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PubMed2005

Reproductive health status, knowledge, and access to health care among female migrants in Shanghai, China.

As the largest labour flow in human history, the recent rise in migration in China has opened up unprecedented opportunities for millions of Chinese to rearrange their lives. At the same time, this process has also posed great challenges to Chinese migrants, especially female migrants, who not only face a bias against 'outsiders' but also have a greater need for reproductive health-related services in their migratory destinations. Based on data collected via multiple sources in Shanghai, China's largest metropolis, this study profiles the changing characteristics of female migrants, presents data on self-reported symptoms of reproductive health-related problems and knowledge on reproductive health issues, compares maternal and child health measures between migrants and local residents, and examines factors related to reproductive health knowledge and migrants' access to health care in urban China. Results of this study show a relatively low level of self-reported reproductive health problems among female migrants, coupled with a relatively high level of ignorance in knowledge related to STD. Both self-reported health status and knowledge of reproductive health are related to migrants' educational attainment and length of stay in the urban destination. This study also finds ample evidence that female migrants' access to urban health care is limited by a number of institutional barriers.

Adolescent↗
PubMed2002

Reproductive health indicators and outcomes among refugee and internally displaced persons in postemergency phase camps.

CONTEXT: Despite increasing awareness of the importance of reproductive health programs and services for refugee and internally displaced populations, there is a paucity of basic epidemiological data on reproductive health outcomes. OBJECTIVES: To collect data on reproductive health outcomes among refugees and internally displaced persons in postemergency phase camps and compare these outcomes with those of host country and country-of-origin populations. To determine programmatic factors that may affect reproductive health outcomes. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of data collected from August 1998 through March 2000 of 688,766 persons living in 52 postemergency phase camps in 7 countries. Reproductive health outcomes of refugee and internally displaced populations were compared with available data of reference populations within their respective host country and country of origin. MAIN OUTCOME MEASURES: Crude birth rate (CBR), neonatal mortality rate (NNMR), maternal mortality ratio (MMR), percentage of newborns with low birth weight (LBW), and incidence of complications of unsafe or spontaneous abortions. RESULTS: Six of 11 groups had lower CBRs than their country of origin and 5 of 9 groups had lower CBRs than their host country. Four of 5 had lower NNMRs than their country of origin and 6 of 9 had lower NNMRs than the host country. Four of 6 had lower MMRs than their country of origin, and 5 of 6 had lower MMRs than their host country. Seven of 9 had lower percentages of LBWs than in the country of origin and 5 of 9 had lower percentages of LBWs than the host country. Higher CBRs were associated with more recently established camps and higher numbers of local health staff per 1000 persons; and higher percentages of LBW newborns were associated with rainy season, more recently established camps, lower numbers of community health workers per 1000 persons, and camps without supplementary feeding programs. CONCLUSIONS: Refugees and internally displaced persons in most postemergency phase camps had better reproductive health outcomes than their respective host country and country-of-origin populations.

Abortion, Illegal↗
PubMed1999

Integrating reproductive health: myth and ideology.

Since 1994, integrating human immunodeficiency virus/sexually transmitted disease (HIV/STD) services with primary health care, as part of reproductive health, has been advocated to address two major public health problems: to control the spread of HIV; and to improve women's reproductive health. However, integration is unlikely to succeed because primary health care and the political context within which this approach is taking place are unsuited to the task. In this paper, a historical comparison is made between the health systems of Ghana, Kenya and Zambia and that of South Africa, to examine progress on integration of HIV/STD services since 1994. Our findings indicate that primary health care in Ghana, Kenya and Zambia has been used mainly by women and children and that integration has meant adding new activities to these services. For the vertical programmes which support these services, integration implies enhanced collaboration rather than merged responsibility. This compromise between comprehensive rhetoric and selective reality has resulted in little change to existing structures and processes; problems with integration have been exacerbated by the activities of external donors. By comparison, in South Africa integration has been achieved through political commitment to primary health care rather than expanding vertical programmes (top-down management systems). The rhetoric of integration has been widely used in reproductive health despite lack of evidence for its feasibility, as a result of the convergence of four agendas: improving family planning quality; the need to improve women's health; the rapid spread of HIV; and conceptual shifts in primary health care. International reproductive health actors, however, have taken little account of political, financial and managerial constraints to implementation in low-income countries.

Adult↗
PubMed2005

Current reproductive technologies: increased access and choice?

This article discusses key issues related to current reproductive technologies including contextual and personal barriers to use, complexity of decision making, limited access to technologies for poor women and women of color, and the politics and social controversy surrounding this area. New reproductive technologies have to be put to the same test as any other product--can and will women use them correctly? We need to not only know about the technology itself; we also need to know about the individuals who intend to use the technology and about contextual factors that influence use. Accordingly, the articles in this issue focus on the multiple determinants that influence acceptability of reproductive technologies and the policy, political, and legal implications associated with their use.

Abortion, Induced↗
PubMed1982

Use of health services for disorders of the female reproductive system: United States, 1977-78.

Using data from the National Ambulatory Medical Care Survey and the National Hospital Discharge Survey, statistics are presented on visits to office-based physicians for care and treatment of female reproductive disorders and on patients discharged from short-stay hospitals with related surgery. Visits are described in terms of patient, physician, and clinical characteristics. Breast and gynecological surgery is shown in terms of associated diagnoses and is charted for 1970-78.

Adolescent↗
PubMed1996

Integrating MCH/FP and STD/HIV services: current debates and future directions.

The issue of integrating MCH/FP and STD/HIV services has gained an increasingly high priority on public health agendas in recent years. In the prevailing climate of health sector reform, policy-makers are likely to be increasingly pressed to address the broader concept of "reproductive health' in the terms consolidated at the Cairo International Conference on Population and Development, and the UN Conference on Women in Beijing. Integrated MCH/FP and STD/HIV services could be regarded as a significant step towards providing integrated reproductive health services, but clarity of issues and concerns is essential. A number of rationales have emerged which argue for the integration of these services, and many concerns have been voiced. There is little consensus, however, on the definition of "integrated services' and there are few documented case studies which might clarify the issues. This paper reviews the context in which rationales for "integrated services' emerged, the issues of concern and the case studies available. It concludes by suggesting future directions for research, noting in particular the need for country-specific and multi-dimensional frameworks and the appropriateness of a policy analysis approach.

Child↗
PubMed2003

Reproductive health care in The Netherlands: would integration improve it?

Since the 1994 ICPD, relatively little attention has been given to constraints in improving reproductive health programmes in industrialised countries. The Netherlands is known for its low rates of unwanted pregnancy, safe and accessible abortion services, low perinatal and maternal mortality and well-developed programmes for adolescent sexual health, but recent studies show a rising incidence of abortions and STDs, particularly among young people and immigrants. This article describes reproductive health services in the Netherlands, their historical roots and current constellation, including services for family planning, abortion, STDs, infertility, information, education and counselling on sexuality, and antenatal and delivery care, in the context of cost containment and other recent reforms. It shows that although these core components are well covered and the system of reimbursement for costs has greatly helped to increase accessibility, they are not all well integrated into the primary health care system. In some cases, they are well covered by other providers, such as midwives. Prevention and management of STDs and infertility, however, are particularly split between different providers and in some cases the extent and quality of service provision is lacking. What emerges is a still fragmented landscape--with many successes but also some significant shortcomings.

Contraception Behavior↗
PubMed1995

A framework for establishing integrated reproductive health training.

The challenge for the next decade will be to make quality family planning services accessible to all sexually active couples who want them. The key to fulfilling this goal is the need to rapidly increase the availability of quality voluntary family planning services globally. This paper presents a framework for integrated reproductive health training which provides a mechanism for ensuring a continuous sustainable supply of qualified trainers and service providers. The paper discusses the approach used by JHPIEGO, a Johns Hopkins University program for international education in reproductive health, to build up national training capacity through the development of integrated reproductive health training. This approach may be seen as a network of pathways linking the national system of higher education, the health care system, the political system and cultural norms to strengthen reproductive health policy, training and services. National integrated reproductive health training includes: updated national policies and service guidelines, pre-service training in health professional schools to prepare students to provide family planning services upon graduation; in-service training for practicing health professionals to improve family planning skills for immediate application on the job; and development of clinical training sites at service delivery points already providing family planning/reproductive health services.

Family Planning Services↗
PubMed2004

Reproductive health needs of adolescent males in rural Pakistan: an exploratory study.

This is the first study done to explore reproductive health needs of adolescent males in Pakistan. The purpose of this exploratory study was to obtain qualitative information on existing knowledge and perceptions on puberty and reproductive health needs and to identify effective communication channels for imparting reproductive health education to adolescent males. Seventy-eight unmarried adolescent males participated in the survey, conducted through in-depth interviews by a semi-structured questionnaire using purposive sampling, in eight rural districts in Pakistan. The study pointed out that there existed misconceptions and gaps in knowledge regarding puberty and reproductive health. These young men also have poor knowledge about sexually transmitted diseases dynamics. The communication between parents or siblings on the said issues was found to be poor and they mainly get information from friends followed by the media. The majority showed interest in getting quality information. Multiple entry points and settings can be used to enhance access to information and services. In-school adolescents could be effectively approached through teachers and peer group. Out-of-school adolescents could be reached via media and local health care providers. The results imply that there is a dire need for reproductive health education for adolescent males and suggestions from this study might be utilized when initiating any reproductive health educational service for male adolescents in rural areas in Pakistan. Future efforts should thus focus on assuring access to timely, comprehensive and high-quality reproductive health education for all teenagers and reducing gaps in access related to gender and school attendance.

Adolescent↗
PubMedDate not supplied

Integrating reproductive health into emergency response assessments and primary health care.

War-affected populations often are displaced for years. When primary health care is focused on the acute conditions that often present in the emergency phase of a complex emergency, insufficient attention often is directed towards other evolving needs of the population. Their reproductive health, psychosocial health, and problems with chronic diseases may be overlooked even after the situation stabilizes. This article examines currently available resources for conducting rapid assessments of health needs and services during complex emergencies. Their respective strengths and weaknesses are discussed, particularly for assessing a population's reproductive health needs, and for fostering the integration of reproductive health and primary health-care services, and for designing health services delivery. When more specific indicators are included in a needs assessment tool, the likelihood that the assessment results will influence the design and scope of the health program is increased. Needs assessments for primary health care that incorporate reproductive health indicators will assist health officials to integrate these services, and thus, use staff and facilities more efficiently, and will highlight areas of opportunity for providing services.

Emergencies↗
PubMed1996

UN conference reaffirms reproductive rights.

The United Nations Conference on Human Settlements, also known as the Habitat II conference, met in Istanbul from June 3 to 14. It was the last major UN gathering of this millennium and the first major UN meeting since 1995's Fourth World Conference on Women (the "Beijing Conference")--and thus an important opportunity for a wider international community to weigh in on agreements reached in Beijing and at the International Conference on Population and Development, held in Cairo in 1994. The final document that emerged from Habitat II, the "Global Plan of Action," affirmed crucial elements of those earlier accords. The Habitat documents calls for action to "[d]evelop and implement programmes to ensure universal access for women throughout their life-span to a full range of affordable health care services, including those related to reproductive health care, which includes family planning and sexual health, consistent with the Report of the International Conference on Population and Development." Language adopted at the Cairo meeting is also affirmed in Habitat's call for "universal access to the widest range of primary health care services." Perhaps most significantly, the Istanbul document reiterated an important declaration from the Beijing conference: "While the significance of national and regional particularities and various historical, cultural, and religious backgrounds must be borne in mind, it is the duty of all States to promote and protect all human rights and fundamental freedoms." Most of the 189 UN members and observer states that attended the conference upheld all three of these provisions. Only a small group of states--Argentina, Guatemala, Iran, Jordan, Lebanon, Malta, Qatar, Saudi Arabia, Sudan, Syria, United Arab Emirates, Yemen, and the Holy See--filed reservations on the health care sections.

Delivery of Health Care↗