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PubMed2000

Violence against women and reproductive health: toward defining a role for reproductive health care services.

Since a large proportion of U.S. women receive reproductive health care services each year, reproductive health care settings offer an important opportunity to reach women who may be at risk of or experiencing intimate partner violence (IPV). Although screening women for IPV in clinical health care settings has been endorsed by national professional associations and organizations, scientific evidence suggests that opportunities for screening in reproductive health care settings are often missed. This commentary outlines what is known about screening and intervention for IPV in clinical health care settings, and points out areas that need greater attention. The ultimate goal of these recommendations is to increase the involvement of reproductive health care services in sensitive, appropriate, and effective care for women who may be at risk of or affected by IPV.

Adolescent↗
PubMed2000

Men's sexual health matters: promoting reproductive health in an international context.

Recent concern regarding the control of sexually transmitted infections (STIs) has resulted in an increased interest in the sexual health of men. This interest has primarily focused on strategies to 'encourage and enable men to take responsibility for their sexual and reproductive behaviour and their social and family roles' (United Nations 1994). Whilst men are deemed to have 'responsibilities', women are said to have 'rights' with regard to making choices about reproductive health and accessing appropriate and effective services. Here it is argued that, whilst provision of services and interventions against STIs in men should never be at the expense of those for women, it is often clinically easier and more effective to diagnose and treat men with STIs compared to women in resource-poor settings. Indeed, this may prove to be an effective strategy in controlling the spread of STIs, and hence reducing the disproportionate burden of their complications suffered by women. The paper reviews key issues in relation to improved service delivery for sexual and reproductive health in men, notably: the heterogeneity of male populations; current knowledge regarding men's sexual behaviour; the role of sexuality; methods of studying sexual behaviour in resource poor countries; men's own concerns in relation to sexual and reproductive health; and where and how they access treatment. It is argued that the time has now come to determine and address men's sexual health needs if we are to expect them to participate fully as responsible partners in improving and protecting their own and others' sexual and reproductive health.

Delivery of Health Care↗
PubMed1998

Outcomes and effectiveness in reproductive health.

Measuring reproductive health is problematic. Awareness of the problems needs to be raised both among those collecting and those using data on reproductive health. This paper discusses two major measurement questions--one related to ascertainment and the other to attribution. The first question is to what extent the observed levels and patterns of reproductive health outcomes in women are valid as opposed to artefacts of the data sources and the data collection methods? The second question is can lack of evidence of effectiveness for any reproductive health intervention ever confidently be separated into no effects vs an inability to measure effects? Determining the effectiveness of health interventions is notoriously difficult. Reproductive health may not be a case for special pleading in the competition for scarce resources, but equally it should not be a case for special standards of proof of the effectiveness of interventions--standards which have not indeed been met by many other, and yet unquestioned, health care priorities. "What works" in reproductive health should in fact be judged from at least four different perspectives: from that of women and their families, health professionals, the scientific community, and national and international policy-makers.

Data Collection↗
PubMed2006

Challenges to integrating sexual health issues into reproductive health programs in Uzbekistan.

This study examines the direction and result of efforts of nongovernmental organizations (NGOs) in the area of reproductive and sexual health in Uzbekistan. It focuses specifically on the institutional, structural, epidemiological, and cultural forces responsible for the exclusion of sexual health issues from reproductive health campaigns in the most populous Central Asian country. In Uzbekistan, as in other countries of the region, significant international support was given to NGOs providing reproductive health services in the mid-to-late-1990s, well into the early period of the HIV/AIDS pandemic and after the 1994 mandate of the International Conference on Population and Development for the inclusion of sexual health as a key reproductive health component. Examining the exclusion of sexual health issues from reproductive health campaigns in Uzbekistan highlights problems relating to time lags in program and evaluative development and the difficulties NGOs experienced in balancing donor-state agendas with recipient-state priorities. Findings question standard assumptions regarding the advantageous structural aspects of NGOs, in terms of flexibility, responsive agenda generation, and state independence.

Abortion, Induced↗
PubMedDate not supplied

Reproductive health awareness: an important dimension to be integrated into existing sexual and reproductive health programs.

The ultimate goal of any sexual and reproductive health program is to ensure cost effectiveness, quality and sustainability. Reproductive health awareness is an educational approach which is both relevant and sensitive to many communities' existing sexual and reproductive health needs and concerns. When working with community groups, a participatory approach that includes reproductive health awareness concepts is a simple non-threatening way for programs to quickly expand beyond pure information giving and explore what reproductive health means to people. Although many community sexual and reproductive health programs do not the term reproductive health awareness, they use techniques similar to the reproductive health awareness education approach, when facilitating discussions about sexual or reproductive health. If reproductive health awareness is identified and included as one of the dimensions of future sexual and reproductive health programs, this will hopefully strengthen the program's overall quality and effectiveness.

Awareness↗
PubMed2000

Health sector reform and reproductive health in Latin America and the Caribbean: strengthening the links.

Many countries in Latin America and the Caribbean (LAC) are currently reforming their national health sectors and also implementing a comprehensive approach to reproductive health care. Three regional workshops to explore how health sector reform could improve reproductive health services have revealed the inherently complex, competing, and political nature of health sector reform and reproductive health. The objectives of reproductive health care can run parallel to those of health sector reform in that both are concerned with promoting equitable access to high quality care by means of integrated approaches to primary health care, and by the involvement of the public in setting health sector priorities. However, there is a serious risk that health reforms will be driven mainly by financial and/or political considerations and not by the need to improve the quality of health services as a basic human right. With only limited changes to the health systems in many Latin American and Caribbean countries and a handful of examples of positive progress resulting from reforms, the gap between rhetoric and practice remains wide.

Caribbean Region↗
PubMedDate not supplied

Sexually active students' willingness to use school-based health centers for reproductive health care services in North Carolina.

OBJECTIVE: School-based health centers (SBHCs) in North Carolina offer limited reproductive health care services. We investigate sexually active students' willingness to seek these services at SBHCs if available and predictors of willingness to seek services. METHODS: Cross-sectional survey of 949 sexually experienced students in 2 middle and 5 high schools in North Carolina in 1994. Bivariate and multivariate analyses tested the influence of sociodemographic characteristics, risk of pregnancy/sexually transmitted infections (STIs), and past health care utilization on willingness to use SBHCs for sexuality-related services. RESULTS: Participants were 52% female, 52% black, and median age at first coitus was 13.0 years. Many (49%) had sex at least once a month. Most (52%) reported inconsistent contraception use. One-fifth (18%) of females had been pregnant; 10% of males reported getting a partner pregnant. Seventy-five percent had used SBHCs. Most reported they would use SBHCs for information to protect against pregnancy and STIs (58%), pregnancy testing (51%), and birth control (48%) if available. Females were more likely than males to report they would use these services (adjusted odds ratio = 3.4, 95% confidence interval = 1.9-6.7), especially those receiving free lunch (adjusted odds ratio = 2.9, 95% confidence interval = 1.2-6.8]) and those with inconsistent use of contraception. We found no association between past health care and willingness to use SBHC services. CONCLUSIONS: Most sexually experienced students report they would use their SBHC for reproductive/STI services if they were available. Absence of these services in SBHCs represents a missed opportunity to provide health care to adolescents who are at substantial risk of pregnancy and STIs.

Adolescent↗
PubMed2004

Health sector reform and reproductive health services in poor rural China.

This paper describes and analyses the major reforms and changes that have occurred in the rural health sector of China. Key findings from a number of empirical studies on reproductive health service provision and utilization are summarized in order to assess the implications for reproductive health services of the ongoing health reform. The focus of this paper is what has actually been happening at the ground level, rather than what should have been happening as stated by rural health sector reform policies. It is argued that reproductive health is a missing component of the current health sector reform agenda. It also argued that the rural health sector reform in China is really a passive response to the changed rural socio-economic conditions rather than an active action aimed at improving the health status of the rural population. The ongoing rural health reform has produced both negative and positive implications for reproductive health services and there is a need for both the state, and for women, to play a much stronger role in this reform. Further studies and actions are required, however, to identify the specific type of roles and activities that the state and women need to undertake so as to fulfil the reproductive health goals and objectives set forth by the 1994 International Conference on Population and Development.

China↗
PubMed2003

Impact of health education program about reproductive health on knowledge and attitude of female Alexandria University students.

In Egypt, adolescents don't have enough and/or correct knowledge regarding reproductive health. Health education interventions are widely seen as the most appropriate strategy for promoting young people's sexual health. The aim of the present work was to assess the impact of a short-term health education program about reproductive health on knowledge and attitude of female Alexandria university students. Quasi-experimental study (pre-post testing control group) was carried out among 682 female university students living in the university hostels, 354 students represented the intervention group (Ezbet-Saad hostel) who received the program and 328 students constituted the control group (El-Shatby hostel). The study revealed that no one had satisfactory knowledge level while 61.7 % and 38.3% respectively had fair and poor levels. The low knowledge level was more evident regarding the questions about: the meaning of the term 'reproductive health' (only 5.1% gave correct complete answer), the benefits of premarital examination (only 37.9% reported complete answer), the investigations done for the pregnant woman (only 28.3% gave complete answer) the benefits of breast feeding (only 8.2% reported complete answer), methods of family planning (only 36.4% gave complete answer), side effects of female genital mutilation (only 4% reported complete answer), sexually transmitted diseases and methods of protection (only 11.9% and 3.9% reported complete answer). It was evident that 32.6% had an overall positive attitude level, 46.3% were in the neutral level and 21.1% had a negative level. It was also found that students of highly or moderately educated mothers and of high social class reported significantly higher knowledge score about premarital examination, age of marriage and breast-feeding than those of non-educated mothers and of low social class. After the intervention program there was a significant improvement in the majority of knowledge questions from pre to post test in the intervention group and no absolute changes were detected in the control group. The highest percentage of gain scores (33.3%) was detected for knowledge about the term 'reproductive health' and female genital mutilation. A significant gain score of 25% was observed for the knowledge about sexually transmitted diseases. Also there was a gain of 20% in the median score concerning the knowledge about breast feeding and family planning. A significant shift towards a positive attitude was found among the intervention group.

Adolescent↗
PubMed2000

Obesity in adolescent girls. Emerging role of reproductive health professionals.

Reproductive health professionals who care for adolescent girls are often confronted with the issue of obesity either through specialty reproductive health concerns or as the primary providers of gynecologic or obstetric health care for young women. There are some significant health concerns that result from obesity in girls; therefore, this review summarizes the epidemiology, evaluation and management of adolescent obesity, focusing on issues pertinent to young women's health care.

Adolescent↗
PubMed2006

Monitoring reproductive health in Europe--what are the best indicators of reproductive health?

Setting up goals to monitor if the goals are achieved and to compare health performance over time and between regions is part of modern health care. A key part in this process is to choose the right indicators. The indicators in reproductive health should be selected on the basis of relevance and validity. They should be simple and action oriented because monitoring for the sake of monitoring alone may do more harm than good. We invite comments from the readers of Human Reproduction on a set of indicators suggested by Reprostat.

Europe↗
PubMed1989

Commentary on a community-based approach to reproductive health care. Society for Education, Action and Research in Community Health Team.

Reproductive care needs to be broadened beyond maternity care and family planning to include care for gynecological and sexual problems, safe abortion services, and sex and reproductive health education. Our epidemiologic study of rural women has shown a very high prevalence of gynecological diseases. We tried to develop a community-based approach to comprehensive reproductive care by undertaking participatory research, fostering mass education with the people's involvement, and by making care available through village-based female workers and improved referral services. We end with two appeals: "MCH" needs to be replaced by WCH: not merely Maternal and Child Health but Woman and Child Health. Care should be provided through a community-based participatory approach, not through narrow technocratic vertical programs. Let people shape their own lives!

Abortion, Illegal↗
PubMed2002

Privatisation of health services and the reproductive health of rural Chinese women.

China's rural health care system has undergone major changes since the early 1980s, when the country began privatising rural health services. Following fiscal devolution, the rural primary health service was transformed into a fee-for-service system, dependent on the availability of local resources. This article reports some of the results of a study undertaken in 1994-96 to examine the impact of privatization on financing, provision and use of reproductive health services by women in two rural counties in Yunnan Province, China. The most common self-reported symptoms of reproductive morbidity were abnormal vaginal discharge and vaginal tears during home delivery, which went mostly untreated. Hospital-based delivery and use of antenatal care was very low, adversely affected by costs and perceived low quality. Service quality was affected by low investment in training, maintenance and supervision of workers. Most of the burden for maternal and child health care fell on local health workers, yet resources for these services had declined from 1985 to 1995. Only support for family planning services, which were funded and provided separately, had increased. Rural women's reproductive health needs were inadequately attended to by rural health services following reforms. Our data has helped to increase attention to those needs within planned reform efforts.

Adolescent↗