Population Council

From 2000 to 2002 the Population Council collaborated with the Palestinian Ministry of Health on the Pilot Health Project (PHP), a 28-month intervention to upgrade the reproductive health services in the West Bank and Gaza. One of the PHP’s goals was the establishment of a basic package of high-quality antenatal and postpartum care among participating clinics operated by nongovernment organizations (NGOs). The package included clinical upgrades, training to improve providers’ skills in maternal care and counseling, a postnatal visit by a community health worker, and counseling on birth spacing, postpartum contraception, and breast self-examination, as breast cancer is the most prevalent cancer among Palestinian women.  Providers were trained to encourage women to obtain a postpartum checkup for herself and her new baby.  A baseline survey showed that high-quality care was available from the NGOs, and that women frequently used antenatal care services, but rarely sought postpartum care. To assess changes resulting from the PHP intervention, researchers conducted postintervention surveys of 1,070 antenatal, postpartum, and family planning clients at 26 of the original 27 participating clinics. Nine physicians and 49 nurses and community health workers were interviewed to assess changes in their behaviors and practices.

Palestinian women have access to antenatal and postpartum care as well as family planning services, although few women seek postpartum services.  Both clients and health care providers have limited knowledge about reproductive health (RH). RH services could be improved by the provision of standardized protocols for RH care in primary health care clinics and pre- and in-service training for  providers.

This study tested the systematic screening technique to increase the integration of reproductive health services in Senegal. The study took place in four urban health posts in the city of Dakar and three rural health posts in the district of Kebemer. A before and after design tested the hypothesis that the use of the systematic screening tool would result in more services received per client visit. In Dakar, services per visit increased significantly by 20 percent, while in Kebemer, services per visit also increased significantly by 35 percent. The study also examined several techniques to improve provider compliance with the screening technique.

This article was meant to cover a workshop whose objectives were: To increase understanding of the importance of integrating postpartum/postabortion care with family planning services, in efforts to improve the health of mothers and children in the Arab region; To share best and promising practices in providing family planning services, especially those within postpartum and postabortion care;  To orient participants in adapting best and promising practices in their own programs through practical sessions and working groups;  To recognize the role of operations research in enhancing the integration of family planning services with postpartum/postabortion care.

This Program Brief reviews evidence from operations research and other studies in 13 countries about the effectiveness of men as CBD workers. It addresses five basic issues that influence whether or not recruiting more men as CBD workers will result in greater use of male condoms as dual protection against pregnancy and STIs: 1) Do communities accept men as CBD distributors? 2) Do men sell more condoms than women do? 3) Do men recruit more male clients than women do? 4) Do male agents distribute as many couple years of contraceptive protection (CYP) as female agents do? 5) Must program managers take special steps to incorporate men into CBD programs?

The study objective was to determine if the use of a checklist that screened for unmet services needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. The study included 3,448 clients visiting six service delivery points during the eighteen-week study period. Measurement included changes in services per visit before and after the introduction of the intervention, and a comparison of services received at screened and non-screened visits. In the nine weeks following the introduction of the intervention, nine percent more services per client visit were provided than in the nine-week period preceding the intervention. Provider compliance was an important constraint. Less than half of visits were screened, but screened visits resulted in twenty-five percent more services per visit than non-screened visits. To the degree that provider compliance can be secured, systematic screening of clients appears to be an effective method for reducing unmet health service needs. The findings of this study replicate those of other studies conducted in Africa, Asia, and Latin America.

This study took a fresh approach to understanding the factors and conditions that influence condom use in the Dominican Republic. Rather than focusing on the barriers that impede successful condom use, as past studies have, we instead explored the behavior of individuals who are successful at using male condoms and the factors that facilitate their use. Specifically, we explored successful users? beliefs about condoms and condom use, the factors that led successful condom users to initially adopt and to continue using condoms, and finally, the conditions that influence successful condom users? ability to use condoms consistently and correctly.

This report presents findings from an exploratory study of the pregnancy-related morbidity and mortality experiences of women who delivered in adolescence and adulthood, and the constraints they faced in seeking appropriate and timely care, in the state of Rajasthan.

Despite the tremendous resources invested in training Traditional Birth Attendants (TBA) over the past two decades, scientific evidence from around the world has shown that training TBAs has not reduced maternal mortality. Any improvement observed when TBA training programmes have been introduced was because of the associated supervision and referral systems, and because of the quality of essential obstetric services available at first referral level.  Since TBAs are highly regarded by their communities, it is critical that they still be encouraged and enabled to play a role in improving maternal health. The Kenya Safe Motherhood Demonstration Project (SMDP) has identified the contributions that TBAs can make, so that they are incorporated into a national plan for maternal and neonatal health during the transition to Skilled Attendance at birth.

A step-by-step comprehensive 6 step SMNH Implementation Process/Framework.

This project was intended to address this gap through analysis of a unique longitudinal data set from rural Bangladesh. Using prospective data from approximately 7,000 reproductive-aged Bangladeshi women, the objective of this study was to evaluate the relative impact of service quality and client characteristics on contraceptive adoption and method continuation. The study employed new, more methodologically rigorous analytical approaches— specifically, multi-level analysis— and measures of fieldworker and clinic service access and quality, which are largely free from the biases of endogeneity (i.e. the inter-correlation of key variables) and unobserved heterogeneity which characterize many existing analyses of this issue. The results provide new and persuasive empirical evidence on the importance of service quality for contraceptive behavior.

The Balanced Counseling Strategy Plus (BCS) job aids and guides are intended for reproductive health programs interested in both strengthening the quality of family planning counseling and responding to the needs of clients at risk for STIs, especially HIV.  The BCS User's Guide explains how to use the job aids and can be distributed during training on the BCS or used for self-teaching with the BCS job aids. The BCS is a developed and tested, practical, interactive, and client-friendly strategy for improving counseling within family planning consultations.  The BCS uses three key job aids for counseling clients about family planning; an algorithm to guide the provider through the counseling process, a set of counseling cards for contraceptive methods, and corresponding brochures for each method.  The strategy, tested and refined in several countries, compromises a series of steps to determine the contraceptive method that best suits the client according to her/his preferences and needs.  This strategy improves the quality of the provider's counseling and allows the client take ownership of the decision.  The approach is practical, low cost, and easy to adapt to local contexts.

Inclusion in the SBS makes PAC services free of charge to women and aims to: 1) increase women’s access to services; 2) reduce the cost of service delivery and hospital length of stay; and 3) improve the quality of care. The operations research (OR) project carried out from May 1999 through August 2001 and summarized in this report was undertaken at the request of the Ministry of Health (MSPS) to help guide the improvement of PAC services as the SBS was implemented.

The Division of Reproductive Health (DSR) of the Senegal Ministry of Health and Social Action, in partnership with the Population Council’s FRONTIERS in Reproductive Health program and Management Sciences for Health (MSH), conducted a study to test and compare three ways of providing reproductive health services to rural communities in the Kébémer district in terms of their effectiveness, cost and cost-effectiveness. FRONTIERS and MSH collaborated with the DSR to design the interventions, MSH supported the DSR to implement the interventions, and FRONTIERS undertook the evaluation. USAID provided funding for the study. This study responded to the recommendations of a 1999 workshop, organized by FRONTIERS and the DSR, on the community-based distribution (CBD) approach, which defined alternative CBD models appropriate for Senegal. The DSR sees the development of community-based service delivery models as essential for the future of health care in Senegal.

The overall objective of the study was to replicate and scale up „best practices? based on findings from FRONTIERS. The specific objectives of the study were: 1) To institutionalize the Systematic Screening Instrument in the entire state of Uttarakhand, India; 2) To strengthen Emergency Contraceptive Pills service provision in the entire state of Uttarakhand, India; and  3) To enhance use of the Lactational Amenorrhea Method (LAM) among Egyptian women. The present report has been divided into two parts. In the first part, implementation of the SSI and ECP activities has been presented jointly, as these activities were implemented together in Uttarakhand. The second part of the report describes activities implemented in Egypt to build national capacity regarding correct use of LAM and for providing postpartum and postabortion family planning.

Evidence from a number of studies globally has shown a reduction in maternal and perinatal mortality when women have a skilled attendant present at every birth. In Kenya, although over 88% of women attend an antenatal clinic at least once during pregnancy a skilled attendant assists only 42% at birth. There are regional disparities within Kenya on who provides support during childbirth. In Central Province, over 70% deliver with a skilled attendant compared to 28% in Western Province.  Building on these results, a Community Midwifery Model was developed by a collaborative group of professionals.  This report discusses the Community Midwifery Model in detail.

Increasing access to safe delivery and family planning services within rural communities increases the opportunities for women to have positive outcomes for their pregnancies as well as to plan and achieve their desired family size. With support from USAID, the Population Council?s Frontiers in Reproductive Health (FRONTIERS) project supported the scaling up of a community-based model in Kenya that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. Originally piloted through a demonstration project implemented by the Population Council with DFID support in Western Province, FRONTIERS assisted the Kenyan Ministry of Health (MOH) to identify an expanded package of safe motherhood services, including postpartum family planning, which could be provided routinely by these "community midwives? living and working from home with minimal supervision and supply of commodities from the MOH. Guidelines and training materials for community midwives were developed and mechanisms for linkages with existing MOH systems at district level strengthened. Four districts (Mount Elgon, Bungoma, Lugari and Butere Mumias) in Western province were selected for scale up of the approach.

This aims to address the work force gap and build on resources available in the community, increase access to, and demand for, skilled attendants during pregnancy, childbirth and the postpartum period and for FP.  It also aims to operationalize the National Community Strategy to utilize human resources outside of the public health sector.

Systematic screening is a strategy to integrate reproductive health services at the provider level. Integration is defined as the proactive provision of multiple reproductive health services in the same facility at the same time (Foreit, Hardee, and Agarwal 2002). Systematic screening is a simple intervention to increase the number of services received at a single client visit. In this strategy, providers use a checklist or brief questionnaire to identify each client’s needs and desires for reproductive health services. They then provide these services to her during the same visit, through an appointment at the same clinic, or through referral to another facility.

This study tested the effectiveness of a systematic screening technique in integrating reproductive health services at the provider level. The study was conducted in large public clinics and small health posts in the city of Vadodara, India. The objective was to determine if women screened during clinic visits received more services, appointments, and referrals per visit than women who were not screened. The intervention consisted of the use of a brief screening algorithm, followed by the offer of the needed services. The study used a pre-test/post-test experimental and control group design.