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Results for “Reproductive Health Services”

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PubMed2003

Models for future delivery of care in infertility-- hospital-based services.

Hospital-based infertility management will alter radically over the next few years. The forthcoming National Institute for Clinical Excellence guidelines should improve financial support for couples having National Health Service (NHS) assisted conception treatment, and increasing NHS interest in clinical governance may well lead to policy on issues such as number of embryos transferred, risk of ovarian hyperstimulation and patient selection for treatment. Changes in clinical practice will follow. In addition, a number of alterations to clinical training in reproductive medicine will soon be in place, with impact on both sub-specialist and specialist registrar training. It is also clear that private sector practice in general, and private facility assisted conception in particular will be more tightly regulated in the coming years, with increasing governance in both research and clinical practice.

Adult↗
PubMed2003

A 6-month pilot of a collaborative clinic between genitourinary medicine services and a young persons' sexual health clinic.

OBJECTIVE: To investigate whether situating a genitourinary medicine (GUM) clinic within a Brook centre is successful in attracting a younger client group than that traditionally seen in GUM clinics within hospitals. DESIGN: A descriptive study of a 6-month pilot clinic. SETTING: Brook in Manchester. A community clinic providing sexual health advice to clients under the age of 25 years. With the collaboration of Withington Hospital GUM Department, Manchester. PARTICIPANTS: All clients under the age of 25 years attending the pilot GUM clinic. MAIN OUTCOME MEASURES: The age of the clients attending and the diagnosis made. RESULTS: A total of 137 visits were made by 93 clients. Under-16s comprised 6% of all visits compared to 1.5% at Withington GUM clinic (adjusted for the under-25s) and 12% at Brook. Far more Chlamydia trachomatis was seen (34% of all clients) than in a traditional GUM clinic (18% of all clients). Contact tracing resulted in 82% of named contacts being traced. CONCLUSION: The pilot clinic was successful in attracting a much younger client group than a traditional hospital-based service.

Adolescent↗
PubMed1995

Maternal health care focus in Bolivian campaign.

Maternal health care is one of the focuses of Bolivia's new reproductive health campaign. The campaign, which uses television, radio and print media to get its message across, has the slogan "Your health is in your hands." Prenatal and postnatal care, as well as safe delivery, form one of the campaign's target areas. Others are family planning, breast-feeding, and the prevention of illegal abortions. The Bolivian campaign, which has a logo showing a child's tiny hand grasping a parent's finger, is supported by the Population Communication Services project of the Johns Hopkins School of Public Health, Baltimore, US. Bolivia has the highest maternal mortality in the western hemisphere. "The need to create an awareness of reproductive health is vital, with the risk of a Bolivian woman dying during pregnancy or childbirth 60 times that for a woman in Europe or the US," according to Dr. Phyllis Piotrow, director of Johns Hopkins' Center for Communication Programs. Further, Bolivia has the second highest infant mortality rate in the western hemisphere after Haiti.

Advertising↗
PubMed2001

Reproductive health: conceptual and operationalization challenges.

This review article is a teaching material for those who are engaged in reproductive health (RH) service delivery, managers, policy makers, professionals and the RH community. It also aims at addressing the RH concept and indicates some of the operationalization modalities, challenges and attempts to promote the realization of RH and population programmes in the country. It has been shown time and again that even five years after the International Conference on Population and Development (ICPD), policy makers, administrators and service providers still lack an understanding of not only the integrated approach of RH services, but the concept of RH also. In addition, the majority poorly perceives the RH rights notion. It is imperative that issues like understanding of the integrated approach of RH services, ensuring the adequacy of the information or choices offered to women and emphasis on the quality of care offered to clients have to be addressed urgently and adequately. The conceptualization and operationalization of RH will require full understanding of the health, population and women policies, legal and institutional implications of these concepts and the actions needed to convert them into reality. In order to achieve better results, commitment not only of relevant governmental agencies but also by non-governmental organizations (NGOs) and the RH community is a prerequisite. This includes allocation of adequate resources and proper interpretation of the RH concept in the Ethiopian context.

Child↗
PubMed2003

Advantages of trained TBA and the perception of females and their experiences with reproductive health in two districts of the Luangprabang Province, Lao PDR.

The study describes reproductive health in two districts of the Luangprabang Province in northern Lao PDR. The aim was to find out whether training traditional birth attendants (TBA) might have an impact on reproductive health. In June/July 2000, a total of 298 women of reproductive age, with children below two years of age, from 30 villages were interviewed by means of a closed questionnaire. In 1996/1997, a training course for TBA was conducted in one of the districts under survey. Information was obtained for demography, symptoms and risks during pregnancy and delivery, antenatal care (ANC), tetanus immunization, food taboos, place of delivery, birth attendant, practising of birth spacing and their attitude towards the services of TBA. The results obtained indirectly pointed towards a high fertility rate and a high rate of child death and abortion. An overwhelming majority of the women delivered at home, attended only by untrained individuals. During pregnancy and after delivery, the women claimed that they often suffered from edema of legs and feet, high fever and hemorrhages. Only 50% of the females in the district where TBA training were conducted, made use of the services of trained TBA. Nevertheless, females in the district with trained TBA, who made use of the TBA service in comparison with women in the same district not using the service of TBA, were 3.8 times more likely to also make use of the ANC service; 3.3 times more likely to seek immunization, and 8.6 times more likely to give colostrum to their new-borns. The educational level of the females proved to be an important factor. Literate women were more likely to practise birth spacing and have been vaccinated. Illiterate women were more likely to be at higher risk for losing a child. In the district without TBA service the loss of a child was less likely among literate than illiterate women. It is concluded that through adequately trained TBA and through their continuous support and supervision, ANC and health education can be improved. In addition to the improvement of the referral system for emergency cases and manpower development within the obstetric curative service, the training of TBA will have a positive impact on reproductive health. However, maternal health depends, to a large extent, on the educational level of the women.

Adolescent↗
PubMed2006

Reproductive health policies in President Bush's second term: old battles and new fronts in the United States and internationally.

The current Bush Administration has made dramatic changes in US domestic and international reproductive health policies. This paper discusses the issues involved in some of these changes, and it considers likely developments in this area during the remainder of George W. Bush's second term. The first section of the paper defines the term reproductive health and presents a framework for classifying reproductive health policies. The second section examines changes that the Administration has made in domestic family planning policies. The third section looks at analogous changes in American assistance for reproductive health internationally. The final section considers the implications of these trends for future policy and women's health.

Abortion, Induced↗
PubMed2006

Confidentiality for adolescents seeking reproductive health care in Lithuania: the perceptions of general practitioners.

Confidentiality is a major determinant of the accessibility and acceptability of sexual and reproductive health care for adolescents. Previous research has revealed that Lithuanian adolescents lack confidence in guarantees of confidentiality in primary health care settings. This study aimed to assess the factors that affect general practitioners' decisions whether to respect confidentiality for Lithuanian adolescents under the age of 18. Twenty in-depth interviews were carried out with a purposive sample of general practitioners. The decision whether to respect confidentiality was found to be influenced by external forces, including the legislative framework and societal attitudes towards adolescent sexuality; institutional features in clinical facilities, such as the presence of a nurse during consultations and the openness of the medical record filing system; and individual factors, including GPs' relationships with adolescents' families and their personal attitudes towards sexual and reproductive health issues. The findings reflect the urgent need for a comprehensive policy to ensure adolescents' right to confidentiality in Lithuanian primary care settings, including legislative reforms, institutional changes in health care settings, professional guidelines and (self-)regulation, and changes in medical training and continuing medical education. Other ways to safeguard confidentiality in adolescent health services, such as establishing youth clinics, should also be explored.

Adolescent↗
PubMed2004

Strategies for engaging the private sector in sexual and reproductive health: how effective are they?

The private health sector provides a significant portion of sexual and reproductive health (SRH) services in developing countries. Yet little is known about which strategies for intervening with private providers can improve quality or coverage of services. We conducted a systematic review of the literature through PubMed from 1980 to 2003 to assess the effectiveness of private sector strategies for SRH services in developing countries. The strategies examined were regulating, contracting, financing, franchising, social marketing, training and collaborating. Over 700 studies were examined, though most were descriptive papers, with only 71 meeting our inclusion criteria of having a private sector strategy for one or more SRH services and the measurement of an outcome in the provider or the beneficiary. Nearly all studies (96%) had at least one positive association between SRH and the private sector strategy. About three-quarters of the studies involved training private providers, though combinations of strategies tended to give better results. Maternity services were most commonly addressed (55% of studies), followed by prevention and treatment of sexually transmitted diseases (32%). Using study design to rate the strength of evidence, we found that the evidence about effectiveness of private sector strategies on SRH services is weak. Most studies did not use comparison groups, or they relied on cross-sectional designs. Nearly all studies examined short-term effects, largely measuring changes in providers rather than changes in health status or other effects on beneficiaries. Five studies with more robust designs (randomized controlled trials) demonstrated that contraceptive use could be increased through supporting private providers, and showed cases where the knowledge and practices of private providers could be improved through training, regulation and incentives. Although tools to work with the private sector offer considerable promise, without stronger research designs, key questions regarding their feasibility and impact remain unanswered.

Delivery of Health Care↗
PubMed1997

Rural school-based clinics: are adolescents willing to use them and what services do they want?

Using a theoretical model of access, factors associated with rural adolescents' willingness to use primary care services through a school-based health center (SBHC) were examined. Standardized measures of health status and use were administered to 633 adolescents in grades 7-12 who resided in one rural western Maryland county. Although only 6.5% (n = 41) of the sample indicated a willingness to change their regular source of care to an SBHC, greater numbers of adolescents reported a willingness to use SBHC services, with 18%, 38%, 25%, and 16%, indicating interest in routine, acute medical, miscellaneous, and reproductive health care services, respectively. Logistic regression analysis found those adolescents who reported eligibility for free-reduced lunch and no regular source of care for illness were 3.3 and 5.4 times more likely, respectively, to use an SBHC as a primary care site than those unwilling to change their source of care. Data suggest that initially many rural adolescents appear unwilling to change their primary care site to an SBHC, but do express a willingness to use offered services.

Adolescent↗
PubMedDate not supplied

Impact of organizational change on the delivery of reproductive services: a review of the literature.

In order to understand the impact of specific maternal health interventions, it is necessary to understand the likely effect of the health system structure. An important aspect of this structure is the organizational culture. Many systems in low-income countries have been based on a centrally planned and financed system. In recent years a series of organizational changes have been introduced into many systems and these substantially alter the way in which the system operates and impacts on reproductive health care provision. The main changes reviewed in this paper are: (i) decentralization, (ii) privatization and (iii) integration and sector wide approaches. Each of these changes is seen to have important implications for reproductive health. In each case it is clear that the nature of the impact depends crucially on the way it is implemented. Quantifying the impact of these changes remains extremely difficult given the many different ways they can be introduced and the many confounding factors that affect the overall impact. The literature does, however, point to a number of key issues that impinge on the way in which change is likely to affect reproductive health initiatives.

Delivery of Health Care↗
PubMed2002

Anonymity and confidentiality: rural teenagers' concerns when accessing sexual health services.

CONTEXT: While confidentiality is recognised as a key aspect of successful health services aimed at young people, most research has looked at the concerns of those in urban centres. This paper reports on qualitative and quantitative data collected from general practitioners (GPs) and young people in a rural health district. OBJECTIVE: To assess the concerns of rural teenagers regarding anonymity and confidentiality when accessing sexual health services. DESIGN: The views of teenagers about using health services for issues of sexual health were sought through an in-school survey of 311 Year 9 and 119 Year 11 students. In addition, 18 single-sex focus groups discussions were conducted in North and East Devon. All GPs in the district were asked to complete a questionnaire. RESULTS: These reveal that the particular concerns of young people from small communities are more to do with the difficulties of remaining anonymous, which are related to visibility and lack of privacy in small communities. These problems were more pervasive among rural young people than those concerns more usually reported about confidential consultations.

Adolescent↗