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PubMed1999

The emerging international policy agenda for reproductive health services in conflict settings.

Over the past 20 years, shifts in the nature of conflict and the sheer numbers of civilians affected have given rise to increasing concern about providing appropriate health services in unstable settings. Concurrently, international health policy attention has focused on sexual and reproductive health issues and finding effective methods of addressing them. This article reviews the background to the promotion and development of reproductive health services for conflict-affected populations. It employs qualitative methods to analyse the development of policy at international level. First we examine the extent to which reproductive health is on the policy agendas of organisations active in humanitarian contexts. We then discuss why and how this has come about, and whether the issue has sufficient support to ensure effective implementation. Our findings demonstrate that reproductive health is clearly on the agenda for agencies working in these settings, as measured by a range of established criteria including the amount of new resources being attracted to this area and the number of meetings and publications devoted to this issue. There are, however, barriers to the full and effective implementation of reproductive health services. These barriers include the hesitation of some field-workers to prioritise reproductive health and the number and diversity of the organisations involved in implementation. The reasons for these barriers are discussed in order to highlight areas for action before effective reproductive health service provision to these populations can be ensured.

Conflict of Interest↗
PubMed2005

Introducing client-centered reproductive health services in a Pakistani setting.

Pakistan is a high-fertility country with elevated levels of maternal mortality and unmet need for family planning. Limited access to and poor quality of reproductive health services and gender-related problems comprise the major explanations for these poor indicators. The authors designed an intervention to address some of these issues and implemented it on a quasi-experimental basis in Bhalwal Tehsil of the Sargodha district of Punjab. The intervention introduced a client-centered approach to providing reproductive health services, including family planning and infant, child, and maternal health care. The intervention consisted of training health-care providers based in fixed-location clinics and in communities. It introduced the concept of SAHR (an acronym for salutation, assessment, help, and reassurance), to inculcate a client-centered approach to care that acknowledges explicitly and addresses a client's gender and power relations within her family and household. Results of the intervention indicate significant effects on providers' behavior related to SAHR elements. The changes provide demonstrable evidence that the public sector can shift toward client-centered services in reproductive health care in a challenging setting.

Adult↗
PubMed2001

Support for school-based reproductive health services among South Carolina voters.

In 1997 a statewide random digit-dialed telephone survey of 534 South Carolina registered voters was conducted to determine level of support for school-based reproductive health services. Results indicated most voters supported services in secondary schools that would provide students with information and counseling about contraceptive methods and refer students to community-based agencies for abstinence education and counseling. Voters were less supportive of reproductive health services that would diagnose or treat sexually transmitted diseases, test for pregnancy, refer students to community-based agencies for contraceptives, or make contraceptives available to students at school. Significant associations in support for school-based reproductive health services were reported based on income, personal beliefs, intentions, and outcome expectations regarding sexuality education and contraceptive availability. These data reinforce the need for school-aged youth in South Carolina to have access to reproductive health services within their communities, outside of the school setting.

Adolescent↗
PubMed2002

Privatisation of health services and the reproductive health of rural Chinese women.

China's rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994-96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women's reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.

Adolescent↗
PubMed2006

Health sector reform and sexual and reproductive health services in Mongolia.

Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

Abortion, Induced↗
PubMed2004

Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia.

PURPOSE: To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability. METHODS: A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software. RESULTS: Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to. CONCLUSION: Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.

Adult↗
PubMed2004

Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people?

OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative. While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China. Training programmes for family-planning workers are urgently needed to address this issue.

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↗
PubMed2003

Integrating reproductive health services in a reforming health sector: the case of Tanzania.

Universal access to comprehensive reproductive health services, integrated into a well-functioning health system, remains an unfulfilled objective in many countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with central level stakeholders and focus group discussions held with health management staff in three regional and nine district health offices, to assess progress in the integration of reproductive health services. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support and lack of linkages with the Health Sector Reform Secretariat. Among reproductive health programmes, sexually transmitted infection (STI) control alone retained its vertical planning, management and implementation structures. District-level respondents expressed frustration in their efforts to coordinate STI service delivery with other, more integrated programmes. They reported contradictory directives and poor communication channels with higher levels of the Ministry of Health; lack of technical skills at district level to undertake supervision of integrated services; low morale due to low salaries; and lack of district autonomy in decision-making. Integration requires a coherent policy environment. The uncoordinated and conflicting agendas of donors, on whom Tanzania is too heavily reliant, is a major obstacle.

Attitude of Health Personnel↗
PubMed2003

A case/comparison study in the Eastern Region of Ghana on the effects of incorporating selected reproductive health services on family planning services.

OBJECTIVE: to assess the impact on the provision of family planning (FP) services when FP providers were also trained to provide additional, selected, reproductive health services. DESIGN: case/comparison study. PARTICIPANTS AND SETTINGS: twenty-four FP service delivery points in which training in sexually transmitted infection prevention and control services or post-abortion care services had been initiated (case facilities), were compared to 19 control facilities in which similar provider training had not yet been targeted. All settings were located in the Eastern Region of Ghana. MEASUREMENTS: service statistics for three study years (1996-1998) were reviewed. Structured interviews with providers, managers and clients provided qualitative data concerning impact and satisfaction. FINDINGS: case facilities which had integrated these additional reproductive health (RH) services experienced consistently higher numbers of clients and the total number of clients receiving FP services increased over time. There was also a statistically significant increase in continuing FP clients within case facilities. In contrast, the number of FP clients serviced in the comparison area remained basically unchanged over time. KEY CONCLUSIONS: interviews conducted with providers and managers in both types of settings indicated strong support for receipt of training to provide these integrated services and a request for additional training in an even broader array of RH and adult/child services. Clients also perceived the benefit of additional RH services and perceived these services to be of high quality. IMPLICATIONS FOR PRACTICE: expanding the repertoire of clinical skills of FP providers, enabling these practitioners to render RH services that augment basic FP services, has the potential to increase the number of new and continuing FP clients, and increases the satisfaction of both providers and consumers with respect to these services.

Abortion, Induced↗
PubMed2000

Reproductive health services for adolescents. Critical legal issues.

The contemporary legal and policy environment has increased the challenges associated with providing health care services to the adolescent population. The issue of reproductive health care services is particularly intense because of the controversial nature of services for contraception and abortion. As the debates continue, one must remember the background against which they are occurring. The current legal framework, developed over nearly 40 years, enables adolescents who are minors to give their own consent for care in numerous circumstances and provides them with a significant level of confidentiality protection, particularly for reproductive health services. Laws have been enacted to expand adolescents' financial access to health care, through targeted publicly funded service programs and expanded health insurance coverage. This background provides the foundation for addressing the current challenges and for protecting and expanding adolescents' access to care.

Abortion, Induced↗
PubMed1998

Removing barriers and improving choices: a case study in reproductive health services and managed care.

Managed care contains inherent structural features that can create obstacles to time-sensitive, confidential reproductive health services. Such structural impediments often exacerbate the sociocultural barriers that have historically affected low-income women--the population that has been targeted for mandatory enrollment in Medicaid managed care plans in many states. This article recommends public policy strategies to overcome and prevent multiple barriers that were identified in a New York-based study in 1995, which focused on access to reproductive health services in managed care settings. This article also includes updated evidence supporting the study's findings and its relevance to other states.

Adolescent↗
PubMed2002

Understanding health sector reforms and sexual and reproductive health services: a preliminary framework.

To understand the implications of health sector reforms for sexual and reproductive health services, there are three major dimensions to consider. The first two relate to the context in which health sector reforms are introduced: the characteristics of the health system, and that of reproductive and sexual health services located within it. The third dimension has to do with the content and scope of health sector reforms introduced into this context, and the actors and processes through which it is introduced. The content, scope, actors and processes have in turn to be located and understood within the larger geopolitical context and the position within it of the country under consideration.

Family Planning Policy↗
PubMed2005

Demand for and accessibility to reproductive health service of urban floating population.

The demand for knowledge of productive health and the current status of productive health services provided by relevant governmental institutions were qualitatively and quantitatively studied. The study identified the key factors that influenced the demand for the productive health services and results of the services. It also discussed the effective approaches to control, planning and sustainable development of the reproductive health services for the floating populations.

Adolescent↗
PubMed1995

Parent and student preferences for services in a school-based clinic.

As a component of program planning for a school-based clinic in a suburban high school, a sample of 199 students and 196 parents were surveyed about preferences for health services. Parents and students were asked about health services desired and level of interest. Student overall interest in health services was less than parent interest, although both groups indicated at least a moderate level of interest. Both students and parents reported interest in availability of comprehensive services, including general health services, reproductive health services, and counseling services. The process of polling parents and students serves dual purposes of informing the population about school-based clinics, as well as gathering information to attempt to match the health services offered with needs identified.

Adolescent↗
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↗
PubMed2003

The contribution of sexual and reproductive health services to the fight against HIV/AIDS: a review.

Approximately 80% of HIV cases are transmitted sexually and a further 10% perinatally or during breastfeeding. Hence, the health sector has looked to sexual and reproductive health programmes for leadership and guidance in providing information and counselling to prevent these forms of transmission, and more recently to undertake some aspects of treatment. This paper reviews and assesses the contributions made to date by sexual and reproductive health services to HIV/AIDS prevention and treatment, mainly by services for family planning, sexually transmitted infections and antenatal and delivery care. It also describes other sexual and reproductive health problems experienced by HIV-positive women, such as the need for abortion services, infertility services and cervical cancer screening and treatment. This paper shows that sexual and reproductive health programmes can make an important contribution to HIV prevention and treatment, and that STI control is important both for sexual and reproductive health and HIV/AIDS control. It concludes that more integrated programmes of sexual and reproductive health care and STI/HIV/AIDS control should be developed which jointly offer certain services, expand outreach to new population groups, and create well-functioning referral links to optimize the outreach and impact of what are to date essentially vertical programmes.

Breast Feeding↗