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PubMed1994

Reproductive health research in China: the Ford Foundation initiatives.

Increasing demographic and epidemiological evidence shows that maternal health problems are widespread and are linked to social, cultural, and economic factors, in particular, to women's status in society. Thus, there is an urgent need to expand existing knowledge about these influences on reproductive health and to empower women to gain control over them. To this end, there is a need for a comprehensive, interdisciplinary approach with an emphasis on social science research and training. The Ford Foundation, after an extensive review of its work in population and development, embarked on a new, ten-year, comprehensive reproductive health program for the 1990s. This paper describes one component of that program, a partnership with the All China Women's Federation to sponsor a series of reproductive health research activities. It examines the development and evaluates the positive and negative outcomes of the project, which commenced in 1991, from the perspective of a consultant involved in the process. So far, the project has generated interest in reproductive health in at least twenty-one Chinese provinces and has fostered a real partnership between the sponsoring and the collaborating agency. Based on the immediate outcomes of a research competition designed to identify research projects and investigators, of participant evaluation of the methodology training course, and of the strategies aimed at building capabilities and strengthening institutions in order to ensure future success, I conclude that the Ford Foundation's reproductive health initiative in China is a worthwhile and sustainable project.

China↗
PubMed2006

Reproductive health indicators in the European Union: The REPROSTAT project.

Our objective was to develop a set of indicators for monitoring and describing reproductive health in the European Union (EU) that reflect common concerns of the different Member States. Ideally, the indicators would possibly draw upon existing data sources. The REPROSTAT project: (i) conducted a review of existing recommendations on reproductive health indicators; (ii) suggested a set of initial indicators in consultation with representatives from relevant outside agencies and organisations; and (iii) invited 200 reproductive health experts throughout Europe to review the provisional set of indicators. The feasibility of using the REPROSTAT indicators was tested for two countries, Italy and Germany. A final set of 13 core indicators was developed, as well as another recommended indicator and four that needed further development. The pilot use of the indicators in Italy and Germany provided useful information about availability of data in different Member States. The REPROSTAT project developed a set of reproductive health indicators believed to be of relevance for planning, prevention, and caring within the EU. Further, harmonisation of data from different Member States will be needed if the benefits of these indicators are to be fully realised.

Abortion, Induced↗
PubMed2006

Preachers, policies and power: the reproductive health of adolescent Aboriginal and Torres Strait Islander peoples in Australia.

The sexual abuses of Indigenous peoples are not a new phenomenon. Many historical documents attest to the active ruination of the sexual and reproductive health of Indigenous peoples in Australia; however, reproductive health is rarely considered to be an appropriate strategy through which Aboriginal and Torres Strait Islander people's lives can be improved. Reproductive health is essential for the replication and evolution of societies and therefore warrants close attention, especially as contemporary policy frameworks place Aboriginal and Torres Strait Islander women approximately 50 years behind non-Indigenous women in our capacities to practice individual autonomy in reproductive decision making, including the positive resolution of pregnancies and ensuring the health, dignity, security and autonomy of victims of gender-based violence. This paper is an examination of contemporary reproductive health issues for adolescents in Aboriginal and Torres Strait Islander communities and a call to action to assist young men and young women in particular to value and have every capacity to control their fertility.

Abortion, Legal↗
PubMed2005

Neighborhood context and reproductive health.

Racial and social class differences in rates of preterm birth and other adverse outcomes are among the most widely recognized and least well-understood phenomena in the study of reproductive health. Individual-level characteristics have failed to account for such gradients. Recently, researchers have begun to argue that health in general and reproductive outcomes specifically are rooted in social inequalities. One area of such inequality may be residential segregation and the associated race/ethnic differences in exposure to adverse neighborhood conditions. We review the empiric data that examine the association between neighborhood conditions and reproductive health. We also review the major challenges that researchers face when trying to incorporate neighborhood-level variables into studies of health outcomes. Our goal is to stimulate further research that simultaneously considers social, economic, and biologic determinants of reproductive health.

Female↗
PubMed2000

Adolescent sexual and reproductive health.

This paper assesses how young people and adolescents are defined within each country according to its laws and policies. Additionally, the reproductive health situation of adolescents varies with gender and age. Age of onset of intercourse, age of marriage and child bearing, use of contraception, and the status of women in society all vary with country and region of the world. These variations have direct implications for the population's reproductive health, with potential consequences leading to disability, infertility, sexual violence and abuse, and even death. Nutritional status, access to educational opportunities, access to reproductive health services and commodities, and some life style behaviours such as alcohol, tobacco and other drug abuse, may all have an impact on the future reproductive health of the current and the next generations.

Journal Article↗
PubMed2000

Sexual violence and reproductive health.

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.

Adolescent↗
PubMed2003

A framework for developing reproductive health policies and programmes in Nepal.

Based on experience in Nepal from 1996-2001, this paper presents a six-element framework to support governments in poor countries in developing and implementing reproductive health programmes. The six elements of the framework are: (i) collaborative planning and programming; (ii) strategic assessment; (iii) policy and strategy development; (iv) guideline and material development; (v) reproductive health programme management; and (vi) policy review. Its implementation calls for collaborative work between policymakers and programme managers at all levels of the health system, external donors and development agencies. Change in Nepal is constrained by poor human and financial resources, extremely difficult geography and strong cultural, religious and social traditions. An informal assessment at district level and below found that information tools, clinical protocols and operational guidelines were highly relevant, though problems with utilisation and motivation were noted. Utilisation of strategy and policy documents and tools was reported to be high at national level, but no causal link can be drawn between instruments in the framework and changes in reproductive health indicators. However, access to the tools described in this article can contribute to improvements in coverage and quality of reproductive health services in the hands of motivated people; improved indicators in family planning use, antenatal care and assisted delivery in Nepal in this period support this view.

Cooperative Behavior↗
PubMed2005

Adolescent reproductive health and gender role attitudes in Oman.

OBJECTIVE: The aim of the study was to investigate the attitudes of Omani adolescents towards the different gender roles and women empowerment with regard to taking household decisions, and to study how they influenced the adolescents' knowledge and attitudes towards some reproductive health issues in a national representative secondary schools-based sample of 1670 boys and 1675 girls. METHODS: In 2001, through a self administrated questionnaire the adolescents answered 2 indices; adolescents Attitudes Toward Gender Roles (ATGR) and adolescents Attitudes Toward Women Empowerment (ATWE) in addition to answering questions on demographic data, environmental factors, and questions assessing their knowledge and attitudes towards reproductive health issues. RESULTS: High scores of ATGR or ATWE were found to significantly predict sound adolescents' reproductive health knowledge or positive attitudes in almost all the logistic regression models. CONCLUSION: The study highlighted the scope of interventions to be initiated for adolescents reproductive health. Changes in attitudes towards gender role have to accompany our endeavors to set up the stage for our future generation's reproductive health.

Adolescent↗
PubMed2026

Exploring Primary Care Clinicians' Sexual and Reproductive Health Care Delivery to Male Adolescents and Young Adults.

INTRODUCTION: Despite existing guidance for adolescent sexual and reproductive health (SRH) care, male adolescent SRH care receipt is inadequate. Limited research has explored factors affecting clinicians' provision of SRH care to male adolescents, specifically. METHODS: This mixed-method study with 12 primary care clinicians included a brief survey assessing care delivery practices and confidence, followed by an in-depth interview to explore factors affecting SRH care delivery. RESULTS: Clinicians reported high confidence delivering male adolescent SRH care (mean ± SD: 8.31 ± 1.71 out of 10), but delivered only about half the recommended services (20 items out of 38). Factors influencing care delivery included gaps in education/training, assumptions about male SRH care, and behavioral constraints at various levels. DISCUSSION: Findings underscore the need to strengthen male adolescent SRH care by enhancing provider training, increasing clinic-level supports, and addressing structural barriers. CONCLUSIONS: Findings can inform strategies to improve the quality and comprehensiveness of SRH services for male adolescents in primary care settings.

Humans↗
PubMed1999

Sexual and reproductive health in young people with spina bifida.

This study aimed to identify the sexual and reproductive health knowledge, attitudes, and behaviour of young people, aged between 14 and 23 years, with spina bifida who had attended the Spina Bifida Clinic at a tertiary centre in Melbourne, Australia within the past 10 years. Subjects participated in a structured interview and their parents completed a written questionnaire. Fifty-one (55%) of 93 eligible young people and 69 of 97 parents (71%) participated. Most young people were satisfied with the amount of general sex education they had received. However, 95% stated they had inadequate knowledge about sexual and reproductive health relating to spina bifida and 59% of parents considered they had inadequate knowledge. Thirty-nine percent of young people and 30% of parents had discussed sexuality issues with a doctor. However, 93% of young people and 100% of parents said that they would definitely talk about these issues if the discussions were initiated by their doctor. A significant degree of sexual intimacy was reported, with 60% reporting an intimate relationship, and 25% (10 females, three males) reporting sexual intercourse. Thirty-seven percent of females had experienced unwanted sexual attention, and 30% reported unwanted sexual touching. This study suggests that health professionals should pay greater attention to sexual and reproductive health issues in young people with spina bifida.

Adolescent↗
PubMed2005

Intimate partner abuse and the reproductive health of sexually active female adolescents.

PURPOSE: The purpose of this study was to determine the associations between verbal and minor physical abuse by an intimate partner and reproductive health behavior. METHODS: Logistic regression analyses of 1996 cross-sectional data from 973 sexually active, dating female adolescents surveyed for wave II of the National Longitudinal Study of Adolescent Health Public Use Dataset examining the relationship between abuse by an intimate partner and reproductive health. We measured verbal (insulted in public, sworn at, or threatened with violence) and minor physical (threw something at them, pushed them, or shoved them) abuse by any intimate partner during the past 18 months and by any current intimate partner. Reproductive health variables included condom use with most recent intercourse, contraception use with most recent intercourse, history of sexually transmitted infection, and history of pregnancy. RESULTS: After adjusting for sociodemographic factors, number of intimate partners, and history of forced sexual intercourse, the current involvement in a verbally abusive relationship was associated with not using a condom during the most recent intercourse (odds ratio, 1.56; 95% confidence interval, 1.02-2.40), and both a history of involvement and current involvement in a physically abusive relationship were associated with a history of pregnancy (odds ratio, 2.50; 95% confidence interval, 1.47-4.17; and odds ratio, 3.57; 95% confidence interval, 1.85-6.67, respectively). Neither verbal nor physical abuse were associated with the other reproductive health outcomes. CONCLUSIONS: Physical abuse by an intimate partner is associated with pregnancy and current involvement in a verbally abusive relationship is associated with decreased condom use among sexually experienced female adolescents. Health care providers should be attentive to the association between abuse and pregnancy among adolescents.

Adolescent↗
PubMedDate not supplied

[Reproductive health and risk as perceived by low-income Brazilian men].

Studies in the field of reproductive health discuss existing gaps in traditional research models, which neglect not only social and cultural aspects but also ethical and philosophical ones. Such aspects cut cross over the definition of essential themes for reproductive health research, like sexuality, reproduction, and gender. The search for connections between the two disciplines (Social Science and Public Health) relates to how people and social groups limit and deal with the risks they face. In this study, we analyze the perception of risk in reproductive health among a group of low-income men from Rio de Janeiro. The group was interviewed during a study on male contraception. The objective was to identify the situations and contexts from which the problem (and the contents ascribed to it) emerge. One can conclude from the interviews that there is a risk hierarchy which is modified according to cultural values and relational, institutional, and social contexts.

Brazil↗
PubMed2000

Implementing the integration of component services for reproductive health.

In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda--integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services--has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed.

Data Collection↗
PubMed2000

[Reproductive health in women in the Czech Republic 1993-1997. I. Study methodology and characteristics of the sample groups].

AIM OF THE STUDY: To identify changes in reproductive health status as a consequence of changes in the system of health care and social affairs. THE AIM OF THIS PART OF STUDY: To prepare the methodology of data collection and to identify changes of demographic characteristics. TYPE OF THE STUDY: Retrospective comparative epidemiological study. INSTITUTION: Institute for the Care of Mother and Child, Praha 4-Podolí. METHODS: Two nation-wide surveys on reproductive health of representative three-stage cluster samples in 1993 and 1997. After selection of residential sites from all districts the households were selected for interview. One hundred and fifty trained interviewers asked selected women of reproductive age (4,497 in 1993 and 1,735 in 1997) questions according to a special questionnaire. The basic demographic characteristics of the two samples were compared with the 1991 Census data. The 1993 Czech Republic Reproductive Health Survey was funded by the United States Agency for international Development via a WHO agreement; the 1997 Survey was funded by the Czech Statistical Office and Ministry of Health. RESULTS: The age structure is very similar in the 1993 sample and in the 1991 Census data, however, there is a remarkably lower proportion of women 15-19 years of age in the 1997 sample. According to the marital status, the 1997 sample has a higher proportion of women living in partner-strip and divorced women. The 1997 sample has a higher proportion of women with only one child and there were fewer women with 4 and more children. Also the proportion of women with secondary education with higher school certificate was higher in the later sample. CONCLUSION: This part of the study evaluate a changes in four demographic characteristics of women of reproductive age, because these changes could influence the reproductive health indicators (contraception, induced abortions), which are the subject of further analysis.

Adolescent↗
PubMed2004

Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda.

CONTEXT: Although there is increasing recognition of the scope and significance of sexual coercion experienced by adolescent women in developing countries, evidence on its consequences for reproductive health remains limited. METHODS: A sample of 575 sexually experienced 15-19-year-old women were interviewed in 2001-2002 as part of the ongoing Rakai surveillance project in rural Uganda. Chi-square tests and logistic regressions were used to investigate associations between coerced first intercourse and selected reproductive health behaviors and outcomes. RESULTS: Fourteen percent of young women reported that their first sexual intercourse had been coerced. After the effects of respondents' demographic characteristics were accounted for, young women who reported coerced first intercourse were significantly less likely than those who did not to be currently using modern contraceptives, to have used condoms at last intercourse and to have used them consistently during the preceding six months; they were more likely to report their current or most recent pregnancy as unintended (among ever-pregnant women) and to report one or more genital tract symptoms. CONCLUSIONS: Coerced first intercourse is an important social and public health problem that has potentially serious repercussions for young women's reproductive health and well-being. Interventions to improve adolescent women's reproductive health should directly address the issue of sexual coercion.

Adolescent↗
PubMed2006

Special needs of adolescent and young women in accessing reproductive health: promoting partnerships between young people and health care providers.

This article considers the unique challenges and opportunities that health care providers (HCPs) face when they address the sexual and reproductive health and rights of young women accessing services. Some of the difficulties that HCPs encounter in their work are highlighted, including poor remuneration, the impact of their personal biases and the effect of an under-equipped working environment. The financial, logistical and emotional challenges young people face in accessing services are also described, as well as some small changes that could promote fruitful partnerships between HCPs and their young clientele. Also considered is how international documents concerning reproductive health can be utilized as advocacy tools to ensure that, when governments speak of making young people's needs a priority, resources are also made a priority-so that reproductive health can become a reality for all young people.

Adolescent↗
PubMed1998

Reproductive health hospitalizations among women with human immunodeficiency virus infections.

OBJECTIVE: Our goal was to determine types of inpatient admissions among human immunodeficiency virus-infected women both before and after the human immunodeficiency virus diagnosis, so that we might outline opportunities for intervention. STUDY DESIGN: A total of 292 human immunodeficiency virus-infected women were interviewed about the reproductive history and prior hospitalizations. A reproductive health hospitalization was defined as either an obstetric admission or a gynecologic admission. Other admissions were categorized as either human immunodeficiency virus related, possibly human immunodeficiency virus related, or not human immunodeficiency virus related. Assignments were made independently by two human immunodeficiency virus specialists. If there was a conflict, a third reviewer was used. RESULTS: In the 10 years before study entry 44.4% of women had at least one obstetric admission, 30.4% had at least one gynecologic admission, 3.1% had at least one human immunodeficiency virus-related admission, 18.1% had at least one admission that was possibly human immunodeficiency virus related, and 13.3% had at least one admission that was not human immunodeficiency virus related. Overall, 226 (77%) women had been admitted to the hospital; of these, 201 (69%) had been admitted for reproductive health reasons. Similar patterns were seen in the year before diagnosis and the time after diagnosis. Reproductive health admissions were more common among women who were younger, who used drugs, and who had higher CD4+ cell counts. CONCLUSION: Women with human immunodeficiency virus infection are often admitted to hospitals for reproductive health reasons before and after the human immunodeficiency virus status is known. Clinicians providing reproductive health care must be actively engaged in efforts to reduce the heterosexual and perinatal transmission of human immunodeficiency virus, to identify human immunodeficiency virus-infected women early in the course of the disease, and to provide ongoing care to human immunodeficiency virus-infected women.

Adult↗