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R Simmons

Publications and source records attributed to R Simmons.

101 records · Page 6Linked to original sources
PubMedDate not supplied

Integrating health services into an MCH-FP program in Matlab, Bangladesh: an analytical update.

This is a follow-up to a 1984 study that analyzed the relationship between areal variation in the contraceptive prevalence time series and in the intensity of maternal and child health (MCH) services of the Matlab Family Planning Health Services Project. Results based on 69 months of observation suggested that the addition of MCH components to a program with basic MCH and comprehensive family planning services had no incremental impact on family planning efficacy. However, basic MCH services, involving clinical back-up to family planning and child care since the beginning of the program in Matlab, may have contributed to clients' faith in the clinic staff and the overall efficacy of the Matlab program. In the 18 months that followed the cut-off date for this analysis, contraceptive prevalence increased markedly in the study areas. The present analysis repeats the earlier one for the extended time series to determine if the intensification of health services in Matlab contributed to this secondary increase in prevalence, and to ascertain whether the MCH service regimes have long-run differential impacts. Results for the 87-month time series are similar to those of the previous analysis, suggesting that the introduction of additional MCH inputs in the Matlab service area over the 1982-83 period had no incremental impact on the contraceptive prevalence rate time trend.

Bangladesh↗
PubMedDate not supplied

Client relations in South Asia: programmatic and societal determinants.

Client relations constitute a neglected area of research in family planning. Findings from studies in northern India and Bangladesh reveal considerable variation in both the quantity and quality of contacts in programs that function under roughly comparable socioeconomic conditions. Client relations are determined by a complex set of forces in which both programmatic factors and conditions pertaining to the societal environment play a key role. Worker-client exchanges have a net, incremental effect on contraceptive use.

Bangladesh↗
PubMedDate not supplied

Integrating health services into an MCH-FP program: lessons from Matlab, Bangladesh.

Since 1977 the International Centre for Diarrhoeal Disease Research, Bangladesh, has conducted a field experiment in family planning and MCH in its Matlab research station. The project began with an emphasis on family planning and MCH services were added in stages. This paper uses time series regression methods to address the question of whether the addition of health services contributed to family planning efficacy in Matlab in a program launched with minimal MCH services. The results show that some MCH interventions increased contraceptive prevalence, some decreased it, and others had no effect. The broader significance of these findings for implementing integrated programs is discussed.

Bangladesh↗
PubMedDate not supplied

Strengthening government health and family planning programs: findings from an action research project in rural Bangladesh.

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.

Bangladesh↗
PubMedDate not supplied

Transferring health and family planning service innovations to the public sector: an experiment in organization development in Bangladesh.

The International Centre for Diarrhoeal Disease Research, Bangladesh, has launched a field experiment in two rural thanas of Bangladesh to test the transferability of its successful health and family planning experiment in Matlab to the Ministry of Health and Population Control service system. This paper reviews the Matlab experiment with particular attention to its organization and identifies elements for transfer. The intervention strategy and operations research design of the new experiment are discussed. The proposed design follows an organization development strategy in which collaborative diagnostic research is used to foster institutional change.

Bangladesh↗
PubMedDate not supplied

Out-of-hospital births in Michigan, 1972-79: trends and implications for the safety of planned home deliveries.

Trends in out-of-hospital births for the State of Michigan, 1972-79, were examined by analyzing (a) location of deliveries, (b) characteristics of the mother, (c) use of health services, and (d) characteristics of the newborn. A large increase occurred in the number of births at the mother's home and other nonhospital sites for both the black and the white populations. For white women, the increase was associated with better education and greater use of prenatal care. Physician attendance for deliveries at mother's home declined. Birth weights for home-born infants increased significantly over the period, more so for whites than for blacks; mortality declined in some groups, especially for high-birth-weight babies born at the mother's home. Assuming that the rise in home births in the 1970s was due to an increase in planned and not precipitate home deliveries, the authors concluded that these trends reflect, at least in part, the impact of planned out-of-hospital births. Toward the end of the 1970s, both the conditions under which these births occurred and some of their outcome measures were more characteristic of safety than at the beginning of the period. Disaggregation by race demonstrated, however, that the safety factor was not necessarily present for out-of-hospital births of black infants.

Black or African American↗
PubMedDate not supplied

Diffusion of the culture of contraception: program effects on young women in rural Bangladesh.

This article describes a process of diffusion of family planning information, ideas, and technology among an unanticipated audience of young, unmarried women in rural Bangladesh. The data are derived from a focus-group study conducted in 1987-88 in the Maternal Child Health and Family Planning Project in Matlab, Bangladesh. A discussion with a staff member revealed her vivid memory of the arrival of the community-based family planning worker in her village 10 years earlier, before she was married. Based on this research lead, four focus-group sessions were held with newly married young women, and a set of questions about young women were incorporated into the sessions with other community women. The discussions showed that many young, unmarried women learn about family planning from an early age from the community-based family planning worker, from female relatives, peers, and the media. The findings of this exploratory study suggest that greater attention be paid to the contraceptive needs of young women and that continued research be conducted with this population of women.

Adolescent↗
PubMedDate not supplied

Worker-client exchanges and contraceptive use in rural Bangladesh.

In this article, longitudinal data from rural Bangladesh are used to assess the impact of household visits from family planning workers on contraceptive use. A panel of women was interviewed in a demographic survey and reinterviewed every 90 days for six successive rounds. Regression methods are used to estimate the effect of these encounters on the odds that a woman will use contraceptives. Statistical controls adjust for the potentially confounding effects of underlying demand for contraception. Findings suggest that both male and female worker-initiated exchanges have an effect, although the impact of outreach is more pronounced if the worker is female. Estimated effects are consistent with the hypothesis that the predominant impact of outreach is to crystallize existing latent demand for contraception. Results also suggest, however, that female worker outreach generates new demand by fostering ideational change.

Adult↗
PubMedDate not supplied

The study of client-provider interactions: a review of methodological issues.

In recent years, increased focus on the quality of family planning and other reproductive health services has led to a better understanding of women's reproductive health needs and has drawn attention to program-client interactions as a critical and neglected dimension of program effort. In this article, the relevant methods and experience related to studying client-provider interactions within family planning programs in southern countries are reviewed. The policy relevance of this work is highlighted first by stressing the operational usefulness of examining what happens when people engage with service-delivery systems that offer family planning or reproductive health services. Subsequently, the content areas encompassed by program-client interactions are clarified by identifying manifest and latent dimensions and by distinguishing the variables that define these interactions from variables related to their determinants and consequences. Finally, a critical review of existing methods is presented, with examples of research and a discussion of ethical issues.

Data Collection↗
PubMedDate not supplied

Women's lives in transition: a qualitative analysis of the fertility decline in Bangladesh.

The fertility decline that began in Bangladesh in the late 1980s and continues has prompted diverse theories to explain it. In this qualitative analysis of 21 focus-group sessions with rural women ranging in age from the teens to late 40s and living in the villages of the Matlab area, the women's perceptions of their changing society and of the influence of the family planning program are examined. The women's statements reveal their awareness of the social and economic transition they are undergoing and their interest in family-size limitation, which is bolstered by a strong family planning program. Although the shifts in economic and social circumstances are not large, in conjunction with the strong family planning program they constitute a powerful force for change in attitudes, ideas, and behavior among these women.

Adolescent↗