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Access to health care, reproductive health and disability: A large scale survey in Sierra Leone

GROCE, Nora
TRANI, Jean-Francois
BROWN, Joyce Brown
KETT, Maria
BAH, Osman
MORLAI, Teddy
BAILEY, Nicki
2011

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This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services.

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

Bridging the gaps between research, policy and practice in low- and middle-income countries a survey of researchers

LAVIS, John N
et al
May 2010

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This article describes the findings from a study which examined efforts to bridge the gaps between research, policy and practice in 10 low- and middle-income countries in which researchers conducting research in one of four clinical areas relevant to the Millennium Development Goals: prevention of malaria (Ghana, Laos, Senegal and Tanzania), care of women seeking contraception (China, Kazakhstan, Laos and Mexico), care of children with diarrhoea (Ghana, India, Pakistan and Senegal) and care of patients with tuberculosis (China, India, Iran and Mexico) were surveyed

The effect of family size and composition on fertility desires, contraceptive adoption, and method choice in South Asia

JAYARAMAN, Anuja
MISHRA, Vinod
ARNOLD, Fred
March 2008

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This research looks at the influence of family size and composition on reproductive behaviour in three South Asian countries - Nepal, India, and Bangladesh - that are known for strong son preference. Data from recent Demographic and Health Surveys, was analysed to see whether the choice of contraceptive method adopted (modern versus traditional; temporary versus permanent) and desire for another child differed by parity and sex composition of surviving children

Interagency list of essential medical devices for reproductive health

WORLD HEALTH ORGANIZATION (WHO)
et al
2008

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This interagency list is a tool to support planning for the selection, quality assurance and procurement of medical devices to implement Maternal and Newborn Health (MNH) interventions, which are defined as the "Essential care to women and their newborn during pregnancy, childbirth and postnatal period: up to six weeks after delivery." The objective is to propose an international consensus on a rational selection of essential medical devices for reproductive health according to their public health relevance based on efficacy, safety and cost effectiveness. Published by the WHO on behalf of John Snow Inc., PATH, Population Action International, United Nations Population Fund, and the World Bank, in collaboration with the United Nations Children's Fund and Medecins Sans Frontieres. The WHO and partnering organisations plan to update this list every two years

A report card on maternal mortality

UNITED NATIONS CHILDREN'S FUND (UNICEF)
2008

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‘Progress for Children’ is a series that monitors progress towards the Millennium Development Goals. This edition focuses on maternal health and, in particular, maternal mortality. It considers general progress and then examines particular regions. The report card acknowledges progress in improving maternal health, but argues that it is not sufficient to meet the MDG target of reducing maternal mortality by three quarters between 1990 and 2015

Sexual health for people with intellectual disability

EASTGATE, Gillian
2008

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This article explores how people with intellectual disability often experience difficulties meeting their sexual needs and desires due to poor education and social isolation. However, the article highlights that people with intellectual disability are capable of safe, constructive sexual expression and healthy relationships with appropriate education and good social support. It emphasises that providing this support is an essential part of supporting people with intellectual disability
Salud Publica Mex, 50 suppl 2

Women and HIV : questions answered

RICHEY, Catherine
SHETTY, Vidya
August 2007

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Questions and answers are grouped into 4 sections: basic facts about HIV; family planning and HIV; health of mother and infant; and mother-to-child transmission of HIV

Reaching truckers in Brazil with non-stigmatizing and effective HIV/STI services

CHINAGLIA, Magda
et al
May 2007

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In 2001, the Population Council conducted an assessment in Brazilian border areas, commissioned by the Brazilian Ministry of Health, with support from USAID/Brazil, to determine which populations were most in need of HIV prevention activities. The research findings in the southern region revealed the presence of an extremely mobile, international truck driver community with little or no access to HIV prevention, testing and treatment services. In response to this need, Horizons/Population Council implemented an operations research study focused on trucker drivers (2002-2005) in the south of Brazil. In collaboration with the administration of the customs stations, municipal and state STI and AIDS programmes, and Health Ministries, the investigators sought to examine the feasibility and impact of an HIV prevention project targeted at truckers crossing the southern border of Brazil

Resources on youth reproductive health and HIV/AIDS

Interagency Youth Working Group [IYWG]
2007

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A global resource providing materials designed for working with young people (aged 10 - 24) in developing countries. The website includes; training materials, research tools, guidance on key programme areas and best practice, a database of recent resources and websites for youth. IYWG is a network of 10 NGOs, donors and cooperating agencies. The website is supported by the US Agency for International Development and the content is overseen by Family Health International

National fact sheet India (provisional data) : 2005-2006 National family health survey (NFHSIII)

INTERNATIONAL INSTITUTE FOR POPULATION SCIENCES, MUMBAI
2007

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This fact sheet presents provisional information on key indicators and trends at a national level from the 2005-2006 National Family Health Survey (NFHS-3), the third in the NFHS series of surveys. The survey provides information on population, health and nutrition in India and each of its 29 states, based on a sample of households which is representative at national and state levels. NFHS-3 provides trend data on key indicators and includes information on several new topics, such as HIV/AIDS-related behaviour and the health of slum populations. For the first time, NFHS-3 also provides information on men and unmarried women. In addition, HIV prevalence is measured at the national level and for selected states. The NFHS-3 fieldwork was conducted by 18 Research Organisations between December 2005 and August 2006

Better breastfeeding, healthier lives [whole issue]

March 2006

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This issue looks at the merits of breastfeeding and suggests ways for programmes and providers to help women improve breastfeeding practices. Breastmilk offers infants and young children complete nutrition and early protection against illness, increasing their chances of survival. National governments need to devise and implement comprehensive strategies to promote optimal practices and advise women about the benefits of breastfeeding. Includes an outline of Madagascar's policy approach and a discussion on breastfeeding as a contraceptive option

Rwanda national policy on condoms

February 2006

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This policy is an integral part of Rwanda's overall HIV & AIDS prevention strategy for 2005 to 2009. It covers; access, behaviour change communication and condom promotion, products and quality assurance, forecasting and resource mobilisation, condom procurement, distribution and pricing, and monitoring and evaluation of the condom policy implementation

The potential impact of community-based distribution programmes on contraceptive uptake in resource-poor settings : evidence from Ethiopia

TAWYE, Yenehun
et al
December 2005

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This article assesses the impact of community-based reproductive health services (CBRHS) and programmes on contraceptive use in Ethiopia. The 1993 National Population Policy provided a strong political backing to community-based contraceptive programmes, which grew in number and outreach to the community. The article shows that 'women living in areas covered by the CBRHS programme were three times more likely to use contraception than the average Ethiopian woman'. The study concludes that scaling up the programme nationwide would have the effect of doubling the national contraceptive prevalence rate

CBD research in Muheza district : final report for Tanzanian German Programme to Support Health (TGPSH)/GTZ

SIMBA, Daudi O
November 2005

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This study was done to determine the extent to which Community Based Distribution (CBD) reaches the poor compared with health facilities. It found that contraceptive prevalence rate in the CBD area was 32 per cent, more than double the national figures for rural areas. People from all wealth categories had equal access to contraceptive services from CBD agents. It is therefore likely that the presence of CBD agents increases the access of the poor to family planning services. Interestingly, adolescents, men, and Catholics were more likely to use CBD services to access contraceptives, than older women and people from other religions

Who do the CBD reach? A study for the Tanzanian German Programme to Support Health (TGPSH)

KIBUGA, Kate Forrester
July 2005

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The GTZ-supported CBD (Community Based Distribution) agents are volunteers at village level in Tanga region of Tanzania, who provide information on sexual and reproductive health topics, and distribute contraceptives in their neighbourhoods, thus increasing access to family planning services and reproductive health information. This study examined whether CBD reached poorer people and whether poverty influences the choice made in sourcing contraceptives. A participatory methodology was used - CBD agents drew maps of their neighbourhood, marking every house, determining the wealth status of each household, and indicating each house using their services. Poorer people are effectively reached by CBD, but the average wealth group makes greater use of it. However, poorer people are more likely to use CBD than to go to the health facilities. CBD agents found the maps a useful tool for monitoring their work, but there were doubts as to their accuracy for this study. CBD agents may have inflated the number of clients, or omitted houses with no clients

Follow up reproductive health needs assessment in the process of evaluating a CBD programme in Lushoto Division, Lushoto District

KRAUT, Angela
et al
April 2004

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The study is the follow up to a baseline study (2000) on Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ) GmbH supported Community Based Distribution (CBD) activities in Lushoto Division in Tanzania. The study found that contraceptive prevalence was 43.2%, almost double previous figures, and that women's knowledge of contraceptive methods had increased from 77.1% to 84.4%. CBD agents provide an important 'social link' between communities and the professional health sector. The knowledge of long term methods is high and it seems, in the comparison with non-CBD villages, that CBD agents intensify the demand for these services. The number of unplanned pregnancies has decreased from 58.3% to 26.8%, while a higher proportion of deliveries was attended by health personnel (22% to 37.5%). In the context of this study, it was however not possible to measure the CBD contribution to these changes over time, other contributing factors being difficult to measure

Follow up reproductive health needs assessment in the process of evaluating a CBD programme in Lushoto Division, Lushoto District

KRAUT, Angela
et al
April 2004

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This study is a follow up to a baseline study (2000) on GTZ supported Community Based Distribution (CBD) activities in Lushoto Division in Tanzania. The study found that contraceptive prevalence was 43.2 per cent, almost double previous figures, and that women's knowledge of contraceptive methods had increased to 84.4 per cent from 77.1 per cent. CBD agents provide an important 'social link' between communities and the professional health sector. The knowledge of long term methods is high and it seems, in the comparison with non-CBD villages, that CBD agents intensify the demand for these services. The number of unplanned pregnancies has decreased to 26.8 per cent from 58.3 per cent , while a higher proportion of deliveries was attended by health personnel (37.5 per cent from 22 per cent). In the context of this study, it was however not possible to measure the CBD contribution to these changes over time, other contributing factors being difficult to measure

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