Community-based Reproductive Health Research Articles

A Community-Based Reproductive Health Care Model Effectively Enhances Reproductive Health Among Lahu Women in Northern Thailand.

Inadequate and delayed access to sexual and reproductive health services among the Hill Tribe population can be attributed to the intersection of socioeconomic challenges and distinct cultural practices. To address this limitation and create a tailored model capable of addressing it, this study assesses the effectiveness of the Community-Based Reproductive Health Care Model (CRHC) in enhancing reproductive health knowledge, attitudes, and practices among Lahu women, a prominent hill tribe population in Northern Thailand. Implementing the CRHC model includes training programs for community influencers and subsequent education for Lahu women using culturally adapted courses. The effectiveness of the model is assessed through pre-test and post-test comparisons of knowledge, attitudes, and practices related to reproductive health care and analyzed using paired t-tests and repeated ANOVA. The scores for knowledge, attitudes, and practices among Lahu women changed from 8.92 ± 2.02, 52.99 ± 5.54, and 27.76 ± 6.67 to 10.47 ± 2.32 (p < 0.001), 56.61 ± 5.54 (p < 0.001), and 29.47 ± 6.76 (p = 0.030), respectively. Significant improvements are observed in these areas, particularly in maternal health practices among pregnant Lahu women (n = 11). This study additionally evaluates the model's impact on the healthcare system by analyzing changes in government performance indexes, showing increased access to high-quality antenatal care and contraceptive usage. This study highlights the challenges faced by hill tribe populations in accessing healthcare, emphasizing the need for tailored reproductive health education and the importance of addressing health insurance barriers. The CRHC model's success illustrates the potential of community-based, culturally sensitive interventions in improving reproductive health outcomes, providing valuable insights for similar interventions in other indigenous or marginalized communities.

Intrauterine Device Placement Success for Adolescents and Young Adults at Community-Based Reproductive Health Clinics

BackgroundDespite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYA) by leading professional organizations and demonstrated acceptance and desirability by AYA, clinicians may worry about procedural difficulty of IUD device placement in younger patients. ObjectiveThe aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. Study DesignWe performed a retrospective cohort study of patients <25 years at reproductive health clinics with an IUD placement attempt between January 1-August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first attempt IUD placement by VD history. We also assessed frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. ResultsWe included 1,325 participants (median age=21.3 years) including 42 (3.2%) with a prior VD. Nearly all IUD placements were successful at first attempt (n=1,301, 98.2%) and performed by advanced practice clinicians (n=1,314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (p>0.999). Ancillary measures other than NSAIDS were used infrequently (n=16, 3.6%.) .(Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within six months of placement were rare (n=29) and mostly comprised of expulsions (n=27, 93.1%). ConclusionIUD placement success among AYA at community-based reproductive health clinics is very high and is not associated with a history of prior vaginal delivery.

Reproductive health challenges among women in internally displaced camps in Benue State: A protocol for a community-based health education interventional study.

Sexual and reproductive health (SRH) services are a necessity for marginalized persons such as the displaced. The protocol describes an intervention that can contribute to overcoming challenges associated with SRH service delivery of three selected reproductive health (RH) services: HIV/AIDS, contraception, and cervical cancer screening. A pre-and post-intervention approach will be used to evaluate the effect of an intervention with trained Community-Based Reproductive Health Personnel (CBRHP) and/or mHealth technology within the selected IDP camps. Three (3) months of health education through the CBRHP and/or via mHealth technology will be provided. Using a questionnaire, interviews, and Focus Group Discussion (FGD) guide, the researcher will assess the suitability of this intervention to attain the objectives. Data analysis will be done with SPSS version 26. Univariate analysis will include mean and standard deviation, bivariate analysis will include a chi-square test of goodness for the association of variables, and McNemer's test to evaluate the effect of the intervention by comparing consistency in response across the variables under study. Multivariate analysis will be used to assess if sociodemographic, knowledge and health service impacts access and use of RH services. For qualitative analysis, findings will be grouped into themes. The outcomes of each theme will be used to complement the findings of the quantitative analysis. The primary outcome measures will include the level of knowledge of SRH, the number of people who want to access RH services and which RH services are most sought by the respondents. If the use of CBRHP is successful, there will be an increase in knowledge and use of HIV/AIDS, contraception and cervical cancer services. Challenges associated with access and uptake of RH services will also be assessed.

Provision of injectable contraceptives by community health workers in sub-Saharan Africa: a systematic review of safety, acceptability and effectiveness

BackgroundInjectable contraceptives are the most popular method of contraception in sub-Saharan Africa (SSA), but their availability in clinical settings has been severely limited, despite the scarcity of health care providers and limited access to health facilities. WHO and USAID have endorsed the community-based distribution of injectable contraceptives as a promising option for improving access to family planning services and expanding the method mix for women who want to limit the number of births. Studies have shown that community health workers (CHWs) can provide women with injectable contraceptives that meet acceptable quality standards. The goal of this study is to identify, evaluate and synthesize evidence supporting the use of community-based administration of injectable contraceptives in SSA. MethodsThis review's guidance was based on a previously developed protocol. Nine international electronic databases and the websites of organizations known to support community-based reproductive health initiatives in SSA were searched systemically. Experts in this area were also contacted for the identification of unpublished literature and ongoing studies. The reference lists of eligible studies were reviewed. The Effective Public Practice Project tool was used to assess the quality and risk of bias in eligible studies. Data were extracted and analysed using a custom data extraction form and a narrative synthesis. ResultsThe search strategy identified a total of 1358 studies with 12 studies meeting the inclusion criteria. One unpublished study was provided by an expert making a total of 13 studies. The results showed that irrespective of the study designs, well-trained CHWs can competently administer injectable contraceptives safely and community-based delivery of injectable contraceptives is acceptable in SSA. Also, the use of community health workers in the provision of depot-medroxyprogesterone acetate expanded access to inhabitants of hard-to-reach areas and led to an overall uptake of injectable contraceptives as well as family planning. Studies that compared CHWs to clinic-based providers revealed equivalent or higher levels of performance in favour of CHWs. ConclusionsThe CHWs can competently provide injectable contraceptives within SSA communities if appropriately trained and supervised. Hence, SSA policymakers should give this initiative due consideration as a way of improving access to family planning services.

Integration of a menstrual health intervention in a community-based sexual and reproductive health service for young people in Zimbabwe: a qualitative acceptability study

BackgroundDespite being fundamental to the health and well-being of women, menstrual health is often overlooked as a health priority and access to menstrual health education, products, and support is limited. Consequently, many young women are unprepared for menarche and face challenges in accessing menstrual health products and support and in managing menstruation in a healthy and dignified way. In this paper, we examine the acceptability of a comprehensive menstrual health and hygiene (MHH) intervention integrated within a community-based sexual and reproductive health (SRH) service for young people aged 16–24 years in Zimbabwe called CHIEDZA.MethodsWe conducted focus group discussions, that included participatory drawings, with CHIEDZA healthcare service providers (N = 3) and with young women who had attended CHIEDZA (N = 6) between June to August 2020. Translated transcripts were read for familiarisation and thematic analysis was used to explore acceptability. We applied Sekhon’s thematic framework of acceptability that looks at seven key constructs (affective attitudes, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy). Data from FGDs and meeting minutes taken during the study time period were used to triangulate a comprehensive understanding of MHH intervention acceptability.ResultsThe MHH intervention was acceptable to participants as it addressed the severe prevailing lack of access to menstrual health education, products, and support in the communities, and facilitated access to other SRH services on site. In addition to the constructs defined by Sekhon’s thematic framework, acceptability was also informed by external contextual factors such as sociocultural norms and the economic environment. Providers highlighted the increased burden in their workload due to demand for MHH products, and how sociocultural beliefs around insertable menstrual products compromising virginity can negatively affect acceptability among young people and community members.ConclusionsMHH interventions are acceptable to young women in community-based settings in Zimbabwe as there is great unmet need for comprehensive MHH support. The integration of MHH in SRH services can serve as a facilitator to female engagement with SRH services. However, it is important to note that contextual external factors can affect the implementation and acceptability of integrated SRH and MHH services within communities.Trial registrationRegistry: Clinicaltrials.gov, Registration Number: NCT03719521, Registration Date: October 25, 2018.

Adapting an evidence-based contraceptive behavioural intervention delivered by mobile phone for young people in Zimbabwe

BackgroundDespite the availability of a range of contraceptive methods, young people around the world still face barriers in accessing and using them. The use of digital technology for the delivery of health interventions has expanded rapidly. Intervention delivery by mobile phone can be a useful way to address young people’s needs with regard to sexual and reproductive health, because the information can be digested at a time of the recipients’ choosing. This study reports the adaptation of an evidence-based contraceptive behavioural intervention for young people in Zimbabwe.MethodsFocus group discussions and in depth interviews were used to evaluate the ‘fit’ of the existing intervention among young people in Harare, Zimbabwe. This involved determining how aligned the content of the existing intervention was to the knowledge and beliefs of young Zimbabweans plus identifying the most appropriate intervention deliver mode. The verbatim transcripts were analysed using a thematic analysis. The existing intervention was then adapted, tested and refined in subsequent focus group discussions and interviews with young people in Harare and Bulawayo.ResultsEleven key themes resulted from the discussions evaluating the fit of the intervention. While there were many similarities to the original study population, key differences were that young people in Zimbabwe had lower levels of personal and smart mobile phone ownership and lower literacy levels. Young people were enthusiastic about receiving information about side effects/side benefits of the methods. The iterative testing and refinement resulted in adapted intervention consisting of 97 messages for female recipients (94 for male), delivered over three months and offered in English, Shona and Ndebele.ConclusionsYoung people in Zimbabwe provided essential information for adapting the existing intervention. There was great support for the adapted intervention among the young people who took part in this study. The adapted intervention is now being implemented within an integrated community-based sexual and reproductive health service in Zimbabwe.

Access to community-based reproductive health services and incidence of low birthweight delivery among refugee and displaced mothers: a retrospective study in the Thailand-Myanmar border region

ObjectivesOver 2.4 million people have been displaced within the Thailand-Myanmar border region since 1988. The efficacy of community-driven health models within displaced populations is largely unstudied. Here, we examined the...

Frequency and determinants of health care utilization for symptomatic reproductive tract infections in rural Indian women: A cross-sectional study.

IntroductionThe public health burden of reproductive tract infections (RTIs) among women in rural areas of low-income countries is poorly addressed because health care seeking for treatment of RTIs is inadequate. There are gaps in knowledge about whether low care seeking behavior stems from challenges in accessing health care versus women's recognition of and response to RTI-specific disease symptoms. We aim to identify determinants of care seeking behavior and analyze the difference in utilization of health care resources in response to symptoms of an RTI versus non-RTI disease symptoms in rural India. This will aid in the design of interventions that promote RTI care seeking behavior.MethodsOur analysis uses data from a cross-sectional, population-based surveillance survey among rural, non-pregnant women in Odisha, India, from 2013–2014 (n = 3,600). We utilized bivariate logistic regression to determine the degree that certain determinants are associated with a woman’s likelihood to seek RTI treatment, and chi-Squared tests to assess for differences in health care resources used for non-RTI versus RTI symptoms.ResultsMarried women were significantly more likely to seek health care for RTI symptoms (Odds Ratio (OR) = 1.9, 95% Confidence Interval (CI): 1.2–3.0) while unmarried adolescents were less likely to seek treatment (OR = 0.4, CI: 0.2–0.6). There was no association between RTI health care seeking with education level, belief about whether symptoms can be treated, or poverty. The majority (73.8%) of women who did not seek treatment for RTI symptoms reported not seeking treatment because they did not know treatment was needed. Women utilized formal health care providers at a higher rate in response to RTI symptoms than in response to their most recent symptoms of any kind (p = 0.003).ConclusionsCommunity-based reproductive health education interventions are needed to increase health care seeking behavior for RTIs in rural Indian women. Interventions should target unmarried women and focus on both sexual health education and access to care.

Yathu Yathu: An Impact Evaluation of Community-based Peer-led Sexual and Reproductive Health Services

Yathu Yathu: An Impact Evaluation of Community-based Peer-led Sexual and Reproductive Health Services

The "Reproductive Transition": A Community-based Reproductive Health Surveillance Paradigm in Developing Countries

The "Reproductive Transition": A Community-based Reproductive Health Surveillance Paradigm in Developing Countries

Alcohol Use and Sexual Risk Behavior in Young Women: A Qualitative Study.

Alcohol use and sexual behavior co-occur frequently in young women, increasing risk for HIV and other sexually transmitted infections. To inform preventive interventions, we used qualitative methods to better understand how women think about the contribution of alcohol use to sexual risk-taking. Young women (N = 25; M = 22.8years; 64% White) were recruited from a community-based reproductive health clinic to attend focus groups; a semi-structured agenda was used to investigate both a priori explanatory mechanisms as well as participant-driven explanations for the alcohol-sex association. Women reported that alcohol reduced their social anxiety, helped them to feel outgoing and confident, and lowered inhibitions and other barriers to sexual encounters (consistent with alcohol expectancies). During drinking events, women described being less concerned with risks, less discriminating regarding sexual partners, and less likely to insist on safer sex practices (consistent with alcohol myopia). These empirical findings support previous theory-based guidance for tailoring preventive programs for alcohol use and sexual risk reduction for young women.

Reducing Inequity in Urban Health: Have the Intra-urban Differentials in Reproductive Health Service Utilization and Child Nutritional Outcome Narrowed in Bangladesh?

Bangladesh is undergoing a rapid urbanization process. About one-third of the population of major cities in the country live in slums, which are areas that exhibit pronounced concentrations of factors that negatively affect health and nutrition. People living in slums face greater challenge to improve their health than other parts of the country, which fuels the growing intra-urban health inequities. Two rounds of the Bangladesh Urban Health Survey (UHS), conducted in 2013 and 2006, were designed to examine the reproductive health status and service utilization between slum and non-slum residents. We applied an adaptation of the difference-in-differences (DID) model to pooled data from the 2006 and 2013 UHS rounds to examine changes over time in intra-urban differences between slums and non-slums in key health outcomes and service utilization and to identify the factors associated with the reduction in intra-urban gaps. In terms of change in intra-urban differentials during 2006–2013, DID regression analysis estimated that the gap between slums and non-slums for skilled birth attendant (SBA) during delivery significantly decreased. DID regression analysis also estimated that the gap between slums and non-slums for use of modern contraceptives among currently married women also narrowed significantly, and the gap reversed in favor of slums. However, the DID estimates indicate a small but not statistically significant reduction in the gap between slums and non-slums for child nutritional status. Results from extended DID regression model indicate that availability of community health workers in urban areas appears to have played a significant role in reducing the gap in SBA. The urban population in Bangladesh is expected to grow rapidly in the coming decades. Wide disparities between urban slums and non-slums can potentially push country performance off track during the post-2015 era, unless the specific health needs of the expanding slum communities are addressed. To our knowledge, this is the first systematic explanation and quantification of the role of various factors for improving intra-urban health equity in Bangladesh using nationally representative data. The findings provide a strong rationale for continuing and expanding community-based reproductive health services in urban areas by the NGOs with a focus on slum populations.

Effect of Deploying Trained Community Based Reproductive Health Nurses (CORN) on Long‐Acting Reversible Contraception (LARC) Use in Rural Ethiopia: A Cluster Randomized Community Trial

To investigate the effect of innovative means to distribute LARC on contraceptive use, we implemented a three arm, parallel groups, cluster randomized community trial design. The intervention consisted of placing trained community-based reproductive health nurses (CORN) within health centers or health posts. The nurses provided counseling to encourage women to use LARC and distributed all contraceptive methods. A total of 282 villages were randomly selected and assigned to a control arm (n = 94) or 1 of 2 treatment arms (n = 94 each). The treatment groups differed by where the new service providers were deployed, health post or health center. We calculated difference-in-difference (DID) estimates to assess program impacts on LARC use. After nine months of intervention, the use of LARC methods increased significantly by 72.3 percent, while the use of short acting methods declined by 19.6 percent. The proportion of women using LARC methods increased by 45.9 percent and 45.7 percent in the health post and health center based intervention arms, respectively. Compared to the control group, the DID estimates indicate that the use of LARC methods increased by 11.3 and 12.3 percentage points in the health post and health center based intervention arms. Given the low use of LARC methods in similar settings, deployment of contextually trained nurses at the grassroots level could substantially increase utilization of these methods.

Sustainability of Evidence-Based Practices for HIV Prevention among Female Sex Workers in Mexico

ObjectiveThis study examined service provider perceptions of requirements for successful sustainment of an efficacious intervention for preventing HIV/AIDS and STIs in female sex workers (FSWs) in Mexico.MethodsSemi-structured interviews were conducted with 77 leaders and counselors from 12 community-based reproductive health clinics located throughout Mexico participating in a large hybrid effectiveness-implementation randomized controlled trial to scale-up the use of Mujer Segura, a psychoeducational intervention designed to promote condom use and enhance safer sex negotiation skills among FSWs.ResultsFive sets of requirements for sustainment were identified: 1) characteristics of the provider, including competence in delivering the intervention, need for continued technical support and assistance from outside experts, and satisfaction with addressing the needs of this population; 2) characteristics of the clients (i.e., FSWs), including client need and demand for services and incentives for participation; 3) characteristics of the organization, including its mission, benefits, and operations; 4) characteristics of the outer setting, including financial support and relationship with the community-based organization’s central offices, and transportation and security in areas where FSWs live and work; and 5) outcomes associated with the intervention itself, including a reduction of risk through education and increased outreach through referrals from FSWs who received the intervention.ConclusionsAlthough the requirements for successful sustainment of interventions like Mujer Segura are consistent with the factors identified in many models of implementation, the results illustrate the importance of local context in assigning priority to these model elements and suggest that the five categories are not discrete entities but interconnected.

Effects of a new community-based reproductive health intervention on knowledge of and attitudes and behaviors toward stress urinary incontinence among young women in Shanghai: a cluster-randomized controlled trial.

This study aimed to evaluate the prevalence of stress urinary incontinence (SUI) and to introduce a new community-based reproductive health intervention. We then evaluated the effectiveness of this intervention. In this cluster-randomized trial, 2100 participants aged 18-40 years were divided randomly into an intervention group (IG, 1400 women) and a control group (CG, 700 women). The CG received traditional community intervention, cmprising limited reproductive information and education; the IG received the new community-based reproductive health intervention model, comprising self-designed handbooks, health lectures, and free medical consultations, in addition to the traditional community intervention. All participants were surveyed face to face using a self-designed questionnaire before and after the 6-month intervention. In Shanghai, the prevalence rate of SUI was 14.3 %. No difference was observed between groups regarding mean knowledge, attitudes, and practices (KAPs) about SUI and the total score at baseline (P > 0.05). The IG scored significantly higher than the CG on the KAP questions at follow-up, and a significant improvement was observed in the IG after the intervention. Total scores increased with age, educational level, income, and time spent working in Shanghai per year but decreased with gravidity and the number of abortions. Native respondents scored higher than did migrants. The prevalence of SUI is high in Shanghai, and the new community-based reproductive health intervention model is both effective and easily implemented. This intervention should focus on women with a low income, women with low education levels, young women, migrant women, and women who have had multiple abortions or pregnancies.

The freedom to choose: integrating communitybased reproductive health services with locally led marine conservation initiatives in southwest Madagascar

Madagascar’s diverse marine ecosystems serve as critical biodiversity habitats and are also essential to the livelihoods, food security and culture of coastal people, including semi-nomadic Vezo fishers based along the southwest coast. Commercialisation of their traditional fisheries, rapid coastal population growth related to unmet family planning needs, and lack of alternatives to fishing in this arid region are resulting in the unsustainable exploitation of coastal resources. In response to these challenges, marine conservation organisation Blue Ventures has developed an approach to community-based conservation and development that reflects the inextricable links between humans, their health and the environment. We describe how this model has evolved in the Velondriake locally managed marine area, home to approximately 10,000 people, over the last decade through strong cross-sector partnerships. It has entailed the integration of community-based reproductive health services with locally led marine conservation initiatives including temporary octopus fishery closures, permanent marine reserves and alternative coastal livelihood activities such as aquaculture. All of these programmes are underpinned by community education that engages men, women, youth and children in both health and conservation topics. The provision of voluntary family planning services in the Velondriake area is estimated to have averted more than 800 unintended pregnancies since 2007, and the temporary octopus fishery closure model has been implemented over 150 times along the southwest coast since 2004. Preliminary, anecdotal reports from community members and programme staff indicate that this integrated Population-Health-Environment approach enables couples to plan and better provide for their families, empowers women, improves food security and directly supports the sustainability of local conservation efforts. It is proving to be an easily replicable model for addressing community health needs and advancing biodiversity conservation efforts in some of Madagascar’s most remote and under-served areas. RESUME Non seulement les ecosystemes marins de Madagascar abritent-ils une biodiversite exceptionnelle mais ils sont egalement intrinsequement lies au mode de vie et a la securite alimentaire des populations cotieres, notamment des pecheurs semi-nomades qui vivent le long de la cote sud-ouest. La commercialisation des produits de la peche traditionnelle, la croissance rapide de la population qui est en partie liee a des defauts en matiere de planification familiale et l’absence d’alternatives a la peche dans cette region aride se traduisent par une exploitation non durable des ressources cotieres. Pour trouver une solution a cette situation, l'organisation de conservation marine Blue Ventures a elabore une approche holistique qui considere les liens obliges entre les Hommes, leur sante et l'environnement. L’evolution du modele elabore pour l’aire marine de Velondriake est decrite ici ; elle concerne environ 10 000 personnes au cours de cette derniere decennie et des partenariats multisectoriels. Le modele a integre des services de sante reproductive avec des initiatives de conservation marine gerees localement, comme des fermetures temporaires de la peche aux poulpes, des reserves marines permanentes et des activites generatrices de revenus telles que l'aquaculture. L’ensemble de ces programmes est soutenu par des actions d’education en mobilisant les hommes, femmes, jeunes et enfants sur des themes aussi varies que la sante ou la protection de l’environnement. Ainsi, on estime que la prestation des services de planification familiale volontaire dans la region de Velondriake a pu eviter plus de 800 grossesses non desirees depuis 2007, et des fermetures temporaires de la peche aux poulpes plus de 150 fois le long de la cote sud-ouest depuis 2004. Des rapports preliminaires et anecdotiques de membres des communautes et des personnels du programmes indiquent que cette approche integree « Sante – Population – Environnement » permet aux couples de planifier et de mieux subvenir aux besoins de leurs familles, aux femmes de s’emanciper et aux familles d’ameliorer leur securite alimentaire tout en soutenant directement la durabilite des activites de conservation marine gerees localement. Ce modele s’est revele etre facilement reproductible pour repondre aux besoins de sante communautaire et pour faire avancer les efforts de conservation de la biodiversite dans les regions les plus reculees et les plus isolees de Madagascar.

Implementing fees for contraceptive service provision: experiences of community-based reproductive health agents in rural Ethiopia

Implementing fees for contraceptive service provision: experiences of community-based reproductive health agents in rural Ethiopia

The Prenatal Experience: Perspectives of Adolescent/Young Adult Couples

Purpose: Prenatal care programs for low-income pregnant adolescents/young adults that engage male partners may increase long-term male involvement as a parent and partner, leading to improved mental health and economic outcomes for mother and child. This study sought to understand, from the perspective of pregnant adolescents/young adults and male partners, the perceived benefits of participating in a group-based prenatal care program, and obtain input about possible modifications that could strengthen engagement in community-based programs. Methods: Focus groups included English-speaking adolescents/ young adults and their partners who participated in a previous group-based prenatal program. Groups were held at a communitybased reproductive health clinic serving primarily low income, minority adolescents/young adults. Written parental consent was obtained for those < 18 years of age. Focus groups lasted 1.5-2.0 hours, a meal was provided and participants received a gift card worth $40. Groups were conducted by two investigators (CW, RB) using a question guide and tape-recorded. Audiotapes were transcribed and verified. Five investigators independently reviewed/ coded all transcripts, using an interpretative phenomenological approach. This involved four connected and overlapping steps: familiarization with the text, identification of preliminary themes, grouping themes as clusters, and tabulating final themes in a summary table. Results: 29 adolescent/young adults participated in 4 focus groups: 12 African-Americans, 15 Latinos and 2 Caucasians; 13 males and 16 females, averaging 23.1 (range 17-36) and 20.6 (range 17-23) years, respectively. Several broad themes, with distinct male and female perspectives, emerged: male involvement; couple communication; opportunities to share experiences and learn from others; and the importance of finances. Males were more likely to attend if told to do so by a male facilitator (repeatedly, if necessary, to demonstrate “that they care”) and if they knew they would be around other males. Providing additional resources, such as help with job placement or school completion, allowed male partners to connect to the program and feel like they could take responsibility as a parent/provider. Group sessions on birth control options, pregnancy mood swings and couple relationships helped many couples mature and strengthen their ability to communicate, skills that ultimately helped them through the more difficult times and provided a basis for informed birth control decisions. It was

An innovative approach to measuring maternal mortality at the community level in low-resource settings using mid-level providers: a feasibility study in Tigray, Ethiopia

This paper proposes a new, community-based approach to the measurement of maternal mortality, and presents results from a feasibility study in 2010–11 of that approach in rural Tigray, Ethiopia. The study was implemented in three health posts and one health centre with a total catchment area of approximately 22,000 people. Priests, traditional birth attendants and community-based reproductive health agents were responsible for locating and reporting all births and deaths in their areas and assisted mid-level providers in locating key informants for verbal autopsy. Community-based health workers were trained to report all births and deaths to the local health post, where vital registries were kept. Once a month, each health post compiled a list of all deaths of women aged 12–49, which were registered in government logbooks. Nurses and nurse-midwives were trained to administer verbal autopsies on these deaths, and assign primary cause of death using WHO ICD-10 classifications. The study drew on the theory of task-shifting, shifting the task of cause-of-death attribution from physicians to mid-level providers. It aimed to build a sustainable methodology for maximizing existing local health care infrastructure and human capacity, leading to community-based solutions to improve maternal health. While the approach has not yet been implemented outside the initial study area, the results are promising as regards its feasibility.

Provision of injectable contraceptives in Ethiopia through community-based reproductive health agents.

To determine whether community-based health workers in a rural region of Ethiopia can provide injectable contraceptives to women with similar levels of safety, effectiveness and acceptability as health extension workers (HEWs). This was a prospective non-randomized community intervention trial designed to test the provision of injectable contraceptives by community-based reproductive health agents (CBRHAs). Effectiveness, safety, acceptability and continuation rates were the outcomes of interest. The outcomes observed when injectable contraceptives were administered by HEWs in health posts and when they were administered by CBRHAs were compared by means of χ(2) tests for association among categorical variables and t-tests for independent samples to determine differences between group means. A total of 1062 women participated in the study. Compared with health post clients, the clients of CBRHAs were, on average, slightly older, less likely to be married and less educated, and they had significantly more living children. Women seeking services from CBRHAs were also significantly more likely to be using injectable contraceptives for the first time; health post clients were more likely to have used them in the past. In addition, clients of CBRHAs were less likely to discontinue using injectable contraceptives over three injection cycles than health post clients. Receiving injectable contraceptives from CBRHAs proved as safe and acceptable to this sample of Ethiopian women as receiving them in health posts from HEWs. These findings add to the growing body of evidence supporting the development, introduction and scale up of programmes to train community-based health workers such as CBRHAs to safely administer injectable contraceptives.