Improving the reproductive health of youth in Mexico

This project assessed the impact of the Mexican Foundation for Family Planning’s Young People Program (YPP) on: a) the attitudes of community stakeholders toward informing youth about reproductive health issues and making reproductive health services available for sexually-active youth; b) the sexual and reproductive health knowledge, attitudes, and behaviors of adolescents; and c) the way that providers offer reproductive health services to adolescents. In addition, the project determined whether adding a school-based sex education component increased the impact of community interventions on the knowledge, attitudes, and behaviors of adolescents. Survey results showed that the reproductive health knowledge and attitudes of adolescents were quite positive to begin with, and that they improved over the course of the project. Other results showed that community stakeholders also had quite positive attitudes, that often improved over time, regarding the delivery of information and services to adolescents. Several suggestions to improve the YPP are made, such as decreasing the turnover of young people coordinators, peer promoters, and multipliers; focusing on the populations most in need; increasing the proportion of information and supply-giving activities; improving the management information system; and improving the focus of the catchment areas

Reproductive health care in the postnatal period in Guatemala

This operations research study aimed to develop and test a job aid to provide comprehensive care to mothers and children during the first year postpartum; to train physicians, nurses, auxiliary nurses, and social workers in its use; and to develop and test strategies and materials for training community health agents to promote services for new mothers during the first year postpartum. It also collected data to establish if these strategies were effective in improving the quality and comprehensiveness of the care received by mothers and children less than one year of age. Drawing from exit interviews, the intervention appeared to be successful, increasing the likelihood that women receive preventive services when they attend health facilities. However, there were no significant changes in the amount of actual information provided to women, the quality of the services received by each mother at health facilities, service providers’ knowledge about danger signs, or preventive behaviors recommended by service providers. The report lists several factors that may account for these results

Introduction of quality of care and a gender perspective in reproductive health service organizations in Latin America and the Caribbean

In 2005 and with the technical assistance of the Frontiers in Reproductive Health (FRONTIERS) Program, the Integrated Health Coordination Program (PROCOSI), a Bolivian network of 33 nongovernmental organizations, designed and tested a set of four guidelines to help organizations deliver high-quality reproductive health services with a gender perspective. The guidelines were: 1) to present a strategy to certify organizations as “gender sensitive” healthcare providers; 2) to present the knowledge staff members should know to be certified; 3) to describe procedures to collect and analyze the data to evaluate implementation of the strategy; and 4) to describe how to assess strategy implementation costs. In PROCOSI’s experience, a large proportion of participating clinics were able to improve the quality of services. During the follow-up period, FRONTIERS staff provided technical assistance to the Bolivian Ministry of Health and Sports, the Salvadoran Social Security Institute, the IPPF-affiliate in Peru, Instituto Peruano de Paternidad Responsable, and the Honduran Women and Family Association in order to present the strategy to managers, conduct baseline studies, prepare work plans, and select achievement indicators

Increasing women\u27s use of the IUD for family planning

The intrauterine device (IUD) is highly effective, easy to use, and has few side effects. The device costs the provider about US$2 and offers a duration of protection that makes it the most cost-effective of the temporary methods if used for two years or more. The IUD\u27s many advantages also make it a good alternative for reducing unmet need for long-term contraception around the world. Between 5 and 17 percent of all married women of reproductive age in 53 less developed countries do not want to have more children but are not using a contraceptive method. Because the IUD can be provided in primary health centers and posts at low cost, it can help women achieve their fertility goals, especially in rural areas. Despite these advantages, the IUD is underused. FRONTIERS conducted projects in Africa, Asia and the Near East, and Latin America and the Caribbean to understand why the IUD is not used more extensively and to test strategies to make it more accessible and acceptable for couples. This brief describes findings from these studies and suggests approaches for increasing the availability and use of IUD services

Meeting the family planning needs of postpartum women

The first days, weeks, and months after a delivery represent a period of substantial information and service needs for both mother and child, including treatment of hemorrhage and infections, breastfeeding information and support, nutritional complements and micronutrients, immunizations for children and mothers, counseling for managing intimate partner violence and depression, and, most importantly, contraception. In areas of high HIV prevalence, contraceptives and antiretroviral therapy are especially critical elements of postpartum care. Yet despite its strategic importance, few organizations have made it a priority to address women\u27s reproductive health and fertility needs during the year following delivery. The situation is compounded by the scarcity of postpartum care in many countries, creating a major public health concern. This brief focuses on the degree to which service delivery organizations in sub-Saharan Africa, Asia and the Near East, and Latin America and the Caribbean meet the contraceptive needs of women in the postpartum period and the strategies they have tested for doing so. The brief principally relies on reviewing the results and lessons learned from operations research projects conducted by the Population Council’s FRONTIERS program

Mexico: Informing service providers and factory workers about emergency contraception

The goal of this project was to inform physicians, pharmacists, and female factory workers about emergency contraception (EC) through mailings of booklets and posters. These materials were developed in a previous operations research project conducted by the Instituto Mexicano de Investigación de Familia y Población and supported by the Population Council INOPAL III project with funding from USAID. The study found that recipients generally liked the print materials and welcomed information about EC. Within three weeks of receiving the materials, many reported that they had taken immediate action to make EC available and/or to educate others about EC. This project demonstrated that targeted mailings to key audiences can increase awareness of emergency contraception at a relatively low cost. The report recommends that public and private agencies in Mexico and other Spanish-speaking countries replicate or modify the existing materials and distribute them widely

Mexico: Protecting informed consent

The objective of this three-month project in Mexico was to disseminate information among key audiences about: 1) the right of women to choose contraceptive methods in a free and informed manner; and 2) the laws and institutions available to help redress any violations of this right. Four publications on these topics, developed by a previous project funded by Population Council/INOPAL III, were reproduced and distributed to 2,750 people in the following target audiences: women of reproductive age; reproductive health service providers; national and state commissions of human rights, complaints offices in public hospitals, feminist and human rights organizations; and legal professionals, such as judges, lawyers, and ministry officials. The project illustrates the value of making research findings available in different formats, including print, interpersonal and electronic, tailored to key audiences. The report recommends that projects allow sufficient time after research completion to produce and distribute summaries of the research findings, respond to information requests, and assess the impact and extent of dissemination activities

Use of systematic screening to increase the provision of reproductive health services in Bolivia

The objective of this study was to determine if the use of a checklist to screen for unmet service needs could increase the number of services per visit provided to clients using rural Bolivian health facilities. 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. Findings show that, 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. The Bolivia Ministry of Health plans to scale-up the intervention

Developing and testing strategies for increasing awareness of the IUD as a contraceptive option

A workshop was held in England in 2004 to identify the most promising interventions for increasing access to the IUD and to generate protocols for small-scale operations research projects to be undertaken in selected countries. Participants were academics, policymakers, program staff, and service providers from Bangladesh, Ghana, Guatemala, Honduras, India, Kenya, and Nepal. The workshop objectives were to review international experiences with approaches to increase access to and use of the IUD; identify factors explaining the decline in IUD use in many countries; identify factors favoring client demand for IUD; review barriers to effective IUD service delivery; identify issues of access and equity in provision for poor and under-served groups; and prepare the basic elements for protocols for operations research studies to address the factors identified. Participants made nine presentations of research projects and developed OR project proposals that could later be finalized and submitted for funding. This report summarizes the presentations, proposals, and outcomes

Consolidating a gender perspective in the PROCOSI network

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed standards, and their achievement was recognized in a public certification ceremony. The project succeeded in developing a cost-effective strategy to incorporate a gender perspective. Drawing from the lessons learned by implementing and evaluating this strategy, the report offers a number of recommendations concerning the program’s future utilization including ways to ensure the continuity of certification processes