Provider imposed restrictions to clients\u27 access to family planning in urban Uttar Pradesh, India: A mixed methods study

Background Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients\u27 access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients\u27 access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results The quantitative findings show that providers restrict clients\u27 access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients\u27 education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods

Patterns and implications of male migration for HIV prevention strategies in Karnataka, India

Karnataka is one of the high HIV prevalence states in India. Results from the National Family Health Survey indicate that 0.69 percent of adults aged 15–49 were infected with HIV in 2005–06. According to sentinel surveillance system data, HIV prevalence among pregnant women receiving antenatal care (ANC) in Karnataka was 1.3 percent. Further, 18 of the state\u27s 27 districts have recorded HIV prevalence of more than 1 percent among pregnant women receiving ANC in sentinel sites. Strong male migration patterns are evident in some of the state’s high HIV prevalence districts. According to the 2001 census, Karnataka ranks fourth in terms of total in-migration, with 2.2 million men on the move from 1991 to 2001. These northern districts are particularly vulnerable to HIV infection. To inform HIV prevention efforts, the Population Council studied patterns and motivations related to migration of male laborers and their links with HIV risk. As part of this study, the Council conducted a systematic analysis of 2001 census data on migration and district-level sentinel surveillance data on HIV prevalence. The purpose of the research was to document patterns of male migration and determine whether there was a relationship between migration and HIV prevalence

Patterns and implications of male migration for HIV prevention strategies in Maharashtra, India

Maharashtra was one of the first states to be affected by HIV in India. Results from the National Family Health Survey (NFHS-3) in 2005–06 indicate that 0.62 percent of men and women aged 15–49 years were infected with HIV, as compared to the national average of 0.28 percent. HIV sentinel surveillance data from sites across Maharashtra indicate that 1.3 percent of pregnant women receiving antenatal care (ANC) and 10.4 percent of patients receiving treatment for sexually transmitted infections in 2005 were infected with HIV. At the same time, Maharashtra ranks first nationally in the proportion of total migrants, and there is a growing consensus among policymakers and program managers that migration could be a major contributor in the spread of HIV in the state. However, empirical evidence to support or refute this conjecture is limited. To address this research gap, the Population Council studied the patterns and motivations related to the migration of male laborers and their linkages with HIV risk. The purpose of the research, as stated in this brief, was to document patterns of male migration and determine whether there was a relationship between migration and HIV prevalence

Family Planning Use among Urban Poor Women from Six Cities of Uttar Pradesh, India

Family planning has widespread positive impacts for population health and well-being; contraceptive use not only decreases unintended pregnancies and reduces infant and maternal mortality and morbidity, but it is critical to the achievement of Millennium Development Goals. This study uses baseline, representative data from six cities in Uttar Pradesh, India to examine family planning use among the urban poor. Data were collected from about 3,000 currently married women in each city (Allahabad, Agra, Varanasi, Aligarh, Gorakhpur, and Moradabad) for a total sample size of 17,643 women. Participating women were asked about their fertility desires, family planning use, and reproductive health. The survey over-sampled slum residents; this permits in-depth analyses of the urban poor and their family planning use behaviors. Bivariate and multivariate analyses are used to examine the role of wealth and education on family planning use and unmet need for family planning. Across all of the cities, about 50% of women report modern method use. Women in slum areas generally report less family planning use and among those women who use, slum women are more likely to be sterilized than to use other methods, including condoms and hormonal methods. Across all cities, there is a higher unmet need for family planning to limit childbearing than for spacing births. Poorer women are more likely to have an unmet need than richer women in both the slum and non-slum samples; this effect is attenuated when education is included in the analysis. Programs seeking to target the urban poor in Uttar Pradesh and elsewhere in India may be better served to identify the less educated women and target these women with appropriate family planning messages and methods that meet their current and future fertility desire needs

Provider imposed restrictions to clients' access to family planning in urban Uttar Pradesh, India: a mixed methods study

Abstract Background Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients’ access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India. Methods Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked about the FP methods they provide, and if they restrict clients’ access to each method based on age, parity, partner consent, or marital status. For the qualitative research, we conducted one-on-one interviews with 21 service providers in four of the six cities in Uttar Pradesh. Each interview lasted approximately 45 minutes. Results The quantitative findings show that providers restrict clients’ access to spacing and long-acting and permanent methods of FP based on age, parity, partner consent and marital status. Qualitative findings reinforce that providers, at times, make judgments about their clients’ education, FP needs and ability to understand FP options thereby imposing unnecessary barriers to FP methods. Conclusions Provider restrictions on FP methods are common in these urban Uttar Pradesh sites. This means that women who are young, unmarried, have few or no children, do not have the support of their partner, or are less educated may not be able to access or use FP or their preferred method. These findings highlight the need for in-service training for staff, with a focus on reviewing current guidelines and eligibility criteria for provision of methods

Pourquoi la reprise après la Covid-19 doit être sexospécifique

This summary highlights key learning from research from the Covid-19 Responses for Equity (CORE) initiative focusing on the impact the pandemic is having across different vulnerable groups and how gender intersects and often exacerbates these effects. Supported by the International Development Research Centre (IDRC), CORE brings together 21 projects to understand the socioeconomic impacts of the pandemic, improve existing responses, and generate better policy options for recovery. The research is being led primarily by local researchers, universities, thinktanks and civil society organisations across 42 countries in Africa, Asia, Latin America and the Middle East.Cette synthèse met en évidence les principaux enseignements tirés de la recherche menée dans le cadre de l’initiative Covid-19 Responses for Equity (CORE) axée sur l’impact de la pandémie sur différents groupes vulnérables et sur la façon dont le genre recoupe et exacerbe souvent ces conséquences. Soutenu par le Centre de recherches pour le développement international (CRDI), CORE réunit 21 projets visant à comprendre les impacts socio-économiques de la pandémie, améliorer les interventions existantes et générer de meilleures options stratégiques pour la reprise. La recherche est principalement dirigée par des chercheurs locaux, des universités, des groupes de réflexion et des organisations de la société civile dans 42 pays d’Afrique, d’Asie, d’Amérique latine et du Moyen-Orient.International Development Research Centr

Why COVID-19 recovery must be gender-responsive

This summary highlights key learning from research from the Covid-19 Responses for Equity (CORE) initiative focusing on the impact the pandemic is having across different vulnerable groups and how gender intersects and often exacerbates these effects. Supported by the International Development Research Centre (IDRC), CORE brings together 21 projects to understand the socioeconomic impacts of the pandemic, improve existing responses, and generate better policy options for recovery. The research is being led primarily by local researchers, universities, thinktanks and civil society organisations across 42 countries in Africa, Asia, Latin America, and the Middle East

Impact evaluation of the Urban Health Initiative in urban Uttar Pradesh, India

The Urban Health Initiative (UHI) was initiated in 2009 with the goal of increasing family planning (FP) use among the poor in urban areas of Uttar Pradesh, India. The Measurement, Learning & Evaluation project (MLE) was tasked with rigorous impact evaluation of the UHI. This paper presents the impact evaluation findings of the UHI program