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PubMed2004

Increasing access to affordable contraception: a look at the Wisconsin Medicaid Family Planning Waiver.

Approximately half of all pregnancies in the United States are unintended. The purpose of the Family Planning Waiver, a Wisconsin Medicaid program implemented in 2003, is to expand access to contraceptive care and other reproductive health services. The waiver provides women with birth control services and supplies, emergency contraception, routine reproductive health exams, and diagnosis and treatment of sexually transmitted diseases. With greater availability of contraception, the expected outcome is a reduction of unintended pregnancies and subsequent therapeutic abortion, which results in a decreased financial burden to the state, as well as an opportunity for women to experience motherhood when they are emotionally prepared to do so.

Adolescent↗
PubMed2004

The feasibility of government partnerships with NGOs in the reproductive health field in Mexico.

In 1995 the Mexican government began to develop policies on establishing collaborative agreements with civil society organisations, and there is currently interest in Mexico in government and NGOs working together. This paper analyses whether the conditions exist in Mexico for successful partnerships between the public sector and NGOs in the reproductive health field. In-depth interviews were carried out with key informants in the public sector at national and state level and the NGO sector in six states in Mexico. Partnerships were found to be an option for the provision of reproductive health services in geographical areas where the population is under-served, and for services the government does not provide. While the contribution of NGOs to the reproductive health field is recognised, at least at federal level, there are still very few public agencies that collaborate with NGOs, and agreements are often limited to short-term financing of projects. The future of NGOs in Mexico will depend largely on their ability to obtain funding from within the country. More effective mechanisms are needed by government to generate resources for health care. Government must recognise the specific contribution of NGOs, including inputs of social capital and creation of community networks, and must share decision-making more equitably with NGO for partnerships to succeed.

Cooperative Behavior↗
PubMed2005

Adolescents and consent to treatment.

Adolescents, defined by WHO as 10 to 19 years old, can give independent consent for reproductive health services if their capacities for understanding have sufficiently evolved. The international Convention on the Rights of the Child, almost universally ratified, limits parental powers, and duties, by adolescents' "evolving capacities" for self-determination. Legal systems may recognize "mature minors" as enjoying adult rights of medical consent, even when consent to sexual relations does not absolve partners of criminal liability; their consent does not make the adolescents offenders. There is usually no chronological "age of consent" for medical care, but a condition of consent, meaning capacity for understanding. Like adults, mature minors enjoy confidentiality and the right to treatment according to their wishes rather than their best interests. Minors incapable of self-determination may grant or deny assent to treatment for which guardians provide consent. Emancipated minors' self-determination may also be recognized, for instance on marriage or default of adults' guardianship.

Adolescent↗
PubMed2006

Burden of abortion: induced and spontaneous.

BACKGROUND: Abortion is a public health concern because of its impact on maternal morbidity and mortality. Each year, about 79 million unintended pregnancies, excluding miscarriage, occur worldwide. More than half of these unintended pregnancies end in abortion. The purpose of this study was to determine the ever-event incidence of abortion (spontaneous and induced) and some related factors in a population-based sample of reproductive age women. METHODS: From July 2003 through January 2004, 2470 women were included in the study through multistage random sampling and were interviewed. Data were collected using a checklist with questions about demographics and specific items regarding abortion history. Information about age, literacy, gravidity, marriage age, abortion, type of abortion, family history of abortion, history of family marriage, smoking, drug use, alcohol use, coffee intake, and incidence of abortion during the previous year were recorded. Statistical analysis included Student's t-test, Chi-square, ANOVA, and logistic regression using SPSS software. RESULTS: Out of the 2,470 women in the study, 775 (45.7%), had at least one abortion in their lives. Of the women who had an abortion, 20.6% reported induced abortion and 74.2% reported spontaneous abortion. Forty-one point four percent of women aged 45 years and older had at least one abortion in their lifetime. Fifty-one (2.1%) women had a history of abortion during the previous year; the largest proportion was 5.4% for the age group 15 - 24 years. The most common method of induced abortion in the previous year was dilatation and curettage (42 to 67%). In multivariate analysis, household number, coffee consumption, gravidity, smoking, and history of abortion in the family were the most important factors related to abortion in the different age groups of women. CONCLUSION: This study shows that the occurrence of at least one abortion in the life of women in our setting is high and varies by age group. There is a need for expanded comprehensive sexual and reproductive health services, and more education and accessibility of contraception methods.

Abortion, Induced↗
PubMed2006

Cultural aspects related to the health of Andean women in Latin America: a key issue for progress toward the attainment of the Millennium Development Goals.

International declarations have affirmed that health is a universal right. In order for people to exercise their right to health, their social and cultural contexts need to be acknowledged. However, due to a number of barriers encountered at different levels of society and geographically this right is not yet fully exercised by a considerable number of women in Latin America. During the last decade progress has been made in the development of public health policies and programs that integrate and recognize the differences in culture that should be considered when addressing indigenous women's health issues. However, a biomedical health model, which discounts cultural influences, prevails globally over a more integrated approach. This leads to a lack of access and use of quality reproductive health services and care among indigenous people and is one of several important factors contributing to high levels of maternal mortality and poor reproductive health among indigenous women. It is important to ensure that an intercultural approach is included in health policies, programs and services. An intercultural strategy fosters dialogue and respect among women, men, and decision-makers and can contribute to the realization of reproductive health rights and improvement of health outcomes. The debate continues on how to accelerate progress in public policies, health programs and health services. An intercultural approach to assure the health of indigenous women should be a key part of this discussion. Specific efforts are critical for obtaining better health outcomes for indigenous women and other vulnerable populations, if not progress will stagnate in the middle of the 21st century, jeopardizing the attainment of the Millennium Development Goal (MDGs).

Attitude to Health↗
PubMedDate not supplied

An evaluation of the impact of community health field stations in Burkina Faso.

The UERD (Unite d'Enseignement et de Recherche en Demographie) carries out an ongoing research project that aims to evaluate community-based strategies in the provision of reproductive health services in the Bazega community health field station in Burkina Faso. UERD evaluates the effectiveness of two different strategies: 1) the improvement of Health Center based FP services and 2) the recruitment and training of agents selected from the local community (community-based service agents, or CBS agents). 18 months after the interventions began UERD made an evaluation of its impact on the general population based on a quasi-experimental research design and a detailed protocol. The results indicate a significant increase in contraceptive prevalence (from 3.6% to 8%) in the zone of CBS intervention over the course of the period. However, the prevalence levels remain weak. The growth in contraceptive prevalence was not determined to be the result of an increased demand brought about by the CBS agents, but instead by improving accessibility due to the proximity of the supply. The research sample comprised 1600 randomly selected compounds (2000 women and 1500 men), which allows for another evaluation in the year 2000. It was designed to permit research in other areas of reproductive health such as HIV/AIDS and STDs, FGM, abortion, etc.

Africa↗
PubMed2006

Rationale and design of the MEMA kwa Vijana adolescent sexual and reproductive health intervention in Mwanza Region, Tanzania.

Large-scale innovative, integrated, multifaceted adolescent sexual and reproductive health (ASRH) interventions are urgently needed in sub-Saharan Africa. Implementation through schools and health facilities may maximize intervention coverage and sustainability, however the impact of the use of these structures on intervention content and delivery is not well documented. This paper describes the rationale and design of a large-scale multifaceted ASRH intervention, which was developed and evaluated over three years in rural communities in Mwanza Region, North West Tanzania. The intervention comprised community mobilization, participatory reproductive health education in primary schools, youth-friendly reproductive health services and community-based condom provision for youth. We examine the effect of socioeconomic, cultural and infrastructural factors on intervention content and implementation. This paper demonstrates the means by which such interventions can be feasibly and sustainably implemented to a high standard through existing government health and school structures. However, the use of these structures involves compromise on some key aspects of intervention design and requires the development of complementary strategies to access out-of-school youth and the wider community.

Adolescent↗
PubMed2002

Ethical issues in gynecology: adolescent confidentiality, provider conscience and abortion, and patient choice of provider gender.

All medical specialists struggle with problems that cannot be solved with medical knowledge alone. The field of gynecology is not unique in medicine for the presence of ethical dilemmas, but the nature of the dilemmas are unique. Gynecologists commonly confront complex ethical questions in their practices that can be answered only through thoughtful consideration of the values, interests, rights, goals, and obligations of those involved. In this paper, three ethical issues that commonly arise in the practice of gynecology are presented: adolescent confidentiality regarding reproductive health services, physician conscience and provision of abortion services, and the question of accommodating patient choice of provider gender. Each topic is introduced with a case vignette followed by an analysis of the issues involved and recommendations for resolution.

Abortion, Induced↗
PubMed2000

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

Caribbean Region↗
PubMed2003

Using accountability to improve reproductive health care.

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.

Attitude of Health Personnel↗
PubMed1998

The transition to managed care: experiences of planned parenthood patients.

A review of the findings from a 1996 survey of women visiting a Planned Parenthood clinic reveals that some members of managed care organizations (MCOs) may not be receiving appropriate preventive services and information from their primary care providers. This article details the results of a survey of 115 women who attended a Planned Parenthood of New York City clinic for reproductive health services. Based on these survey findings, the authors provide recommendations for MCOs and traditional providers of reproductive health to improve service delivery.

Family Planning Services↗
PubMed2003

The reliability and validity of willingness to pay surveys for reproductive health pricing decisions in developing countries.

This paper examines the reliability, theoretical and predictive validity of willingness to pay (WTP) surveys for setting prices for reproductive health services in developing countries. Four country applications were conducted; the surveys used similar elicitation methods (a series of three closed-ended questions to cover the range of target prices, followed by a single open ended question to elicit maximum WTP) and samples of current or potential users of family planning, gynecology, and prenatal care services. In all four applications, respondents were able to understand WTP questions and responded with high levels of internal consistency. Evidence supporting theoretical validity was also found in all surveys. Higher income and more highly motivated users had higher WTP than lower income and less motivated users. Predictive validity was assessed in one study. Services utilization predicted by a WTP survey was compared with actual post-price increase utilization. Adding WTP to information already possessed by program managers resulted in a threefold increase in ability to predict utilization change as a result of a price increase, and in nearly half of cases predicted percent change in utilization was within 10% of observed change. WTP surveys when used for reproductive services price setting appear reliable and valid, and improve a program manager's ability to predict client responses to price changes.

Attitude to Health↗
PubMed1998

Factors determining the choice of contraceptive methods at the Family Planning Clinic, University College Hospital, Ibadan, Nigeria.

In a study of 2000 women volunteers seeking contraceptive services at the Family Planning Clinic (FPC), University College Hospital, Ibadan, Nigeria, 66.2 per cent chose the intrauterine device (IUD) making it the most common method of contraception. Factors influencing choice of contraceptive methods were advice from friends and family members, intended duration of use and information from the media. Ignorance, fear and unfounded cultural beliefs were factors responsible for the delay in seeking contraceptive advice. The mass media was an important source of information for most of the women. We conclude that the IUD is the contraceptive of choice in our clinic because of the highly selective nature of our clients. In order to provide a service with a broader clientele, we suggest the incorporation of other priority reproductive health services such as cervical and breast cancer screening, prevention and treatment of reproductive tract infections and sexually transmitted diseases including HIV/AIDS.

Adolescent↗
PubMed2006

Changes in perceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

Adult↗
PubMed2004

The role of reproductive health providers in preventing HIV.

Reproductive health providers serve millions of women in developing countries now at the center of the global HIV pandemic and are increasingly reaching out to young people and to men. As such, they are poised to play an important role in reducing the incidence of new HIV infections over the coming years. Policymakers, donors, researchers and activists should recognize the benefits of supporting the fuller integration of HIV prevention efforts with reproductive health services.

Acquired Immunodeficiency Syndrome↗