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PubMedDate not supplied

Reproductive health in Romania: reversing the Ceausescu legacy.

As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.

Abortion, Legal↗

PubMedDate not supplied

Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina.

OBJECTIVE: School-based health centers (SBHCs) in North Carolina offer limited reproductive health care services. We investigate sexually active students' willingness to seek these services at SBHCs if available and predictors of willingness to seek services. METHODS: Cross-sectional survey of 949 sexually experienced students in 2 middle and 5 high schools in North Carolina in 1994. Bivariate and multivariate analyses tested the influence of sociodemographic characteristics, risk of pregnancy/sexually transmitted infections (STIs), and past health care utilization on willingness to use SBHCs for sexuality-related services. RESULTS: Participants were 52% female, 52% black, and median age at first coitus was 13.0 years. Many (49%) had sex at least once a month. Most (52%) reported inconsistent contraception use. One-fifth (18%) of females had been pregnant; 10% of males reported getting a partner pregnant. Seventy-five percent had used SBHCs. Most reported they would use SBHCs for information to protect against pregnancy and STIs (58%), pregnancy testing (51%), and birth control (48%) if available. Females were more likely than males to report they would use these services (adjusted odds ratio = 3.4, 95% confidence interval = 1.9-6.7), especially those receiving free lunch (adjusted odds ratio = 2.9, 95% confidence interval = 1.2-6.8]) and those with inconsistent use of contraception. We found no association between past health care and willingness to use SBHC services. CONCLUSIONS: Most sexually experienced students report they would use their SBHC for reproductive/STI services if they were available. Absence of these services in SBHCs represents a missed opportunity to provide health care to adolescents who are at substantial risk of pregnancy and STIs.

Adolescent↗

PubMedDate not supplied

Reproductive health and AIDS-related services for women: how well are they integrated?

To explore the relationship between human immunodeficiency virus (HIV) and AIDS services and reproductive health services, a survey was undertaken in 1994 of 30 health care facilities that are grantees under Title IIIb of the Ryan White Comprehensive AIDS Resource Emergency Act, 19 family planning clinics that offer at least some HIV services, and two family planning agencies that are also grantees under Title IIIb. The Title IIIb providers and the family planning agencies offer similar sets of services, but they tend to view reproductive health and HIV and STD services as distinctly different categories. Eliminating the perceptual distinctions between these services and viewing reproductive health services as key components of HIV and AIDS prevention could result in a more integrated system of helping women with HIV infection or AIDS as well as those at risk of HIV infection.

Comprehensive Health Care↗

PubMed2004

HIV/AIDS, sexual and reproductive health: intersections and implications for national programmes.

HIV and AIDS have a myriad of effects on sexual and reproductive health and rights, and sexual and reproductive health services are critical for women and men with HIV and AIDS. Yet there has been a dearth of visible, in-depth mainstream attention to the links between sexual and reproductive health and prevention and treatment of HIV/AIDS since the early 1990s among major stakeholders internationally. This paper argues that access to essential sexual and reproductive health care should be provided in HIV/AIDS prevention, care and treatment programmes, and appropriate forms of prevention and treatment of HIV/AIDS should be included in all sexual and reproductive health services as a public health priority, particularly in sex education, family planning and abortion services, pregnancy-related care, sexually transmitted infection (STI) services and services addressing sexual violence. The paper analyzes existing barriers to linking and integrating these services, e.g. at country level due to the traditional training of health workers to implement vertical programmes, separate sources of funding for National AIDS Control Programmes and sexual and reproductive health services, and in international donor programme and UN agency structures. This paper calls for leadership to be exercised by donors, all the UN agencies working together, governments, health service managers and providers, NGOs and advocates in both fields to develop and implement these linkages at country level. Finally, it is crucial that UNAIDS, WHO, UNFPA, UNICEF, the Global Fund to Fight AIDS, TB and Malaria and those working to reach the targets set by the Millennium Development Goals come on board in these efforts.

Cooperative Behavior↗

PubMed2003

The Italian STD 'Hot-Line'. Making people aware.

BACKGROUND: To increase the accessibility of qualified and anonymous information on sexually transmitted diseases (STDs) in Italy, a national telephone hotline was initiated in February 1997. GOAL: The goal was to determine the profile of callers to the national STD hotline, assess their concerns, identify their sources for the hotline telephone number, and to compare callers' disease interests with diagnoses made at STD clinics. STUDY DESIGN: The survey analyzed 3577 calls received from February 1997 to December 1999. Hotline operators addressed callers' questions, asked 6 short-answer questions, and recorded the data collected. RESULTS: The survey showed callers' sex distribution (49.8% women, 50.2% men), average age (women's mean+/-standard deviation [SD], 34.3 +/- 11.8 y; men's mean +/- SD, 36.2 +/- 12.2 y), level of education (66.4% had a secondary school degree), residence (47.9% northern part of Italy), risk category (44% reported being definitely infected by a STD), specific disease interest (30% were concerned about HIV), and source of hotline telephone number (67.3% learned the hotline telephone number from magazines or newspapers). Hotline callers' specific disease interests were compared with diagnoses made at STD clinics; the top 4 disease concerns of hotline callers were HIV, genital herpes, human papillomavirus/genital warts, and mycosis, whereas the top 4 diagnoses made at STD clinics were genital warts, nonspecific vaginitis, nonspecific urethritis, and genital herpes. CONCLUSION: The hotline seems to be an effective way to deliver information and to allay fears about STDs, although it needs to be promoted more widely, especially in central and southern Italy.

Adult↗

PubMed2004

Rural Mexican-American adolescent sexual risk behavior.

CONTEXT: There is a need for community-based, culturally sensitive, cognitive-behavioral interventions to reduce sexual risk behavior among minority adolescents. Studies of adolescent risk and protective behaviors have focused on identifying modifiable psychosocial variables that predict differential outcomes for subsequent intervention efforts. Research has been scarce in studies of rural minority adolescent women. PURPOSE: To examine the protective and risk behaviors of these rural Mexican-American adolescent women and their relationship to physical or sexual abuse. METHODS: Mexican-American adolescent women aged 14-19 years were recruited through a rural health clinic and administered a self-report assessment for protective and risk behavior and sexual, physical, and psychological abuse. FINDINGS: Rural minority adolescent women endured high levels of psychological distress and many risk behaviors yet experienced few protective behaviors. Barriers to health care included access and confidentiality. Physically or sexually abused adolescents endured relatively greater risk and fewer protective behaviors than nonabused. CONCLUSIONS: Rural Mexican-American adolescent women may benefit from confidential identification and assessment of abuse history and risk and protective behaviors so that appropriate psychological treatment can accompany accessible medical treatment. The prevalence of risk behaviors and abuse among these women presents a need for development of behavioral interventions for risk reduction and promotion of health protective behaviors.

Adolescent↗

PubMed2006

Beijing and beyond: women's health and gender-based analysis in Canada.

On the tenth anniversary of the Fourth World Conference on Women, held in Beijing, this article evaluates Canada's progress in the area of women's health by critically examining the Women's Health Strategy. Introduced in 1999 by Health Canada, the Strategy is considered Canada's key response to its international commitments for promoting women's health and in particular for implementing a gender-based analysis in all programs, services, policies, and research. By reviewing each objective of the Strategy, the article illustrates the limited progress that has been made to date. It provides arguments for why and how all levels of government should work to improve their response to women's health in Canada and, specifically, how the Women's Health Strategy can be redesigned to be more effective in attending to the needs and concerns of all Canadian women.

Canada↗

PubMed2001

Serving rural Australia with reproductive health expertise.

This study aimed to review the use of reproductive health services in Family Planning clinics by women from rural (non-metropolitan) Australia through a retrospective analysis of data collected at clinics of seven state/territory Family Planning Organisations (FPO). From a total of 146 157 client visits to FPO clinics between July 1998 and June 1999, 42 497 (29.1%) were by clients who lived outside metropolitan areas. Some 97% of clients were women. Our results show the use of reproductive health services by women from rural areas was different from the services used by women from metropolitan areas. There were fewer male clients, more women over 40 years of age, and fewer clients from a non-English speaking background. More of the attendees had pension cards and fewer were privately insured. We concluded there is considerable demand for reproductive health services among the rural population and reproductive health care needs to be expanded to reach rural women.

Adult↗

PubMedDate not supplied

Trends in women's health services by type of physician seen: data from the 1985 and 1997-98 NAMCS.

As managed care enrollment has increased, controversy has arisen about the role of internists (IM), family physicians (FP), and obstetrician/gynecologists (ob/gyns) in the provision of women's health care. Efforts to improve training in women's health needs have also increased. Yet it is unclear how these trends have affected practice. We used the National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based medical visits, to examine by physician specialty a) trends in the proportion of visits for women's health care and b) the content of nonillness care. Between 1985 and 1997-98, market share of reproductive health services increased for IMs (e.g., from 3.7% to 10.5% of contraceptive visits, p <.05) and decreased for FPs (from 30.5% to 20.5% for contraceptive visits, p <.05). Ob/Gyns increased their share of women's health care visits, with reproductive health visits increasing from 56.2% to 65.9% (p <.0001). The trend in hormone replacement therapy visits differed, with nonsignificant gains in market share for IMs and decreases for ob/gyns. Nonillness care (1997-98 data only) differed predictably by specialty, with IMs and FPs more often providing cholesterol screening while ob/gyns more often provided reproductive health services. Compared with IMs and FPs, ob/gyns were more likely to counsel women on reproductive health topics and equally likely to counsel on general health topics, but additional time spent in counseling was lower. Specialty differences in the provision of women's health services continue, though the scope of care provided by IMs has broadened. Still, women are unlikely to obtain a full range of preventive services in a single nonillness visit. Ensuring adequate coordination among physicians providing primary care to women continues to be a critical concern.

Adult↗

PubMed2006

Validating neonatal mortality and use of NGO reproductive health outreach services in rural Bangladesh.

Although the neonatal mortality rate (NMR) in Bangladesh remained steady between 1995-99 and 1999-2003 (41-42 deaths per 1,000 live births), evidence from the management information system (MIS) of a large nongovernmental organization (NGO) program indicates that the NMR declined by about 50 percent between 1996 and 2002 in the area served. This study aims to validate the recording of neonatal deaths among the cohort of children registered as born in 2003 and to assess the evidence of a decline in the NMR. It also measures the coverage of reproductive health outreach services, focusing on 12 of the 27 NGOs that have provided services in the same areas since 1996. Field-workers' registers, verbal autopsy reports, and immunization records were checked to confirm infants' survival. Interviews were conducted with 142 mothers of children who died within 28 days postpartum and with a random sample of 109 women with registered stillbirths. Out of 11,253 registered live births in 2003, 210 neonatal deaths were found, compared with 194 deaths that were reported in the MIS for 2003. The corrected NMR was 19 deaths per 1,000 live births, and it was in the range of 15-29 deaths per 1,000 live births in 11 of the NGO areas. Because underreporting of neonatal deaths was probably higher in 1996 when the MIS-reported NMR was 39 deaths per 1,000 live births, the decline in the NMR is likely to have been genuine.

Bangladesh↗

PubMed2000

Implementing the integration of component services for reproductive health.

In the wake of the 1994 International Conference on Population and Development in Cairo, considerable activity has occurred both in national policymaking for reproductive health and in research on the implementation of the Cairo Program of Action. This report considers how effectively a key component of the Cairo agenda--integration of the management of sexually transmitted infections, including human immunodeficiency virus, with maternal and child health-family planning services--has been implemented. Quantitative and qualitative data are used to illuminate the difficulties faced by implementers of reproductive health programs in Ghana, Kenya, South Africa, and Zambia. In these countries, clear evidence is found of a critical need to reexamine the continuing focus on family planning services and the nature of the processes by which managers implement reproductive health policies. Implications of findings for policy and program direction are discussed.

Data Collection↗

PubMedDate not supplied

[Contraceptive methods used by young women in the township of Lomé (Togo)].

Despite intensive development of reproductive health services among Togolese youth over the past ten years, contraceptive prevalence remains low, particularly among young women. To help understand the reasons for the low rate of use of reproductive health services by young women (adolescents and young adults) and to assess prevalence of their contraceptive use in Lomé. In a cross-sectional study in the five precincts of Lomé township from March 08, 1999, to April 17, 1999, approximately 500 adolescent girls and young women (aged 10-24 years) were interviewed according to a semi-structured questionnaire. The variables studied were: social and demographic characteristics; knowledge about family planning, including whether they had discussed sexual issues with their parents; conditions of contraceptive use (method used by the interviewee or her sexual partner, who made the decision, geographical and financial accessibility of the method); suggestions to improve contraceptive prevalence. Data were analysed with Epi-Info 6.3 and comparisons tested with the chi-square test (significance set at 5%). 63.6% (318 of 500) of the young women and female teenagers lived with a partner; 43.4% discussed some aspects of reproductive health with their parents, especially menstruation and STDs, including AIDS. Although 93.4% of the interviewees knew about condoms and 68.2% about the calendar (rhythm) method, few of them used these (respectively 33.6% and 31.8%). The interviewees decided about contraceptive use with their partners (37%) or alone (28%), and rarely asked their parents (1%). Contraceptives were obtained at a health facility by 3.8% of the subjects, and at the drugstore or market by 20.6%. The main reason for the low rates of use of health facilities (10.4%) and of medical contraceptive methods (11.2% of all contraceptive methods used) were: lack of means, information, and interest (in such facilities and methods), and finally, lack of sexual activity. The condom was essentially the only modern contraceptive method used. The main reason for the low rate of use of reproductive health services may be that apart from the condom, women and female teenagers rarely use modern contraceptive methods. Improving information about reproductive health, creating more "young friendly clinics", and developing peer educators might improve the contraceptive prevalence rate among young women in Togo.

Adolescent↗

PubMed2026

Exploring Primary Care Clinicians' Sexual and Reproductive Health Care Delivery to Male Adolescents and Young Adults.

INTRODUCTION: Despite existing guidance for adolescent sexual and reproductive health (SRH) care, male adolescent SRH care receipt is inadequate. Limited research has explored factors affecting clinicians' provision of SRH care to male adolescents, specifically. METHODS: This mixed-method study with 12 primary care clinicians included a brief survey assessing care delivery practices and confidence, followed by an in-depth interview to explore factors affecting SRH care delivery. RESULTS: Clinicians reported high confidence delivering male adolescent SRH care (mean ± SD: 8.31 ± 1.71 out of 10), but delivered only about half the recommended services (20 items out of 38). Factors influencing care delivery included gaps in education/training, assumptions about male SRH care, and behavioral constraints at various levels. DISCUSSION: Findings underscore the need to strengthen male adolescent SRH care by enhancing provider training, increasing clinic-level supports, and addressing structural barriers. CONCLUSIONS: Findings can inform strategies to improve the quality and comprehensiveness of SRH services for male adolescents in primary care settings.

Humans↗

PubMed2003

Reproductive health and human rights.

Reproductive health programs should adopt an approach based on human rights at the levels of clinical management as well as national policy, especially those programs responsible for abortion and post-abortion care. Resource-poor women face greater maternal mortality and morbidity, suffer continuous risk because of a lack of access to adequate reproductive health services, and are likelier than more affluent women to resort to unsafe, inaccessible, and/or unaffordable abortion services. The public health and medical communities are highly effective when providing safe abortion procedures and treatment in the event of complications. Efforts must be continued to develop strategies to prevent unwanted pregnancies, unsafe abortions, and abortion-related deaths; to treat abortion complications; to broaden the types of medical and health professionals who are allowed to perform abortions; and to enhance training for abortion providers.

Abortion, Induced↗

PubMed1997

Health care access and utilization among pregnant adolescents.

PURPOSE: To assess access to and use of health care by adolescents prior to their becoming pregnant. METHODS: An interviewer-administered questionnaire was completed by all pregnant adolescents (n = 65) entering the Rochester Adolescent Maternity Program (RAMP) between January and June 1994. Questions addressed access and utilization issues including routine care and other services used, and existence of a regular source of care prior to pregnancy. RESULTS: Sixty-one adolescents (94%) completed questionnaires. Almost all (93%) had made a doctor or clinic visit, and 77% had had a checkup in the prior year. Most had Medicaid (85%) or private insurance (13%). The median number of visits to a regular source of care was 2.0 (range 0-10). Most frequently reported sources of regular care were hospital clinics (43%), community health centers (26%), and private physician offices (15%). Two-thirds (66%) reported having used multiple sources of care. Of those who used other sources in addition to a primary care source, 40% used reproductive health clinics. Adolescents whose primary care source was a traditional physician's office were more likely to also use reproductive health clinics than those who reported using more comprehensive primary care sources. CONCLUSIONS: Most pregnant adolescents in this sample had previously used routine primary care, usually in hospital clinics or health centers. Many of those adolescents also use multiple sources of care, most often for reproductive services. Access to reproductive health services does not seem to have been a problem for these adolescents prior to their pregnancies.

Adolescent↗

PubMed2001

Male involvement in reproductive health care.

The programme of action globally endorsed at the International Conference on Population and Development (ICPD) emphasised the need for equity in gender relations with a special focus on men's shared responsibility and active involvement to promote reproductive and sexual health. If men are brought into a wide range of reproductive health services in such a way that they are supported as equal partners and responsible parents, as well as clients in their own right, better outcomes are expected in reproductive health indicators such as contraception acceptance and continuation, safer sexual behaviours, use of reproductive health services, and reduction in reproductive morbidity and mortality. This paper focuses on these key questions. What does men's involvement mean and how should it be operationalised? What does shared responsibility mean for various reproductive health problems subsumed within the reproductive health framework? Programmes to involve men should be designed to address three major goals: (1) Improve sexual and reproductive health of men and women, (2) generate men's support for women's actions related to reproduction and respect for women's reproductive and sexual rights, and (3) promote responsible and healthy reproductive and sexual behaviour in young men and boys. Gender inequality is a major barrier that must be overcome if these goals are to be met. Improving the reproductive well-being of women and men requires freeing them both from restricted gender roles.

Contraception↗

PubMed1998

Medicaid and managed care: meeting the reproductive health needs of low-income women.

State Medicaid programs have increasingly turned to managed care with hopes of controlling spending while improving access to care. The move to managed care has significant implications for the provision of reproductive health services--family planning, abortion, sterilization, sexually transmitted diseases, and maternity care. However, the delivery of reproductive health services in a Medicaid managed care environment is wrought with many difficulties. The complexity inherent in Medicaid policy, the changing world of managed care, and the health and social needs of the Medicaid population are compounded by the sensitive nature of reproductive health needs.

Adult↗

PubMed2001

Adolescent reproductive health practices in Nigeria.

Adolescents have become a focal point of discussions of sexuality and reproductive health matters because they belong to a most active segment of the population and because of practical concerns in resolving problems such as unintended pregnancy and sexually transmitted diseases, including HIV/AIDS Employing in-depth interviews and focus group discussion techniques, this study of 2,510 respondents from four tertiary educational institutions in Nigeria examined various forms of reproductive health practices, their origins, reproductive health services available in the institutions, and the role of gender relations in reproductive health concerns. The findings show that respondents engage in a wide range of folk practices and do-it-yourself procedures to maintain personal hygiene, prevent and treat STDs, as well as prevent and terminate unwanted pregnancies. These practices, which involve the use of every day commodities such as lime, antacid and other drugs in particular ways, are learnt from and passed on through peers. The practices are considered more confidential and are preferred to the reproductive health services in the institutions' clinics. There are obvious implications for avoidable complications, morbidity and mortality, all of which need to be redressed through intervention.

Abortion, Induced↗