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PubMedDate not supplied

IEC interventions for health: a 20 year retrospective on dichotomies and directions.

In January 1997, the World Health Organization's Family Planning and Population Unit (WHO/FPP) commissioned a retrospective qualitative study of 20 years of experience in information, education, and communication (IEC) as it had been applied to public health initiatives globally. The purpose of the study, which relied on a literature search, a field survey, and in-depth interviews, was to examine lessons learned from two decades of experience in applying IEC interventions in support of public health in order to improve the integration of reproductive health services through IEC initiatives. While the focus of the study was on ways in which IEC can support reproductive health strategies, the discourse surrounding this effort pointed to a number of generic issues of interest or concern to all health education, communication, and promotion practitioners. An analysis and synthesis of "best practices" as perceived by IEC program managers, field implementers, donors, and evaluators revealed significant dichotomies and differences of opinion that have emerged in the field of IEC in recent years and helped to identify several areas for future operations research. This article articulates those divergent opinions, cites major areas for further research, and highlights a strategic approach to partnerships aimed at improving the delivery of health and communication programs.

Communication↗
PubMed1989

AIDS in women: epidemiology.

Several facts concerning the distribution of AIDS in U.S. female populations are clear. This disease has made significant inroads, in a quantitative sense, into the female segment of our society as documented by AIDS surveillance data, information on pregnant women and parturients, and by screening data from the military. The impact on women in the reproductive years, on the reproductive health of these women, and on the reproductive outcome of their pregnancies is of substantial concern. Monitoring epidemiologic trends in certain groups will require clever and creative strategies like those of Hoff and colleagues. Additional data may be derived from the CDC's Family of Surveys that will examine HIV prevalence in five groups (in addition to the newborn infant survey described above): intravenous drug users, patients admitted to hospitals, sexually transmitted disease clinic patients, women's health and reproductive health clinics, and tuberculosis clinics. It is hoped that the data obtained from these studies, as well as data gathered on college students and Job Corps applicants, will contribute additional information on HIV infection in women. Monitoring the progress of the AIDS epidemic in women will be difficult. Even more difficult will be the effort to respond to the epidemic in the women it most frequently affects: the poor, minority, disenfranchised women who may be involved in illegal activities (drug use, prostitution, illegal immigration) who are not well networked into the medical and social services of our society.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Adolescent sexuality and fertility in Kenya: a survey of knowledge, perceptions, and practices.

This article presents findings from a survey conducted in Kenya in 1985 of the reproductive health knowledge, attitudes, and practices among more than 3,000 unmarried Kenyan youth, students and nonstudents, between the ages of 12 and 19. The survey was designed to elicit information that would be useful in gauging the kinds of problems Kenyan adolescents face in order to design programs that meet their needs. The study shows that although a solid majority of adolescents appear to have received information on reproductive health, the quality of the information is generally low. Fewer than 8 percent could correctly identify the fertile period in a woman's menstrual cycle. A substantial proportion of the population surveyed, more than 50 percent, is sexually active, having initiated intercourse some time between 13 and 14 years of age, on average. In spite of a general disapproval of premarital sex (but approval of the use of contraceptives among the sexually active), most of the sexually active population--89 percent--have never used contraceptives. The many contradictions between attitudes and practices pose serious questions and demonstrate the need to reexamine the programs (and policies) that provide access to reproductive health services to adolescents in Kenya.

Abortion, Induced↗
PubMed2001

Establishment of assisted reproduction technologies in female and male African wild dogs (Lycaon pictus).

Transrectal ultrasonography, electroejaculation and cryopreservation of spermatozoa were applied to the African wild dog (Lycaon pictus) to establish non-invasive protocols for assessing the reproductive health of one of the most endangered African canids. Transrectal ultrasonography was performed on immobilized male (n = 2) and female (n = 5) captive wild dogs. The testes and epididymides of the male dogs were imaged transcutaneously, followed by electrostimulation and cryopreservation of spermatozoa. The sonomorphology of the female and male urogenital tracts was characterized. In females, the vagina, cervix, non-pregnant uterus and ovary were imaged and the reproductive health of each female was evaluated. The sonographic assessment helped to identify one pyometra and extensive abdominal fat deposits in two other individuals in which pyometra had been suspected. Images of the adrenal glands showed differences in size among individuals of the same breeding group. Whether these differences were related to the dominance hierarchy remains to be determined. In males, visualization of the prostate gland, testis and epididymis indicated sexual maturity. Three ejaculatory fractions (1.0, 1.5 and 0.5 ml, with 50, 95 and 95% motility, respectively; 1.125 x 10(8) spermatozoa per ejaculate) were collected from one male. The motility of each of these fractions after thawing was 0, 30 and 40%, respectively. Electrostimulation of the second male, in which a cystic structure in a testis had been identified by sonography, resulted in an aspermic ejaculate (0.5 and 1.0 ml). These technologies provided basic data on reproduction in female and male African wild dogs and were an efficient way to evaluate reproductive health.

Adrenal Glands↗
PubMed2004

Association of in utero exposure to maternal smoking with reduced semen quality and testis size in adulthood: a cross-sectional study of 1,770 young men from the general population in five European countries.

Between 1996 and 1999, the authors invited all young men from five European countries who were undergoing compulsory medical examination for possible military service to participate in a study on male reproductive health. The participation rate was 19% in two cities in Denmark (n = 889), 17% in Oslo, Norway (n = 221), 13% in Turku, Finland (n = 313), 14% in Kaunas, Lithuania (n = 157), and 19% in Tartu, Estonia (n = 190). Each man provided a semen sample, was examined by a physician, and, in collaboration with his mother, completed a questionnaire about general and reproductive health, current smoking habits, and exposure to smoking in utero. After adjustment for confounding factors, men exposed to smoking in utero had a reduction in sperm concentration of 20.1% (95% confidence interval (CI): 6.8, 33.5) and a reduction in total sperm count of 24.5% (95% CI: 9.5, 39.5) in comparison with unexposed men. Percentages of motile and morphologically normal sperm cells were 1.85 (95% CI: 0.46, 3.23) and 0.64 (95% CI: -0.02, 1.30) percentage points lower, respectively, among men exposed in utero, and exposed men had a 1.15-ml (95% CI: 0.66, 1.64) smaller testis size. The associations were present when data from the study centers were analyzed separately (though not in Lithuania, where only 1% of mothers smoked during pregnancy), although the strength of the association varied. Maternal smoking may have long-term implications for the reproductive health of the offspring. This is another good reason to advise pregnant women to avoid smoking.

Adolescent↗
PubMed2005

Availability of services for emergency contraceptive pills at high school-based health centers.

CONTEXT: School-based health centers have the potential to increase adolescents' awareness of, access to and use of emergency contraceptive pills, which can prevent unintended pregnancy following unprotected sex. METHODS: In 2001, 250 high school-based health centers responded to a nationwide mail survey that assessed the provision of education, referral and prescription services for emergency contraceptive pills, as well as the perceived benefits and barriers related to offering these services. Frequencies, cross-tabulations and logistic regression models were used to analyze the data. RESULTS: Fifty-nine percent of the centers provided education and referrals for emergency contraceptive pills, while 30% provided prescriptions. Staff generally identified the same benefits of and barriers to services, although centers that provided services were more likely than nonproviders to report benefits and less likely to report barriers. Predictors of offering education were providing reproductive health services (odds ratio, 4.6) and citing the increased likelihood that students would use the method (3.5) and have the opportunity to discuss contraception (2.6). Reporting the benefit of pregnancy prevention was a predictor of offering referrals (2.9), while providing reproductive health services (30.4) and citing pregnancy prevention (6.3) were predictors of offering prescriptions. Predictors of the decreased likelihood of offering services were also identified. CONCLUSIONS: School centers that provide all three services have the greatest potential to ensure the successful use of emergency contraceptive pills by adolescents. While the number of centers offering services appears to be increasing, greater efforts are needed to improve students' awareness of and access to the method so they can make informed decisions regarding their reproductive health.

Adolescent↗
PubMed1995

Factors associated with adolescent pregnancy in rural Nigeria.

A community-based case-control study to determine the risk factors associated with adolescent pregnancy was conducted in the rural community of Gbongan in southwestern Nigeria. 132 pregnant girls aged 20 years or less were compared with 131 nonpregnant girls of similar age. Information on their sociodemographic characteristics and those of their parents, their knowledge of reproductive health, and practice of contraception were obtained by household confidential interviews and by focus group discussions with parents and adolescents. Univariate analyses revealed a large number of potential risk factors, but after adjustment by logistic regression, only two factors remained significantly associated with pregnancy. These were being married (OR=9.8) and doing an income job as opposed to being an apprentice (OR=4.7). In turn, doing an income job was the only significant factor that predicted marriage in the logistic regression model (OR=1.5). Both pregnant and nonpregnant adolescents had poor knowledge of, and negative attitude toward, contraception, and only a small percentage of them had ever used contraceptives. The authors conclude that pregnancy among adolescents in this community is mostly associated with completion of formal education at an early age by the girls and to their lack of knowledge of reproductive health. Measures that could reduce the high rate of pregnancies among adolescents in rural Nigeria include 1) a program to encourage adolescents to continue formal and informal education, 2) reproductive health education and services for adolescents, and 3) appropriate legislation to discourage early marriage and pregnancy in the community.

Africa↗
PubMed1992

Family planning needed for all women.

Dr. Angele Petros-Barvazian, Director of the WHO's Family Health Division in Geneva, outlined a strategy for the survival of mothers during the FIGO congress, at a plenary session on Maternal Mortality and Safe Motherhood. Of the estimated 500,000 women who die each year from causes related to pregnancy and childbirth, 99% are from developing countries, she said. The main causes of maternal mortality are postpartum hemorrhage and unsafe abortions, which go untreated because of a lack of obstetric services. But the underlying reasons for poor reproductive health are rooted in social and economic factors which affect women from childhood on, she explained. Teenage pregnancy, which carries a higher risk of mortality for both mother and child, is far more common in developing countries than in the industrialized nations. The rate in Japan is just 2%, compared with 56% in Malawi. If the age of pregnancy and marriage were delayed through family planning, this would not only save lives, but would also allow girls more time for education. Since family size falls in line with the rise in mothers' standards of education, improved education would contribute to population goals and enable women to play a more productive role in society. We see no contradiction between reproduction and a productive social role. Other important factors affecting women's reproductive health are nutrition and maternal care, she told the meeting. The populations where women's nutritional requirements are not met during pregnancy and lactation, this is frequently reflected in a high proportion of low birth weight babies. Maternal care also has a major effect on maternal mortality. Dr. Petros-Barvazian quoted the example of a small US community in which healthy women refuse all maternity care on religious grounds, and which consequently has maternal mortality rates almost as high as among unhealthy women in developing countries. Summing up, she said that the WHO strategy for the survival of mothers requires social equity and improved education for all women. For women of reproductive age, what we need is improved reproductive health and in particular, family planning for all. For pregnant women, we need improved prenatal and maternity care for all, with facilities for obstetric care for high-risk cases. Socially, we need to ensure that social and cultural relations are supportive to women in their roles as mothers to children, and not just as pregnant women. If we improve the social status of women, we will improve mortality and fertility; and the reverse is also true.

Demography↗
PubMed2004

'It makes me want to run away to Saudi Arabia': management and implementation challenges for public financing reforms from a maternity ward perspective.

Poor practice by health care workers has been identified as contributing to high levels of maternal mortality in South Africa. The country is undergoing substantial structural and financial reforms, yet the impact of these on health care workers performance and practice has not been studied. This study, which consisted of an ethnography of two labour wards (one rural and one urban), aimed to look at the factors that shaped everyday practice of midwives working in district hospitals in South Africa during the implementation of a public sector reform to improve financial management. The study found that the Public Financing Management Act, that aimed to improve the efficiency and accountability of public finance management, had the unintended consequence of causing the quality of maternal health services to deteriorate in the hospital wards studied. The article supports the need for increased dialogue between those working in the sexual and reproductive health and health systems policy arenas, and the importance of giving a voice to front-line health workers who implement systems changes. However, it cautions that there are no simple answers to how health systems should be organized in order to better provide sexual and reproductive health services, and suggests instead that more attention in the debate needs to be paid to the challenges of policy implementation and the socio-political context and process issues which affect the success or failure of the implementation.

Female↗
PubMed1999

Making Cairo work.

The 1994 International Conference on Population and Development set broad new goals for family planning and reproductive health. The resources available to fund these much needed programmes, however, are much smaller than was originally calculated. To divide the limited budgets for the maximum health impact, likely resource flows need to be set against the cost of various family planning and reproductive health interventions. Preliminary analysis suggests that selection of cost-effective delivery of family planning services would still meet much of the need for family planning, and that some progress could be made towards improved control of sexually transmitted diseases.

Congresses as Topic↗
PubMed2006

Perceived quality of reproductive care for girls in a competitive voucher programme. A quasi-experimental intervention study, Managua, Nicaragua.

OBJECTIVE: To determine whether female adolescents from low-income areas in Managua were satisfied with the sexual and reproductive health (SRH) care provided through a competitive voucher programme and to analyse the determinants of their satisfaction. DESIGN: A community-based quasi-experimental intervention study from 2000 to 2002. SETTING: Low-income areas of Managua. INTERVENTION: Distribution of 28,711 vouchers giving adolescents free-access to SRH care in 19 clinics; training and support for health care providers. STUDY PARTICIPANTS: A random sample of 3009 girls from 12 to 20 years completed self-administered questionnaires: 700 respondents had used this care in the last 15 months, 221 with voucher (users-with-voucher) and 479 without voucher (users-without-voucher). MAIN OUTCOME MEASURES: User satisfaction; Satisfaction with clinic reception; Clarity of doctors' explanations. RESULTS: User satisfaction was significantly higher in users-with-voucher compared with users-without-voucher [Adjusted odds-ratio (AOR) = 2.2; 95% confidence interval (95% CI) = 1.2-4.0]. Voucher use was associated with more frequent satisfaction with clinic reception, especially among sexually active girls not yet pregnant or mother (AOR = 6.9; 95% CI = 1.5-31.8). The clarity of doctors' explanations was not perceived differently (AOR = 1.4; 95% CI = 0.9-2.2). User satisfaction was highly correlated to satisfaction with clinic reception and clarity of doctors' explanations (P < 0.001). Longer consultation times, shorter waiting times, older age, and having a female doctor positively influenced user satisfaction. CONCLUSION: Voucher use by teenage girls was associated with a better perceived SRH care. This is an important result, given the crucial role user satisfaction plays in adoption and continued use of health care and contraceptives. Though more research is needed, confidential and guaranteed access appear key factors to voucher success.

Adolescent↗
PubMed1991

Resurgence of a new "clean living" movement in the United States.

During the late 19th century, a "clean living" movement emerged in the U.S. dominated by efforts to control alcohol consumption, tobacco use, and females' reproductive health. The movement also advocated proper diet, exercise and physical fitness, pure water, and moderation in caffeine and red meat consumption. Remarkably similar concerns have emerged again in contemporary American society. The current "movement" lacks central organization. Rather, it reflects a loosely related coalition of single-issue advocacy groups. Yet, the focus seems remarkably similar to the 19th century movement--legislative limitation of individual choice regarding personal health behavior, particularly with substance use and females' reproductive health. This article reviews the 19th century movement, describes aspects of the contemporary movement, and offers implications and recommendations for school health professionals.

Alcohol Drinking↗
PubMed1998

Dead mothers and injured wives: the social context of maternal morbidity and mortality among the Hausa of northern Nigeria.

Northern Nigeria has a maternal mortality ratio greater than 1,000 maternal deaths per 100,000 live births. Serious maternal morbidity (for example, vesico-vaginal fistula) is also common. Among the most important factors contributing to this tragic situation are: an Islamic culture that undervalues women; a perceived social need for women's reproductive capacities to be under strict male control; the practice of purdah (wife seclusion), which restricts women's access to medical care; almost universal female illiteracy; marriage at an early age and pregnancy often occurring before maternal pelvic growth is complete; a high rate of obstructed labor; directly harmful traditional medical beliefs and practices; inadequate facilities to deal with obstetric emergencies; a deteriorating economy; and a political culture marked by rampant corruption and inefficiency. The convergence of all of these factors has resulted in one of the worst records of female reproductive health existing anywhere in the world.

Adolescent↗
PubMedDate not supplied

Services for men at publicly funded family planning agencies, 1998-1999.

CONTEXT: Men's reproductive health needs are receiving increased attention, but most family planning clinic clients are female, and clinics have reported barriers to serving men. METHODS: A 1999 survey of publicly funded agencies that administer family planning clinics asked several questions about current policies and services and the number of men served in 1998. Data on 17 services were collected, as well as the proportion of clients who were male and agencies' barriers to serving men. RESULTS: The services most commonly offered to men in 1999 were condom provision and sexually transmitted disease (STD) counseling (95% of all agencies), contraceptive counseling (93%), and STD treatment (90%) and testing (89%). The proportions offering various male reproductive health services were lowest among hospital-based clinics. Eighty-seven percent of agencies served some male contraceptive or STD clients in 1998; those that did served a mean of 255 men and a median of 50. The male client caseload increased between 1995 and 1998 at 53% of agencies, and four out of five agencies were interested in serving more men in the future. The most commonly reported barriers to serving men were men's unawareness that services were available (58%) and inadequate agency funding (55%). CONCLUSIONS: Although most clients of publicly funded family planning agencies are women, a nonnegligible number are men. Additional efforts are needed to determine the best way to deliver reproductive health services to men.

Attitude to Health↗
PubMed2001

[New public health approach to STIs prevention].

International Conference on Population and Development (1994) recommended that the scope of reproductive health should be broadened beyond family planning and maternal care. It should include prevention and management of HIV/AIDS/STIs and many others issues. The arguments for this shift and some organizational rules for health reproductive system performance are presented.

Communicable Disease Control↗
PubMed2004

Acceptability of emergency contraception in Brazil, Chile, and Mexico. 2 - Facilitating factors versus obstacles.

A multi-center study was performed in Brazil, Chile, and Mexico to identify factors that may facilitate or hinder the introduction of emergency contraception (EC) as well as perceptions concerning emergency contraceptive pills. Background information on the socio-cultural, political, and legal context and the characteristics of reproductive health services was collected. The opinions of potential users and providers were obtained through discussion groups, and those of authorities and policymakers through semi-structured interviews. Barriers to introduction included: perception of EC as an abortifacient, opposition by the Catholic Church, limited recognition of sexual and reproductive rights, limited sex education, and insensitivity to gender issues. Facilitating factors were: perception of EC as a method that would prevent abortion and pregnancy among adolescents and rape victims; interest in the method shown by potential users as well as by some providers and authorities. It appears possible to reduce barriers through support from segments of society committed to improving sexual and reproductive health and adequate training of health care providers.

Adolescent↗
PubMedDate not supplied

Induced abortion potential among Indian women.

Information on abortion is limited and inaccurate, especially in the developing world, which has led to speculation on the prevalence of abortion in these regions. A rise in prevalence of abortion is mostly counted in terms of increase in the prevalence of induced abortions which reflects on the reproductive health of women. With the growing concern for the reproductive health of women, the study of abortion has drawn the attention of researchers world-wide. This paper is an attempt to assess the induced abortion potential among Indian women by utilizing information on proportion of unwanted and ill-timed pregnancies obtained through National Family Health Survey, India. This exercise may facilitate a better understanding of the exact prevalence of induced abortion, which necessarily should be less than the estimated potential depending on the levels of unwanted and ill-timed fertility.

Abortion, Induced↗