Training In Family Planning Research Articles

The benefits of family planning training: a 10-year review of the Ryan Residency Training Program

ObjectiveThe objective was to determine the effect of routine, opt-out abortion and family planning training on clinical exposure to uterine evacuation, contraception and other gynecologic skills. MethodsData from the first 10 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Pre- and postrotation surveys assessed residents’ experience with abortion, contraception and other gynecologic skills. Thirty-nine residency program director surveys were analyzed to assess benefits of the training from the educators’ perspective. ResultsA total of 491 residents completed both pre- and postrotation surveys. During the rotation, residents, including those who partially participated, gained significant exposure to all methods of first- and second-trimester termination and contraception care. Ninety-seven percent of Residency Program Directors reported that training improved resident competence in abortion and contraception care. ConclusionRoutine, opt-out training in abortion and family planning gives OB-GYN residents an opportunity to increase proficiency in patient counseling, contraception care, ultrasound and all aspects of uterine evacuation, regardless of level of participation.

Providers' Perspectives on Provision of Family Planning to HIV-Positive Individuals in HIV Care in Nyanza Province, Kenya.

Objective. To inform an intervention integrating family planning into HIV care, family planning (FP) knowledge, attitudes and practices, and perspectives on integrating FP into HIV care were assessed among healthcare providers in Nyanza Province, Kenya. Methods. Thirty-one mixed-method, structured interviews were conducted among a purposive sample of healthcare workers (HCWs) from 13 government HIV care facilities in Nyanza Province. Structured questions and case scenarios assessed contraceptive knowledge, training, and FP provision experience. Open-ended questions explored perspectives on integration. Data were analyzed descriptively and qualitatively. Results. Of the 31 HCWs interviewed, 45% reported previous FP training. Few providers thought long-acting methods were safe for HIV-positive women (19% viewed depot medroxyprogesterone acetate as safe and 36% viewed implants and intrauterine contraceptives as safe); fewer felt comfortable recommending them to HIV-positive women. Overall, providers supported HIV and family planning integration, yet several potential barriers were identified including misunderstandings about contraceptive safety, gendered power differentials relating to fertility decisions, staff shortages, lack of FP training, and contraceptive shortages. Conclusions. These findings suggest the importance of considering issues such as patient flow, provider burden, commodity supply, gender and cultural issues affecting FP use, and provider training in FP/HIV when designing integrated FP/HIV services in high HIV prevalence areas.

Opting out of abortion training: benefits of partial participation in a dedicated family planning rotation for ob-gyn residents

BackgroundThis study was conducted to describe the experiences of residents who opt out of some components of a dedicated abortion rotation. Study DesignEligible residents at programs receiving funding from the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were invited to complete a cross-sectional, online survey. ResultsThe majority of residents who opted out of some portion of the family planning training reported that the rotation positively affected skills in pregnancy options counseling, cervical dilation, first-trimester ultrasound, techniques of first-trimester uterine evacuation and other skills. Twenty-one of the 65 (31%) did an elective abortion, and 56 (84%) completed aspirations for at least one non-elective indication including therapeutic abortion and miscarriage. While no resident desired additional elective abortion training, 11 (16%) wanted additional uterine aspiration and 14 (21%) wanted additional second-trimester uterine aspiration training for non-elective indications. ConclusionProviding access to an abortion rotation for residents who do not plan to do elective abortions gives them the opportunity to improve their skills in family planning, therapeutic abortion and miscarriage management.

Routine training is not enough: structured training in family planning and abortion improves residents' competency scores and intentions to provide abortion after graduation more than ad hoc training

BackgroundAbortion provision remains threatened by the paucity of physicians trained to provide them. Lack of training during residency has been cited by obstetrician and gynecologist (ob-gyn) physicians as a reason for not including abortion in their practice. Study DesignWe administered surveys on interest, competency and intention to provide abortions to two groups of ob-gyn residents: one experiencing a new comprehensive and structured family planning rotation, and another group at our affiliate hospital's residency program receiving “ad hoc” training during their routine gynecology rotations. Surveys were anonymous and blinded to investigator. ResultsThe structured family planning rotation group compared to the ad hoc group reported significantly increased competency score using a Likert scale in manual vacuum aspiration (MVA) (4.5 vs. 1; p=.003) and had a higher proportion reporting intent to provide office MVA postresidency (100% vs. 39%; p=.01) and being trained to 22.5 weeks' vs. 12 weeks' gestation (p=.005). In bivariate analysis, competency in MVA was associated with higher intentions to provide MVA after residency (p=.007). ConclusionsA structured rotation in family planning and abortion for obstetrics/gynecology residents results in increases in competency and intentions to provide abortion, and an association between the two. In-hospital structured training proved to be superior to ad hoc training in our affiliate institution in improving competency and intention to provide abortion after residency.

Family Planning in a Family Health Unit

The aim of this study was to identify the care provided by health professionals who work in family planning, in a Family Health Unit in the municipality of Ribeirao Preto, São Paulo. This was a descriptive, cross-sectional and qualitative-quantitative study. Data were collected through interviews with 11 health professionals. The results revealed that most professionals had not received training in family planning, and that information about contraceptive methods is transmitted in an individual way, having women as the target-public. The contraceptive methods which the professionals suggest and offer more are those considered most effective. These findings indicate that family planning care at the Family Health Unit needs to be adjusted not only to ensure quality of service, but also to ensure sexual and reproductive rights.

Case Study: Does training of private networks of Family Planning clinicians in urban Pakistan affect service utilization?

BackgroundTo determine whether training of providers participating in franchise clinic networks is associated with increased Family Planning service use among low-income urban families in Pakistan.MethodsThe study uses 2001 survey data consisting of interviews with 1113 clinical and non-clinical providers working in public and private hospitals/clinics. Data analysis excludes non-clinical providers reducing sample size to 822. Variables for the analysis are divided into client volume, and training in family planning. Regression models are used to compute the association between training and service use in franchise versus private non-franchise clinics.ResultsIn franchise clinic networks, staff are 6.5 times more likely to receive family planning training (P = 0.00) relative to private non-franchises. Service use was significantly associated with training (P = 0.00), franchise affiliation (P = 0.01), providers' years of family planning experience (P = 0.02) and the number of trained staff working at government owned clinics (P = 0.00). In this setting, nurses are significantly less likely to receive training compared to doctors (P = 0.00).ConclusionsThese findings suggest that franchises recruit and train various cadres of health workers and training maybe associated with increased service use through improvement in quality of services.

Differences in Quality of Life Between Infertile Women and Men in Turkey

To examine potential differences in quality of life between infertile women and men. A descriptive, cross-sectional design. A questionnaire was used to collect individuals' sociodemographic data; the World Health Organization Quality of Life-BREF (WHOQOL-BREF) tool was used to collect information about quality of life. The research sample comprised 248 infertile individuals (141 women and 107 men) admitted to the clinic for the first time for diagnosis and treatment between January 1 and June 30, 2007, and who voluntarily agreed to participate. The research was conducted at the Ege University Family Planning and Infertility Research and Training Center Infertility Clinic in Izmir, Turkey. Physical health, psychological health, and social relations domain score means did not show significant differences between infertile women and infertile men (p>.05). However, score means for the environment domain were significantly higher (p<.05) for infertile women than for infertile men. Unemployed infertile men had significantly lower score means in the physical health and social relation domains (p<.01). No such significant differences were found for the other quality of life domain scores for infertile women or infertile men (p>.05). In the environmental domain, the quality of life of infertile women was greater than that of infertile men. Variables affecting quality of life of infertile individuals were seen to affect women and men in similar ways. Nurses and health care professionals caring for infertile individuals should be aware of the factors that affect quality of life and should plan to meet their care needs accordingly.

Delivering integrated HIV services: time for a client-centred approach to meet the sexual and reproductive health needs of people living with HIV?

Delivering integrated HIV services: time for a client-centred approach to meet the sexual and reproductive health needs of people living with HIV?

How are we training obstetric and gynecology residents in family planning?

To assess whether residents' perception of family planning (FP) training varies in faith-based (FBP) vs. non���faith-based training programs (NFBP).

Providers' knowledge of, attitude to and practice of emergency contraception

Objectives Barriers to widespread use of hormonal emergency contraceptives (EC), such as lack of knowledge and prejudices held by health-care providers, still exist today. This study was initiated to evaluate the knowledge, attitudes and prejudices of family-planning (FP) providers.Methods This survey was conducted in FP units of primary-health-care centers in Istanbul. A total of 180 providers were interviewed in 80 units to whom a questionnaire was administered by face-to-face technique.Results One-hundred and fifty-two of the providers stated that they had heard of EC. The correct timing and dose interval of EC were known by 50% of them. The participants held the belief that EC caused abortion (39.4%), and that it was harmful for the fetus (31.1%). Other prejudices were the possibility of increased unprotected sexual intercourse (78.9%) and a tendency for men to give up condom use (75%); female providers were more prejudiced concerning these statements. The providers' tendency towards the provision of counseling was significantly related to their prejudices (p = 0.011, p = 0.033) and to the application rate (p = 0.000).Conclusion Providers need more detailed information about EC. During FP training courses, the providers should be encouraged towards counseling EC which would increase the application rate of the users and decrease their own prejudices.

Attitude of Reproductive Healthcare Providers to the Post-Partum Intrauterine Device (PPIUD) in Jos, Nigeria

Context: The knowledge, attitude and practice of the post partum IUD among staff in the obstetrics and gynaecological unit of the Jos University Teaching Hospital has been in doubt all along. Clients were not forth coming for this method of contraception despite the fact that it was readily available in the facility. Objective: To assess the knowledge, attitude and practice of the post partum IUD among the clinical staff of the obstetric and gynaecological unit of the Jos University Teaching Hospital, Jos Plateau State. Method: A semi-structured self-administered questionnaire was developed and administered to a sample of randomly selected health providers working in the Obstetrics and Gynaecology department of the Jos University Teaching Hospital. Of the 200 questionnaires that were distributed, 166 were completed and returned giving a response rate of 83%. All the returned questionnaires were analyzed. Results: The highest number of responders was within the 31-40 year age-group, and 59.6% were females. About 95% had heard about intrauterine devices, 30% had had a formal training in family planning, but none of them had had training in offering PPIUD services. Up to 60% thought that the IUD could be inserted at any time within 6 weeks of delivery. Most (67.5%) of the responders were not willing to recommend the use of PPIUD to anyone for contraception. The commonest reason for not recommending the method was that the complications were more that those inserted as interval procedures, followed by high fall out rate of the IUD. The practice of the method among the respondents was absent, as none of them had actually performed the procedure. Conclusion: There is need for proper education of the health workers themselves about the PPIUD and its benefits to our women especially at the various points of contact with both the obstetric and gynaecological services. This, we believe, would positively influence the attitude and subsequent practice of the method by the majority of the respondents who were clinicians. Key Words: Knowledge, Attitude, Practice, Postpartum Intrauterine Device (PPIUD) [Trop J Obstet Gynaecol, 2004 21:91-94]

Diagnosis of genital chlamydia in primary care: an explanation of reasons for variation in chlamydia testing

Objectives: To explore the reasons for the 40-fold variation in diagnostic testing for genital Chlamydia trachomatis by general practices. Methods: A qualitative study with focus groups. We randomly selected urban...

Health personnel perceptions about emergency contraception in primary health-care centers

Objective: The aim of this study was to assess the knowledge, attitudes and practices regarding emergency contraception in primary health-care workers. Methods: This survey was conducted among health-care personnel in 20 primary healthcare centers in Izmir. A self-administered questionnaire was completed by 190 health-care personnel (doctors, nurses and midwives). Specific questions regarding knowledge of emergency contraception were asked. Results: In all, 22% of personnel had received specialized training in family planning. Of the respondents, 53.7% had heard of emergency contraception. General practitioners were much more well informed than other health personnel. Conclusion: Primary health-care personnel play a significant role in the provision of reproductive health care for women. There is a need to educate primary health-care personnel further about emergency contraception.

Health personnel perceptions about emergency contraception in primary health-care centers

Objective: The aim of this study was to assess the knowledge, attitudes and practices regarding emergency contraception in primary health-care workers.Methods: This survey was conductedamong health-care personnel in 20 primary healthcare centers in Izmir. A self-administered questionnaire was completed by 190 health-care personnel (doctors, nurses and midwives). Specific questions regardingknowledge of emergency contraception were asked.Results: In all, 22% of personnel had received specialized training in family planning. Of the respondents, 53.7% had heard of emergency contraception.General practitioners were much more well informed than other health personnel.Conclusion: Primary health-care personnel play a significant role in the provision of reproductive health care forwomen. There is a need to educate primary health-care personnel further about emergency contraception.

Reproductive health in eastern Europe: a collaborative training project in Romania.

Since the fall of the Berlin Wall, fundamental political changes in eastern Europe have affected the Soviet-style health care systems that formerly provided basic care for everyone. Many of these systems have collapsed, and the new systems of social insurance that have replaced them often are inadequate. Advanced Training in Reproductive Health in Romania aimed to create an authority in family planning and reproductive health in selected Romanian university centers and to improve training and research capabilities. Initially, the project had 2 main goals: to provide advanced training in reproductive health and family planning to Romanian obstetrics-gynecology specialists from the main university centers-which would allow them to train other physicians (obstetricians, gynecologists, and general practitioners) and medical students-and to develop, test, and finalize specific training materials in Romanian to be used by the new trainers.

On-the-job training through follow-up visits to improve the quality of family planning services

As part of a broader set of activities to strengthen family planning training and improve the quality of family planning services in Turkey, follow-up visits were performed at different family planning sites across the country in order to conduct on-the-job training. The objective of on-the-job training was to refresh and improve family planning counselling skills for all methods as well as to refresh and improve intrauterine device insertion/removal skills and also some determinants of quality care. It was also aimed at transferring up-to-date information to family planning practitioners, identifying frequently encountered problems and helping with solution approaches for problems both at the individual and programmatic levels. The results of the follow-up visits reflect issues about both the staff and the clinical facility itself in terms of conforming with the standards of the ‘National Family Planning Guidelines’ set forth by the Ministry of Health.The follow-up team consisted of nine members who were specially trained. They represented different sectors such as a non-governmental organization, a medical school and the Ministry of Health. The follow-up team performed 90 visits to 16 clinics in 11 provinces between 1995 and 1998. Methods used were structured observations via standard checklists, meetings with the clinic staff, self-assessment, role plays, demonstration, coaching and the provision of feedback. During this period, a total of 130 health professionals working in 16 clinics were trained on-the-job. A significant improvement was observed in the performance of the family planning practitioners and the quality of care provided in clinics. While none of the service providers were found to have a standard skill level in general counselling during the first visit, at the end of the fifth visit all were capable of providing counselling services according to the national standards. Intrauterine device insertion skills were high at the beginning of the visits, and 16 of the 17 observed service providers (94%) were assessed as conforming to the standards, At the fifth visit, all of the 42 service providers (100%) were found to be adequate. At the facility level, all 16 clinics established separate counselling rooms in the follow-up period. Additionally, the number of clinics conforming to infection prevention standards increased from two clinics in 15 at the first visit to all 16 clinics at the fifth visit. This study showed that the ultimate success of family planning programs depend on structured and well-supervised on-the-job training through follow-up visits to the sites.

Internal Medicine Training in Ambulatory Gynecology

Practicing internists commonly provide gynecologic care, yet internists receive little formal training in ambulatory gynecology. To evaluate current residency training, we surveyed house staff perceptions of their training in gynecology. Data were collected from house staff at five Portland, Ore, internal medicine training programs by questionnaire using a Likert scale about training in 24 gynecologic and five nongynecologic internal medicine problems. Responses were compared by level of training, institution, and gender. Responses were received from 195 (89%) of 221 residents. House staff reported less than adequate training in gynecology, particularly in the areas of family planning and medical complications of pregnancy, while reporting much superior training in the traditional medicine problems. House staff in internal medicine report little training in the diagnosis and treatment of gynecologic problems. Training in family planning may be particularly deficient. Residency programs must seek effective teaching strategies to address this deficiency.

Family planning: better training for practice nurses.

A new report highlighted the need for practice nurses to be given more training in family planning and sexual health. Mike George discusses the findings

Family planning in Russia: Experience and attitudes of gynecologists

A survey was made of 375 Russian gynecologists. The questionnaire on family planning and contraceptives was distributed at the beginning of three local educational symposia. Almost all participants filled in the questionnaire on attitudes, knowledge and experience with family planning. The sample consisted of departmental specialists and heads of departments/clinics, working mainly at in- or out-patient women's health clinics. The mean age was 37 years; 83% were women, living in medium-sized or large cities (80%). Half of them had been working as a gynecologist for more than 10 years. Only 55% had been trained in family planning. The main reasons mentioned for the high abortion rate in Russia were the lack of education, non-involvement of male partner, and lack of modern contraceptives. Most of the gynecologists were in favor of special family planning clinics with special attention to services for the users. About half of the physicians knew how the pill works and estimated that 41% of women know that the pill contains estrogens. Sixty-two percent found that patients are badly informed about available contraception. Main sources of information on contraception were journals/books, colleagues and mass media. The majority reported having a directive style of patient counseling, and stated that parents should be informed of their teenagers' sexual experiences. The more experienced physicians with a training in family planning were better informed on contraception and showed a more patient-concerned attitude. It is concluded that health care providers should be the main target group of training and education in family planning, and need the support of Western European family planning organizations.

Training in family planning.

In spite of extensive programmes for training in family planning and extensive services in contraception in the UK, the number of unplanned pregnancies has not decreased. On the contrary it is increasing. Medical graduates are now educated in methods of contraception. There is an extensive programme for postgraduates, regulated by the Joint Committee on Contraception (JCC), which is well integrated and co-ordinated. The provision of good training opportunities at a local level will be enhanced by the establishment of consultant posts in Reproductive Health/community Gynaecology and the development of higher training programmes to meet the projected expansion of these posts. They can play a role in education in reproductive health with respect to sexuality and personal relationships, as well as in the provision of family planning services and training to all reproductive health care professionals and teachers.