically aims to: (a) understand the barriers to male involvement in maternal health and (b) explore men's, women's, and providers' attitudes towards the promotion of male involvement in antenatal care and maternal health. In-depth interviews were conducted with fourteen couples and eight maternal health care providers at a public maternity hospital in Katmandu, Nepal. Additionally, seventeen couples participated in focus group discussions. The most prominent barriers to male involvement in maternal health included low levels of knowledge, social stigma, shyness/embarrassment and job responsibilities. Though providers also foresaw some obstacles, primarily in the forms of hospital policy, manpower and space problems, providers unanimously felt the option of couples-friendly maternal health services would enhance the quality of care and understanding of health information given to pregnant women, echoing attitudes expressed by most pregnant women and their husbands. Accordingly, a major shift in hospital policy was seen as an important first step in introducing couple-friendly antenatal or delivery services. The predominantly favorable attitudes of pregnant women, husbands, and providers towards encouraging greater male involvement in maternal health in this study imply that the introduction of an option for such services would be both feasible and well accepted.

Adult↗
PubMedDate not supplied

The study of client-provider interactions: a review of methodological issues.

In recent years, increased focus on the quality of family planning and other reproductive health services has led to a better understanding of women's reproductive health needs and has drawn attention to program-client interactions as a critical and neglected dimension of program effort. In this article, the relevant methods and experience related to studying client-provider interactions within family planning programs in southern countries are reviewed. The policy relevance of this work is highlighted first by stressing the operational usefulness of examining what happens when people engage with service-delivery systems that offer family planning or reproductive health services. Subsequently, the content areas encompassed by program-client interactions are clarified by identifying manifest and latent dimensions and by distinguishing the variables that define these interactions from variables related to their determinants and consequences. Finally, a critical review of existing methods is presented, with examples of research and a discussion of ethical issues.

Data Collection↗
PubMed2005

Adolescents' reports of parental knowledge of adolescents' use of sexual health services and their reactions to mandated parental notification for prescription contraception.

CONTEXT: Legislation has been proposed that would mandate parental notification for adolescents younger than 18 years (minors) obtaining prescription contraception from federally funded family planning clinics. OBJECTIVE: To determine the extent to which parents are currently aware that their teenage daughters are accessing reproductive health services and how minors would react in the face of mandated parental involvement laws for prescription birth control. DESIGN, SETTING, AND PARTICIPANTS: A total of 1526 female adolescents younger than 18 years seeking reproductive health services at a national sample of 79 family planning clinics were surveyed between May 2003 and February 2004. MAIN OUTCOME MEASURES: Proportions of minor females who reported that a parent or guardian was aware that they were at the family planning clinic and, under conditions of mandated parental involvement, proportions of minors who would access prescription contraceptives at family planning clinics or engage in unsafe sex. RESULTS: Sixty percent of minors reported that a parent or guardian knew they were accessing sexual health services at the clinic. Fifty-nine percent of all adolescents would use the clinic for prescription contraception even if parental notification were mandated. This response was less common (29.5%) among adolescents whose parents were unaware of their clinic visits and more common (79%) among those whose parents were aware. Many adolescents gave more than 1 response to mandated parental involvement. Forty-six percent would use an over-the-counter method, and 18% would go to a private physician. Seven percent said that they would stop having sex as one response, but only 1% indicated this would be their only reaction. One in 5 adolescents would use no contraception or rely on withdrawal as one response to mandated notification. CONCLUSIONS: Most minor adolescent females seeking family planning services report that their parents are aware of their use of services. Most would continue to use clinic services if parental notification were mandated. However, mandated parental notification laws would likely increase risky or unsafe sexual behavior and, in turn, the incidence of adolescent pregnancy and sexually transmitted diseases.

Adolescent↗
PubMed1994

Family planning in Viet Nam: a vigorous approach.

Viet Nam, a country in transition, is vigorously implementing its population and family planning policies and plans, despite the fact that increased government expenditure for family planning only amounts to some US $0.15 per capita, far short of the minimum $0.60 required. An increased range of family planning methods will be offered to the population through a "cafeteria" approach. Genital tract infections will be reduced, as well as the incidence of abortion. Research continues on injectable and implanted contraceptives, and the use of quinacrine nonsurgical female sterilization. In the long term, a mix of imported and locally-produced contraceptives is envisaged to achieve greater sustainability. Family planning will be closely linked to economic development and poverty alleviation, with mass organizations developing family planning-linked credit, savings and income generating schemes. Pilot experience has indicated value if integrated approach linking family planning, nutrition, and parasite control. The health manpower and health services systems are being overhauled, with plans to appoint family planning focal points at commune level, linked to mobile district teams and grassroots motivators. Medical equipment, contraceptives and essential drugs for family planning and reproductive health services are in short supply at an estimated 60% of commune health stations. Both the public sector and the growing private sector will need to face the challenge of providing the population with high-quality reproductive health services and family planning options suited to individual needs and preferences.

Contraception↗
PubMed2006

Meeting the sexual and reproductive health needs of people living with HIV.

KEY POINTS: (1) Sexual expression and the desire for parenthood are central to the lives of most people. Acknowledging these aspirations is essential to vindicating the human rights of people living with HIV. (2) Meeting the sexual health needs of HIV positive people is essential to global HIV prevention efforts. (3) Efforts to provide sexual and reproductive health services to HIV-positive people are impeded worldwide by weak and fragmented health systems and by sexual taboos, gender inequality, and HIV stigma and discrimination. (4) Effective HIV programming demands taking advantage of the perspectives, expertise and accumulated experiences of people living with HIV.

Family Planning Services↗
PubMedDate not supplied

Users of reproductive health clinic services in a school pregnancy prevention program.

Although the potential of school-based programs in the prevention of adolescent pregnancy is well recognized, few have been evaluated. This paper describes the use of a reproductive health care clinic associated with a school pregnancy prevention program which had demonstrated success. The program operated in one junior and one senior high school in a large city during the 3 school years from 1981 to 1984. Three facets of the 818 users of the program clinic are explored: who enrolled in the clinic, why they enrolled and what contraceptive methods they received, and their continuation with the clinic. Chi-square analysis and Student's t-tests were used to test for significant differences between the two school and sex groups. Life table and regression techniques were employed to examine clinic continuation. The main findings are teens of both sexes used the clinic, and junior high males used it in surprisingly large numbers; there were no major school or sex differences in the characteristics of those who enrolled; most students enrolled to obtain a contraceptive method; although many females served by the clinic had previously used another family planning clinic, the majority of them had unmet needs; the rate of clinic continuation was high; and certain factors contributed to clinic continuation. These findings suggest that a clinic in a school-linked setting can successfully attract students to use its services and it may offer certain advantages for reaching sexually active teens in search of contraceptive protection.

Adolescent↗
PubMed2003

Decentralisation and its implications for reproductive health: the Philippines experience.

Decentralisation is one of the most common health sector reforms initiated in developing countries in the 1980-90s. Although decentralisation is often politically driven, it can significantly improve health sector performance. However, the early phase of the Philippines experience indicates that decentralisation in and of itself does not always improve the efficiency, equity and effectiveness of the health sector. Instead, it can exacerbate inequities, weaken local commitment to priority health issues and decrease the efficiency and effectiveness of service delivery by disrupting the referral chain. Such effects pose a particularly serious threat to accessibility and delivery of reproductive health services, some of which (e.g. family planning) are controversial and thus susceptible to local pressures, and others of which (e.g. emergency obstetric care) require a functioning and effective health system. Moreover, those undertaking decentralisation need to take account of the impacts of non-health factors as well as other reforms that interact with decentralisation to affect accessibility, affordability and quality of services, including for reproductive health. The Philippines experience also demonstrates that authority should be shared between the centre and local units in order to achieve national health objectives and respond to local health needs. Adjustments must be made during implementation to correct for both emerging and pre-existing problems.

Decision Making, Organizational↗
PubMedDate not supplied

Gender double standards in young people attending sexual health services in Northern Thailand.

Concern about the sexual and reproductive health of young people has been mounting recently in Thailand. Unequal gender relations have a considerable influence on the lives of young people, especially young women, yet few studies have explored the ways in which they have impacted on provision of sexual health care. Drawing upon data from a qualitative study in Northern Thailand, this paper explores the views and experiences of young people in seeking health care, highlighting the kinds of gender double standards and power imbalances that may pose obstacles to their use of sexual and reproductive health services. Findings reveal the vulnerability of sexually active young women in seeking support and care from partners, parents, and service providers. Those who experience adverse outcomes of sexual activity, such as unwanted pregnancy or infection, report facing indifference, victim blaming, or the threat of abandonment by their partners. Because of their fear of disclosure to their parents and communities, of their sexual activity, they opt for clandestine and unsafe abortion and seek the counsel of peers and drugstores rather than parents and providers. At the service provider level, young women report facing threatening and judgemental attitudes, indifferent counselling, and possible violation of confidentiality. This is in marked contrast to the treatment of young men, who generally meet with a more sympathetic and accepting response.

Adolescent↗
PubMed2006

Helping public sector health systems innovate: the strategic approach to strengthening reproductive health policies and programs.

Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.

Developing Countries↗