Delivery Of Reproductive Health Services Research Articles

Adolescents perception of reproductive health care services in Sri Lanka.

BackgroundAdolescent health needs, behaviours and expectations are unique and routine health care services are not well geared to provide these services. The purpose of this study was to explore the perceived reproductive health problems, health seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery.MethodsThis qualitative study was conducted in a semi urban setting in Sri Lanka. A convenient sample of 32 adolescents between 17–19 years of age participated in four focus group discussions. Participants were selected from four midwife areas. A pre-tested focus group guide was used for data collection. Male and female facilitators conducted discussions separately with young males and females. All tape-recorded data was fully transcribed and thematic analysis was done.ResultsPsychological distresses due to various reasons and problems regarding menstrual cycle and masturbation were reported as the commonest health problems. Knowledge on existing services was very poor and boys were totally unaware of youth health services available through the public health system. On reproductive Health Matters, girls mainly sought help from friends whereas boys did not want to discuss their problems with anyone. Lack of availability of services was pointed out as the most important barrier in reaching the adolescent needs. Lack of access to reproductive health knowledge was an important reason for poor self-confidence among adolescents to discuss these matters. Lack of confidentiality, youth friendliness and accessibility of available services were other barriers discussed. Adolescents were happy to accept available services through public clinics and other health infrastructure for their services rather than other organizations. A demand was made for separate youth friendly services through medical practitioners.Conclusions and recommendationsAdolescent health services are inadequate and available services are not being delivered in an acceptable manner. Proper training of health care providers on youth friendly service provision is essential. A National level integrated health care program is needed for the adolescents.

Reproductive Health: A Right for Refugees and Internally Displaced Persons

Continued political and civil unrest in low-resource countries underscores the ongoing need for specialised reproductive health services for displaced people. Displaced women particularly face high maternal mortality, unmet need for family planning, complications following unsafe abortion, and gender-based violence, as well as sexually transmitted diseases, including HIV. Relief and development agencies and UN bodies have developed technical materials, made positive policy changes specific to crisis settings and are working to provide better reproductive health care. Substantial gaps remain, however. The collaboration within the field of reproductive health in crises is notable, with many agencies working in one or more networks. The five-year RAISE Initiative brings together major UN and NGO agencies from the fields of relief and development, and builds on their experience to support reproductive health service delivery, advocacy, clinical training and research. The readiness to use common guidance documents, develop priorities jointly and share resources has led to smoother operations and less overlap than if each agency worked independently. Trends in the field, including greater focus on internally displaced persons and those living in non-camp settings, as well as refugees in camps, the protracted nature of emergencies, and an increasing need for empirical evidence, will influence future progress.RésuméLes troubles politiques et civils dans les pays à faibles ressources soulignent le besoin de services spécialisés de santé génésique pour les personnes déplacées. Les femmes déplacées souffrent en particulier d’une mortalité maternelle élevée, de besoins insatisfaits de planification familiale, des complications d’avortements non médicalisés et de la violence sexiste, ainsi que d’IST, notamment le VIH. Les institutions d’aide humanitaire et de développement et les Nations Unies ont préparé du matériel technique et introduit des changements politiques positifs dans les environnements de crise et elles s’efforcent d’améliorer les soins de santé génésique. Des manques importants n’en demeurent pas moins. La collaboration pendant les crises est bonne, beaucoup d’institutions travaillant dans un ou plusieurs réseaux. L’initiative quinquennale RAISE rassemble les principales institutions des Nations Unies et ONG spécialisées dans l’aide humanitaire et le développement, et se fonde sur leur expérience pour soutenir la prestation de services, le plaidoyer, la formation clinique et la recherche en santé génésique. Ces organisations ont accepté d’utiliser des directives communes, de définir conjointement les priorités et de partager les ressources, permettant ainsi de mener des opérations plus harmonieuses et de réduire le nombre d’activités qui se chevauchent. Les progrès futurs seront influencés par les tendances dans ce domaine, notamment la priorité accrue accordée aux personnes déplacées à l’intérieur de leur pays et qui vivent hors des camps, en plus des réfugiés des camps, la durée prolongée des urgences et le besoin croissant de données empiriques.ResumenEl continuo descontento político y civil en países con pocos recursos recalca la necesidad continua de proporcionar servicios especializados en salud reproductiva para personas desplazadas. Las mujeres desplazadas en particular afrontan una alta tasa de mortalidad materna, necesidad insatisfecha de planificación familiar, complicaciones después del aborto inseguro y violencia basada en género, así como enfermedades de transmisión sexual, incluido el VIH. Las organizaciones de socorro y desarrollo y organismos de la ONU han elaborado materiales técnicos, realizado cambios positivos a las políticas, específicos a los ámbitos de crisis, y están trabajando para proporcionar mejores servicios de salud reproductiva. Sin embargo, aún existen importantes brechas. La colaboración en el campo de la salud reproductiva en crisis es notable, ya que muchos organismos trabajan en una o más redes. La Iniciativa RAISE de cinco años reúne importantes organismos de la ONU y ONG de los campos de socorro y desarrollo, y se basa en su experiencia para apoyar la prestación de servicios de salud reproductiva, actividades de promoción y defensa, capacitación clínica e investigación. La buena disposición para utilizar documentos de orientación en común, determinar prioridades conjuntamente y compartir recursos ha propiciado mejores actividades y menos traslapo que si cada organismo hubiera trabajado independientemente. Futuros avances serán influenciados por las tendencias en el campo, como un mayor enfoque en las personas desplazadas internamente, aquéllas fuera de los campamentos y los refugiados en los campamentos, la prolongada naturaleza de las urgencias y la creciente necesidad de evidencia empírica.

Service integration and teen friendliness in practice: A program assessment of sexual and reproductive health services for adolescents

Purpose To aid front-line program administrators and providers in adopting national reproductive health recommendations, this exploratory case study examines the implementation of service integration and teen friendliness as strategies to improve adolescent sexual and reproductive health. Methods The project team conducted semi-structured interviews with administrators, providers, and adolescent clients from 10 clinical adolescent sexual and reproductive health service agencies in Alameda County, California. Programs were placed into a topology of integrated service delivery models. The teen friendliness of each program was assessed. Spearman rank correlations were calculated to evaluate the relationship between integration and teen friendliness. Results Clinical programs exhibited a great range of service delivery models within the integration topology. Human immunodeficiency virus (HIV) counseling and testing services were poorly integrated into clinic services. Teen friendliness and integration showed a negative, but not statistically significant, correlation ( R = −.45, p = .19). Conclusion Programs have made different levels of commitment to service integration or teen friendliness policies. Lessons learned through the integration of sexually transmitted disease (STD) and family planning services may assist efforts to better integrate HIV services for adolescents. Further work to elucidate the relationship between integration and teen friendliness is needed. Periodic reviews can ensure that recommended clinical guidelines, specifically annual risk assessment, are being met, as well as identifying achievable next steps to improve adolescent sexual and reproductive health service delivery.

Donor Agencies' Involvement in Reproductive Health: Saying One Thing and Doing Another?

The debates about what services constitute reproductive health, how these services should be organized, managed, and delivered, and what the role of donor agencies' support should be mirror the long-standing debates on how best to implement primary health care. After briefly reviewing the development of the discourse on primary health care and reproductive health, the authors present results of qualitative research in Ghana, Kenya, and Zambia that indicate a range of factors influencing and explaining the way donors operate in these countries and consider the implications of these results for the delivery of comprehensive reproductive health services. These findings are compared with South Africa, a country with limited donor activity. In the light of the complex interplay of factors, the authors suggest that donors' words and actions frequently do not correlate. Conclusions are drawn as to the potential for donor support for integrated reproductive health service delivery in sub-Saharan Africa, drawing on the research to provide lessons and a reappraisal of the role of donors in health sector aid.

Disasters happen: would you know what you can do?

The focus of this issue of the Journal of Midwifery and Women's Health is “Low Tech, High Effect: Caring for Women and Infants During Disasters.” By its very nature, a disaster means that events and consequences have occurred that require assistance beyond the ability and resources of the affected population. During the aftermath of a disaster, people from near and far offer their assistance. Some volunteers have much needed skills. Most have good intentions. However, not every pair of helping hands is actually helpful in the midst of a disaster response. The expertise of a health professional may be functional in high-tech environments, but might not be practical in low-resource settings. Communities affected by disasters often experience a period of limited access to resources. Services and supplies may be destroyed or rendered unavailable due to lack of electricity, or unreachable due to closed roads or lack of transportation. When resources are limited, providers need to rely on interventions that use basic or minimal technologies. Disaster training and preparedness can provide health professionals with an orientation for learning new skill sets and adapting existing skills for effective care in low-tech environments. In the midst of the initial chaos and focus on finding affected people and triaging the wounded, life cycle events continue. Pregnant women go into labor and need someone to assist them through the birthing process. Women and their infants deserve safe, effective care in disaster settings. The articles presented here share current knowledge of effective care for women and infants in disaster or low-resource settings. Practitioners are provided with an introduction to disasters, disaster response, and disaster preparedness in the article by Gwen Brumbaugh Keeney, CNM, PhD. Naeema Al Gasseer, RN, PhD, Elissa Dresden, RN, ND, Gwen Brumbaugh Keeney, CNM, PhD, and Nicole Warren, CNM, PhD(c), focus the readers' attention on health service and policy issues affecting women and infants in complex humanitarian emergencies, such as war and drought. Judith O'Heir, NM, MN, describes approaches for maternal and reproductive health service delivery in refugee and displaced populations. Doulas or supportive birth companions, providing low-tech interventions that benefit childbearing women in stressful circumstances, are discussed by Debra Pascali-Bonaro, CD, CPPD, BEd, and Mary Kroeger, CNM, MPH. Riccardo Davanzo, MD, PhD, provides the evidence-based data for neonatal interventions that can be used in low-resource settings. In-depth descriptions of neurohormonal stress responses and mediating multimodal interventions for infants, including massage, acoustic, and rocking stimuli, are presented by Rosemary White-Traut, RN, DNSc. Additional resources are listed to facilitate access to disaster literature and information about organizations involved in disaster policy, service delivery, and training. Two informational resources are provided for clinicians to use and/or share with parents and other disaster responders: 1) a delineation of basic steps to manage a birth when there are no skilled attendants, and 2) strategies for assisting young children to help them cope with their disaster experiences. Midwives and women's health nurses can draw upon their existing knowledge and skills that use minimal intervention to achieve positive outcomes. The interventions presented in this issue are consistent with being “with women” to facilitate optimum care and perinatal outcomes, whether in high-resource, developed country birthing facilities or low-resource settings, such as developing country rural health posts or communities affected by disasters. Knowing what simple technologies are effective and developing the skills to implement those interventions can increase the quality of care in the midst of adverse circumstances.

New Reproductive Technologies and Infertility Treatment in Africa / Les Nouvelles Technologies Reproductives et le Traitement de la Stérilité en Afrique

New Reproductive Technologies and Infertility Treatment in Africa / Les Nouvelles Technologies Reproductives et le Traitement de la Stérilité en Afrique

Decentralisation and its Implications for Reproductive Health: The Philippines Experience

Decentralisation is one of the most common health sector reforms initiated in developing countries in the 1980–90s. Although decentralisation is often politically driven, it can significantly improve health sector performance. However, the early phase of the Philippines experience indicates that decentralisation in and of itself does not always improve the efficiency, equity and effectiveness of the health sector. Instead, it can exacerbate inequities, weaken local commitment to priority health issues and decrease the efficiency and effectiveness of service delivery by disrupting the referral chain. Such effects pose a particularly serious threat to accessibility and delivery of reproductive health services, some of which (e.g. family planning) are controversial and thus susceptible to local pressures, and others of which (e.g. emergency obstetric care) require a functioning and effective health system. Moreover, those undertaking decentralisation need to take account of the impacts of non-health factors as well as other reforms that interact with decentralisation to affect accessibility, affordability and quality of services, including for reproductive health. The Philippines experience also demonstrates that authority should be shared between the centre and local units in order to achieve national health objectives and respond to local health needs. Adjustments must be made during implementation to correct for both emerging and pre-existing problems.

Using Accountability to Improve Reproductive Health Care

Accountability is best understood as a referee of the dynamics in two-way relationships, often between unequal partners. The literature on accountability distinguishes between political, fiscal, administrative, legal and constitutional accountability. This paper focuses on accountability mechanisms in health care and how they mediate between service providers and communities and between different kinds of health personnel at the primary health care level. It refers to case studies of participatory processes for improving sexual and reproductive health service delivery. Information, dialogue and negotiation are important elements that enable accountability mechanisms to address problems by supporting change and engagement between participants. In order to succeed, however, efforts towards better accountability that broaden the participation of users must take into account the social contexts and the policy and service delivery systems in which they are applied, address power relations and improve the representation of marginalised groups within communities and service delivery systems.

Why Refugees Need Reproductive Health Services

Over the years humanitarian crises have grown more complex and intervention has become more difficult. The number of people who are displaced within their own country has increased and providing for their care and protection is risky and difficult. The articles in this special section of International Family Planning Perspectives review several aspects of the struggle to meet the needs of refugees internally displaced persons and migrants. The history of an international initiative to guide delivery of comprehensive reproductive health services to refugees and the internally displaced is described in detail in the special report by Laurel Schreck. Francoise Girard and Wilhelmina Waldman examine the framework for the reproductive rights of refugees and the internally displaced along with the policies of some agencies and organizations involved in humanitarian assistance. Review of the literature is done by Therese McGinn to determine how refugee womens reproductive health status is both similar to and different from that of settled populations. Sandra Krause Rachel Jones and Susan Purdin describe efforts that have been made among war-affected populations in key program areas. Finally Virginia Morrison examines the specific contraceptive needs of Cambodian refugees who lived in a camp in Thailand. Several critical issues which need to be addressed are specified.

Global Agendas: Health sector reforms and reproductive health rights in Zambia

Priya Nanda looks at the impact of decentralization on the delivery of quality reproductive health services in Zambia as a part of the health sector reform process initiated in 1991. Using research that focused on field-based perspectives of policy makers, donor organizations, women's rights-based NGOs and providers of services, Nanda highlights the limitations of decentralization for a reproductive health and rights agenda in Zambia.

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.

Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions

Sexually transmitted diseases, unintended pregnancies, infertility, and other reproductive problems are a growing concern around the world, especially in developing countries. Reproductive Health in Developing Countries describes the magnitude of these problems and what is known about the effectiveness of interventions in the following areas: Infection-free sex. Immediate priorities for combating sexually transmitted and reproductive tract diseases are identified. Intended pregnancies and births. The panel reports on the state of family planning and ways to provide services. Healthy pregnancy and delivery. The book explores the myths and substantive socio-economic problems that underlie maternal deaths. Healthy sexuality. Such issues as sexual violence and the practice of female genital mutilation are discussed in terms of the cultural contexts in which they occur. Addressing the design and delivery of reproductive health services, this volume presents lessons learned from past programs and offers principles for deciding how to spend limited available funds.Reproductive Health in Developing Countries will be of special interest to policymakers, health care professionals, and researchers working on reproductive issues in the developing world.

Preserving the pot and water: A traditional concept of reproductive health in a Yoruba community, Nigeria

Within the background of the outcome of the 1994 Cairo Conference, this paper describes a traditional conceptualization of prenatal care in a Nigerian community and draws their implication for effective delivery of reproductive health services in the area. The data used were from qualitative interviews during 2 field trips to the community in 1988–1989 and 1991. The finding of the study highlights a local metaphor that likened the risks of pregnancy and child birth to a group of women that trekked to a local brook to fetch water with their earthen pots: some fell, broke their pots; some missed steps and spilt their water but kept their pots, and others returned without any mishap. The first group represented cases of maternal mortality; the second group were cases of miscarriage, still-births or infant deaths, and the third group represented successful outcomes for both pregnancy and the resultant baby. Various steps that were traditionally taken to ensure that the mother neither lost her pot nor spilled her water are described. The implications of these findings for policy and research are discussed in the paper.

Indonesia's educational challenges and opportunities for the 21st century

This paper discusses Indonesias efforts to improve health status and to introduce appropriate technology that would strengthen reproductive health education and delivery of reproductive health services. The paper was presented at a pre-congress seminar entitled Learning Without Walls that was held on October 13-14 1995 in Bali Indonesia in conjunction with the XVth Asian and Oceanic Congress of Obstetrics and Gynecology. A small group of decision makers was given the opportunity to update its knowledge of the revolution and to explore the possible impact on health care education and training. Indonesias goal is to increase the availability of reproductive health care services by introducing appropriate technological innovations. Indonesia incorporated competency-based training (CBT) in reproductive health and found that it required both service delivery and training systems to manage and access information differently. A major challenge in the future is to find alternative ways to design develop and implement the four components of CBT. User access to information can improve by eliminating some common constraints such as slow and difficult access to expert information lack of an adequate supply of trainers and time factors. Other innovations include increasing the availability of information usable by decision makers improving access to up-to-date technical information for training programs improving efficiency and effectiveness of transfers of standard and CBT knowledge and improving clinical training in emergency procedures and acute care problems at remote sites. The government action plan includes the adaptation of the ReproSystem establishment of computer-based learning centers and information services at 800 sites and establishment of MomCare services at 800 sites over a 5-year period.