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Four case studies of successfully negotiated affiliations between Catholic and non-Catholic organizations reveal the strategies employed to address a range of reproductive health services.
Until African Americans make a conscious decision to gain control of the social and economic context in which they live, and assume primary responsibility for their health, the reproductive disparities and associated deaths experienced by African-American women will persist. There is truly a need for continued clinical, epidemiologic, and molecular investigations into the problems. Ultimately, however, the permanent elimination of reproductive health disparities will require a social movement, led by members of the target population, informed by the findings of evidenced-based medicine, and fueled by a desire to raise the standard of living of the African-American community. As this occurs, all women will benefit.
Public sector health systems that provide services to poor and marginalized populations in developing countries face great challenges. Change associated with health sector reform and structural adjustment often leaves these already-strained institutions with fewer resources and insufficient capacity to relieve health burdens. The Strategic Approach to Strengthening Reproductive Health Policies and Programs is a methodological innovation developed by the World Health Organization and its partners to help countries identify and prioritize their reproductive health service needs, test appropriate interventions, and scale up successful innovations to a subnational or national level. The participatory, interdisciplinary, and country-owned process can set in motion much-needed change. We describe key features of this approach, provide illustrations from country experiences, and use insights from the diffusion of innovation literature to explain the approach's dissemination and sustainability.
OBJECTIVE: To understand how the social construction and expression of masculinity among male adolescents and young adults are related to sexual health and reproductive risks. MATERIAL AND METHODS: The study was carried out in an underserved and a popular area of Mexico City. Eighteen focal groups and 18 individual interviews were applied to a sample of males from three age groups: 10 to 14, 15 to 19, and 20 to 24 years. Data analysis was performed inductively through open codification of the verbal transcriptions. These were used to create more abstract concepts and search for relationships among them. RESULTS: This paper centers on interpretations of masculinity as expressed by the youngsters themselves. Our research sheds light on what youngsters do and say to "be men". Their ideas and practices produce different forms of masculinity through which risk behavior is manifested, as well as specific speech and dressing styles, and ways of courting and "going steady". These behaviors and their meanings are associated with sexual and reproductive health risk taking. CONCLUSIONS: The traditional model of masculinity characteristic of both social settings involves poor communication about sexuality in couple relationships, which results in infrequent protection and exposure to Sexually Transmitted Infections and unwanted pregnancies. On the other hand, their economic living conditions prevent them from fully practicing central elements of their own concept of masculinity, such as being a hard worker, a provider, and a responsible person. These unmet needs may cause frustration, aggression, and domestic violence.
OBJECTIVE: To evaluate a staff-administered questionnaire to identify life-style issues and social-health determinants. DESIGN: Structured questionnaire administered by a health professional after dealing with the primary reason for attendance. SETTING: Community-based UK sexual and reproductive health service. POPULATION: First 1329 selected clinic patients comprising 1018 women attending Family Planning and 161 women plus 150 men attending Genitourinary Medicine; 47% were aged under 25. MAIN OUTCOME MEASURES: Identification of relevant health-risk taking, life-style issues, and unaddressed health concerns. Participants were offered appropriate support, information and referrals. RESULTS: Two hundred and sixty-four (23%) of the Family Planning women and 83 (52%) of the Genitourinary Medicine women [plus 103 (69%) of the men] reported two or more sexual partners in the last year. A third of participants denied regular condom use. Six per cent of women and 5% of men questioned had previously been forced to have sex. Eleven per cent of men admitted to having paid for sex and 9% of women disclosed physical assault (one-quarter in the home). Eight per cent of women and 7% of men had unresolved issues relating to previous miscarriage, termination, or stillbirth. CONCLUSIONS: It is possible to identify relevant life-style issues and social determinants of health during routine practice using a staff-administered questionnaire. The resulting information may not otherwise have been disclosed and may impact significantly on health and care delivery. The information collected provides opportunities for both individuals and service planners to address wider health needs.
Since 1994, integrating human immunodeficiency virus/sexually transmitted disease (HIV/STD) services with primary health care, as part of reproductive health, has been advocated to address two major public health problems: to control the spread of HIV; and to improve women's reproductive health. However, integration is unlikely to succeed because primary health care and the political context within which this approach is taking place are unsuited to the task. In this paper, a historical comparison is made between the health systems of Ghana, Kenya and Zambia and that of South Africa, to examine progress on integration of HIV/STD services since 1994. Our findings indicate that primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical programmes which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programmes (top-down management systems). The rhetoric of integration has been widely used in reproductive health despite lack of evidence for its feasibility, as a result of the convergence of four agendas: improving family planning quality; the need to improve women's health; the rapid spread of HIV; and conceptual shifts in primary health care. International reproductive health actors, however, have taken little account of political, financial and managerial constraints to implementation in low-income countries.
Reproductive health is a wide concept, covering sexuality, pregnancy, birth and the puerperium, and infant health. Its four cornerstones are family planning, maternal health care, new-born and infant care, and control of sexually transmitted diseases, including AIDS. In view of the population explosion and the dire figures of maternal and infant mortality in third world countries, reproductive health is one of the most urgent fields for collaborative efforts. Norway contributes more of its gross national product to development assistance than any other nation. A substantial amount of this aid goes to reproductive health projects. We should also strengthen our manpower input proportionally.
A study was conducted on 130 girl students aged 13-17 years in Haryana to assess their awareness and health seeking behaviour regarding menstrual and reproductive health. Mean age at menarche of the girls was 13.6 +/- 0.83 years. Awareness about the process of menstruation was poor. Commonest reported menstrual problem was dysmenorrhoea (40.7%) followed by irregular menses (2.3%) of which only 5.3% consulted a doctor and 22.4% took over the counter medications from the chemist shops. Knowledge about normal duration of pregnancy and need for extra food during pregnancy was poor. Most of the girls knew about importance, duration of child spacing and need for three medical examinations during pregnancy. Major sources of information were television (73.1%), radio (37.1%) and parents (36.1%). Girls preferred to consult parents (49.2%) and doctors (44.6%) for help at times of having reproductive health problems. This study highlights the need for educating school girls about adolescent health, pregnancy and reproductive health problems through schools and parents by the health professionals.
Enhancing male reproductive health, and increasing men's participation in it, involves encouraging a range of positive reproductive health and social behaviour by men to help ensure women's and children's well-being. More intellectual work-including research programmes-is urgently needed to clarify the conceptual framework for male reproductive health. At the Asia and the Pacific Symposium 'Intra-regional Cooperation in Reproductive Health Research' (Shanghai, China, 12-13 October 1998) the Symposium participants identified regional research needs and recommended a regional reproductive health research agenda, which addresses six key issues related to male reproductive health: (i) male contraceptive technology; (ii) reproductive tract infections/sexually transmitted diseases and male infertility; (iii) male involvement in reproductive health; (iv) male adolescent reproductive health; (v) male reproductive ageing; and (vi) environment and male reproductive health. One of the major challenges now facing us is the elaboration of a comprehensive, yet realistic, male reproductive health research agenda that reflects the needs and demands of Asian developing countries. Making full use of an interdisciplinary approach is of strategic importance to achieve this.
Reproduction is a dual commitment, but so often in much of the world, it is seen as wholly the woman's responsibility. She bears the burden not only of pregnancy and childbirth but also the threats from excessive child bearing, some responsibility for contraception, infertility investigation and often undiagnosed sexually transmitted diseases (STDs) including AIDS. Failure to target men in reproductive health interventions has weakened the impact of reproductive health care programmes. The paper proposes that sophisticated and dynamic strategies in Africa and elsewhere which target women's reproductive health and research (such as control of STDs including AIDS, family planning, infertility investigation) require complementary linkage to the study and education of men. Men's perceptions, as well as determinants of sexual behavioural change and the socioeconomic context in which STDs, including AIDS, become rife, should be reviewed. There is a need to study and foster change to reduce or prevent poor reproductive health outcomes; to identify behaviours which could be adversely affecting women's reproductive health. Issues of gender, identity and tolerance as expressed through sexuality and procreation need to be amplified in the context of present risks in reproductive health. Researchers and providers often ignore the social significance of men. This paper reviews the impact of male dominance, as manifested through reproductive health and sexual decisions, against the background of present reproductive health problems. A research agenda should define factors at both macro and micro levels that interact to adversely impinge on reproductive health outcomes. This should be followed up by well-developed causal models of the determinants of positive reproductive health-promoting behaviours. Behaviour specific influences in sexual partnership include the degree of interpersonal support towards prevention, for example, of STDs, unwanted pregnancy or maternal deaths. Perceived efficacy and situational variables influencing male compliance in, say, condom use, form part of the wider study that addresses men. Thus preventive reproductive health initiatives and information should move from the female alone to both sexes. Women need men as partners in reproductive health who understand the risks they might be exposed to and strategies for their prevention.
Research that addresses male reproductive health should assist in the development of reproductive health programmes and policy; identify and test new leads in male contraceptive technology; establish effective male involvement initiatives which are likely to have a positive impact on the reproductive health of men and women; guide the allocation of health care resources to ensure cost-effectiveness of interventions; generate new knowledge, develop diagnostic technology in reproductive health and offer optimal treatment/care regimens. In considering the needs and demands of male reproductive health research in Asia and the Pacific, the following six research topics are recommended as the priority research areas: male contraceptive technology; male reproductive health behaviour and male adolescent reproductive health; male reproductive aging including male menopause and other diseases; male RTIs, STDs, HIV/AIDS; prevalence, management and prevention of male infertility; environment and semen quality and other male reproductive problems. One of the major challenges now facing us is the elaboration of a comprehensive, yet realistic male reproductive health research agenda that reflect the needs and demands of Asian developing countries. To this end, to make use of an interdisciplinary approach is of strategic importance. The most creative insights and productive leads are likely to emerge from a research team that is interdisciplinary especially in the field of reproductive health.
BACKGROUND: The aim of this study was to assess knowledge of reproductive health and the opinions of university students towards reproductive health education and family planning services. METHODS: A questionnaire about reproductive health knowledge and the opinions of students was submitted to 673 systematically and randomly selected students at Ataturk University. A set of 39 questions was used to determine the level of knowledge of reproductive health. RESULTS: The level of reproductive health knowledge was below the theoretical mean value. An association was found between gender, residential area, parents' education and sibling number with the reproductive health knowledge score. Most of the students approved of formal reproductive health education (88.4%). Approval of family planning services was lower than that of reproductive health education (71.6%). The percentage of men who support family planning services and reproductive health education was lower than that of women. Students who had graduated from Islamic religious schools had more negative opinions towards family planning services. CONCLUSIONS: University students lack knowledge about reproductive health and most of them agree that reproductive health education should be given in schools. Knowledge about reproductive health differs significantly depending on some sociodemographic variables. Some students have negative opinions towards family planning services and reproductive health education.
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Nurses have been providing reproductive health counseling to adolescent females for over 20 years. Yet, we found no studies in the nursing literature in which the investigator examined the types of reproductive health counseling nurses provide to adolescent females. Therefore, the purpose of this study was to examine nurses' description and evaluation of the types of reproductive health counseling they used for adolescent females. Five registered nurses, with at least 10 years experience in providing reproductive health counseling to adolescent females, were interviewed using a semi-structured guide. Four areas were explored: type of information provided, barriers to providing counseling, adolescent female decision-making capacity, and nursing recommendations. Two general themes emerged from the respondents' evaluations: frustration and unused potential of nurses to affect the reproductive health of adolescent females, and the inappropriateness of current reproductive health strategies for adolescent females.
OBJECTIVE: To explore reproductive health condition of college students in Shanghai and provide scientific basis for reproductive health education. METHODS: From July 2004 to March 2005, 1192 college students (majors including medicine, science and engineering, arts and culture; 618 medical students and 549 non-medical; 555 male and 612 female) from seven time-day colleges in Shanghai were investigated with a reproductive health questionnaire involving sex. The questionnaire was constituted by 72 topics, involving the need of education, sex attitude, sex videos, sex hygiene knowledge and sexually transmitted diseases (STDs), etc. RESULTS: 39.33% (459/1167) students thought they had accepted formal sex education; 49.19% (574/1167) students chose lecture as the favorite way; 41.90% (489/1167) students thought the reproductive health education would not increase the incidence of premarital sexual behavior; 64.10% (748/1167) students thought it was necessary to give college students reproductive health instructions and knowledge. On the other hand, we found 45.05% (250/555) boys and 27.45% (168/612) girls could accept the premarital sexual behaviors; 35.32% (196/555) boys and 39.38% (241/612) girls could accept premarital pregnancy; 44.39% (518/1167) students could calculate the safe period accurately; 71.38% (833/1167) students knew emergency contraception measures; 57.67% (673/1167) students knew how to and when to use condoms; To our surprise, only 2.19% (12/549) non-medical students and 12.14% (75/618) medical students knew exactly the whole 4 sexually transmitted diseases that needed to be essentially prevented in China. CONCLUSION: At present, the reproductive health condition of college students in Shanghai is sophisticated. Much more education on sex safety, self-protection skills and acquired immunodeficiency syndrome (AIDS) knowledge, etc should be reinforced.
OBJECTIVE: To describe reproductive health needs and screening rates for breast and cervical cancer for newly arrived (less than 90 days) refugee women in the United States. DESIGN: A retrospective study of existing medical charts from 1996 to 2000. SETTING: Refugee health screening clinic, central Texas. PATIENTS: Refugee women (n = 283) newly arrived in the United States from Cuba (31.1%), Bosnia (26.1%), Vietnam (24.7%), and other countries (18.0%); age range = 18 to 74 years, mean age = 34.4 years. MAIN OUTCOME MEASURES: Frequency of reproductive health problems and breast and cervical cancer screening rates. RESULTS: Twenty-five percent of women in the sample were pregnant or had a reproductive health problem. A significant percentage older than 40 (86%) had never had a mammogram when compared to American women of the same age (33%). Only 24% reported having had a Pap test within the previous 3 years. CONCLUSIONS: The risk of not receiving adequate reproductive health care is higher among newly arrived refugee women compared to nonrefugee women in the United States. For refugee women to enjoy optimum health, their individual needs and health care system issues must be addressed.
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.
To study the maturation processes during puberty, the Task Force on Adolescent Reproductive Health of the World Health Organization implemented a multicenter study on the age of menarche. From seven centers in six countries, 3,073 girls between the ages of 11 and 15 years volunteered for a two-year study. The girls were questioned at entry as to whether they had menstruated; social background data were recorded, and height and weight were measured. The median age for menarche was calculated by a life-table technique. The median ages were: Hong Kong-12 years, 9 months; Geneva, Switzerland-13 years, 1 month; Zafed, Israel and Stockholm, Sweden-13 years, 3 months; urban Colombo, Sri Lanka-13 years, 6 months; Ile-Ife, Nigeria-13 years, 9 months; and rural Peradeniya, Sri Lanka-14 years, 5 months. Menarche of the rural Peradeniya girls was later than the urban girls from Colombo and other study centers. The mean heights, weights, and obesity indices (Quetelet's Index) were higher in postmenarcheal girls compared to premenarcheal girls for each age at all centers.