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PubMed2003

Medical Students for Choice: origins, current orientations, and potential impact.

BACKGROUND: Medical Students for Choice is a U.S.-based organization concerned with the shortage of abortion providers, the lack of abortion education in medical schools, and violence against abortion providers. Created in 1993, MSFC has 110 chapters in North America with 7,000 student affiliates. DESCRIPTION: The rapid spread of MSFC chapters since its creation prompted the Northeastern Ohio Universities College of Medicine's chapter to undertake group interviews of 40 medical students affiliated with 7 MSFC chapters in 4 midwestern states in the United States. EVALUATION: Interview questions were developed to identify students' motivations for affiliation with MSFC, how abortion was currently addressed in the medical curriculum and where it should be, how students think abortion providers are perceived by the medical community, and how they plan to integrate their commitment to reproductive choice in their future practice. CONCLUSIONS: Not all students affiliated with MSFC will become abortion providers, but they are politically enthusiastic and committed to the inclusion of abortion in medical training and to legitimizing and normalizing its provision. More research tracking this group across time and geography will add much to understanding abortion services in the United States and what part the medical curriculum plays in educating students to provide comprehensive reproductive health services for women.

Abortion, Induced↗
PubMed2005

The India Local Initiatives Program: a model for expanding reproductive and child health services.

The India Local Initiatives Program adapted a model used in Indonesia and Bangladesh to implement the government's reproductive and child health strategy. From 1999 to 2003, three Indian nongovernmental organizations (NGOs) provided services for 784,000 people in four northern states. The program established health committees in 620 villages, recruited and trained 1,850 community health volunteers, and added 232 sites to extend government services. Using three strategies--demand creation, increased access to services, and local capacity building--the NGOs increased contraceptive-use rates by 78 percent, on average; child immunizations by 67 percent; and antenatal care by 78 percent among the populations served. Community resources--such as local health personnel, community-supplied clinic sites, and community drug funds--added 40 cents to every dollar provided by donors. This model proved to be a suitable platform upon which to build health-care service delivery and create behavioral change, and the NGOs quickly found ways to sustain and expand services.

Adult↗
PubMed2005

Donor agencies' involvement in reproductive health: saying one thing and doing another?

The debates about what services constitute reproductive health, how these services should be organized, managed, and delivered, and what the role of donor agencies' support should be mirror the long-standing debates on how best to implement primary health care. After briefly reviewing the development of the discourse on primary health care and reproductive health, the authors present results of qualitative research in Ghana, Kenya, and Zambia that indicate a range of factors influencing and explaining the way donors operate in these countries and consider the implications of these results for the delivery of comprehensive reproductive health services. These findings are compared with South Africa, a country with limited donor activity. In the light of the complex interplay of factors, the authors suggest that donors' words and actions frequently do not correlate. Conclusions are drawn as to the potential for donor support for integrated reproductive health service delivery in sub-Saharan Africa, drawing on the research to provide lessons and a reappraisal of the role of donors in health sector aid.

Comprehensive Health Care↗
PubMed1999

When is research participatory? Reflections on a reproductive health project in Brazil.

This article addresses women's participation in an organization development project designed to improve public sector family planning and reproductive health services in Brazil. Although community women collaborated in aspects of the intervention and research, the project nonetheless raises the basic question whether such involvement of community women does or does not correspond to what scientific writers consider to be the essence of participatory research. We review key project features in the context of recent literature and conclude that although the project is committed to the sharing of power and control, it does not fully correspond to the characteristics of participatory research. Moreover, we argue that given the project's central focus on reproductive health outcomes, complete adherence to the process-oriented, pure version of participatory research would have been inappropriate.

Brazil↗
PubMed2006

Provision of contraceptive and related services by publicly funded family planning clinics, 2003.

CONTEXT: In addition to contraceptive services, publicly funded family planning clinics provide low-income women with a range of reproductive diagnostic, treatment and educational services. Nationally representative information about the scope of services available from clinics is needed to formulate policy and programmatic recommendations. METHODS: In 2003, more than 1,000 U.S. clinics responded to an eight-page survey on service availability and clinic policies. Differences in the proportions of clinics reporting each service or policy were examined by clinic type and receipt of Title X funding. RESULTS: Nearly all clinics offer pills, injectables and condoms; 75% offer the patch; and 80% offer emergency contraception. Most clinics (73%) typically use a conventional Pap smear for initial cervical cancer screenings; 27% use liquid-based Pap tests. For follow-up, 68% of clinics use liquid-based or other advanced testing. Virtually all clinics screen at least some clients for chlamydia; Planned Parenthood and Title X-funded clinics, more than others, tend to focus screening efforts on sexually active women aged 25 and younger. Single-dose treatments are provided by 58% of clinics. Nine in 10 clinics offer HIV testing on-site, most of them to any client who requests it. Services targeted to specific populations include counseling about abstinence for minors (91%); non-reproductive health services for men (36%); and availability of staff such as translators (81%) and bilingual administrative (59%) or clinical personnel (57%) for non-English-speaking clients. CONCLUSIONS: More public funding is imperative for clinics to keep up with the demands of new technologies and a diverse client base.

Adolescent↗
PubMed1991

Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services.

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.

Adolescent↗
PubMed1997

Gynecological complaints and war traumas. A study from Zenica, Bosnia-Herzegovina during the war.

BACKGROUND: During the war in former Yugoslavia people endured great suffering. Although many had sought refuge in other countries, the majority remained within Bosnia-Herzegovina. Special service for women within the war zone was urgently needed. A Women's Therapy Center was established in Zenica, Bosnia-Herzegovina offering reproductive health services and psychosocial assistance. The aim of the study was to establish the most commonly occurring gynecological problems during different periods in the war and relate these to war traumas. METHODS: Information from 486 records of consecutive gynecological consultations in four different periods during in 1993/94 were retrospectively recorded. RESULTS: Vaginal discharge, pelvic pain, and amenorrhea were the most commonly occurring problems. A higher proportion of pregnant women requested legal abortion in the first period compared to later periods when the situation was improved. In 14 (3%) of the consultations a history of rape during the war was recorded. Additionally 42 (9%) had suffered from other types of war traumas. The reporting of war traumas was significantly related to suffering from pelvic pain (p < 0.05). CONCLUSIONS: The focus on the need of victims of rape during war has highlighted the need for reproductive services as part of emergency situations. The suffering of war traumas has to be taken into account in the handling of gynecological problems in this situation.

Abortion, Legal↗
PubMed1998

Quality of care in reproductive health programmes: concepts, assessments, barriers and improvements--an overview.

At the end of the first decade of the Safe Motherhood Initiative there are still, at a minimum, 1600 women dying every day from complications of pregnancy and childbirth: this is an intolerable human tragedy. The fact that there are almost 100,000 more maternal deaths annually now compared to 10 years ago, 585,000, must present a challenge to every citizen in society. Policy makers, health professionals, social workers, religious leaders, human-rights advocates and the media all have a responsibility to ask themselves: 'What can I do?' All have a role in affecting quality reproductive-health services, which are essential for the reduction of maternal mortality and morbidity, and are an intrinsic human right. The midwife is the obvious catalyst and linch-pin for this effort in the fabric of society. Three papers will address the issues of quality of care in reproductive-health programmes with particular emphasis on safe motherhood. This, the first, article describes the concepts of quality of care in reproductive-health programmes, the determinants of quality improvement, assessment tools for service quality, barriers to quality of care and quality improvement together with examples from relevant countries. The second article will address education issues relative to quality of care, and the third will describe the monitoring and evaluation of quality of care with relevant indicators and project results.

Female↗
PubMed2006

The role of urine pregnancy testing in facilitating access to antenatal care and abortion services in South Africa: a cross-sectional study.

BACKGROUND: Effective confirmation of pregnancy is a basic component of reproductive health services. It is a prerequisite for accessing antenatal care (AnC) if the pregnancy is wanted and abortion services if the pregnancy is unwanted. This study examined the role of urine pregnancy testing in the timing of presentation for pregnancy-care. METHOD: A cross-sectional study was conducted among 158 women presenting for antenatal care and 164 women presenting for abortion at public sector clinics in Cape Town, South Africa. RESULTS: The median gestational age at first presentation was 23 weeks for AnC clients and 13 weeks for abortion clients. Obtaining a urine pregnancy test of one's own accord was associated with a decrease in the gestational age at presentation of 3.6 and 1.4 weeks for antenatal and abortion clients, respectively, independently of all other factors. CONCLUSION: Given the proven clinical benefit and public health impact of early presentation for antenatal and abortion services, strategies to decrease gestational age at presentation for pregnancy care should be given priority. 'Fast-track' urine pregnancy testing services should be established in public sector clinics in South Africa.

Journal Article↗
PubMed1988

Act (Chapter 13), 9 June 1988.

This Rhode Island Act authorizes and directs the Director of Health to establish a payer of last resort program to cover the cost of outpatient family planning counseling and comprehensive reproductive health services for those ineligible for Medicaid and who lack coverage for these services and whose family income is between 100 and 185% of the federal poverty level. The following services are to be included in the program: 1) patient education and counseling on options for timing and spacing pregnancy; 2) comprehensive medical services to prevent and control the spread of sexually transmitted diseases; and 3) access to safe and effective methods of contraception. Excluded services include, among other things, abortion and infertility related services. No funds are to be expended to support school-based clinics dispensing "contraceptive methods."

Americas↗
PubMed2002

Menstrual disorders in rural Gambia.

As part of a community-based reproductive morbidity survey in rural Gambia, the prevalence and association of menstrual disorders with sociodemographic characteristics and other reproductive morbidities, and with knowledge, attitudes, and beliefs concerning menstrual problems were assessed. A questionnaire was administered by a field-worker and by a gynecologist, who also examined the women. Semistructured interviews were conducted to assess knowledge, attitudes, and beliefs in a subsample. Of 607 menstruating women not using hormonal contraceptives, 16 percent complained to the gynecologist of irregular cycles, 14 percent of dysmenorrhea, 8 percent of spotting, and 4 percent of heavy or prolonged bleeding. Each complaint was associated with other reproductive morbidities. A minority of women with menstrual problems had sought health care, and menstruation was revealed to be a highly personal and secretive topic in this population. Menstrual disorders constitute an important unaddressed area of reproductive health service needs in developing countries for which relatively simple and inexpensive therapies are often available. Information, education, and support combined with clinical management of menstrual problems should be core elements of reproductive health programs.

Adolescent↗
PubMed1995

Abortions in rural Idaho: physicians' attitudes and practices.

This study surveyed all family physicians, obstetrician-gynecologists, and general surgeons practicing in rural Idaho in 1994. Although most respondents provided a wide range of reproductive health services, less than 4% performed abortions, so most rural Idaho women wanting abortions must travel long distances for this procedure. Physicians report that they do not provide abortion services because of both their own moral objections and local community opposition to the procedure. Yet 26% of the respondents indicated interest in using RU-486 for abortions when it becomes available. This suggests that the development of acceptable medical abortifacients may improve access to this procedure even in very conservative rural areas.

Abortifacient Agents, Steroidal↗
PubMed1995

Post-abortion family planning.

In many countries, reproductive health services do not actively include post-abortion family planning services for women who are treated for complications of unsafe abortion. This greatly increases the risk of further unintended pregnancies and unsafe abortions. The authors, drawing on the recommendations of a meeting of experts, make a plea for bridging the gap and dealing more realistically with this urgent need.

Abortion, Therapeutic↗
PubMed1999

Legal and ethical perspectives on delivery of reproductive and sexual health services in the countries of eastern Europe and the CIS (countries with economies in transition, Europe).

International human rights conferences have repeatedly declared that reproductive and sexual health and choice are human rights entitled to protection and respect. This is no less true in the countries of Eastern Europe and the New Independent States (NIS). It was widely believed that the dissolution of the former Soviet Union and of Communist rule in Eastern Europe would lead to conditions of greater freedom, health and prosperity and to a time of greater respect for reproductive health and rights of choice. In fact, that has not happened; in some respects, the situation in these countries is now worse than before. This article examines the current state of reproductive and sexual health in these countries and several of the reasons why conditions, generally speaking, have not improved since the transition. It closes by identifying some suggestions for positive change and some resources for reproductive health advocacy in these countries.

Adolescent↗
PubMed2000

Barriers to implementing South Africa's Termination of Pregnancy Act in rural KwaZulu/Natal.

INTRODUCTION: South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. METHODS: As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. RESULTS: Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18 and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape or incest, or if the continued pregnancy would endanger a woman's health (61 and 56%, respectively), but few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. CONCLUSIONS AND RECOMMENDATIONS: Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability.

Abortion, Legal↗