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PubMed2006

Nurse-midwives' attitudes towards adolescent sexual and reproductive health needs in Kenya and Zambia.

Adolescent sexuality is a highly charged moral issue in Kenya and Zambia. Nurse-midwives are the core health care providers of adolescent sexual and reproductive health services but public health facilities are under-utilised by adolescents. The aim of this study was to investigate attitudes among Kenyan and Zambian nurse-midwives (n=820) toward adolescent sexual and reproductive health problems, in order to improve services for adolescents. Data were collected through a questionnaire. Findings revealed that nurse-midwives disapproved of adolescent sexual activity, including masturbation, contraceptive use and abortion, but also had a pragmatic attitude to handling these issues. Those with more education and those who had received continuing education on adolescent sexuality and reproduction showed a tendency towards more youth-friendly attitudes. We suggest that critical thinking around the cultural and moral dimensions of adolescent sexuality should be emphasised in undergraduate training and continuing education, to help nurse-midwives to deal more empathetically with the reality of adolescent sexuality. Those in nursing and other leadership positions could also play an important role in encouraging wider social discussion of these matters. This would create an environment that is more tolerant of adolescent sexuality and that recognises the beneficial public health effect for adolescents of greater access to youth-friendly sexual and reproductive health services.

Abortion, Induced↗
PubMed1995

Reproductive health in young people with cystic fibrosis.

The improving survival rates of young people with cystic fibrosis now results in reproductive health being of greater significance than previously. This article reviews how cystic fibrosis affects the reproductive health of male and female patients with this chronic illness, highlights recent advances, and identifies some deficiencies that still exist in our understanding of reproductive health in cystic fibrosis. A further aim is to encourage health professionals to discuss reproductive health issues with their adolescent and adult patients.

Adolescent↗
PubMed2006

Factors associated with the reproductive health risk behavior of high school students in the Republic of the Marshall Islands.

This study revealed factors associated with reproductive health risk behavior among high school students in the Republic of the Marshall Islands. The survey was conducted among high school students from grades 9 through 12 at 2 schools in Majuro, the capital of the Marshall Islands. The questions asked inquired about knowledge, attitude, and behavior related to reproductive health, experience of sexual acts and pregnancy. Multiple logistic regression analysis was performed to assess the association between risk behavior and knowledge, attitude, and other factors. Data obtained from 433 students were used in the analysis. Factors significantly associated with reproductive health risk behavior among both the boys and the girls were a negative attitude toward condom use (odds ratio of the risk group to the low-risk group: boys, 19.54; girls 4.10), not considering receiving public health information and services as a human right (8.10, 3.96), and not knowing where to go for consultation about questions and concerns related to sex (3.32, 4.73). A factor associated with risk behavior in boys alone was acceptance of sexual acts without love (8.46), and factors in girls alone were insufficient knowledge concerning routes of infection by sexually transmitted diseases (6.75) and lack of future life plans (5.00). Neither age nor sex education was a significant predictor. In conclusion, considering reproductive health not to be a personal right was associated with the risk behavior of high school students in the Marshall Islands in regard to reproductive health.

Access to Information↗
PubMed2000

Exposure to hazardous substances and male reproductive health: a research framework.

The discovery in the mid-1970s that occupational exposures to pesticides could diminish or destroy the fertility of workers sparked concern about the effects of hazardous substances on male reproductive health. More recently, there is evidence that sperm quantity and quality may have declined worldwide, that the incidence of testicular cancer has progressively increased in many countries, and that other disorders of the male reproductive tract such as hypospadias and cryptorchidism may have also increased. There is growing concern that occupational factors and environmental chemical exposures, including in utero and childhood exposures to compounds with estrogenic activity, may be correlated with these observed changes in male reproductive health and fertility. We review the evidence and methodologies that have contributed to our current understanding of environmental effects on male reproductive health and fertility and discuss the methodologic issues which confront investigators in this area. One of the greatest challenges confronting researchers in this area is assessing and comparing results from existing studies. We elaborate recommendations for future research. Researchers in the field of male reproductive health should continue working to prioritize hazardous substances; elucidate the magnitude of male reproductive health effects, particularly in the areas of testicular cancer, hypospadias, and cryptorchidism; develop biomarkers of exposure to reproductive toxins and of reproductive health effects for research and clinical use; foster collaborative interdisciplinary research; and recognize the importance of standardized laboratory methods and sample archiving.

Biomarkers↗
PubMed2006

[Sexual behaviors and incidence of sexual and reproductive health programs among poor secondary students and public university students in Cali, Colombia].

In order to qualitatively evaluate sexual behaviors or practices and the incidence of sexual and reproductive health programs in adolescent and postadolescent users educated in Cali, Colombia, two quota samples were carried out, one in schools in poor neighborhoods of the city and one at Valle University (UNIVALLE). In addition, a limited number of twelve open interviews was made among two different student population groups, the schools and the university. The study addresses the sexual behaviors of adolescents and postadolescents, contraceptive methods and prevention of STDs and HIV/AIDS, and the uses of sexual and reproductive health programs by both populations, controlling for social class (socioeconomic stratum), gender, and race. Two sexual and reproductive health programs were taken as reference: that of PROFAMILIA (Pro-Wellbeing of the Colombian Family Association), and the sexual and reproductive health program of the University Medical Service of the UNIVALLE. Results show how the behaviors and responses to sexual and reproductive health programs are mediated by multiple sociological categories that orient the analysis.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Trends in reproductive health knowledge following a health education intervention among adolescents in Zimbabwe.

BACKGROUND: Unwanted teenage pregnancy, sexually transmitted infections and the attendant morbidity and mortality necessitate the need for understanding factors influencing adolescent sexuality and the implementation of programmes designed to improve their knowledge, reproductive behaviour, sexual and reproductive health. OBJECTIVE: To determine the impact of an intervention package on knowledge levels of various reproductive health issues through trend analysis. DESIGN: Randomized controlled trial of a health education intervention in schools stratified for representativeness. SETTING: Rural and urban secondary schools in Zimbabwe. SUBJECTS: 1,689 students recruited from 11 secondary schools in Mashonaland Central. MAIN OUTCOME MEASURE: Knowledge level before and after intervention. RESULTS: The demographic characteristics of the pupils at baseline, five months and nine months were comparable between the two groups. There was an overall increase in knowledge on menstruation. Students from the intervention schools were more likely to have correct knowledge over time on aspects of reproductive biology. A significant linear trend (p = 0.017) was observed in the area of family planning and contraception. A linear decreasing trend (p = 0.001) was observed on pregnancy risk. Though not significantly linear, the general trend of knowledge levels in all the areas of reproductive health, pregnancy risk, STDs and HIV/AIDS showed an upward trend, from 20% to 96%. Worth noting was that in all the areas the intervention group had knowledge above that in the control group. CONCLUSION: The reproductive health education intervention had an impact on aspects of reproductive biology and contraception as measured by the increased scoring at follow up when comparing intervention and control schools. The overall findings point to the need for early school based reproductive health education programmes incooperating correct information on reproductive biology and the prevention of subsequent reproductive morbidity by imparting information on non-risk behaviour during the early developmental years.

Adolescent↗
PubMed2004

Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans.

CONTEXT: Few rigorous evaluations have been conducted of locally designed, culturally consistent adolescent reproductive health programs. METHODS: A quasi-experimental research design was used to measure behavioral changes associated with a culturally consistent reproductive health program for young people in Kenya. Baseline and endline surveys were conducted in 1997 and 2001, respectively, in the project and control areas. Multivariate analysis was used to assess whether the project was associated with changes in young people's sexual initiation, safer-sex behavior and discussion of reproductive health issues with adults. RESULTS: The 36-month project was associated with considerable changes in young people's sexual and reproductive health-related behavior, but behavior change differed by gender. Females in the project site were significantly more likely than those in the control site to adopt secondary abstinence (odds ratio, 3.3) and less likely to have had three or more sex partners (0.1). Males in the project site were more likely to use condoms than those in the control site (3.7). Both males and females in the project site were more likely to discuss sexual and reproductive health issues with a nonparent adult than were young people in the control site (1.9 and 5.5, respectively). CONCLUSIONS: Interventions that adapt to indigenous traditions can be both acceptable to communities and associated with significant changes in young people's behavior.

Adolescent↗
PubMed1997

Perspectives of reproductive health.

This issue of Patient Education and Counseling is dedicated to reproductive health. The main focus is infertility as it is experienced in different of our world. In western societies, medical breakthroughs give couples with fertility problems a good chance to have a child. However, in many developing societies adequate medical treatment is only available for the upper classes, and many women keep going to traditional healers. In addition, the social consequences of childlessness are much greater than in western societies. Another focus of this issue is negative experiences regarding pregnancy. A very distressing experience is late pregnancy loss. Late pregnancy loss is different from infertility with respect to the tangibility of an object of grief, though it may also result in permanent childlessness. Other aspects of negative pregnancy experiences are exceptional physical reactions and recurrent induced abortions. Furthermore, two other elements of reproductive health are addressed in this issue: STD among female adolescents and gender aspects of gene technology. Finally, the ramifications of these various aspects of reproductive health on education and counseling are discussed.

Adolescent↗
PubMed2005

Reproductive health education and sexual risk among high-risk female adolescents and young adults.

STUDY OBJECTIVE: The objective of this study was to explore the associations of sources, content, and timing of reproductive health education with cognitive and behavioral sexual risk in a sample of high-risk female adolescents and young adults. DESIGN: Female adolescents and young adults (n=113, median age 17 years) receiving treatment for a sexually transmitted disease (STD) reported sources of reproductive health education, topics covered, and when first formal education occurred. Dependent variables included sexual risk knowledge; condom attitudes, negotiation skills, and use (consistent and at last sex); and number of sexual partners. RESULTS: Most participants reported receiving reproductive health education from both parental (80%) and formal sources (92%). Parents discussed the menstrual cycle (94%) more frequently than other sex education topics, while formal sources focused most on teaching about STDs (91%). Although median age of first formal instruction was 12 years, 26% of girls received their first formal education during or after the year they initiated coitus. Girls with a parental source of education and those receiving formal instruction on pregnancy reported greater ability to negotiate condom use. Girls who received education later in relation to the onset of sexual activity and those with a parental source of education reported more sexual partners. CONCLUSIONS: Early reproductive health education and education from both parental and formal sources is associated with reduced sexual risk among high-risk adolescent girls. Interestingly, receiving parental education is also associated with more sexual partners, suggesting that parental educational efforts may be reactive to their daughters' increasing sexual risk behavior. Future research should examine multiple sources of reproductive health education and the timing of education from these sources to enhance understanding the dynamic interactions between reproductive health education and adolescent sexual risk.

Adolescent↗
PubMedDate not supplied

Couples and reproductive health: a review of couple studies.

Traditionally, fertility and family planning research and programs have focused on women. With the expansion of the field to include reproductive health following the 1994 International Conference on Population in Cairo, the more appropriate focus for most reproductive health components appears to be the sexually active couple. This review of studies of couples and reproductive health outcomes examines reports of objective reproductive events, of attitudes and reproductive intentions, of the effect of each partner's attitudes and intentions, of reproductive outcomes, and of the effectiveness of interventions that target couples compared with those that target one partner or the other. For couples' statements about reproductive events, studies throughout the world typically show identical reports less than 90 percent of the time. Concordance between partners on subjective matters is in the range of 60 to 70 percent. Data based on reports of reproductive intentions from both partners have been shown to lead to better predictions of behavior than have data from only one partner. Finally, reproductive health interventions that target couples are found to be more effective than those directed to only one sex. The evidence clearly justifies a focus on couples.

Decision Making↗
PubMed1999

Reproductive health issues in Greece.

OBJECTIVE: To evaluate reproductive health issues in Greece. METHODS: Analysis of hospital data and national registry reports. RESULTS: The rate of population growth in Greece is declining and is now 0.99% p.a. The maternal mortality ratio is approximately 3.6 per 100,000 live births, and perinatal and infant mortality are approximately 10/1,000 and 16/1,000 respectively. However, only 28-30% of sexually active women use contraception and approximately 300,000 terminations are performed each year. Sexually transmitted diseases are less common than in 1985: the incidence of syphilis is less than 4 per 100,000 population and that of gonorrhoea is less than 25/100,000. Between 1984 and September 1996, 1,421 cases of AIDS were reported; of these, 1,252 (88.1%) were in men and 169 (11.9%) in women. The incidence of human papilloma virus infection increased and at least 30% of sexually active women are infected. CONCLUSION: Good reproductive health is of major importance to women and health agencies but there are still significant obstacles to overcome in some regions.

Family Planning Services↗
PubMed2002

Universal coverage and its impact on reproductive health services in Thailand.

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

Financing, Government↗
PubMed2001

Implications for evaluating the impact of family planning programs with a reproductive health orientation.

In 1994, Jain and Bruce proposed an index--HARI, an acronym for Helping Individuals Achieve their Reproductive Intentions--to measure success or failure of family planning programs with a reproductive health orientation. HARI applies the principle of individual rights and well-being to the assessment of these programs. The index measures two components: the achievement of an individual's reproductive intentions and the avoidance of severe reproductive health problems associated with an individual's efforts to achieve her stated reproductive intentions. A family planning program can be deemed successful if an individual is able to avoid having an unintended pregnancy (or is able to have a wanted child) within the stipulated period and if she experiences no severe reproductive health problems in the process. If these conditions are not met, the program could be deemed a failure. The HARI index has not yet been applied in field conditions. This report illustrates the procedure for estimating HARI by using data from a panel survey conducted in Peru. It discusses the usefulness and limitations of the index in assessing the success or failure of a family planning program with a reproductive health orientation.

Evaluation Studies as Topic↗
PubMed2004

[The effect of cadmium pollution on reproductive health in females].

OBJECTIVE: To study the relationship between cadmium pollution and its adverse effects on female reproductive health status in people living in cadmium polluted area in Zhenghe, Fujian provinces. METHODS: Data through laboratory studies on reproductive health of female residents in Cd-pollution area were studied and compared with those in control areas in Zhenghe. RESULTS: Both prevalence rates of abnormal menstrual cycle and dysmenorrhea in unmarried women in Cd-pollution area (19.1% vs. 42.6%) were significantly higher than those in control area (5.7% vs. 18.9%) and the rates of sterility in married women in Cd-pollution area (6.3%) were significantly higher than those in control area (1.1%). During the first two pregnancies, rates of queasiness, disgorgement, spontaneous abortion and stillbirth in married women in polluted area were 44.7%, 31.7%, 10.27% and 4.23%, significantly higher than those 26.5%, 17.8%, 2.85% and 1.05% in control area, with significant differences (P < 0.05). Results from cumulative odds model analysis showed that: living in Cd-pollution area was a possible risk factor related to female reproductive health (OR = 2.072), after the other risk factors being under control. CONCLUSION: The female reproductive health status of people residing in the cadmium polluted area had already been deteriorated.

Abortion, Spontaneous↗
PubMed2003

Does making clinic-based reproductive health services more youth-friendly increase service use by adolescents? Evidence from Lusaka, Zambia.

PURPOSE: To report the findings of a study that evaluated the impact of three youth-friendly service (YFS) projects in Lusaka, Zambia. In 1994, the Lusaka District Health Management Team (LDHMT) identified adolescents as a priority underserved population with regard to reproductive health information and services. As part of its long-term goal to improve the health and well-being of Lusaka youth, the LDHMT, in collaboration with CARE, UNICEF/Zambia Family Life Movement, and John Snow International, implemented three separate YFS projects to increase service use among adolescents. METHODS: Service statistics from 10 clinics (8 "treatment clinics" and 2 "non-YFS clinics") were used to measure adolescent service use. Qualitative and quantitative data were collected to measure the degree of "youth-friendliness" at the clinics and the level of community acceptance of providing reproductive health services to youth. Specific indicators of youth-friendliness were developed that measured the attitudes of the clinic staff toward giving services to youth, whether clinic staff honored privacy and confidentiality, whether boys and young men were welcomed, whether the clinic policies supported providing services for youth, whether clinic staff promoted its services to youth in surrounding community, and whether youth, themselves, perceived that they would be welcomed and have their needs met at the clinics. Similarly, indicators of community acceptance were developed that measured whether parents and other adults supported the provision of reproductive health services to youth. RESULTS AND CONCLUSIONS: Although the projects appear to have improved the clinic experience for adolescent clients and to have increased service use levels at some clinics, the findings suggest that community acceptance of reproductive health services for youth may have a larger impact on the health-seeking behaviors of adolescents.

Adolescent↗
PubMed2005

Service integration and teen friendliness in practice: a program assessment of sexual and reproductive health services for adolescents.

PURPOSE: To aid front-line program administrators and providers in adopting national reproductive health recommendations, this exploratory case study examines the implementation of service integration and teen friendliness as strategies to improve adolescent sexual and reproductive health. METHODS: The project team conducted semi-structured interviews with administrators, providers, and adolescent clients from 10 clinical adolescent sexual and reproductive health service agencies in Alameda County, California. Programs were placed into a topology of integrated service delivery models. The teen friendliness of each program was assessed. Spearman rank correlations were calculated to evaluate the relationship between integration and teen friendliness. RESULTS: Clinical programs exhibited a great range of service delivery models within the integration topology. Human immunodeficiency virus (HIV) counseling and testing services were poorly integrated into clinic services. Teen friendliness and integration showed a negative, but not statistically significant, correlation (R = -.45, p = .19). CONCLUSION: Programs have made different levels of commitment to service integration or teen friendliness policies. Lessons learned through the integration of sexually transmitted disease (STD) and family planning services may assist efforts to better integrate HIV services for adolescents. Further work to elucidate the relationship between integration and teen friendliness is needed. Periodic reviews can ensure that recommended clinical guidelines, specifically annual risk assessment, are being met, as well as identifying achievable next steps to improve adolescent sexual and reproductive health service delivery.

Adolescent↗
PubMedDate not supplied

Reproductive health knowledge, attitudes and practices of Iranian college students.

To study reproductive health knowledge, attitudes and practices of youth in the Islamic Republic of Iran, 1111 university students completed a questionnaire with 43 closed questions. The overall mean knowledge score was 54%. Knowledge of males and females, and of married and single students, was similar. Of 664 students answering questions about reproductive health behaviour, 54 (8%) reported having sexual intercourse before marriage; 16% of males and 0.6% of females; 48% of them had used condoms. The majority of students believed that the risk of AIDS and other sexually transmitted infections was moderate but that youth had a low ability to practise healthy behaviour. The majority believed in the benefits of reproductive health knowledge for youth but felt that services were inadequate.

Attitude to Health↗