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At least 19 recordsLinked to original sources
PubMed2004

Investigating access to reproductive health services using GIS: proximity to services and the use of modern contraceptives in Malawi.

This paper attempted to identify whether access to reproductive health services partly explains use of modern contraception in Malawi. Recent changes in Malawi's population policy have brought the state's population ambitions into alignment with the consensus reached at the International Conference on Population and Development held in Cairo in 1994. Concurrently, Malawi witnessed a large increase in the use of modern contraceptives from 7% in 1992 to 26% in 2000. A geographic information system (GIS) was employed to integrate health facility data from the Malawi health facilities inventory and global positioning data from the 2000 Malawi demographic and health survey. An effort to detect a plausible causal pathway was made by using distance to health services as a proxy variable for access to services. In a multivariate logistic regression analysis, after controlling for background variables traditionally associated with use of modern contraception, access could not be shown to explain use of modern contraception in Malawi.

Attitude to Health↗
PubMed1999

[Management and performance of human resources in reproductive health services].

For most people, utilizing reproductive health services is colored by strong emotional and subjective implications. Therefore, it is essential to know the local situation well when planning those services and designing activities directed toward the community. User satisfaction also depends on allowing those persons to participate in solving problems from their own perspective and on the treatment they receive from health service personnel. It's impossible to overstate the importance of the performance of health care providers and, accordingly, the management of those personnel. This article presents general principles that govern such management, the tasks that management entails, and the most desirable attitudes in reproductive health service providers.

Community Health Services↗
PubMed2000

Use of reproductive health services among young men, 1995.

PURPOSE: To analyze the extent to which teenage males receive preventive reproductive health services and identify demographic and health factors associated with their receipt. METHODS: Bivariate and multivariate analyses of nationally representative data from the 1995 National Survey of Adolescent Males were conducted using logistic regression to determine which factors predicted whether teenagers had a physical examination and whether they discussed reproductive health topics with a medical professional, had a human immunodeficiency virus (HIV) test, or had a sexually transmitted disease (STD) test. RESULTS: Although 71% of males aged 15-19 years received a physical examination in the past year, only 39% of them received any of the three reproductive health services. Less than one-third of all young men discussed reproductive health with their doctor or nurse. Among sexually experienced males, one-sixth had an STD test and one-quarter an HIV test. In multivariate analysis, males who had a physical examination were more likely to have an STD or HIV test, but were no more likely to discuss reproductive health topics. Minority and low-income youth were more likely to receive these reproductive health services, as were young men with multiple sex partners and those with health problems. CONCLUSIONS: In general, the proportion of teenage men receiving reproductive health services is low, although levels are higher among minority youth and certain groups at risk. To reduce rates of teen pregnancy and STDs, physicians and nurses need to incorporate reproductive health care into routine health services for teenage males, as well as females.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Adolescents' use of school-based health clinics for reproductive health services: data from the National Longitudinal Study of Adolescent Health.

Offering reproductive health services to students through school-based clinics (SBCs) may be a valuable public health strategy. Using data from the National Longitudinal Study of Adolescent Health, this report describes adolescents' use of SBCs for family planning and STD-related services. Of more than 1,200 students receiving reproductive health services in the year preceding the survey, 13.3% received family planning services from a SBC and 8.9% received STD-related services. Rural residence, no driver's license, younger age, and minority ethnicity increased the likelihood of using a SBC for family planning services. Rural residence, minority ethnicity, male gender, having a physical exam from a SBC, and less perceived parental approval of sex increased the likelihood of using a SBC for STD-related services. Further research should determine factors that increase adolescents' acceptance of reproductive health services from a SBC.

Adolescent↗
PubMedDate not supplied

Public or private providers? U.S. women's use of reproductive health services.

CONTEXT: U.S. women receive contraceptive and reproductive health services from a wide range of publicly funded and private providers. Information on trends in and on patterns of service use can help policymakers and program planners assess the adequacy of current services and plan for future improvements. METHODS: Women who reported in the 1995 National Survey of Family Growth that they had obtained any contraceptive or other reproductive health service in the past year were classified by their primary source of care, and the services they received, their characteristics and their primary source of care were analyzed. Logistic regression was used to test which factors predict women's use of publicly subsidized family planning clinics and of specific types of services. RESULTS: The percentage of women of reproductive age who obtained family planning services increased slightly between 1988 and 1995, primarily among women aged 30 and older. Nearly one in four women who received any contraceptive care visited a publicly funded family planning clinic, as did one in three who received contraceptive counseling or sexually transmitted disease (STD) testing and treatment. Women whose primary source of reproductive care was a publicly funded family planning clinic received a wider range of services than women who visited private providers; moreover, the former were significantly more likely to report obtaining contraceptive care or STD-related care, even after the effects of their background characteristics were controlled. Young, unmarried, minority, less-educated and poor women were more likely than others to depend on publicly subsidized family planning clinics. Source of health insurance was one of the most important predictors of the use of public family planning clinics: Medicaid recipients and uninsured women were 3-4 times as likely as women with private insurance to obtain clinic care. CONCLUSIONS: Publicly funded family planning clinics are an important source of contraceptive and other reproductive health care, providing millions of U.S. women with a wide range of services. Since women's need for reproductive care and for publicly subsidized care is not likely to diminish, clinics may be financially challenged in their efforts to continue delivering this broad package of services to growing numbers of uninsured or disenfranchised women.

Adolescent↗
PubMed2004

Courses for medical residents and trainers in Turkey for promotion of quality of reproductive health services: a pilot study.

In order to provide high quality services in reproductive health, training of health professionals is essential. In Turkey, a project for in-service training of medical residents was conducted in 2003 under the aegis of the Human Resources Development Foundation, the Turkish Ministry of Health and UNFPA. The project included a needs assessment, training programme development and evaluation activities. A seven-day course was developed to train institutional trainers in both training skills and reproductive health information. Fourteen experienced master trainers conducted four courses for 67 institutional trainers from 37 hospital departments in four cities, who in turn conducted a three-day programme on reproductive health topics in their respective institutions, using interactive teaching methods. 163 residents from departments of obstetrics and gynaecology, family medicine, urology, public health and paediatrics participated. Over three-quarters of trainers and residents who participated in the programme approved of the content of the courses. A limited number of topics, e.g. sexual health and adolescent reproductive health, were thought to need more attention. Trainers cited improvements in doctor-patient communication and quality of outpatient and in-patient care, and initiation of counselling in their institutions. We conclude that this training programme, attended by trainers and participants from different disciplines and using interactive teaching methods, has been successful as an effective training model for medical residents. The establishment of an ongoing collaboration between the Ministry of Health and other institutions involved in resident training in Turkey is needed to ensure the expansion of this programme to all residents in training.

Curriculum↗
PubMedDate not supplied

Attitudes of Icelandic young people toward sexual and reproductive health services.

CONTEXT: Iceland has higher levels of fertility among both adult women and adolescents than many other western European countries. There is a need to make sexual and reproductive health services more accessible to teenagers in Iceland. METHODS: A descriptive, cross-sectional national postal survey was conducted in 1996 to explore the attitudes of 2,500 young people aged 17-20 toward sexual and reproductive health services in Iceland and to determine which factors might be of importance for the development of such services. RESULTS: Icelandic adolescents want specialized sexual and reproductive health services offered within a broad-based service setting. Half of them would prefer to have these services located in a sexual and reproductive health clinic, and about one-third want such services to be located in community health centers. Having services that are free, that are anonymous and that do not require an appointment are important to teenagers who live in Reykjavik, but proximity and equal access to services are more highly valued by adolescents who live outside Reykjavik. Characteristics that young women, in particular, value include close proximity to services, access to a comfortable environment, a friendly staff, absolute confidentiality, and the ability to come with a friend and to have enough time for discussion. Adolescents who have already used contraceptive services mentioned that they need enough time for discussion and that they value high-quality client-provider interaction. CONCLUSIONS: The attitudes of adolescents should be considered when specialized sexual and reproductive health services are developed for young people in Iceland. Specialized services that respond to the unique concerns of adolescents may increase their utilization of contraceptive methods and other reproductive health services.

Adolescent↗
PubMed2002

Universal coverage and its impact on reproductive health services in Thailand.

Thailand has recently introduced universal health care coverage for 45 million of its people, financed by general tax revenue. A capitation contract model was adopted to purchase ambulatory and hospital care, and preventive care and promotion, including reproductive health services, from public and private service providers. This paper describes the health financing system prior to universal coverage, and the extent to which Thailand has achieved reproductive health objectives prior to this reform. It then analyses the potential impact of universal coverage on reproductive health services. Whether there are positive or negative effects on reproductive health services will depend on the interaction between three key aspects: awareness of entitlement on the part of intended beneficiaries of services, the response of health care providers to capitation, and the capacity of purchasers to monitor and enforce contracts. In rural areas, the district public health system is the sole service provider and the contractual relationship requires trust and positive engagement with purchasers. We recommend an evidence-based approach to fine-tune the reproductive health services benefits package under universal coverage, as well as improved institutional capacity for purchasers and the active participation of civil society and other partners to empower beneficiaries.

Financing, Government↗
PubMedDate not supplied

Reproductive health services for adolescents under the State Children's Health Insurance Program.

CONTEXT: The federal government enacted the State Children's Health Insurance Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-income children up to age 19. Individual states' decisions when designing their CHIP efforts will in large part determine the extent to which the program will help the nation's nearly three million low-income uninsured adolescents get needed reproductive health services. METHODS: CHIP administrators in all states and the District of Columbia were sent a survey concerning reproductive health services for adolescents aged 13-18 provided under their state's CHIP effort. The questionnaire asked about services covered, information provided to adolescents, confidentiality, outreach and enrollment activities, managed care and performance measures. RESULTS: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort, and 28 states included a state-designed component. Overall, states provided relatively comprehensive coverage of reproductive health services, with all 58 CHIP programs covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the most commonly used prescription contraceptive methods, although only 43 covered emergency contraception. Twenty of 58 CHIP programs required that adolescents be provided with information about coverage for the full range of reproductive health services, and 18 required that information be provided about accessing care. Seventeen programs reported guarantees of confidentiality before and after receipt of reproductive health care. In 26 programs, enrollees in managed care were guaranteed access to contraceptive services through out-of-network providers. Twenty-six states and the District of Columbia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach materials at middle schools, high schools and community-based organizations serving teenagers. CONCLUSIONS: Despite their nearly comprehensive coverage of reproductive health services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to adolescents' ability to access care. In addition, many states failed to creatively use strategies to target uninsured adolescents for enrollment, although new initiatives are under way to correct this problem.

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↗
PubMed2005

Focus on women: linking HIV care and treatment with reproductive health services in the MTCT-Plus Initiative.

Despite important advances in expanding access to antiretroviral therapy in the countries most heavily affected by HIV/AIDS, there has been little consideration of the connections between HIV prevention, care and treatment programmes and reproductive health services. In this paper, we explore the integration of reproductive health services into HIV care and treatment programmes. We review the design and progress of the MTCT-Plus Initiative, which provides HIV care and treatment services to HIV positive women as well as their HIV positive children and partners. By emphasising the long-term follow-up of families and the provision of comprehensive care across the spectrum of HIV disease, MTCT-Plus highlights the potential synergies in linking reproductive health services to HIV care and treatment programmes. While HIV care and treatment programmes in resource-limited settings may not be able to integrate all reproductive health services into a single service delivery model, there is a clear need to include basic reproductive health services, such as access to appropriate contraception and counselling and management of unplanned pregnancies. The integration of these services would be facilitated by greater insight into the reproductive choices of HIV positive women and men, and into how health care providers influence access to reproductive health services of people with HIV and AIDS.

Africa South of the Sahara↗
PubMed2001

Reproductive health services and the law and ethics of conscientious objection.

Reproductive health services address contraception, sterilization and abortion, and new technologies such as gamete selection and manipulation, in vitro fertilization and surrogate motherhood. Artificial fertility control and medically assisted reproduction are opposed by conservative religions and philosophies, whose adherents may object to participation. Physicians' conscientious objection to non-lifesaving interventions in pregnancy have long been accepted. Nurses' claims are less recognized, allowing nonparticipation in abortions but not refusal of patient preparation and aftercare. Objections of others in health-related activities, such as serving meals to abortion patients and typing abortion referral letters, have been disallowed. Pharmacists may claim refusal rights over fulfilling prescriptions for emergency (post-coital) contraceptives and drugs for medical (i.e. non-surgical) abortion. This paper addresses limits to conscientious objection to participation in reproductive health services, and conditions to which rights of objection may be subject. Individuals have human rights to freedom of religious conscience, but institutions, as artificial legal persons, may not claim this right.

Abortion, Induced↗
PubMed1996

Utilization of reproductive health services in a mountainous area in Vietnam.

This study uses data from two surveys performed in 1991 and 1994 in a mountainous district of northern Vietnam. The aim was to describe the utilization of family planning, antenatal care, delivery and immunization services during a period of rapid structural change in the health services in general and implementation of a primary health care project in the study area. This project was aimed at increasing access to health services and improving the quality of primary health care services. Factors influencing the utilization of reproductive health services were analyzed. The contraceptive prevalence among women aged 15-49 increased significantly from 48% in 1991 to 60% in 1994. The most commonly used contraceptive method was intra-uterine devices. The BCG coverage among children under five years of age increased from 36 to 70%. The proportion of pregnant women receiving three antenatal check-ups, as recommended by the health authorities was low and increased slightly from 15% in 1991 to 20% in 1994. About one third of the pregnant women were delivered in health care institutions during this period. The utilization of family planning, antenatal care and delivery services varied with ethnicity and was positively related to the mother's educational level both in 1991 and 1994. There is a need to strengthen the reproductive health services, especially antenatal care and delivery services, in terms of improving the quality of care and accessibility to women. Efforts should be made to reach women with a low education level as well as those belonging to ethnic minorities.

Adolescent↗
PubMed2005

What is youth-friendly? Adolescents' preferences for reproductive health services in Kenya and Zimbabwe.

While there has been increased attention to youth-friendly reproductive health services, little research has been conducted among adolescents in developing countries to assess what characteristics of reproductive health services are most important to them. Large scale population-based surveys were carried out among youth in Kenya and Zimbabwe. A list of characteristics that programmers often think of as youth-friendly was read to respondents, after which they were asked to assess the importance of those characteristics in choosing their reproductive health services. Adolescents rated confidentiality, short waiting time, low cost and friendly staff as the most important characteristics. The least important characteristics included youth-only service, youth involvement and young staff, suggesting that adolescents do not prioritise stand-alone youth services such as youth centres, or necessarily need arrangements particular to youth such as youth involvement. The findings imply that most existing clinical services, even in the most resource-poor settings, are in a position to improve their level of youth friendliness.

Adolescent↗
PubMed2003

The impact of decentralisation on sexual and reproductive health services in Ghana.

This paper analyses the impact of decentralisation on the political organisation, management and provision of sexual and reproductive health services in Ghana. It draws on qualitative research and interviews with key informants from the Ministry of Health, donors, NGOs, regional and district health management teams, local government and community leaders. Within a national reproductive health policy framework, previously disparate family planning, maternal and child health, STI and HIV/AIDS programmes have become more integrated, and donors have pooled or co-ordinated their funding. Some decision-making about resource allocation is meant to happen at district and regional level but in practice, this remains centrally controlled, which may be a necessary safeguard for sexual and reproductive health services. Earmarked donor funds still ensure a regular supply of contraceptives and STI drugs. However, paying for these is problematic at local level. Sexual and reproductive health staff make up a large proportion of primary health care staff, but especially in rural areas they experience poor working conditions, and there is high turnover and vacancies. District and sub-district level links are working well in this new system, but clarity is still needed on how different national sexual and reproductive health bodies relate to each other and to regional and district health authorities. The development of formal mechanisms for priority setting and advocacy at local levels could help to secure benefits for sexual and reproductive health care.

Attitude of Health Personnel↗
PubMed2004

The determinants of reproductive health service provision by general practitioners in Pakistan.

OBJECTIVE: The aim of this cross-sectional study was to identify the factors that influence the provision of reproductive health services by General Practitioners (GPs) working in the province of Sind, Pakistan. METHODS AND PARTICIPANTS: One hundred and ninety-eight GPs were selected as the study participants by a multistage, randomized stratified, proportionate sampling procedure. Data were collected using a self-completed questionnaire, which was validated for content validity by an expert review panel and for face validity by a pilot test administered to doctors from developing countries. Data collection took place between November 2000 and February 2001. RESULTS: Eighty-six percent of GPs (171/198) responded to the questionnaire. Of those, only 25% reported providing reproductive health services in their clinics. The major determinants of reproductive health service provision were found to be the urban location of the GP clinic, being a female GP, postgraduate training in reproductive health and a good knowledge of reproductive health. CONCLUSIONS: The findings of this study suggest that the provision of reproductive health services in Sind could be improved by increasing the involvement of female GPs. This can be achieved by encouraging more female GPs into the specialty, with the use of incentives if necessary, and providing adequate postgraduate training to improve their reproductive health knowledge and skills. The results of this study have broadened understanding of the factors that influence GPs in their provision of reproductive health services, and will contribute significantly to research on reproductive health in Pakistan.

Adult↗
PubMed2002

The role of oversight in the health sector: the example of sexual and reproductive health services in India.

This paper examines the role of oversight in influencing the health sector, using examples from sexual and reproductive health services in India. Rather than simply trying to provide services through traditional bureaucratic mechanisms, governments can make use of oversight tools to influence how health care is delivered through the public and private sectors. Three main oversight functions are described: understanding health system performance, deciding when to intervene in the health system and strategizing and implementing change. Governments also need to understand the ethical basis for decisions. The potential for administering oversight through policy-making, disclosing and informing, regulating, collaborating, and strategically subsidising and contracting services in sexual and reproductive health is described. This approach implies an engagement with a broader set of stakeholders in the health sector than is often the case. It requires a set of skills for public officials beyond managing public programmes, and relies on a larger role for other stakeholders and the general public. When applied to reproductive and sexual health, implementation of the full range of oversight functions offers new opportunities to provide more effective, equitable, accountable and affordable services.

Decision Making, Organizational↗
PubMed2005

Selecting, implementing, and evaluating teen pregnancy prevention interventions: lessons from the CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To summarize 13 communities' experiences with selecting, implementing, and evaluating teen pregnancy prevention interventions within the CDC Community Coalition Partnership Programs for the Prevention of Teen Pregnancy. The study focuses on decision-making processes and barriers encountered in five categories of interventions: reproductive health services, reproductive health education, parent-child communication, male involvement, and programs for pregnant and parenting teens. METHODS: Telephone interviews were conducted with program directors, lead evaluators, and community coalition chairpersons in each of the 13 communities. The descriptive analysis explored factors that influenced community decisions to develop or not to develop interventions. These factors were analyzed by type of intervention. RESULTS: Each community implemented an average of six interventions and operated them with a variety of funding sources. Interventions were selected on the basis of need, and the community needs and assets assessment process was "very important" for most reported interventions. Decision-making was influenced most often by project staff, the coalition, or related work groups. Teens were infrequently viewed as primary decision-makers in the selection of interventions. Communities with family planning services as hub agencies were more likely to address reproductive services and reproductive health education. Communities with child advocacy or youth-serving agencies were more likely to focus on other intervention categories. About two-thirds of the interventions were evaluated by either process or outcome measures, or by both. CONCLUSIONS: This study highlights important lessons learned that should be considered in examinations of the overall effectiveness of this community coalition approach to the prevention of teen pregnancy.

Adolescent↗