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PubMed2006

Changes in perceptions of quality of, and access to, services among clients of a fractional franchise network in Nepal.

With declining levels of international donor funding for financing reproductive health programmes, developing country governments and international donors are looking towards private sector strategies to expand the supply of quality reproductive health services. One of the challenges of a health franchise is to improve the quality of services provided by independent private practitioners. Private providers are more likely to abide by the quality standards set by a franchiser if they see a financial benefit resulting from franchise participation. This study was conducted to measure whether (a) there were improvements in perceived quality of care and perceived access to health facilities once these facilities became part of a franchise and (b) improvements in perceived quality and perceived access were associated with increased client loyalty to franchised clinics. Franchisees were given basic reproductive health training for seven days and services marketing training for two days. Exit interviews were conducted with male and female clients at health facilities. A pre-test measurement was taken in April 2001, prior to the start of project activities. A post-test measurement was taken in February/March 2002, about 9 months after the pre-test. Multilevel regression analysis, which takes the hierarchical structure of the data into account, was used for the analysis. After taking provider-level variation into account and controlling for client characteristics, the analyses showed significant improvements in perceived quality of care and perceived access to services. Private provider participation in a franchise network helps improve client perceptions of quality of, and access to, services. Improvements in client perceptions of quality and access contribute to increased client loyalty to franchised clinics. Once increased client loyalty translates into higher client volumes, providers are likely to see the benefits of franchise participation. In turn, this should lead to increased provider willingness to remain part of the franchise and to abide by the standards of quality set by the franchiser.

Adult↗
PubMed2005

Seroprevalence of varicella, measles and hepatitis B among female health care workers of childbearing age.

To evaluate the relation between infectious agents and reproductive health hazards for health care workers (HCWs), a cross-sectional study consisting of 73 HCWs and 65 bureau workers was conducted. The reproductive health problems of both groups were compared using a questionnaire, and serologic examinations for measles, varicella and hepatitis B were performed. There were no differences between the two groups according to the rate of seropositivity of measles and varicella (P > 0.05). The prevalence of anti-HBc seropositivity was significantly higher among HCWs than controls (31.5 versus 16.9%). There were no differences between seropositive and seronegative subgroups of measles, varicella and hepatitis B regarding the rates of normal delivery time, preterm and postterm delivery and stillbirth. Subjects seropositive for anti-HBc showed a higher spontaneous abortion rate than those who were seronegative (38.2 versus 16.3, P = 0.009). Although these data showed that HCWs had a high rate of anti-HBc seropositivity and that the rate of spontaneous abortion was associated with past hepatitis B virus infection, further studies including larger populations are needed. We considered that it should be strongly recommended that all HCWs be vaccinated against this virus, and future studies should be focused on the relationship between infectious diseases and reproductive health problems in HCWs.

Abortion, Spontaneous↗
PubMed2001

Socioenvironmental predictors of abortion and stillbirths in an industrial community in Egypt.

Air pollution is considered to be one of the overgrowing problems of cosmopolitan distribution, due to marked progress in industrialization. The applied epidemiological and environmental studies related to reproductive health in the community, are considered as the main principles for comprehensive health development in industrial cities. The present study focused on the role of air pollution on the occurrence of abortion and stillbirths among married fertile women during the childbearing age (15-50 years) in two industrial areas, namely Helwan in Cairo Governorate and Tenth of Ramadan City in Sharqyia Governorate. A cross-sectional epidemiological study based on community background was implemented in the two studied areas. The unit of observation was the family including married fertile women based on specific inclusion criteria. Cluster sampling procedure was used in which the unit of sampling was the household, selected within a radius of not less than five Kilometers around the factories. Using Epi-info program, the total sample size in the two studied areas was 1934 women. The interview questionnaire was the tool adopted for data collection, which includes gynecological and obstetric data related to reproductive health. The socio-economic status of studied women was determined using scoring system that includes the education and occupation of both couples. The environmental study was carried-out in the two areas in order to assess the levels of air pollutants and their chemical nature. Data management using Logistic regression analysis was done to determine the effect of independent variables, such as socioeconomic factor, exposure to air pollutants on the occurrence of abortion and stillbirths as examples of reproductive health problems. The mean age of the studied women was 33.8+/-8.8 years in Helwan and 28.1+/-6.5 years in Tenth of Ramadan. Also the study showed significant differences in both the socioeconomic status, smoking inside houses and parity between the studied women in Helwan and Tenth of Ramadan City. The overall prevalence of abortion and stillbirths among women in the studied areas were 29.2% and 4.5%, respectively. However, the prevalence of such reproductive health hazards among women in Helwan was significantly higher than in Tenth of Ramadan City. Also the results of environmental study indicated that Helwan has higher mean values of total dust count, suspended and respirable dust concentrations as well as lead concentration in the ambient air than in Tenth of Ramadan City. The Logistic regression analysis showed that the respirable dust concentration in the air and smoking inside houses are the significant independent factors for the occurrence of abortion. Moreover, Lead concentration in the air and women education is the main predictors of both abortion and stillbirths. Accordingly, the Egyptian authorities should attempt to improve air quality in urban industrial communities to promote reproductive health and prevent woman' s health hazards.

Abortion, Spontaneous↗
PubMed1999

IPPF Charter on Sexual and Reproductive Rights. International Planned Parenthood Federation.

For most of human existence and in most societies, women have been considered to be property and subject to men. Throughout history, with such notable exceptions as Queen Boadicea, Eleanor of Aquitaine, Elizabeth I of England, and Catherine the Great of Russia, women had little or no power until early in the 20th century when the women's suffrage movement was successful in the United States and in some European countries. As women have gained political rights, groups of women have sought sexual and reproductive rights, as exemplified by the feminist movement of the past few decades in the United States. Although marked strides toward achievement of reproductive choice have been taken in high-income countries, there remain major strictures to reproductive freedom for women in low-income countries. This area, which is replete with ethical and moral issues, has been addressed by the International Planned Parenthood Foundation (IPPF), which has worked to improve the sexual and reproductive health of women throughout the world. The IPPF Charter on Sexual and Reproductive Rights is a paradigm for both women's rights and human rights. Karen Newman is policy adviser with the IPPF and has codrafted the IPPF Charter on Sexual and Reproductive Rights together with two lawyers. She has held several positions within the IPPF, including medical researcher, press officer, and programme adviser in Europe, where she had responsibility for working with new family planning associations (FPAs) in the Czech Republic and Slovakia. At present, she is working to increase the capacity of IPPF member FPAs to undertake human rights-based advocacy for sexual and reproductive health and rights. Judith F. Helzner is director of Sexual and Reproductive Health at International Planned Parenthood Federation/Western Hemisphere Region, Inc., where she has worked since 1987. She holds M.A. degrees from the University of Pennsylvania in International Relations and Demography. Her previous employment includes the Pathfinder Fund and the International Women's Health Coalition.

Family Planning Services↗
PubMedDate not supplied

Adolescent self reported reproductive morbidity and health care seeking behaviour.

BACKGROUND: Addressing reproductive health issues of women is now on the global social agenda in the new millennium. Maternal mortality has long been the only indicator of women's health even though reproductive morbidity occurs far more frequently and seriously affects women's lives. In this paper, an attempt was made to assess the magnitude of self reported gynaecological morbidity unrelated to childbearing among the adolescents irrespective of their marital status. The paper also explored the determinants of health care seeking behaviour of the adolescents for their reproductive ailments. METHODS: Both quantitative and qualitative data were collected for this study. Cross sectional study was conducted both in rural and urban areas using a multistage cluster sampling technique. A nationally representative data on 2883 adolescents irrespective of their marital status were analysed. RESULTS: Analysis revealed that a large proportion of the adolescents (64.5%) reportedly has been suffering from gynaecological morbidity. The most frequent form of morbidity was menstrual disorders (63.9%) followed by lower abdominal pain (58.6%), burning sensation during urination (46.1%), genital itching (15.5%), vaginal discharge (3.4%) etc. Multivariate logistic regression analysis revealed that older adolescents aged 15-19 years, family income, type of family, type of residence and hygienic practice during menstruation appeared to be influencing factors for adolescents reproductive morbidity. The results also revealed that about one fifth (18.0%) sought health care for their gynaecological ailments indicating that adolescents were unaware about their reproductive morbidity (p<0.05). For assessing the factors influencing their health care seeking for reproductive morbidity, multivariate logistic regression analysis found significant positive association with adolescents aged 15-19 years, having autonomy in treatment, working status, adolescents of joint or extended family (p<0.05). DISCUSSION: Adolescent reproductive health in Bangladesh indicates high incidence of maternal morbidity. The incidence of these health problems varied by socio-economic and demographic characteristics of the adolescents. Recommendations to address these problems include encouragement of female education, introduction of family life education in school curricula, creating community awareness for seeking health care and empowerment of women in household decision making process.

Adolescent↗
PubMed2004

Five reasons why inbreeding may have considerable effect on post-reproductive human health.

As the genetic architecture of common complex diseases of late onset is emerging through intensive research, it is intriguing to assess the predicted effect of inbreeding on those diseases. In this paper, we propose five reasons why we believe inbreeding may have a considerable effect on post-reproductive human health. (i) The joint effect of inbreeding depression on all polygenic quantitative phenotypes that confer risk for late-onset diseases is predicted to be multiplicative rather than additive. (ii) The "genetic load" of rare "Mendelian" variants with large deleterious effects in post-reproductive adults is unknown, but could be much greater than expected as these variants were invisible to selection through human history. (iii) Deleterious effects resulting from autozygosity in hundreds of affected rare recessive variants of small effect under common disease/rare variant (CD/RV) hypothesis could result in epistatic effects that could jointly impair capacity to compensate against environmental risks. (iv) Heterozygote advantage in loci under balancing selection could be reduced by inbreeding. (v) Published empirical evidence in animals and humans consistently report large inbreeding effects on late-onset traits. Since inbreeding is common in many populations and the effects of inbreeding depression could substantially contribute to disease burden and reduced life expectancy we believe there is now a clear need for further genetic epidemiological research in humans to investigate this issue.

Animals↗
PubMed2006

[Effects of endocrine disrupting chemicals on male reproductive function--epidemiological views].

Numerous medical studies have recently focused on the adverse trends in human male reproductive health including possible decline in semen quality and increasing incidences of reproductive anomalies such as testicular cancer, cryptorchidism and hypospadias, which have been reported from many counties during past decades. We have no sufficient evidence on the basis of which we could determine whether human male reproductive health is really declining and whether endocrine disrupting chemicals are responsible for this observed decline. However, Skakkebaek's group has currently proposed a hypothesis that the male reproductive problems are symptoms of one underlying entity, the testicular dysgenesis syndrome (TDS), which may be increasingly common due to adverse environmental influences. According to this hypothesis, TDS is a result of the disruption of embryonal programming and gonadal development during the fetal stage and the recent rise in the prevalence of TDS may be causally linked to endocrine disrupting chemicals affecting genetically susceptible individuals. This review aims to give a brief overview of the suspected adverse trend in human male reproductive health and current data associated with TDS.

Endocrine Disruptors↗
PubMed2006

Perspectives of midwives and doctors on adolescent sexuality and abortion care in Vietnam.

BACKGROUND: Vietnam has one of the highest abortion rates in the world and adolescent abortions are thought to constitute at least one-third of all cases. Lack of balanced reproductive health information and services to adolescents and negative social attitudes towards adolescent sexuality are contributing factors to the high abortion rates. Health providers are important in guiding and counselling adolescents on how to protect their reproductive health. There is a lack of studies on health providers' perspectives on their work in adolescent reproductive health care. AIM: To explore the perspectives of midwives and doctors on adolescent sexuality and abortion, and what they considered to be quality abortion care for adolescents and the barriers to it, as well as to their own training needs. METHODS: Observations of care in abortion clinics and focus-group discussions (FGD) were used to collect data. Doctors and midwives from three healthcare facilities in Quang Ninh province in Northern Vietnam participated in a total of eight FGDs. Data were analysed using latent content analysis. FINDINGS: Major barriers identified for quality abortion care were of technical and managerial nature. Participants considered that counselling unmarried clients in connection with abortion should focus on warning against the risks and dangers of abortion and pre-marital sexual relations, which they strongly disapproved of. However, they also expressed a pragmatic and caring attitude towards the unmarried girls and couples coming for abortion. Adolescent sexuality and abortion are morally sensitive issues in the Vietnamese culture. The contradictions between cultural norms and the reality facing health providers while counselling unmarried adolescents need to be addressed in education and training programmes.

Abortion, Induced↗
PubMed1998

Women's health: where are nurse practitioner programs headed?

Until quite recently, the discipline of women's health has been restricted to reproductive health. While graduate nurse practitioner (NP) programs have included issues across the life cycle and health promotion in their curricula, there is growing emphasis on primary care of women. Graduate nursing programs that offer women's health and obstetric/gynecologic NP tracks were surveyed in 1996 to elicit content in the curriculum and to ascertain whether changes in requirements for certification were impacting programs. Programs listed in the 1994 National Organization of Nurse Practitioner Faculties directory (NONPF) were surveyed. Twenty-eight of 31 programs responded; results were tallied by frequency distribution. Results documented differences in programs, suggesting that a clear definition of women's health advanced practice is needed. The author recommends a national dialog to explore advanced practice in women's health and asks if there should be two types of NP programs--primary care of women (a generalist NP) and reproductive health (a specialist NP)--and how NP programs and credentialing bodies should differentiate graduate programs as well as content for certification exams.

Certification↗
PubMed2000

Contemporary patterns of adolescent sexuality in urban Botswana.

In Botswana, as in other areas in southern Africa, there is a growing concern about the risks associated with adolescent sexuality. To facilitate the design of policies that can address these problems, it is necessary to gain a thorough understanding of contemporary patterns of adolescent sexual behaviour, and the factors that affect them. This paper examines these issues using data from the 1995 Botswana Adolescent Reproductive Health Survey in conjunction with data from focus group discussions. The results suggest that adolescents become sexually active at an early age, and that many of them, males and females alike, have multiple sex partners. This early sexual initiation implies that adolescent reproductive health programmes should target youths aged 13 or younger. For school-based programmes this implies starting no later than Grade 6 or Standard 1, and preferably earlier. Young males appear to be a particularly vulnerable group that needs further attention. Adolescents perceive that teachers, peers and parents have the largest influence on their reproductive health attitudes. Schools appear to have the most potential for providing reproductive health information, because they reach youths both directly and indirectly by educating their peers. The results also show that male and female sexual behaviour is affected by different factors. Among males, having secondary education strongly increases the odds of being sexually active, presumably because such males make attractive partners. Among females, on the other hand, being in school significantly reduces the odds of being sexually active. This finding is consistent with the policy imposing a one-year school expulsion for pregnant schoolgirls, which was implemented as a deterrent to schoolgirl pregnancy.

Adolescent↗
PubMed2002

An overview of changing agendas in health sector reforms.

This paper discusses health sector reforms and what they have meant for sexual and reproductive health advocacy in low-income countries. Beginning in the late 1980s, it outlines the main macro-economic shifts and policy trends which affect countries dependent on external aid and the main health sector reforms taking place. It then considers the implications of successive macro-economic and reform agendas for reproductive and sexual health advocacy. International debate today is focused on the conditions necessary for socio-economic development and the role of governments in these, and how to improve the performance of health sector bureaucracies and delivery systems. A critical challenge is how to re-negotiate the policy and financial space for sexual and reproductive health services within national health systems and at international level. Advocacy for sexual and reproductive health has to tread the line between a vision of reproductive health for all and action on priority conditions, which means articulating an informed view on needs and priorities. In pressing for greater funding for reproductive health, advocates need to find an appropriate balance between concern with health systems strengthening and service delivery and programmes, and create alliances with progressive health sector reformers.

Africa South of the Sahara↗
PubMed1990

A chill wind blows: Webster, obstetrics, and the health of women.

The Supreme Court decision in Webster v Reproductive Health Services permits states to regulate abortion in fashions that may be medically unsound and may significantly restrict access. This decision challenges the contemporary practice of obstetrics and threatens to curtail access to needed services, particularly for poor women, who are at highest risk of pregnancy-associated medical complications and death. Governmental restrictions on abortion interfere with the obstetrician's basic goal of providing optimal care for the patient. Obstetricians dedicated to providing the best care to their patients should help to ensure that safe abortion be part of a spectrum of reproductive health care that is available to all American women.

Abortion, Legal↗
PubMed2006

Assessing effects of a media campaign on HIV/AIDS awareness and prevention in Nigeria: results from the VISION Project.

BACKGROUND: In response to the growing HIV epidemic in Nigeria, the U.S. Agency for International Development (USAID) initiated the VISION Project, which aimed to increase use of family planning, child survival, and HIV/AIDS services. The VISION Project used a mass-media campaign that focused on reproductive health and HIV/AIDS prevention. This paper assesses to what extent program exposure translates into increased awareness and prevention of HIV/AIDS. METHODS: This analysis is based on data from the 2002 and 2004 Nigeria (Bauchi, Enugu, and Oyo) Family Planning and Reproductive Health Surveys, which were conducted among adults living in the VISION Project areas. To correct for endogeneity, two-stage logistic regression is used to investigate the effect of program exposure on 1) discussion of HIV/AIDS with a partner, 2) awareness that consistent condom use reduces HIV risk, and 3) condom use at last intercourse. RESULTS: Exposure to the VISION mass media campaign was high: 59%, 47%, and 24% were exposed to at least 1 VISION radio, printed advertisement, or TV program about reproductive health, respectively. The differences in outcome variables between 2002 baseline data and the 2004 follow-up data were small. However, those with high program exposure were almost one and a half (Odds Ratio [O.R.] = 1.47, 95% Confidence Interval [C.I.] 1.01-2.16) times more likely than those with no exposure to have discussed HIV/AIDS with a partner. Those with high program exposure were over twice (O.R. = 2.20, C.I. 1.49-3.25) as likely as those with low exposure to know that condom use can reduce risk of HIV infection. Program exposure had no effect on condom use at last sex. CONCLUSION: The VISION Project reached a large portion of the population and exposure to mass media programs about reproductive health and HIV prevention topics can help increase HIV/AIDS awareness. Programs that target rural populations, females, and unmarried individuals, and disseminate information on where to obtain condoms, are needed to reduce barriers to condom use. Improvements in HIV/AIDS prevention behaviour are likely to require that these programmatic efforts be continued, scaled up, done in conjunction with other interventions, and targeted towards individuals with specific socio-demographic characteristics.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

The study of client-provider interactions: a review of methodological issues.

In recent years, increased focus on the quality of family planning and other reproductive health services has led to a better understanding of women's reproductive health needs and has drawn attention to program-client interactions as a critical and neglected dimension of program effort. In this article, the relevant methods and experience related to studying client-provider interactions within family planning programs in southern countries are reviewed. The policy relevance of this work is highlighted first by stressing the operational usefulness of examining what happens when people engage with service-delivery systems that offer family planning or reproductive health services. Subsequently, the content areas encompassed by program-client interactions are clarified by identifying manifest and latent dimensions and by distinguishing the variables that define these interactions from variables related to their determinants and consequences. Finally, a critical review of existing methods is presented, with examples of research and a discussion of ethical issues.

Data Collection↗
PubMed2006

Can the Internet be used effectively to provide sex education to young people in China?

PURPOSE: To assess the feasibility and effectiveness of sex education conducted through the Internet. METHODS: Two high schools and four colleges of a university in Shanghai were selected as the research sites. Half of these were assigned to the intervention group and the other half to the control group. The interventions consisted of offering sexual and reproductive health knowledge, service information, counseling and discussion to all grade one students in the intervention group. The intervention phase lasted for 10 months and was implemented through a special website, with web pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from the intervention, and 713 from the control schools and colleges participated in the baseline survey, and about 97% of them were followed up in postintervention survey to assess changes that can be attributed to the sex education interventions provided through the Internet. RESULTS: The median scores of the overall knowledge and of each specific aspect of reproductive health such as reproduction, contraception, condom, sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) were significantly higher in the intervention group as compared with those in the control group at postintervention (p < .0001), although no significant differences were found between these two groups in the baseline survey (p > .05). Group by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p < .0001) and in attitude of high school students toward sex-related issues (p < .05), suggesting that interventions increased subjects' knowledge significantly and changed high school students' attitudes to being less liberal toward sex. The intervention also had positive influence on students' attitudes toward providing contraceptive service for unmarried people. CONCLUSIONS: Providing sex education to students in Shanghai through the Internet was found feasible and effective. The Internet-based sex education program increased students' reproductive health knowledge effectively and changed their attitudes toward sex-related issues in terms of being less liberal toward sex and more favorable to providing services to unmarried young people. The Internet thus offers an important and hitherto untapped potential for providing sex education to students and young people in China.

Adolescent↗
PubMed1994

Japan lagging in reproductive rights.

Japan is one of only 11 of the world's countries that have not authorized the oral contraceptive pill for contraceptive purposes, noted Margaret Catley-Carlson, president, Population Council. Catley-Carlson made her comments on the low-dose pill at a special lecture meeting in Tokyo on October 14 where she served as guest speaker. The meeting was organized by the Japan Family Planning Association (JFPA) in cooperation with the Family Planning Federation of Japan (FPFJ), and JOICFP. It was attended by medical experts, parliamentarians, representatives of non-governmental organizations (NGOs) and the media. During her lecture, Catley-Carlson noted the emphasis on women's empowerment and reproductive health and rights for women made in the World Population Program of Action adopted at the recent International Conference on Population and Development (ICPD) in Cairo. She emphasized that NGOs have an important role to play in realizing the goals of the program of action. Widening the choice of contraceptives, an important reproductive health issue, is the responsibility of the service providers including NGOs, she added. Noting the relatively high rate of induced abortion in Japan, Catley-Carlson commented that the lack of access to the low-dose pill is not desirable from the perspective of reproductive health and rights. She called for widening the choice of contraceptives in Japan to include the low-dose pill and a wider selection of IUDs to promote reproductive health.

Asia↗
PubMed2004

A strategic assessment of abortion and contraception in Romania.

The history of fertility regulation in Romania illustrates the complex interactions between politics, women's reproductive health and rights and access to high quality care. This paper describes the current situation of abortion and contraception in Romania, based on national statistics, recent reproductive health surveys and the findings of a strategic assessment led by the Ministry of Health in late 2001. This rapid assessment employed a participatory, qualitative methodology. Over 500 people were interviewed from 145 institutions in 25 cities, towns and villages in Romania, about the range of actions needed to prevent unwanted pregnancies, reduce abortion-related morbidity and mortality and improve the quality, accessibility and availability of abortion and contraceptive services. Although much progress has been made in contraceptive services over the past ten years, improvements in abortion care have lagged considerably The assessment played an important role in raising team members' awareness and motivation to take action. Some of the issues identified are already being addressed by the institutions that took part. National standards and guidelines for comprehensive abortion care have been developed, contraceptive services have been expanded at primary health care level, sexual and reproductive health education provided by classroom teachers has been introduced in schools, and a study to test a model of comprehensive abortion care services for Romania is planned.

Abortion, Induced↗