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PubMed1996

Disparities in access to family planning services in Jamaica.

In order to improve the effectiveness and subtainability of the family planning programme, the National Family Planning Board has devised a strategy to shift users to longer-acting methods and increase the role of the private sector. To design interventions, a better understanding of existing services was thought to be necessary. This study examines the distribution of family planning service delivery points in Jamaica and the services offered by the public and private sectors through an examination of records and questionnaire interviews. The study found that, because of the concentration of private sector providers-the main outlets for longer-acting methods-in urban areas, rural areas had poor access to these methods. Because rural areas are not attractive to private sector providers, the public sector should recognize the need to continue to serve these areas.

Delivery of Health Care↗
PubMedDate not supplied

Factors hindering access to abortion services.

Although abortion services are readily available in large urban areas to those able to pay, a 1993 survey of U.S. abortion providers shows that access to service is still problematic for many women because of barriers related to distance, gestation limits, costs and harassment. Among women who have nonhospital abortions, an estimated 24% travel at least 50 miles from their home to the abortion facility. Although 98% of providers will perform abortions at eight weeks after the last menstrual period, only 48% will perform abortions at 13 weeks and 13% at 21 weeks. Half of nonhospital abortion providers estimate that more than four days elapse on average between their patients' first telephone contact and the date of the procedure; one in seven say that more than one week elapses. Most women are able to obtain abortion services in one visit to a clinic. The average woman having a first-trimester nonhospital abortion with local anesthesia paid $296 for the procedure in 1993, up from $251 in 1989. On average, nonhospital facilities charged $604 at 16 weeks of gestation and $1,067 at 20 weeks. Eighty-six percent of nonhospital facilities providing 400 or more abortions in 1992 were the targets of antiabortion harassment. Picketing at facilities and the homes of staff members, vandalism and chemical attacks increased significantly between 1988 and 1992, but the incidence of bomb threats decreased.

Abortion Applicants↗
PubMed2000

Health inequalities and the health of the poor: what do we know? What can we do?

The contents of this theme section of the Bulletin of the World Health Organization on "Inequalities in health" have two objectives: to present the initial findings from a new generation of research that has been undertaken in response to renewed concern for health inequalities; and to stimulate movement for action in order to correct the problems identified by this research. The research findings are presented in the five articles which follow. This Critical Reflection proposes two initial steps for the action needed to alleviate the problem; other suggestions are given by the participants in a Round Table discussion which is published after these articles. The theme section concludes with extracts from the classic writings of the nineteenth-century public health pioneer, William Farr, who is widely credited as one of the founders of the scientific study of health inequalities, together with a commentary. This Critical Reflection contributes to the discussion of the action needed by proposing two initial steps for action. That professionals who give very high priority to the distinct but related objectives of poverty alleviation, inequality reduction, and equity enhancement recognize that their shared concern for the distributional aspects of health policy is far more important than any differences that may divide them. That health policy goals, currently expressed as societal averages, be reformulated so that they point specifically to conditions among the poor and to poor-rich differences. For example, infant mortality rates among the poor or the differences in infant mortality between rich and poor sectors would be more useful indicators than the average infant mortality rates for the whole population.

Global Health↗
PubMedDate not supplied

Effect of family planning availability and accessibility on contraceptive use in Nepal.

This study examines the importance of availability and accessibility of family planning services in relation to current contraceptive use in Nepal. The proportion of women who knew of a family planning services outlet in Nepal increased sharply between 1976 and 1981, from 6 percent to 33 percent. The Contraceptive Prevalence Survey data of 1981 indicate that an inverse relationship exists between the prevalence of current contraceptive use and travel time to an outlet. Unfortunately, a majority of current users in Nepal still need more than one hour to reach an outlet. The effects of education and place of residence on contraceptive use become weaker when the analysis is confined to women who have access to an outlet within a half-hour's travel time.

Adolescent↗
PubMedDate not supplied

Family planning clinic services in U.S. counties, 1983.

Organized family planning clinics are a major source of contraceptive services for low-income women, who are less likely than higher income women to be using a contraceptive method. A 1983 study estimated that 9.5 million U.S. women with family incomes below 150 percent of poverty were at risk of unintended pregnancy, and identified a network of 5,106 clinics providing them with services. Seventy-six percent of all counties in the United States have organized clinics that offer family planning services; almost all of those without services are nonmetropolitan counties. An estimated 52 percent of low-income women at risk of unintended pregnancy were served by organized family planning clinics in 1983, while the rest either went unserved or sought care elsewhere. Ten percent of low-income women not served by clinics live in counties that have no family planning clinics, but 67 percent live in counties where existing clinics reach fewer than half of potential low-income patients. More sites may be needed, particularly in counties without clinics, to effectively serve low-income women at risk of unintended pregnancy. However, since the majority of unserved women live in counties where at least one clinic exists, coverage might be improved through increased accessibility and outreach.

Community Health Centers↗
PubMed1983

Location, use, and locational efficiency of health facilities in a Madras neighbourhood.

The present paper has two related aims: an attempt to measure locational efficiency of health facilities in a Madras neighbourhood - Alandur - through an analysis of use patterns obtained from a questionnaire study, and an application of two significant methods on problems relating to organisation of health services - set covering reasoning and maximal covering location method. Some major conclusions of the two related analyses are: - Generally use declines with distance. However, beyond the eleventh distance zone, the use increases sharply, only to decrease after the fourteenth distance zone, the number of visits attributable to quality services at locations in these distance zones. - Among the variables determining the use patterns, distance is most important, followed by cost of treatment, the quality care, nature of facility and its availability. - Set covering method yielded 5 potential health location sites which proved to be efficient in both population coverage and maximum time distances of five and ten minutes /maximal covering location method/. Two alternative sets identified by set covering method proved to be inefficient on both population and distance counts when maximal covering method was applied.

Community Health Services↗
PubMed1997

Medicine on the margins: perspectives of abortion operating surgeons in southern New Zealand.

AIMS: This research surveys operating surgeon perspectives on their work with a view to providing information relevant to improving access to abortion services. METHODS: In depth interviews were held with 14 abortion operating surgeons in the southern region. Interviews were transcribed and analysed according to emergent themes. RESULTS: Operating surgeons reported their work as technically uninteresting but felt an obligation to provide a safe service and derived important satisfaction from helping patients. They valued peer support in the workplace and did not feel isolated from colleagues or lacking professional status. They noted that the introduction of medical abortions would provide opportunities to improve access. DISCUSSION: Mainstreaming abortions into other gynaecology services might improve the work environment for operating surgeons and training opportunities for doctors. Increased use of medical abortion techniques, may encourage doctors to become operating surgeons and improve access to services in some localities.

Abortion, Induced↗
PubMed1998

Women in New York City's Medicaid program: a report on satisfaction, access, and use.

This article analyzes the experiences of women in New York City's Medicaid program regarding their satisfaction with, access to, and use of medical care during an early phase of a managed care enrollment initiative. Data for this study are from a 1994 survey of New York City Medicaid beneficiaries (1,221 women) as well as from focus group discussions. Differences in reported satisfaction levels, access, and use between managed care enrollees and conventional Medicaid beneficiaries are examined, as are differences between women in fair and poor health and those in excellent, very good, and good health. Multivariate analyses found that women enrolled in Medicaid managed care overall were significantly more likely to report greater satisfaction with access, interpersonal quality, technical skills, and arrangements for choosing a personal doctor; equivalent use; and better access compared to those in conventional Medicaid. Female managed care beneficiaries who reported worse health, however, were significantly more likely than those in better health to also report less satisfaction in 13 dimensions of medical care. Continued evaluation of Medicaid managed care is warranted, particularly as more vulnerable groups are enrolled.

Adolescent↗
PubMed1986

Determinants of the utilization of maternal and child health services in Jordan.

The utilization of antenatal, delivery and postnatal services by a random sample of married women in Jordan during their most recent pregnancy resulting in a live birth is analysed. Marked variations are shown in the use of these services and of preventive infant care for women living in urban and rural areas. Women with increasing levels of formal education and those living near services were significantly more likely to use services. If effective coverage of these services is to be achieved then it is suggested that greater emphasis should be placed upon outreach and realistic social marketing.

Adolescent↗
PubMedDate not supplied

Ethnic differences in contraceptive use in Sri Lanka.

In Sri Lanka in 1975, the majority Sinhalese had a much higher use of contraception than either the Sri Lanka Tamils or the Moors. This study uses a national sample of women of childbearing age gathered by the Sri Lanka World Fertility Survey in 1975 to assess four possible reasons for differential contraceptive use: (1) differences in socioeconomic position; (2) cultural differences; (3) minority status; and (4) differential access to family planning services. The first three explanations focus on differences in the demand for contraception while the fourth explanation focuses on differences in the availability of contraceptives. The socioeconomic, cultural, and minority status hypotheses fail to explain the higher contraceptive use among the Sinhalese. The evidence is consistent with the idea that ethnic differences in contraceptive use were largely caused by differential access to family planning services.

Adult↗
PubMed1997

Adolescents report their need for and use of health care services.

PURPOSE: The goals of this study were to describe student access to health care services, identify populations of students who remained in need of health care services, and highlight particular unmet needs for health care identified by these adolescents. METHODS: Students in Grades 9-12 attending 50 schools in Oregon completed the Youth Risk Behavior Surveillance Survey (YRBS). Questions requesting adolescents to report their need for specific types of health care, and access to general and specific types of care were added to the core YRBS. Multivariate logistic regression analysis was used to determine independent relationships between student or community characteristics and health care access or unmet needs for care. RESULTS: Almost 14,000 adolescents completed surveys, of whom 75% reported visiting one or more health care provider within the last 12 months. Nineteen percent of adolescents reported that they had not received 1 or more of 10 specific types of care when needed in the last year. Females, some racial/ethnic minorities, rural, and sexually active adolescents were more likely to report unmet needs for health care. Most frequently, adolescents reported they needed but did not receive care for an illness (7%) or for personal or emotional problems (6%). In addition, about 400 (3%) students reported they needed birth control that they did not receive. CONCLUSIONS: A majority of high school-age adolescents had visited health care providers within the year prior to study. However, the number of adolescents who reported unmet specific health care needs within the same time period remained substantial.

Adolescent↗
PubMedDate not supplied

Factors influencing the delivery of abortion services in Ontario: a descriptive study.

CONTEXT: Although Canadian women have had the right to obtain legal induced abortions for the past decade, access to the procedure is still limited and controversial in many areas. METHODS: Chiefs of obstetrics and gynecology, chiefs of staff, directors of nursing and other health professionals at 163 general hospitals in Ontario, Canada, were asked to provide information on issues concerning the availability of abortion services of their facility. The hospital participation rate was 97% and the individual response rate was 75%. RESULTS: Nearly one-half (48%) of hospitals perform abortions. Approximately 36% of these hospitals do so up to a maximum gestational age of 12 weeks, 23% to a maximum of 13-16 weeks, 37% to a maximum of 17-20 weeks and 4% at greater than 20 weeks. Hospital factors, including resources and policies, did not significantly influence whether abortions are provided. However, these factors did affect the number performed, whether there were gestational limitations and the choice of procedure. About 13% of provider hospitals indicated that staff training contributes to the existence of gestational age limits, and 24% said that it directly influences procedure choice. Only 18% of hospitals reported that their physicians have received additional training outside of their medical school or medical residency education to learn abortion techniques or to gain new skills. Forty-five percent of hospitals that provide abortions had experienced harassment within the past two years, and 15% reported that this harassment has directly affected their staff members' willingness to provide abortions. CONCLUSION: Based upon the provision of obstetric care, many hospitals in Ontario that are capable of offering abortion services do not. Some of the reasons for this failure are related to the procedure itself, while others may be related to resource issues that affect the delivery of other medical services as well. Variation in the availability of abortions is due to a shortage of clinicians performing the procedure, and training directly influences gestational limits and procedural choices.

Abortion, Legal↗
PubMedDate not supplied

Adolescent pregnancy in the United States: a review and recommendations for clinicians and research needs.

Adolescent pregnancy, often unplanned and unwanted, has a negative impact on the physical, emotional, educational, and economic condition of the pregnant teenager. Forty percent of the one million adolescents who became pregnant in 1986 chose abortion, and, of the remainder, 61% were unmarried. Teenage mothers in greater numbers and at younger ages are opting to keep and raise their children. In 1987 over $19 billion in federal monies were expended on families begun when the mother was a teenager. The preferred approach to this problem is prevention of teenage pregnancy rather than abortion, with emphasis on sex education and access to family planning information and contraceptive devices for both females and males. Sex education in schools is presented in widely varying formats; in fact, prevention of pregnancy may not even be presented. Family planning clinics are subject to the whims and biases of the funding agencies. Clinicians have an important role in providing guidance for teenage patients and their parents, but can also influence school and community leadership to ensure that all teenagers receive sound sex education in school programs and that family planning agencies are permitted to counsel teenagers and provide contraceptive devices.

Adolescent↗