The public sector's role in infertility management in India.

This objective of this paper is to explore the public sector's role in infertility management in India. It focuses on services available in the public sector, problems faced by and critiques of public sector providers. A postal survey was conducted with a sample of 6000 gynaecologists and in-depth interviews were conducted with 39 gynaecologists in four cities. The role of the public sector in infertility management is weak as even basic investigations and services were limited or incomplete. Inadequate infrastructure, inappropriate management including time management, lack of information and training, absence of clear protocols at all levels, private practice by public health doctors, pre-occupation with other health issues and lack of regulation were the main problems mentioned by providers. Amongst key recommendations are realistic and low-cost management, streamlining and regulating services, counselling of couples, providing information and raising awareness of patients, health personnel and policy makers

Seeking conception: experiences of urban Indian women with in vitro fertilisation.

OBJECTIVES: This paper reports on a study of involuntarily childless Indian women/couples seeking in vitro fertilisation (IVF). The focus is on the social context of infertility and on women's perceptions of and experiences with IVF. METHODS: Twenty-two childless women/couples who sought IVF. The sample was drawn from consenting clients of clinics in two major Indian cities, viz. New Delhi and Mumbai. RESULT: In-depth interviews revealed that infertility is deeply feared, women's status and security are affected, and they experience stigmatisation and isolation. IVF was pursued after less intrusive avenues had been exhausted. Inadequate information/counselling is provided, success rates are low, IVF is commercialised and the process is physiologically, emotionally and financially stressful. CONCLUSION: In Indian society fertility defines womanhood and motherhood, and infertility is stigmatised. Women faced a lot of pressures to produce a biological child, and go through all kinds of treatments, including the expensive ARTs, to have a child. PRACTICE IMPLICATIONS: Integration of infertility services into the state's reproductive health programme and disseminate information on infertility and to offer other appropriate choices, such as adoption. Effective counselling on coping with psychosocial/sexual problems. Monitoring of the prevalence of sex preselection

Malawi (2015): WASH Baseline study in primary schools of Nkhatabay, Salima and Mangochi districts.

Numerous interventions have been implemented to reduce incidence of diarrhea among the vulnerable groups in Malawi. Hand Washing with Soap (HWWS) is the single-most cost-effective health intervention with regard to diarrhea prevention. The national HWWS campaign was initiated to transform small scale or ad hoc efforts into a single, well-coordinated and comprehensive intervention. Children in primary schools form the key target group as their habits may be more easily molded at a young age, and they may serve as agents of change by reinforcing the selected hygiene practices within the home environment. The goal of this study was to assess whether the planned hand washing intervention in schools results in behavior change among school-aged children. The study also assessed whether children are effective as behavior change agents for proper hand washing among peers, family, and the wider community. The study used three methods: 1. Assessments of Schools at baseline and endline to observe hand washing stations; 2. Key Informant Interviews at baseline and endline with school administrators to understand OAMs around provision of soap and access to HWF in schools; and 3. Endline Assessment of Student Households including surveys with both randomly selected students and one caregiver of each student from participating schools, as well as observation of handwashing facilities and soap availability within households

Assisted reproductive technologies in India: the views of practitioners.

BACKGROUND: This article documents the context of Assisted Reproductive Technology/ies (ART) services and providers' perceptions regarding services offered in India. The objective is to facilitate understanding of critical issues and relevant concerns. METHODS: A postal survey conducted with a sample of 470 gynaecologists and in-depth interviews with 39 gynaecologists in four cities. RESULTS: ART clinics have proliferated in cities and towns; they are commercialised and the quality of treatment is variable. Most providers perceived that patients lack knowledge about infertility and ART, costs are high, investigations unnecessarily repeated and success rates low. ART providers do not have clear selection criteria, some lack rigorous specialised training and infrastructure and most are deficient in record-keeping and counselling and lack transparency. Monitoring and regulation by appropriate authorities are also lacking. CONCLUSION: Both providers and regulatory authorities need to look critically at exploitation of patients and commercialisation, excessive costs, lack of information, informed consent, and transparency, counselling, unethical practices, variations in quality of treatment and ensuring proper monitoring and regulation