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At least 91 records · Page 5Linked to original sources
PubMed1999

Rapid appraisal of needs in reproductive health care in southern Sudan: qualitative study.

OBJECTIVES: To identify the need for reproductive health care among a community affected by conflict, and to ascertain the priority given by the community to reproductive health issues. DESIGN: Rapid appraisal. This comprised interviews with key informants, in-depth interviews, and group discussions. Secondary data were collated. Freelisting, ranking, and scenarios were used to obtain information. SETTING: Communities affected by conflict in southern Sudan. PARTICIPANTS: Interviews and group discussions were chosen purposively. Twenty interviews with key informants were undertaken, in-depth interviews were held with 14 women, and 23 group discussions were held. MAIN OUTCOME MEASURES: Need for reproductive health care. Perceived priority afforded to reproductive health issues in comparison with other health problems. RESULTS: Reproductive health in general and sexually transmitted diseases in particular were important issues for these communities. Problems in reproductive health were ranked differently depending on the age and sex of the respondents. Perceptions about reproductive health issues in communities varied between service providers, and community leaders. Settled and displaced communities had different priorities and differing experiences of reproductive health problems and their treatment. CONCLUSION: Rapid appraisal could be used as the first step to involving communities in assessing needs and planning service provision.

Age Distribution↗
PubMed2002

Definition and measurement of reproductive health.

An internationally agreed conceptual definition of reproductive health is applied to the development and testing of practical indicators for use in the community. Basic criteria are proposed for an interview-based tool to measure reproductive health -- as opposed to morbidity or mortality -- adapting methods from the health status measurement field. Proposed domains and indicators linked to the definition of reproductive health adopted at the International Conference on Population and Development (ICPD) should be comparable across and within diverse populations. Two sets of domains that describe reproductive health are recommended for further development and testing, seven domains that focus directly on health and six others that assess related areas of well-being.

Female↗
PubMed2003

Racial disparities in reproductive health outcomes.

Racial and ethnic disparities exist in many areas of health care, but the magnitudes of these disparities vary and are not fully understood. In women's health care, disparities in reproductive health outcomes are quite common. In this article, a review was performed to assess the magnitude and reasons for some of the most common disparate reproductive health outcomes, such as infant and maternal mortality, unintended pregnancies, and preventive care. Papers were retrieved by systematically searching OVID-MEDLINE (1966-2002) electronic databases and hand-searching relevant reference lists and bibliographies. Those findings are reviewed here, and some interventions to move toward a reduction of these disparities are suggested. Our review, which contained mostly data on black-white differences, suggest that large disparities continue to exist in many reproductive health outcomes and that collaborative efforts at multiple levels in the community and health care system are needed if we are to effectively close the gaps.

Adolescent↗
PubMed1997

Zambia moves towards reproductive health.

Several events in Zambia this year have marked the development of an integrated approach to reproductive health. A team met in March to draw up a national safe motherhood policy, plus strategies and guidelines. These were completed by April and are being distributed for comments. Clinical guidelines for safe motherhood in health centers have also been developed. These aim to reduce mortality and morbidity among mothers and infants by helping health workers to provide quality care to women at every stage of pregnancy and delivery. A reproductive health workshop was held in Ngwerere in May to create awareness of the concept of reproductive health, identify reproductive health problems in the area, propose solutions and outline activities. The 75 participants included community health workers, community leaders, teachers, youth leaders, and community members, as well as health workers and policymakers. The workshop was conducted in the local language so that those present were able to participate fully. June 1997 saw the official launch of Zambia's new policy framework, guidelines and strategy on family planning within reproductive health. The country's Minister of Health, Dr. Katele Kalumba, said the family planning guidelines were a sign of the government's commitment to providing a basic health care package for all Zambians. To promote widespread discussion of the whole concept of reproductive health, local newspapers printed feature articles with the headline "Let's talk reproductive health." The articles raised a variety of sensitive issues that ranged from safe sex and adolescent sexuality to safe motherhood and HIV prevention. Plans are going ahead in Zambia for drawing up a national training curriculum for safe motherhood and family planning. The curriculum for health workers will cover both pre-service and in-service training.

Africa↗
PubMed2003

Reproductive health in school-based health centers: findings from the 1998-99 census of school-based health centers.

PURPOSE: To describe the state of reproductive health services, including access to contraception and health center policies, among school-based health centers (SBHCs) serving adolescents in the United States METHODS: We examined questionnaire data on provision of reproductive health services from the 1998-99 Census of School-Based Health Centers (response rate 70%). We examined 551 SBHCs in schools with high or middle school grades. We used logistic regression to define factors independently associated with services and policies. RESULTS: Most SBHCs (76%) were open full-time; over one-half (51%) of centers had opened in the past 4 years. Services provided, either on-site or by referral, included gynecological examinations (95%), pregnancy testing (96%), sexually transmitted disease (STD) diagnosis and treatment (95%), Human Immunodeficiency Virus (HIV) counseling (94%), HIV testing (93%), oral contraceptive pills (89%), condoms (88%), Depo-Provera (88%), Norplant (78%), and emergency contraception (77%). Counseling, screening, pregnancy testing, and STD/HIV services were often provided on-site (range 55%-82%); contraception was often provided only by referral (on-site availability = 3%-28%). SBHCs with more provider staffing were more likely to provide services on-site; rural SBHCs and those serving younger grades were less likely to provide these services on-site. Over three-quarters (76%) of SBHCs reported prohibitions about providing contraceptive services on-site; the sources of these prohibitions included school district policy (74%), school policy (30%), state law (13%), and health center policy (12%). While SBHCs generally required parental permission for general health services, many allowed adolescents to access care independently for certain services including STD care (48%) and family planning (40%). Older SBHCs were more likely to allow independent access. CONCLUSIONS: SBHCs provide a broad range of reproductive health services directly or via referral; however, they often face institutional and logistical barriers to providing recommended reproductive health care.

Adolescent↗
PubMed2000

Reproductive health needs worldwide: constraints to fertility control.

Reproductive health, defined in the 1994 UN Cairo Conference on Population and Development, is discussed and its limits identified. Mortality and morbidity impacts of components of male and female reproductive health are quantified. Use is made of survey data and the estimates of deaths and disease burdens provided by the Global Burden of Disease Inquiry. Maternal causes are the greatest contributors to the total disease burden among women aged 15-44 years. In developing countries, up to half of those who want to delay or avoid further pregnancy are not using contraception. Worldwide, induced abortion accounts for 61,000 deaths annually. Sexually transmitted diseases and other illnesses also result from unsafe sexual practices, resulting in at least 1 million deaths each year. These deaths-and an overall disease burden of 50 million disability-adjusted life years-are entirely preventable. Constraints include, lack a of international commitment to improving reproductive health, social and economic factors, lack of biomedical research, insensitive social science research, and inadequate knowledge. Men and women have the right to demand better services and the knowledge and conditions in which to use them. Those in the more developed countries have the responsibility of ensuring adequate financial and technical support to make reproductive health possible everywhere.

Adolescent↗
PubMed2001

Reproductive health of male radiographers.

OBJECTIVE: To compare certain reproductive health problems reported in 2 groups of males, one of which was exposed to x-ray radiation (radiographers) and the other group that was not exposed to x-ray radiation. The reproductive health problems were miscarriage, congenital anomalies, still births and infertility. METHODS: Two groups of men were selected (90 in each group). The first group consisted of radiographers and the other groups consisted of men not exposed to x-ray radiation. The 2 groups were matched for age and source. Relative risk, attributable risk percentage and level of significance were calculated. RESULTS: Incidence rate of reproductive health problems was increasing with the increase in duration of exposure to x-ray radiation ranging between 17% (for those exposed for 1-5 years) to 91% (for those exposed for more than 15 years). There were significant associations between exposure to radiation and miscarriage (relative risk = 1.67, attributable risk percentage = 40%), congenital anomalies (relative risk = 10, attributable risk percentage = 90%), still birth (relative risk = 7, attributable risk percentage = 86%), and infertility (relative risk = 4.5, attributable risk = 78%). CONCLUSION: The incidence rates of reproductive health problems reported by male radiographers were significantly higher than that reported by the non exposed group and higher than the incidence rates reported in community-based studies in Jordan. The incidence rates of fetal death (miscarriage and stillbirth together) and infertility reported by our radiographers were higher than had been reported by the British radiographers. An immediate plan of action is needed to protect our radiographers. Further studies are needed in this field taking into account all extraneous variables that may affect the reproductive health of radiographers.

Adult↗
PubMed2006

The appropriateness of gatekeeping in the provision of reproductive health care for adolescents in Lithuania:the general practice perspective.

BACKGROUND: Adolescents' consultation of primary health care services remains problematic despite their accessibility. The reproductive health service seeking behavior of adolescents is the object of much research but little is known about how this behavior is influenced by the gatekeeping system. This study aimed to explore general practitioners' perceptions of the appropriateness of gatekeeping in adolescent reproductive health care. METHODS: Twenty in-depth interviews regarding factors affecting adolescent reproductive health care were carried out on a diverse sample of general practitioners and analyzed using grounded theory. RESULTS: The analysis identified several factors that shaped GPs' negative attitude to gatekeeping in adolescent reproductive health care. Its appropriateness in this field was questionable due to a lack of willingness on the part of GPs to provide reproductive health services for teenagers, their insufficient training, inadequately equipped surgeries and low perceived support for reproductive health service provision. CONCLUSION: Since factors for improving adolescent reproductive health concern not only physicians but also the health system and policy levels, complex measures should be designed to overcome these barriers. Discussion of a flexible model of gatekeeping, encompassing both co-ordination of care provided by GPs and the possibility of patients' self-referral, should be included in the political agenda. Adolescents tend to under-use rather than over-use reproductive health services and every effort should be made to facilitate the accessibility of such services.

Adolescent↗
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

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↗
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↗
PubMed2003

Frequency and perceived credibility of reported sources of reproductive health information among primary school adolescents in Arusha, Tanzania.

AIMS: To describe adolescents' sources of reproductive health information and perceived credibility of these sources. METHODS: A questionnaire survey was conducted among 1247 seventh grade pupils in Arusha district; enquiring their sources of reproductive health information and perceived credibility of these sources. Mean scores were computed for each type of information in relation to frequency of source and credibility, and scales for reproductive health information sources and credibility constructed. Analysis of covariance was used to compare mean scores by demographic and sexual behaviour variables. RESULTS: Mass media ranked first as sources of reproductive health information, followed by teachers and health workers. Health workers ranked first in credibility followed by parents, while credibility rating for media was low. Religious leaders and respondents' friends played a rather minor role as sources of reproductive health information, and their credibility ratings were also low. CONCLUSION: Mass media were the most frequent sources of reproductive health information for primary school adolescents, but parents and health workers were regarded as more credible sources. Programmes seeking to promote reproductive health of young people should take into account the diverse arenas through which young people currently obtain reproductive health information, and strive to tap into and strengthen the full range of these arenas. Increased involvement of parents and health workers in providing reproductive health information to young people seem indispensable.

Adolescent↗
PubMed2002

The politics of priority setting for reproductive health: breast and cervical cancer in Ghana.

Priority setting for reproductive health is affected by health sector reform policies, the often politically charged nature of issues such as abortion, decreasing funding for reproductive health activities and the broad agenda of the ICPD Programme of Action. This paper examines the influence of political and organizational factors on national priority setting for reproductive health and argues that existing priority setting tools such as disability-adjusted life years and cost-effectiveness analysis do not consider the influence of politics on the priority setting process or account for the interpretation of evidence in priority setting. It suggests that priority setting tools can be strengthened by incorporating empirical measures of political and organizational attention to an issue, and through a new measure--policy priority. The paper applied this new measure to a case study of attention to breast and cervical cancer in Ghana from 1990-97, illustrating how traditional priority setting methods cannot explain the priority given to breast cancer in Ghana. It demonstrates how local politics can trump scientific and economic evidence and suggests that the priority setting process can have unforeseen equity and social implications. It concludes by arguing that the policy priority measure provides a more complete picture of reproductive health priorities and is useful for better understanding the implications of the priority setting process for reproductive health.

Breast Neoplasms↗
PubMed2004

ACOG Committee Opinion No. 307. Partner consent for participation in women's reproductive health research.

Recent advances in reproductive medicine include treatment of subfertility as well as investigation of agents that may serve as both contraceptives and potential prophylaxis against sexually transmitted diseases, including potential protection from human immunodeficiency virus (HIV). Although there is no doubt regarding the need for informed consent by women participating in trials evaluating the safety and effectiveness of these novel agents and treatments, there has been some debate regarding the necessity and propriety of requiring consent from the partners of women involved in certain types of clinical trials involving reproductive health. Issues of partner consent are unique to research surrounding women 's reproductive health as opposed to research pertaining to women's health, in general. This is due, in part, to a valid concern about a potential effect of the research on the partner. There are, therefore, legitimate reasons to obtain partner consent for a woman's participation in a clinical trial. In the absence of such reason, partner consent should not be mandated.

Clinical Trials as Topic↗
PubMedDate not supplied

Ethical aspects of reproductive health in the workplace.

Reproductive health in the workplace presents in microcosm all of the ethical dilemmas raised by occupational medicine and medicine generally, including confidentiality, workers' right to know, individual autonomy, paternalism, informed consent, cost-benefit analysis, and a host of other issues.

Employment↗
PubMed2004

Male Reproductive Health: A village based study of camp attenders in rural India.

BACKGROUND: A paucity of information about male reproductive health and a perceived interest in involvement among local men provided the impetus for carrying out a village based male reproductive health camp. The aim was to investigate men's willingness to participate in such camps, and to describe reproductive health problems in men. METHODS: Structured interviews were carried out with 120 men attending a reproductive health check-up in a village in rural West Bengal, India. General information, details of family planning methods used and data on reproductive health complaints were collected. Clinical examinations were also carried out. Socio-demographic characteristics were compared for men with and without reproductive health and urinary complaints. RESULTS: Three quarters of the married men were using contraception, but the majority stated that their wives were responsible for it. The most common reproductive health complaint was urinary problems; 28% had burning on urination, and 22% reported frequent and/or difficult urination. There were few social or demographic differences between men with and without problems. Seventeen percent of the men had clinically diagnosed reproductive health problems, the most common being urethral discharge. None of the men with diagnosed problems were using condoms. CONCLUSIONS: This study highlights the interest of men in their reproductive health, but also highlights the high proportion of men with problems. In addition, a number of men with clinically diagnosed problems had not reported them in the interviews, illustrating either the reticence to report or the lack of knowledge about symptoms of reproductive health problems. Recommendations for future programmes and research in this field are given.

Journal Article↗
PubMedDate not supplied

The other half of the equation: Serving young men in a young women's reproductive health clinic.

CONTEXT: Efforts to improve reproductive health typically target women. Family planning agencies serving high-risk young women may be particularly suited to integrating young men in their health promotion efforts. METHODS: In 2001, a family planning clinic in San Francisco serving primarily young women opened a male clinic as part of a male involvement program that includes education and outreach components. Client volume was assessed by reviewing billing data. New male clients completed questionnaires on their demographic characteristics, sexual and health-seeking behavior, and reason for clinic visit. Before and after the male clinic opened, female clients completed questionnaires assessing their satisfaction with services and their attitudes on males' being served at the clinic. Data were analyzed by using descriptive and chi-square statistics. RESULTS: In the first year of the male clinic, the number of adolescent and adult male clients served at the facility increased by 192% and 119%, respectively, over the previous year. Among 110 males making first visits, 88% came for sexually transmitted disease testing or treatment. Three-quarters had learned of the clinic by word of mouth--from a sexual partner (37%), friend (29%) or sibling (6%)--rather than directly from outreach efforts. The proportion of female respondents very or mostly satisfied with their care was similarly high before (98%) and after (92%) the male clinic opened. CONCLUSIONS: Increasing capacity within the female reproductive health model to serve males is feasible. To reach at-risk males, "in-reach" efforts with female clients may be as important as targeted outreach efforts.

Adolescent↗