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A qualitative evaluation of the impact of the Stepping Stones sexual health programme on domestic violence and relationship power in rural Gambia.
[Unpublished] 2002. Presented at the 6th Global Forum for Health Research, Arusha, Tanzania, November, 2002.  p.The work presented here came from a preliminary evaluation and was followed up by several applications for funding to carry out a prospective community randomised trial. So far none have been accepted. This may be partly due to the fact that such an evaluation runs against current funding culture. Because of it's holistic approach and focus on core skills in couple communication, the Stepping Stones programme is neither just an HIV prevention or just a domestic violence prevention programme, but has something to contribute to both (and would see the two problems as inter-related). Funding on the other hand is often organised 'vertically' by problem, and evaluation criteria may differ from one problem to another. For example donors who fund evaluation of HIV prevention activities usually require a biological outcome, and hence concentrate on geographical areas with high HIV incidence where the epidemic is seen as most severe. Where sociological outcomes are used this tends to be either the use of quantitative tools to assist in risk factor analysis, or qualitative tools which can assist in replication of the intervention. As such they are usually considered secondary to the primary (biological) outcomes. The hope here is that these interventions may provide a 'blueprint' which can subsequently be applied in low prevalence areas. However by concentrating on proximal rather than distal determinants of infection these blueprints may only capture 'half the story', leading to locally inappropriate assumptions about which groups or behaviours HIV prevention programmes should target. An example would be the demand by some donors that interventions should have an exclusive focus on adolescents, when in a polygamous society adolescent's risk is often mediated by the older generation. On the other hand community interventions against domestic violence are forced to rely on self reported behaviour (perhaps backed up by participant observation) as an outcome. If the intervention is also a reflexive process then qualitative studies become essential to describe a process of change which contains empowerment, group dynamic and normative dimensions. The locally appropriate nature of such interventions is used to justify participatory interventions as being more effective than didactic approaches, but at the same time in the epidemiological-evaluation paradigm it can be seen as problematic, because (I would argue incorrectly) a participatory process is assumed to generate a wide spectrum of outcomes (low replicability), which mitigates against quantitative evaluation. (excerpt)
PEOPLE AND DEVELOPMENT CHALLENGES. 1997 May; 4(7):13-4.Member family planning associations in the East, South East Asia, and Oceania Region (ESEAOR) of the International Planned Parenthood Federation (IPPF) have long recognized the importance of having a strong volunteer base for resource development and program sustainability. About 60 volunteers currently participate in the Planned Parenthood Federation of Korea's (PPFK) hotline counseling service for adolescents launched in 1985 with financial assistance from the IPPF. Upon recruitment, the volunteer trainees receive 40 hours of basic training, followed by refresher training courses held 6 times per year. The volunteers, mostly women, are encouraged to fill in for each other when unexpected family problems arise. The difficult and delicate nature of sexuality counseling, however, has led some volunteers to abandon work in the counseling program. The Japan Family Planning Association's (JFPA) Reproductive Health Center Clinic is staffed by 1 full-time doctor, 4 part-time doctors, 1 full-time clerical staff, 30 part-time co-medicals who are mainly nurses and midwives, and 6 peer counselors who operate the hotline on infertility. The co-medicals are qualified family planning workers (FPWs) and adolescent health workers (AHWs) who receive a small honorarium for their services. FPWs must attend and pass the examination of the Licensing Course for FPW implemented by the JFPA and the Family Planning Federation of Japan. AHWs are trained by the JFPA under the auspices of the Health Ministry and the Japan Society of Adolescentology.
[Comments on reproductive health and obligations since Cairo] Comentario. Salud Reproductiva y Obligaciones Dupues de El Cairo.
In: IV Reunion Nacional sobre Poblacion, [sponsored by] United States. Agency for International Development [USAID], Asociacion Multidisciplinaria de Investigacion y Docencia en Poblacion, United Nations Population Fund [UNFPA]. Lima, Peru, PROPACEB, 1995 Sep. 127-8.The family planning programs of the 1950s and 1960s were vertical and stressed contraception, while in the 1970s a natural association was created with maternal-child health care. The accords of the Cairo conference on population incorporated socioeconomic development, the right of health, and reproductive and sexual health rights. Actions in the health sector deal with family planning (with a focus on men and adolescents); maternal health (from menarche to menopause, with a focus on adolescence); abortion (the high rate of induced abortion makes imperative prevention efforts in education, counseling, and increasing contraceptive use rates); reproductive tract infections (of concern are the increasing numbers of sexually transmitted disease and HIV cases, as well as the culture of silence among the poorest that permits pelvic pain, leukorrhea, and dyspareunia to be considered the normal and untreated afflictions of womanhood); and infertility (with its relationship to sexually transmitted diseases and tuberculosis).
[Reproductive health: agreements and obligations since Cairo] Salud reproductiva: acuerdos y obligaciones despues de El Cairo.
In: IV Reunion Nacional sobre Poblacion, [sponsored by] United States. Agency for International Development [USAID], Asociacion Multidisciplinaria de Investigacion y Docencia en Poblacion, United Nations Population Fund [UNFPA]. Lima, Peru, PROPACEB, 1995 Sep. 83-92.The outcome of the International Conference on Population and Development held in Cairo in 1994 had important implications for the development of future programs. Since the end of the 1950s family planning programs have been characterized by an emphasis on contraception, measuring effectiveness by means of continuation rates and new acceptors. In the 1970s it became clear that family planning also had to be associated with maternal-infant health. The 1984 conference in Mexico revealed the importance of the condition of women as relating to problems of fertility, morbidity, mortality, and family formation. The central topic of the Cairo conference was that the right to health includes reproductive health. The Program of Action had a section on reproductive rights and reproductive health from a social perspective. This also means the right to information, services, and family planning methods. The conference accepted five actions relating to family planning, maternal health, abortion (in Peru there were 271,150 abortions out of 905,400 pregnancies in 1989), infections of the reproductive tract including AIDS, and infertility caused by tuberculosis and STDs. Actions outside the health sector relate to problems of the population and health with socioeconomic development and improvement of the status of women and equality with men. Other objectives deal with the elimination of all discrimination against girls, the participation of women in the programs, access to education, and the elimination of poverty.
Reproductive health: a key to a brighter future. Biennial report 1990-1991. Special 20th anniversary issue.
Geneva, Switzerland, World Health Organization [WHO], 1992. xiii, 171 p.WHO established its Special Programme of Research, Development, and Research Training in Human Reproduction in 1972 to promote, coordinate, conduct, and evaluate research in human reproduction in both developed and developing countries. Its aim is to assist developing countries meet the reproductive health needs of their populations. The first section of the biennial report discusses the reproductive health status in the world including fertility regulation, sexual health, infertility, and safe motherhood since 1972. Despite considerable progress in the last 20 years, unmet needs remain substantial. New environmental concerns related to population growth and maternal and child health concerns, women's status, and human development all dictate a sense of urgency. The second section covers specific activities of the Programme in the last 20 years. It includes the results of an external evaluation of the effect the Programme has had. It found the Programme's effect to be most successful due to its collaborating centers and multicenter trials and studies, epidemiologists, clinicians, and laboratory scientists. This section also includes viewpoints from China, Kenya, and Mexico. 2 former directors of the Programme present a historical account of the Programme's accomplishments. The third section discusses progress the Programme had made during 1990-91. It specifically covers development and assessment of fertility regulation technologies, prevention of infertility, improving family planning choices through systematic introduction and proper management of contraceptive methods, epidemiologic research, social measurements of reproductive health, and improving capacity for key national reproductive health research.
CEYLON MEDICAL JOURNAL. 1990 Dec; 35(4):136-42.The story of the Sri Lankan Family Planning movement is told from its inception in 1953, prompted by a visit by Margaret Sanger 1952. The Family Planning Association of Sri Lanka was founded with the health of women and children, and both contraception and infertility treatment as its policies. The first clinic, called the "Mothers Welfare Clinic," treated women for complications of multiparity: one woman was para 26 and had not menstruated in 33 years. The clinic distributed vaginal barriers, spermicides and condoms, but the initial continuation rate was <5% year. Sri Lanka joined the IPPF in 1954. In 1959, after training at the Worcester Foundation, and a personal visit by Pincus, the writer supervised distribution of oral contraceptives in a pilot project with 118 women for 2 years. Each pill user was seen by a physician, house surgeon, midwife, nurse and social worker. In 1958 Sweden funded family planning projects in a village and an estate that reduced the birth rate 10% in 2 years. The Sri Lankan government officially adopted a family planning policy in 1965, and renewed the bilateral agreement with Sweden for 3 years. In 1968 the government instituted an integrated family planning and maternal and child health program under its Maternal and Child Health Bureau. This was expanded in 1971 to form the Family Health Bureau, instrumental in lowering the maternal death rate from 2.4/1000 in 1965 to 0.4 in 1984. During this period IUDs, Depo Provera, Norplant, and both vasectomy and interval female sterilizations, both with 1 small incision under local anesthesia, and by laparoscopic sterilization were adopted. Remarkable results were being achieved in treating infertile copies, even from the beginning, often by merely counseling people on the proper timing of intercourse in the cycle, or offering artificial insemination of the husband's semen. Factors contributing to the success of the Sri Lankan planned parenthood program included 85% female literacy, training of health and NGO leaders, government participation, approval of religious leaders, rising age of marriage to 24 years currently, and access of all modern methods.
[Main objectives of the WHO Special Program on Human Reproduction] Osnovnye napravleniia Spetsialnoi Programmy VOZ po Reproduktsii Cheloveka.
AKUSHERSTVO I GINEKOLOGIIA. 1984 Jul; (7):3-6.The WHO Special Program on Human reproduction was established in 1972 to coordinate international research on birth control, family planning, development of effective methods of contraception, and treatments for disorders of the human reproductive system. The Program's main objectives are: implementation of family planning programs at primary health care facilities, evaluation of the safety and effectiveness of existing birth control methods, development of new birth control methods, and development of new methods of sterility treatment. In order to attain these goals, the Program forth 3 major tasks for international research: 1) psychosociological aspects of family planning, 2) birth control methods, and 3) studies on sterility. Since most of the participating nations belong to the 3rd World, the Program is focused on human reproduction in developing countries. The USSR plays an important role in the WHO Special Program on Human reproduction. A WHO Paticipating Center has been established at the All-Union Center for Maternal and Child Care in Moscow. Soviet research concentrates on 3 major areas: diagnosis and treatment of female sterility, endocrinological aspects of contraception, and birth control prostaglandins.
London, Eng., International Planned Parenthood Federation, 1980. 43 p.Add to my documents.
Report of the Expert Group Meeting on Fertility and Mortality Levels, Patterns and Trends in Africa and their Policy Implications.
In: United Nations Economic Commission for Africa [UNECA]. Population dynamics: fertility and mortality in Africa. Addis Ababa, Ethiopia, UNECA, 1981 May. 1-31. (ST/ECA/SER.A/1; UNFPA PROJ. No. RAF/78/P17)The Expert Group Meeting on Fertility and Mortality Levels, Patterns and Trends in Africa, held in Monrovia late in 1976, examined the various aspects of the interrelationships of fertility and mortality to development process and planning in Africa. Focus in this report of the Expert Group Meeting is on the following: background to fertility and mortality in Africa; usefulness and relevance of existing methodology for collecting and processing and for analyzing fertility and mortality data; fertility and mortality levels and patterns in Africa -- regional studies and country studies; fertility trends and differentials in Africa; mortality trends and differentials; biological and socio-cultural aspects of infertility and sterility; the significance of breast feeding for fertility and mortality; nutrition, disease and mortality in young children; evolution of causes of death and the use of related statistics in mortality studies in Africa; and fertility and mortality in national development. It was suggested that a strategy for development with equity must direct itself, among other things, to the issue of how to monitor progress in the elimination of underdevelopment, poverty, malnutrition, poor health, bad housing, poor education and employment through the use of indicators which measured changes in those variables at the national and local levels. In order to achieve development with equity, it was obvious that demographers and policymakers should ensure that there was regular monitoring of socioeconomic differentials in mortality and morbidity rates since such differentials essentially measured inequality in a society. The following were included among the recommendations made: recognizing that fertility and mortality data for a majority of African countries are now 20 years out of date, efforts should be directed toward collecting and analyzing fertility and mortality data by the use of both direct and indirect methods; and international and national organizations should support country efforts to improve the supply of data and analytical work on census and other existing data.
London, International Planned Parenthood Federation, 1979. 58 p.This International Planned Parenthood report states the agency's policy position on management of infertility, and then briefly goes on to cover the following topics, in handbook form: 1) epidemiology of infertility; 2) etiology of infertility; 3) proper infertility counseling; 4) prevention (trauma avoidance and early treatment of diseases); 5) diagnostic techniques for the couple, man, and woman; 6) treatment of infertility in women and men; 7) use of artificial insemination, both with donor's semen and partner's semen; and 8) the place of adoption within the community of infertile couples. Prevalence of infertility is placed at an international average of 10%, though places such as Cameroon have rates as high as 40%. The factors influencing infertility are divided into 3 groups: 1) socio-cultural, 2) sexually transmitted diseases, and 3) other diseases and disorders. Causes of female infertility include: ovulation dysfunction; tubal obstruction or dysfunction; uterine actors such as fibroids, polyps, or developmental abnormalities; cervical abnormalities; vaginal factors, such as severe vaginitis or imperforate hymen; endocrine and metabolic factors, particularly thyroid disturbances, diabetes, adrenal disorder, severe nutritional disorders (anemia), or other systemic conditions; and repeated pregnancy wastage. Male causes include poor semen quality; ductal obstruction; ejaculatory disturbances (i.e., failure to deliver sperm to vagina); emotional stress (may lead to hypogonadism); and genetic factors (Klinefelter syndrome). Causes specific to the couple include lack of understanding of reproductive physiology, immunoloigcal incompatibility, nutritional deficiencies, and psychogenic factors.
In: All India Conference on Family Planning. (Report of the proceedings of the third conference, January 5-9, 1957, Calcutta.) Bombay, Family Planning Association of India, 1957. p. 137-153. 1957The work of the Family Planning Association of India since its last All India Conference in Lucknow in January 1955 is reported. The Lucknow Conference recommended a Scientific Seminar on Family Planning which was held in November 1955. Clinic work continues. Specialized training, including a visiting specialist, is being provided for doctors, health and social workers, before they begin work in family planning clinics. The publicizing of correct information in the family planning area has been emphasized. Under the Five-Year Plan, the government of India is funding many family planning services. The local association in India is maintaining international contacts.
Geneva, Switzerland, WHO, 1983 Nov. 167 p.As the main instrument within WHO for promoting and coordinating international research and development relating to family planning, the Special Programme aims to improve the health status of the populations of developing countries by: devising improved approaches to the delivery of family planning care in the primary health care context; assessing the safety of existing methods of fertility regulation; developing new birth control technology; and generating the knowledge and technology required for the prevention and treatment of infertility. The 2nd and related objective of the Programme is to promote national self-reliance for research in family planning by collaborating with national authorities in building up manpower and facilities that will enable developing countries to plan and carry out research, adapt technology, and contribute fully to the advancement and application of science. The major topics under review are research and development, institution strengthening, dissemination of information, and relations with industry and patents. The chapter on research and development includes a discussion of: delivery of family planning care; current methods of fertility regulation; development of new methods such as new intrauterine devices, sterilization and birth control vaccines; infertility; and interagency coordination on biomedical research in fertility regulation.