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The balanced counseling strategy plus : a toolkit for family planning service providers working in high HIV/STI prevalence settings

POPULATION COUNCIL
2011

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"This "is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV. The BCS+ was adapted from the Balanced Counseling Strategy, an evidence-based and well-researched tool for improving counseling on contraceptive methods. The BCS+ toolkit, developed and tested in Kenya and South Africa, provides the information and materials needed for health care facility providers to provide complete and high-quality family planning counseling to clients who live in areas with high rates of HIV and STIs.The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts
This second edition toolkit includes the following: * BCS+ Trainer’s Guide: Supervisors and others can use this to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients. * BCS+ User’s Guide: This guide focuses on how to implement the Balanced Counseling Strategy Plus. It can be distributed during training or used on its own with the BCS+ job aids. * BCS+ job aids comprising: - BCS+ algorithm that summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI/HIV counseling. - BCS+ counseling cards that the provider uses during a counseling session. There are 26 counseling cards, the first of which contains six questions that the service provider asks to rule out the possibility a client is pregnant. Each of the next 16 cards contains information about a different family planning method. The next 3 cards provide advice on pregnancy and the postpartum period. The last 6 cards provide essential information for counseling on preventing, detecting, and treating STIs and HIV. - BCS+ method brochures on each of the 16 methods represented by the counseling cards. The brochures provide counseling to clients on the method they have chosen and then are given to clients for later reference. This means clients do not have to rely on their recollection of what was discussed with the provider. - WHO Medical Eligibility Criteria Wheel (offsite link) guides providers through medical conditions and medications that may be contraindications to use of particular contraceptive methods. The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts"
A video describing use of the BCS+ toolkit in South Africa also is available. To obtain Microsoft Word versions of BCS+ files to modify or revise according to your local setting, please contact the publisher

Community based approaches to prevention of mother-to-child transmission of HIV : findings from a low income community in Kenya

KAAI, Susan-Baek
et al
August 2007

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This is the report of an intervention study in Kibera, an urban slum in Nairobi, to determine what effect three different community-based activities had on the utilisation of key prevention of mother-to-child transmission (PMTCT) services. The interventions included moving services closer to the population via mobile clinics, as well as increasing psychosocial support through the use of traditional birth attendants and peer counsellors as PMTCT promoters

Teacher absence as a factor in gender inequalities in access to primary schooling in rural Pakistan

GHUMAN, Sharon
LLOYD, Cynthia B.
June 2007

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Public-sector education in many countries in western and southern Asia, including Pakistan, is characterised by separate schools for boys and girls at the primary and secondary levels. In Pakistan, primary school enrolment among girls in rural areas is substantially lower than among children in urban areas and boys in rural areas, owing to lack of access to government girls’ schools. The focus of this report is on teacher absence as a further barrier to schooling for girls. Absence rates among the all-female teachers in government girls’ schools are substantially higher than among the all-male teachers in government boys’ schools. Whether they teach in government or private schools, women who live in the same community as the school are substantially less likely to be absent. In government girls’ schools, better basic amenities are also related to lower teacher absence. Both findings suggest the importance of recent government investments in schools and the higher inter-village travel costs faced by women relative to men

Key findings from an evaluation of the mothers2mothers program in KwaZulu-Natal, South Africa

BAEK, Carolyn
et al
June 2007

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Mothers2mothers (m2m) is a peer support programme that aims to provide education and psycho-social support to HIV-positive pregnant women and new mothers' help women access existing health care services to prevent mother-to-child transmission of HIV (PMTCT); and follow up with mothers and babies to ensure they receive appropriate medical care after delivery. While there has been much interest in innovative psycho-social support programmes that complement PMTCT clinical services, only a few such programmes exist, and there are very little data about their effectiveness. Although m2m is a well known programme with anecdotal accounts of successfully supporting HIV-positive women, it had yet to undergo an external evaluation. The Horizons Program of Population Council, in collaboration with Health Systems Trust, completed the first evaluation of m2m as part of its introduction in KwaZulu-Natal Province, South Africa

Providing new opportunities to adolescent girls in socially conservative settings : the Ishraq program in rural Upper Egypt

BRADY, Martha
et al
2007

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Out-of-school girls are among the most disadvantaged adolescents in rural Upper Egypt. Compared with girls attending school, they are more likely to be engaged in poorly paid farm work, more likely to be married early, and at greater risk for early childbearing and poor pregnancy outcomes. To respond to their situation, the Ishraq program was designed: a holistic intervention to address the unmet needs of out-of-school adolescent girls. The pilot phase of Ishraq was launched in four rural villages of one of the country's poorest regions through the partnership of Caritas, the Center for Development and Population Activities, the Population Council, and Save the Children. This research report provides data from the baseline and endline surveys conducted during the pilot

Community advocates training manual : the HIV/AIDS prevention project for vulnerable youth in northern Nigeria

POPULATION COUNCIL
2007

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"The Community Advocates training manual is a curriculum developed by Population Council, Nigeria under the HIV Prevention Project for Vulnerable Youth in Northern Nigeria funded by USAID/Nigeria. The curriculum was developed as a tool for training community advocates to conduct advocacy activities on the issues of early marriage, HIV/AIDS and reproductive health. The curriculum is developed on the premise that community representatives can speak out on issues concerning their lives and community, if given the necessary skills"

Teachers matter : baseline findings on the HIV-related needs of Kenyan teachers

KIRAGU, K.
et al
August 2006

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This paper summarises a baseline study on assessing changes in teachers’ knowledge of HIV & AIDS, risk behaviours (e.g., multiple partners and unprotected sex), and utilisation of voluntary counselling and testing. The workplace model will also aim to assist teachers who are infected with and affected by the disease through helping them to identify and access available treatment, care, and support community resources

Pregnancy-related school dropout and prior school performance in South Africa

GRANT, Monica
HALLMAN, Kelly
June 2006

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Although considerable attention has been paid to the prevalence of adolescent childbearing in the less-developed world, few studies have focused on the educational consequences of schoolgirl pregnancy. Using data collected in 2001 in KwaZulu-Natal, South Africa, this paper examines the factors associated with schoolgirl pregnancy, as well as the likelihood of school dropout and subsequent re-enrollment among pregnant schoolgirls. This analysis triangulates data collected from birth histories, education histories, and data concerning pregnancy to strengthen the identification of young women who became pregnant while enrolled in school and to define discrete periods of school interruption prior to first pregnancy. We find that prior school performance - defined as instances of grade repetition or non-pregnancy-related temporary withdrawals from school - is strongly associated with a young woman's likelihood of becoming pregnant while enrolled in school, dropping out of school if she becomes pregnant, and not returning to school following a pregnancy-related dropout. Young women who are the primary caregivers to their children are also significantly more likely to have left school than are women who shared or relinquished childcare responsibilities. Furthermore, young women who lived with an adult female were significantly more likely to return to school following a pregnancy-related dropout. Given the increasing levels of female school participation in sub-Saharan Africa, our findings suggest that future studies will benefit from exploring the causal relationships between prior school experiences, adolescent reproductive behavior, and subsequent school attendance

Multiple disadvantages of Mayan females : the effects of gender, ethnicity, poverty, and residence on education in Guatemala

HALLMAN, Kelly
June 2006

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Although access to primary education in Guatemala has increased in recent years, particularly in rural areas, levels of educational attainment and literacy remain among the lowest in Latin America. Problems include late entry, grade repetition, and early dropout. Inequalities in school access and grade attainment linked to ethnicity, gender, poverty, and residence remain. Age trends show that Mayan females are the least likely to ever enroll, and, if they do enroll, to start school the latest and drop out earliest. Mayan females are not a homogeneous group, however. Summary statistics indicate that the one-fourth of Mayan girls who are non-poor have primary school entry rates, school entry age, and grade-for-age levels equal to those of Ladina females, and, conditional upon primary school completion, have secondary school enrollment levels about 80 percent of those of Ladina females. The one-quarter of Mayan girls who are extremely poor, on the other hand, have the worst educational outcomes of all. Multivariate results indicate that being Mayan and female is a barrier to enrollment, particularly among those who are poor. Enrollment rates drop sharply at age 12, and the dropout curve is steepest for Mayan females. While age 12 would be a time of transition from primary to secondary school for children who entered school on time and made regular progress, most nonenrolled children aged 12 and older, especially those who are Mayan, have very low grade attainment and few have completed primary school. The main constraint to Mayan educational achievement therefore appears to be primary school completion. Among nonenrolled young people aged 13-24, household duties and lack of money were the constraints most frequently mentioned by females. Early marriage did not appear to directly affect female enrollment, but related qualitative findings indicate that Mayan parents’ expectations of daughters’ future roles may reduce parental incentives to invest in education beyond the age of puberty. For adolescent males, regardless of ethnicity, market work was by far the most frequently cited cause for nonenrollment, followed by lack of money. Lack of physical access to school was not a frequently cited constraint for children in any age group. In addition to poverty-reduction programs, mechanisms to encourage poor families to start their children’s schooling at age 7 may lead to fewer competing interests with regard to time allocation as children approach puberty and are compelled to assume adult work roles

The implications of changing educational and family circumstances for children’s grade progression in rural Pakistan : 1997 - 2004

LLOYD, Cynthia B
METE, Cem
GRANT, Monica J
2006

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This paper assesses the effects of primary school characteristics, household characteristics, and recent household economic and demographic shocks on school dropout rates during the first eight grades (primary and middle school) in rural Punjab and North West Frontier Province. The analysis is based on two waves of panel data, collected in 1997 and 2004. These data are unique in a developing-country setting in that they track longitudinally changes in the school environment (i.e., school and teacher characteristics) and in the household environment (including the arrival of unwanted births) for a panel of women and their children. While grade retention has improved over the past six years, dropout rates for girls remain fairly high, particularly at the end of primary school (grade five), at which point one-third of girls who started school have left. The results provide evidence of the importance of both household and school factors as statistically significant determinants of dropout rates. For girls, the arrival in the family of an unwanted birth in the last six years and enrollment in a government primary school (as opposed to a private school) significantly increase the likelihood of dropout, whereas the availability of postprimary schooling in the community, having a mother who had attended school, and living in a household with higher consumption levels reduce the probability of dropout. For boys, school quality, as measured by the percent of teachers in the primary school attended who reside in the community, and living in a more developed community significantly reduce the probability of dropping out; a loss of remittances in the household during the past six years significantly increases the likelihood of dropping out.

Yaari dosti : Young men redefine masculinity, a training manual

POPULATION COUNCIL
2006

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This manual was adapted from the Brazilian Program H curriculum and piloted in urban slum communities in India as part of an operations research study aimed at reducing HIV risk among young men by addressing perceptions of gender norms. The manual can be used by health educators, teachers and/or other professionals or volunteers who want to work, or are already working, with young men between 15 and 24 years old. It is divided into four subsections: gender, sexuality and reproductive health, violence, and preventing and living with HIV & AIDS, around each of which there is a series of activities

Programming for HIV prevention in South African schools : a report on program implementation

REDDY, Priscilla
SHEGS, James
MCCAULEY, Ann
December 2005

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This is an evaluation study conducted in KwaZulu Natal, South Africa. It provides insights into whether learners who participated in a fact-based, interactive course had more knowledge about HIV risks, prevention, and care practices; more positive attitudes toward prevention practices and people living with HIV and AIDS; and a higher prevalence of reported safe behaviours, than comparable learners who did not participate in the course

Trends in the timing of first marriage among men and women in the developing world

MENSCH, Barbara S
SINGH, Susheela
CASTERLINE, John B
August 2005

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The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection.

A client-centered approach to reproductive health : a trainer's manual

POPULATION COUNCIL
February 2005

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'The Population Council has developed a novel framework for training providers to deliver client-centered reproductive health services. The essence of the approach is to bring about behaviour change in providers by making them more receptive and responsive to client needs. Further, providers are taught to treat clients with respect and dignity, to assess their reproductive health needs holistically within the context of their household circumstances, and to negotiate solutions that clients are able to implement. Known by the acronym SAHR, this approach involves four interconnected steps: Salutation, Assessment, Help, and Reassurance. Through operations research, SAHR was successfully tested in Pakistan in 2000-02. The training manual describes the SAHR approach and is meant to facilitate training of reproductive health providers in how to offer client-centered services. The manual is written in fairly generic terms and can be used, with slight modifications, in any setting or country. The manual has three sections. Section One, the introduction, is an overview of the contents. Section Two, the trainer's guide, comprises the training modules. Each module describes the individual components of client-provider interaction and includes learning objectives, key learning points, a schedule, and a list of materials required. Trainer notes and step-by-step instructions for each activity are included within each module. Section Three contains support materials to help trainers prepare for the sessions.'

Gender differences in time use among adolescents in developing countries : implications of rising school enrollment rates

RITCHIE, Amanda
LLOYD, Cynthia B
GRANT, Monica
2004

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Three research questions are addressed in this paper : 1) How does time use change during the transition to adulthood? 2) Does gender role differentiation intensify during the transition? 3) Does school attendance attenuate gender differences? The research addresses significant gaps in the literature, in particular the lack of attention to how time use is affected by school attendance. The study documents differences in time use patterns between students and non-students. Although female adolescent students still work longer hours than male adolescent students, the gender division of labour that typically develops during adolescence is greatly attenuated among students when time spent at work is measured by combining labour market work with noneconomic household work

The effect of a livelihoods intervention in an urban slum in India : do vocational counseling and training alter the attitudes and behaviour of adolescent girls?

MENSCH, Barbara S
et al
2004

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This paper examines whether an experimental intervention for girls aged 14-19 that provided reproductive health information, vocational counseling and training, and assistance with opening savings accounts in slum areas of Allahabad in Uttar pradesh, India, had an effect on their attitudes and behaviours. A quasi-experimental pre- and post-test design was used in which adolescent girls were compared with girls of the same age residing in control-area slums. Although the livelihoods program was acceptable to parents and feasible to implement, the project had only a minimal impact on the behaviour and attitudes of adolescent girls taking part in the project. Girls exposed to the intervention were significantly more likely to have knowledge of safe spaces, be a member of a group, score higher on the social skills index, be informed about reproductive health, and spend time on leisure activities than were the matched control respondents. No effect was found on gender role attitudes, mobility, self-esteem, work expectations, or on number of hours visiting friends, performing domestic chores, or engaging in labour market work

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