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Reproductive Health

Use of Facility Assessment Data to Improve Reproductive Health Service Delivery in the Democratic Republic of the Congo

Citation:

Casey, Sara E., Kathleen T. Mitchell, Immaculée Mulamba Amisi, Martin Migombano Haliza, Blandine Aveledi, Prince Kalenga, and Judy Austin. 2009. “Use of Facility Assessment Data to Improve Reproductive Health Service Delivery in the Democratic Republic of the Congo.” Conflict and Health 3: 12.

Authors: Sara Casey, Kathleen T. Mitchell, Immaculée Mulamba Amisi, Martin Migombano Haliza, Blandine Aveledi, Prince Kalenga, Judy Austin

Abstract:

Background:

Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP).

Methods:

Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities.

Results:

None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC.

Conclusions:

Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for health providers in RH and infection prevention; 4) improving referral systems to the hospitals; 5) advocating for changes in national RH policies and protocols; and 6) providing technical assistance for monitoring and evaluation of key RH indicators. Together, these initiatives will improve the quality and accessibility of RH services in the DRC - services which are urgently needed and to which Congolese women are entitled by international human rights law.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2009

Female Solider’s Gynecological Healthcare in Operation Iraqi Freedom

Citation:

Nielsen, Peter. 2009. “Female Solider’s Gynecological Healthcare in Operation Iraqi Freedom.” Military Medicine 174 (11): 1172–6.

Author: Peter Nielsen

Abstract:

OBJECTIVE: To describe female soldiers' predeployment gynecologic healthcare screening, common symptoms, and availability of gynecologic care during Operation Iraqi Freedom.

METHODS: A questionnaire distributed to U.S. military females presenting to outpatient facilities in level 3 echelon of care between August 2005 and March 2006.

RESULTS: Three-hundred ninety seven of 401 surveys (99%) were returned. Ten percent of deployed females (40) had no cervical cytology screening 1 year before deployment and 27% of the 399 required additional treatments for abnormal cervical cytology during deployment. Thirty-five percent reported a gynecologic problem and 44% received care at their base. Irregular bleeding was the most common gynecologic problem. Forty-four percent of women used some form of hormonal contraception; however, 43% changed methods because of unavailability. One-third of soldiers received pre-deployment menses regulation counseling, with 48% of those using continuous oral contraceptive pills for cycle control.

CONCLUSION: Gaps remain in predeployment gynecologic screening and counseling. These critical predeployment medical evaluations must remain a priority for all female soldiers to ensure unit readiness.

Topics: Combatants, Female Combatants, Gender, Women, Health, Reproductive Health Regions: Americas, North America Countries: United States of America

Year: 2009

Congo Ceasefire Brings Little Relief for Women

Citation:

Truscott, Amanda. 2008. “Congo Ceasefire Brings Little Relief for Women.” CMAJ: Canadian Medical Association Journal 179 (2): 133–4.

Author: Amanda Truscott

Topics: Gender, Women, Gender-Based Violence, Health, Reproductive Health, Trauma, Sexual Violence, Male Perpetrators, Rape, SV against women Regions: Africa, Central Africa Countries: Congo-Brazzaville

Year: 2008

Observations from a Maternal and Infant Hospital in Kabul, Afghanistan - 2003

Citation:

Williams, Jennifer, and Brian McCarthy. 2005. “Observations from a Maternal and Infant Hospital in Kabul, Afghanistan - 2003.” Journal of Midwifery & Women's Health 50 (4): 31-5.

Authors: Jennifer Williams , Brian McCarthy

Abstract:

Afghanistan is believed to have one of the highest infant and maternal mortality rates in the world. As a result of decades of war and civil unrest, Afghan women and children suffer from poor access to health services, harsh living conditions, and insufficient food and micronutrient security. To address the disproportionately high infant and maternal mortality rates in Afghanistan, the US Department of Health and Human Services pledged support to establish a maternal health facility and training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected because this hospital admits approximately 36,000 patients and delivers more than 14,000 babies annually. This article reports the initial observations at Rabia Balkhi Hospital and describes factors that influenced women's access, the quality of care, and the evaluation health care services. This observational investigation examined areas of obstetric, laboratory and pharmacy, and ancillary services. The investigators concluded that profound changes were needed in the hospital's health care delivery system to make the hospital a safe and effective health care facility for Afghan women and children and an appropriate facility in which to establish an Afghan provider training program for updating obstetric skills and knowledge.

Topics: Armed Conflict, Gender, Women, Girls, Boys, Health, Reproductive Health Regions: Asia, South Asia Countries: Afghanistan

Year: 2005

Safe Abortion: A Right for Refugees?

Citation:

Lehmann, Aimee. 2002. “Safe Abortion: A Right for Refugees?” Reproductive Health Matters 10 (19): 151–5.

Author: Aimee Lehmann

Abstract:

Thanks to initiatives since 1994, most reproductive health programmes for refugee women now include family planning and safe delivery care. Emergency contraception and post-abortion care for complications of unsafe abortion are recommended, but provision of these services has lagged behind, while services for women who wish to terminate an unwanted pregnancy are almost non-existent. Given conditions in refugee settings, including high levels of sexual violence, unwanted pregnancies are of particular concern. Yet the extent of need for abortion services among refugee women remains undocumented. UNFPA estimates that 25-50% of maternal deaths in refugee settings are due to complications of unsafe abortion. Barriers to providing abortion services may include internal and external political pressure, legal restrictions, or the religious affiliation of service providers. Women too may be pressured to continue pregnancies and are often unable to express their needs or assert their rights. Abortion advocacy efforts should highlight the specific needs of refugee women and encourage provision of services where abortion is legally indicated, especially in cases of rape or incest, and risk to a woman's physical and mental health. Implementation of existing guidelines on reducing the occurrence and consequences of sexual violence in refugee settings is also important. Including refugee women in international campaigns for expanded access to safe abortion is critical in addressing the specific needs of this population.

Topics: Displacement & Migration, Refugees, Gender, Women, Health, Reproductive Health

Year: 2002

Reproductive Health Concerns in Six Conflict-Affected Areas of Sri Lanka

Citation:

Kottegoda, Sepali, Kumudini Samuel, and Sarala Emmanuel. 2008. “Reproductive Health Concerns in Six Conflict-Affected Areas of Sri Lanka.” Reproductive Health Matters 16 (31): 75–82.

Authors: Sepali Kottegoda, Kumudini Samuel , Sarala Emmanuel

Abstract:

This article draws on a study conducted by the Women and Media Collective between 2004 and 2005 to highlight some of the reproductive health concerns of women from Sinhalese, Tamil and Muslim ethnic groups, living in situations of conflict in Sri Lanka. The study focused on women from six conflict-affected areas in the north and east of the country: Jaffna (Northern Province), Mannar and Puttalam (North-Western Province), Polonnaruwa (North-Central Province), Batticaloa and Ampara (Eastern Province). Higher levels of poverty, higher rates of school drop-out, low pay and precarious access to work, mainly in the informal sector, higher rates of early marriage, pregnancy and home births, higher levels of maternal mortality and lower levels of contraceptive use were found. Economic, social and physical insecurity were key to these phenomena. Physically and psychologically, women were at a high risk of sexual and physical violence, mainly from their partners/spouses but also from family members, often related to dowry. The article brings out the voices of women whose lives have been overshadowed by conflict and displacement, and the nature of structural barriers that impede their right to health care services, to make informed decisions about their lives and live free of familial violence.

Keywords: conflict and crisis settings, maternity services, contraception and unwanted pregnancy, gender-based violence, Sri Lanka

Topics: Armed Conflict, Displacement & Migration, Gender, Women, Gender-Based Violence, Health, Mental Health, Reproductive Health, Sexual Violence, SV against women Regions: Asia, South Asia Countries: Sri Lanka

Year: 2008

USAID Program for the Prevention and Treatment of Vaginal Fistula

Citation:

MacDonald, P., and M. E. Stanton. 2007. “USAID Program for the Prevention and Treatment of Vaginal Fistula.” Prevention and Treatment of Obstetric Fistula: Identifying Research Needs and Public Health Priorities 99 (Supplement 1): 112–16.

Authors: P. MacDonald, M. E. Stanton

Abstract:

The cornerstone of the US Agency for International Development (USAID) fistula program is to support and strengthen local capacity for fistula repair. The USAID program includes support to upgrade facilities, enhance local surgical repair capability, allocate equipment and supplies to operating rooms, implement quality improvement systems, and cover the women's transportation costs to and from the treatment facilities. The program also offers training in clinical and counseling skills; transferring skills South-to-South; and monitoring and evaluating the program's effectiveness. As new fistula cases continually increase the backlog of untreated cases, its efforts are also directed toward the prevention of fistula and the reintegration of treated women into their communities. Furthermore, the program challenges the culture of sexual violence against women that leads to traumatic gynecologic fistulas.

Topics: Gender, Women, Gender-Based Violence, Health, Reproductive Health, International Organizations, Sexual Violence, SV against women

Year: 2007

Reproductive Health in Afghanistan: Results of a Knowledge, Attitudes and Practices Survey Among Afghan Women in Kabul

Citation:

Van Egmond, Kathia, Marleen Bosmans, Ahmad Jan Naeem, Patricia Claeys, Hans Verstraelen, and Marleen Temmerman. 2004. “Reproductive Health in Afghanistan: Results of a Knowledge, Attitudes and Practices Survey Among Afghan Women in Kabul.” Disasters 28 (3): 269–82. doi:10.1111/j.0361-3666.2004.00258.x.

Authors: Kathia Van Egmond, Marleen Bosmans, Ahmad Jan Naeem, Patricia Claeys, Hans Verstraelen, Marleen Temmerman

Abstract:

A reproductive-health knowledge, attitudes and practices (KAP) survey was carried out among 468 Afghan women of reproductive age. A convenience sample of women was selected from attendees in the outpatient departments of four health facilities in Kabul. Seventy-nine per cent of respondents had attended at least one antenatal consultation during their last pregnancy. Two-thirds (67 per cent) delivered their first child between 13 and 19 years. The Caesarean-section rate was low (1.6 per cent). Two-thirds (67 per cent) of deliveries occurred in the home. The contraceptive prevalence rate was 23 per cent (16 per cent modern and 7 per cent natural methods). Twenty-four per cent had knowledge of any STIs, although most of these women did not know correctly how to prevent them. Most of the women (93 per cent) needed authorization from their husband or a male relative before seeking professional health-care. In multivariate analysis, women's schooling was significantly associated with antenatal-care attendance (AOR 4.78), institutional delivery (AOR 2.29), skilled attendance at birth (AOR 2.07) and use of family planning (AOR 4.59). Reproductive-health indicators were noted to be poor even among these women living in Kabul, a group often considered to be the most privileged. To meet the reproductive-health needs of Afghan women, the socio-cultural aspects of their situation--especially their decision-making abilities -- will need to be addressed. A long-standing commitment from agencies and donors is required, in which the education of women should be placed as a cornerstone of the reconstruction process of Afghanistan.

Topics: Gender, Women, Health, Reproductive Health Regions: Asia, South Asia Countries: Afghanistan

Year: 2004

Palestinian Women's Sexual and Reproductive Health Rights in a Longstanding Humanitarian Crisis

Citation:

Bosmans, Marleen, Dina Nasser, Umaiyeh Khammash, Patricia Claeys, and Marleen Temmerman. 2008. “Palestinian Women’s Sexual and Reproductive Health Rights in a Longstanding Humanitarian Crisis.” Reproductive Health Matters 16 (31): 103–11. doi:10.1016/S0968-8080(08)31343-3.

Authors: Marleen Bosmans, Dina Nasser, Umaiyeh Khammash, Patricia Claeys, Marleen Temmerman

Abstract:

This paper results from a study conducted in the Occupied Palestinian Territory in September 2002 to test the usefulness of a guide for a comprehensive approach to sexual and reproductive health rights and needs of refugee women. In-depth interviews with key informants from 19 organisations and two focus group discussions were carried out in the West Bank and Gaza. Three refugee camps were visited as well as five health facilities. The findings revealed that severe restrictions on mobility had reduced access to health facilities for both staff and patients in a significant way. For pregnant women, this had resulted in decreased access to antenatal and post-natal care and an increasing number of home deliveries, induced deliveries and deliveries at military checkpoints. Lack of donor interest and withdrawal of donor support were mentioned as hampering the implementation of the National Reproductive Health Guidelines, and the sustainability and quality of existing sexual and reproductive health services. Family planning had become a politically sensitive issue, and there were indications of increased gender-based violence. Lack of access to reproductive health services was the most visible aspect of the impact of the conflict on women's sexual and reproductive health. Little attention is paid to the less visible evidence that women's reproductive rights have been subordinated to the political situation.

Topics: Displacement & Migration, Refugees, Gender, Women, Gender-Based Violence, Health, Reproductive Health Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2008

Raising Institutional Delivery in War-Torn Communities: Experience of BRAC in Afghanistan

Citation:

Hadi, A., T. Rahman, D. Khuram, J. Ahmed, and A. Alam. 2007. “Raising Institutional Delivery in War-Torn Communities: Experience of BRAC in Afghanistan.” Asia Pacific Family Medicine 6: 1–9.

Authors: A. Hadi , T. Rahman, D. Khuram, J. Ahmed, A. Alam

Abstract:

Aims: Although reproductive health services have been expanded in rural communities in Afghanistan in the last several years, no systematic attempt has been made to assess their contribution to promote safe delivery. This study assesses the effects of the Bangladesh Rural Advancement Committee (a non-government organisation) health programme in raising institutional delivery in post-conflict traditional communities in Afghanistan.

MethodsData for this study came from two surveys conducted by Management Science of Health/United States Agency of International Development in 2004 and 2006 in the district of Paghman in Kabul province. A total of 180 randomly selected married women who gave birth in the last 2 years preceding the survey were interviewed.

ResultsFindings reveal that institutional delivery in rural communities has been increasing even in post-conflict poor rural communities. The use of services was much higher if antenatal care was provided by midwives and physicians. Intensive community mobilization, provision of free services and transport facilities at night, incentives to health providers, maintaining privacy in the delivery room and the quality of services were the key factors in raising the number of institutional deliveries.

ConclusionsThe provisions of free services and incentives for health providers worked well in raising the frequency institutional delivery. Given that Afghan communities are sparsely distributed in the countryside and largely inaccessible by most modern transport, the expansion of this approach to provide institutional delivery may not be feasible at this stage. This study argues for the promotion of new approaches to maternal health by testing the cost-effective intervention models. The study concludes that an integrated approach to address health services can significantly improve access to and the utilization of institutional delivery among poor and disadvantaged communities in Afghanistan.

Topics: Armed Conflict, Gender, Women, Health, Reproductive Health, International Organizations Regions: Asia, South Asia Countries: Afghanistan

Year: 2007

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