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PubMed2004

Franchising reproductive health services.

OBJECTIVES: Networks of franchised health establishments, providing a standardized set of services, are being implemented in developing countries. This article examines associations between franchise membership and family planning and reproductive health outcomes for both the member provider and the client. METHODS: Regression models are fitted examining associations between franchise membership and family planning and reproductive health outcomes at the service provider and client levels in three settings. RESULTS: Franchising has a positive association with both general and family planning client volumes, and the number of family planning brands available. Similar associations with franchise membership are not found for reproductive health service outcomes. In some settings, client satisfaction is higher at franchised than other types of health establishments, although the association between franchise membership and client outcomes varies across the settings. CONCLUSIONS: Franchise membership has apparent benefits for both the provider and the client, providing an opportunity to expand access to reproductive health services, although greater attention is needed to shift the focus from family planning to a broader reproductive health context.

Developing Countries↗
PubMed2002

Effect of mercury on general and reproductive health of largemouth bass (Micropterus salmoides) from three lakes in New Jersey.

The influence of mercury on the general and reproductive health of wild fish populations has not been well studied. Therefore, a variety of health and reproductive indicators were measured in male largemouth bass (Micropterus salmoides) collected from three bodies of water in New Jersey: Assunpink Lake, Manasquan Reservoir, and Atlantic City Reservoir. The mean mercury content in fish muscle from Assunpink Lake was 0.30 microg/g; from Manasquan Reservoir, 1.23 microg/g; and from Atlantic City Reservoir, 5.42 microg/g. Body weight, length, condition factor, and gonadosomatic index were similar for all three lakes. Furthermore, there was no significant relationship between muscle mercury content and adrenocortical function, indicated by interrenal nuclear diameter and serum cortisol levels following stress. Bass from the Atlantic City Reservoir had a slightly lower, although significant, liver somatic index than bass from the two other lakes. A significant, positive correlation between 11-ketotestosterone serum concentrations and mercury muscle content was detected, although no significant relationship between testosterone serum concentrations and mercury muscle content was found. The findings of this study suggest that, while elevated levels of mercury in fish potentially alter androgen profiles, they do not substantially decrease other indicators of general and reproductive health.

Androgens↗
PubMed2000

Violence and reproductive health: current knowledge and future research directions.

OBJECTIVES: Despite the scope of violence against women and its importance for reproductive health, very few scientific data about the relationship between violence and reproductive health issues are available. METHODS: The current knowledge base for several issues specific to violence and reproductive health, including association of violence with pregnancy, pregnancy intention, contraception use, pregnancy terminations, and pregnancy outcomes, are reviewed and suggestions are provided for future research. RESULTS: Despite the limitations of current research and some inconclusive results, the existing research base clearly documents several important points: (1) violence occurs commonly during pregnancy (an estimated 4%-8% of pregnancies): (2) violence is associated with unintended pregnancies and may be related to inconsistent contraceptive use; and (3) the research is inconclusive about the relationship between violence and pregnancy outcomes. CONCLUSIONS: Improved knowledge of the risk factors for violence is critical for effective intervention design and implementation. Four areas that need improvement for development of new research studies examining violence and reproductive-related issues include (1) broadening of study populations, (2) refining data collection methodologies, (3) obtaining additional information about violence and other factors, and (4) developing and evaluating screening and intervention programs. The research and health care communities should act collaboratively to improve our understanding of why violence against women occurs, how it specifically affects reproductive health status, and what prevention strategies may be effective.

Battered Women↗
PubMed2005

A strategic assessment of the reproductive health and responsible parenthood programme of Buenos Aires, Argentina.

Since 1991, Argentina has had provincial reproductive health laws, a far-reaching national programme and strong public consensus in support of reproductive health policies. Nevertheless, the challenges of strengthening public services, increasing the number of programme sites and resisting conservative attacks remain. This article describes an assessment of the reproductive health programme of the city of Buenos Aires, passed in 2000, whose objectives are to prevent unwanted pregnancies and sexually transmitted diseases/HIV and to train health personnel. The programme operates in every public hospital and primary health care centre in the city. The assessment was conducted jointly by the Ombudsperson's Office of Buenos Aires and the Centre for the Study of State and Society (CEDES). Hormonal contraceptives, IUDs and male condoms were mostly available, but emergency contraception, female condoms and other barrier methods were not Some health professionals and service users were knowledgeable about the new laws and the reproductive rights recognised under the law. Over 90% were satisfied with quality of care in service delivery but many professionals described excessive workloads, deficient infrastructure, and shortages of supplies and staff. Wanting help to obtain a tubal ligation was the most frequent reason for the claims lodged with the Ombudsperson's Office, followed by HIV, quality of care, and abortion. Information and training for both health care providers and women's and human rights NGOs was carried out.

Adolescent↗
PubMedDate not supplied

Where does reproductive health fit into the lives of adolescent males?

CONTEXT: To develop interventions to promote responsible sexual behaviors and design reproductive health services for adolescent males, we need a better understanding of the context of reproductive health in adolescent males' lives. METHODS: A total of 32 males (mean age, 15.5 years) were recruited from two urban high schools. At each school, three group sessions, consisting of both individual free-listing activities and focus group discussions, were conducted; each addressed issues related to one of three domains-masculinity, responsibility and priorities. Data from the focus groups were examined through standard content analyses. RESULTS: Participants identified school, family, future career and sports as their current life priorities; health was not a top concern. Pregnancy and sexually transmitted infections (STIs) were not seen as interrelated health concepts. STIs were considered a health issue, whereas pregnancy was perceived as a negative event that could prevent achievement of specific life goals. At times, notions regarding how a male behaves reflected traditional masculine beliefs: that violence is justified as a way to protect oneself, that having sex is part of a male's role in a relationship and that males should handle health issues by themselves. CONCLUSIONS: To meet the reproductive health needs of adolescent males, program developers should consider how other life priorities and traditional masculine beliefs may serve as barriers to care and how to ensure that services reflect the adolescent male's perspective.

Adolescent↗
PubMed2006

Girls experiencing sexual intercourse early: could it play a part in reproductive health in middle adulthood?

The aim of the present study is to examine the possible relationship between experiencing early intercourse and reproductive health characteristics in midlife for women. The participants belonged to the Swedish longitudinal research program Individual Development and Adaptation (IDA) project. By the age of 14, the cohort consisted of 590 girls, whereas 522 gave information about the timing of their first sexual intercourse experience. Approximately 29 years later, when the women were 43 years old, a sub-cohort of 369 women participated in the psychological-medical investigation. Those who experienced early intercourse were likely to be different on various demographics and have markers of poorer reproductive health characteristics than their counterparts. More specifically, those experiencing early intercourse were less formally educated, left home earlier, and earned on average less than their counterparts who experienced sexual intercourse later. Early intercourse likely plays a role in not only specific reproductive health but also reproductive health characteristics as a whole in midlife. Early intercourse was consistently a predictor of teenage pregnancy, terminated pregnancies, no use of contraception, and having menstrual symptoms.

Adolescent↗
PubMed1999

[What significance does "reproductive health" have for the dermatologist?].

"Reproductive rights embrace certain human rights that are already recognized in national laws, international human rights documents and other relevant UV consensus documents. These rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence. Full attention should be given to promoting mutually respectful and equitable gender relations and particularly to meeting the educational and service needs of adolescents to enable them to deal in a positive and responsible way with their sexuality." (The International Conference on Population and Development (ICPD), held in Cairo, Egypt, from 5 to 13 September 1994).

Diagnosis, Differential↗
PubMed1995

Indonesia. Adolescent reproductive health forms part of 5th country programme cycle.

Indonesia is now entering the Fifth Country Program Cycle of Population. The reproductive health and family well-being of the youth forms part of the country program. In order to translate this component into concrete action program, a project document in its first draft was developed for UNFPA (UN Population Fund) funding by the government and with the assistance of UNFPA CST, Bangkok and UNFPA Field Office in Jakarta. The project aims to raise the level of commitment and degree of participation of families, particularly parents, for developing among their pre-adolescent and adolescent children a better understanding of the concepts/process of adolescent reproductive health and desirable attitudes and values dealing with family well-being. This is to be achieved through family-centered learning approaches that will contribute to the adoption of the small, happy, and prosperous family norm. To achieve this goal, the project will develop national capacity by creating management teams, developing sets of training and counseling materials, delivering key messages through the media, upgrading skills in adolescent counseling and developing better understanding of adolescent reproductive health and family well-being issues among the facilitators. The strategy to be used is to set up small groups of 20-30 families which will regularly meet to discuss adolescent problems and issues with the help of cadres. They will be supported by provincial reproductive health and family well-being counseling centers which will also be set up to handle serious cases difficult for parents to handle. These centers, to be run by NGOs, will provide counseling services to parents and youth, evolve innovative and culturally acceptable counseling techniques, and at the same time serve as material and information collection, development and dissemination centers. The project will be launched in collaboration with seven NGOs in seven selected provinces. It is currently under review by UNFPA and the Government.

Adolescent↗
PubMedDate not supplied

Reproductive health services for adolescents under the State Children's Health Insurance Program.

CONTEXT: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services. METHODS: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures. RESULTS: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers. CONCLUSIONS: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.

Adolescent↗
PubMed2004

Observations on reproductive health programs in the Baltic States.

Public attention in Sweden has been drawn to three neighboring states that recently joined the European Union: Estonia, Latvia, and Lithuania. At this historic moment, it seems instructive to look at how the rapidly reformed health sectors of these ex-Soviet republics are responding to the vision of reproductive health articulated in Cairo 10 years ago. Reproductive health and rights have improved in these states in spite of recent reforms often acting to oppose improvement. Reforms such as the introduction of family medicine need continued adjustment, especially regarding antenatal care. One special challenge is the retention of essential mid-level providers, such as midwives, as the mode of HIV transmission becomes increasingly sexual.

Baltic States↗
PubMed2004

Improving adolescent sexual and reproductive health. A view from Australia: learning from world's best practice.

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australia's high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.

Abortion, Induced↗
PubMed2001

Adolescent sexual and reproductive health: the challenge for society.

Within almost all countries of the world there is a growing concern about the sexual and reproductive health of adolescents. This concern has resulted from either a real or a perceived increase in adolescent sexual activity, coupled with high rates of unplanned pregnancies, early childbearing and the transmission of sexually transmitted infections, including HIV. Although many adults have difficulties in accepting young people as sexual beings, there is now a growing consensus that young people need more information and services to help them ensure their sexual and reproductive health. Many of the programmes designed to make sexual and reproductive health information and services available to young people have used 'top down' approaches, based on adult-led risk and lifestyle orientation. In such programmes, young people are often looked upon negatively, in terms of their problems, rather than positively, in terms of their potential and capabilities. This article argues that a focus on the negative aspects of adolescent sexual and reproductive health means that young people are seen as collections of discrete problems. Furthermore, such approaches tend to view all young people as one homogeneous group when in reality adolescents are an enormously diverse group, not only in terms of age and gender, but also in terms of ability and beliefs. Such approaches therefore fail to address the vulnerabilities of particular young people and fail to contextualize sexual health within a wider framework of young people's lives. A challenge for the next century is to move away from focusing on risks, towards embracing needs and rights, and to involve young people in identifying issues and developing solutions.

Adolescent↗
PubMedDate not supplied

Sexual and reproductive health in young people with congenital heart disease: a systematic review of the literature.

BACKGROUND: Improved survival in young people with congenital heart disease (CHD) alters the significance of a range of developmentally important subjects, such as sexual and reproductive health. The aim of this study was to determine the level of knowledge about sexual and reproductive health issue in young people with CHD. METHODS: We undertook a systematic review of the literature from 1966 to March 2004, searching Medline, Psych Info, and Em base using a broad range of search terms. Additionally, we searched the literature for published guidelines on standards of care for young people with CHD. RESULTS: We identified ten articles that examined patients,' understanding of their heart disease. Seven of them specifically investigated knowledge of sexual and reproductive health as it related to cardiac disease. CONCLUSIONS: In general, young people have a poor understanding of their heart disease. They appear to have a particularly poor grasp of sexual and reproductive health issues, yet they are interested in these issues. Therefore, health care programs for young people with CHD should incorporate sexual and reproductive health information and include anticipatory counseling and health risk screening.

Adolescent↗
PubMedDate not supplied

[A sociological study of factors affecting reproductive health of female teenagers and young women].

The reproductive health of teenagers deserves a special attention and must be regarded from the viewpoint of their future prospects as well as their social and cultural media. The mentioned social-and-cultural factors affecting the teenagers' attitude towards sexuality and preconditioning their access to information and services of healthcare have an impact on the status of their reproductive health and on their general well-being, including the ability of teenagers to avoid an undesired pregnancy or sexually transmitted diseases.

Adolescent↗
PubMed2004

Exploring the socioeconomic dimension of adolescent reproductive health: a multicountry analysis.

CONTEXT: The design and evaluation of adolescent health programs rarely account for socioeconomic differences in reproductive health needs and service utilization among young women in developing countries. METHODS: Nationally representative Demographic and Health Survey data for 12 developing countries were used to assess socioeconomic differentials in reproductive health outcomes and service utilization among young women. For each country, chi-square tests were performed to identify statistically significant differences between the poorest and the richest quintiles, which were constructed using a household wealth index. RESULTS: In most countries, young women from the poorest households were more likely than those from the richest households to be married by age 18 and to have had at least one child by that age; they were less likely to report a mistimed birth, to be practicing contraception, to use maternal health services and to know how to prevent sexual transmission of HIV. Economic autonomy, school enrollment and regular exposure to mass media were less common among poor than among rich adolescents. CONCLUSIONS: Poor adolescents may be overlooked by current service delivery modes that rely solely on mass media, clinics or schools. Alternative strategies, such as community-based outreach programs, must be implemented to serve the needs of poor young women.

Adolescent↗
PubMedDate not supplied

Reproductive health counseling for young men: what does it do?

A reproductive health intervention combining a highly explicit half-hour slide-tape program with a personal health consultation was provided to male patients aged 15-18 at a large health maintenance organization. A test of the consultation's impact against a control group provides no support for the argument that highly explicit instruction in contraception encourages early initiation of intercourse. In fact, the consultation may have reduced pressure to become sexually active among young men who had never had sexual intercourse. There is also some evidence that the consultation helped improve the effectiveness of contraceptive practice among the men who were sexually active at follow-up; those exposed to the consultation were more likely than those who were not to report that their last intercourse was protected by the pill and that their main method of contraception in the previous year was the pill. Compared with those in the control group, patients who received the health consultation scored higher on measures of fertility knowledge and knowledge of the prevention of sexually transmitted diseases, including AIDS. Furthermore, the young men who had the consultation were more likely to have practiced testicular self-examination. In many cases, however, the positive effects of the consultation were stronger or were only statistically significant among those who had not been sexually active at the time of the baseline survey.

Adolescent↗
PubMed2001

Ethics in reproductive health: clinical issues in Zimbabwe.

Reproductive health can present health practitioners with ethical problems because of the complex interaction between cultural practices, the laws of the country and individual personal preferences. In particular, the problems of pregnancy, sexually transmitted infections, family planning, sexual violence, and domestic abuse require a good knowledge of the laws of the country and the culture in which they operate. The practitioner should at all times respect the patient's autonomy and serve their best interests, whilst keeping in mind the legitimate interest of their partners, spouses, parents or guardians.

Adolescent↗