Elements of Family Planning Success

This report presents the results of a situation analysis of the provision and use of contraception in Postpartum, Postabortion and Prevention of Mother-to-Child transmission of HIV (PMTCT) Services in Haiti. The Centre d'Evaluation et de Recherche Apliquee (Center for Evaluation and Applied Research or CERA), a Haitian health research and evaluation consulting firm, was responsible for the data collection, cleaning, and entry processes. FRONTIERS provided CERA with technical assistance throughout these phases and analyzed the data. Data were collected between November and December 2006 from a sample of 41 public, private and mixed health establishments in five of Haiti's 10 departments, including the three most heavily populated departments. Data were collected through: content analysis of the National Family Planning and Maternal Health Norms; inventories of equipment, supplies, and service statistics in family planning, antenatal care, delivery care, maternal and child care in the extended postpartum, and PMTCT services; structured interviews with health providers; exit interviews with women in antenatal, delivery, and postpartum care and women in the six-month postpartum period visiting a health outlet for any reason; and with women living with HIV and receiving care in an integral care unit (ICU); observation of client-provider interactions in antenatal, delivery and postabortion care by non-participants; focus groups with women who had delivered recently, women who had delivered in the last six months and women who did not use reproductive health services. (excerpt)

This community situational analysis determined factors impacting the utilization of maternal health services in South Africa. Quantitative and qualitative research methods were used, including semistructured household interviews, case studies of women with no antenatal care and/or home birth, and verbal/social autopsies of maternal and infant deaths, conducted in three diverse sites across the country. Data analysis used quantitative statistics for the semistructured interviews and a qualitative thematic content approach for the case studies and verbal/social autopsies. Each component was analyzed separately and then triangulated. The following themes emerged: 1) transport and distance to care were the biggest problems, particularly in rural areas; 2) providers' communication with families was very poor; 3) health-seeking behavior was better than anticipated; 4) treatment by health providers and quality of care showed mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and neonatal service quality cannot be overlooked; and 6) families and communities are an untapped resource for improving maternal and neonatal health. Implications for maternal and infant health care in developing countries are discussed, with a particular focus on barriers to utilization and involvement of communities and families in maternity care. (author's) | This community situational analysis determined factors impacting the utilization of maternal health services in South Africa. Quantitative and qualitative research methods were used, including semistructured household interviews, case studies of women with no antenatal care and/or home birth, and verbal/social autopsies of maternal and infant deaths, conducted in three diverse sites across the country. Data analysis used quantitative statistics for the semistructured interviews and a qualitative thematic content approach for the case studies and verbal/social autopsies. Each component was analyzed separately and then triangulated. The following themes emerged: 1) transport and distance to care were the biggest problems, particularly in rural areas; 2) providers' communication with families was very poor; 3) health-seeking behavior was better than anticipated; 4) treatment by health providers and quality of care showed mixed results; 5) HIV/AIDS is a major issue; however, basic maternity and neonatal service quality cannot be overlooked; and 6) families and communities are an untapped resource for improving maternal and neonatal health. Implications for maternal and infant health care in developing countries are discussed, with a particular focus on barriers to utilization and involvement of communities and families in maternity care.

Emergency contraceptive pills are now available on a nonprescription basis in over 25 countries worldwide. In an effort to learn about women’s experiences with this new means of emergency contraception (EC) service delivery, we conducted focus-group discussions with nonprescription EC users from France, Norway, Portugal and Sweden. Participants from these countries overwhelming supported pharmacy access to EC, explaining that pharmacy delivery facilitated rapid access to the method. Despite expressing mixed reviews of the counseling given by the providing pharmacists, participants reported that they knew how use the method safely and properly. Most indicated that the package insert was easy to understand and adequately answered the majority of their questions. Participants described the EC experience as a motivating factor that, in many cases, has led to more consistent use of regular contraceptive methods. These data are valuable to policy-makers and institutions interested in learning more about the safety and acceptability of nonprescription access to emergency contraceptive pills. (author's)

Objective: To understand how personal and social attitudes are changing regarding more available safe abortion in Europe. Results: Abortion has been commonly practiced for a long time throughout most of the world, either in legal or illegal conditions, but it is a subject that arouses passion and controversy, because abortion raises two important issues, namely sex and life, sometimes mixed with religion and ethics. Over the past few years, we have observed changes in laws, and personal and professional attitudes towards abortion. Social needs modify the attitudes of the authorities and individuals. In many countries where the performance of abortion is illegal, statistics indicate that large numbers of abortions are carried out, but authorities are indifferent, ignore or tolerate it or even unofficially license clinics for the abortion. In some other countries where abortion is technically legal, access to authorized facilities and personnel may be limited, or resources to pay for the abortion may be lacking, resulting in more illegal abortions. There are, therefore, two categories of abortion: legal versus illegal, and safe versus unsafe. However, laws are changing, becoming even more liberal, even it, in certain nations, there are renewed attempts to question the right of' women to decide. Practice is changing and in some cases becoming separate from the law. Basic ideas are changing, because, in a large number of European countries, we are moving from a culture of abortion to a culture of contraception and prevention of abortion, through an effort of governments, women, professionals, and non-governmental organizations. Certainly, important steps have been taken in the different ways of performing an abortion. For example, we have seen the arrival of medical abortion, with the use of mifepristone and misoprostol. Finally, there is also a change in the way of supporting women through humane and complete counseling, which includes attention to follow-up services offering a choice of contraceptive methods to help women avoid another unwanted pregnancy. Conclusions: There is some resistance at different levels, but attitudes are changing in a positive way throughout Europe, offering a good quality of service, good facilities, well-trained practitioners and more open minds. (author's)

South Africa's Termination of Pregnancy Act, the most liberal abortion law in Africa, took effect early in 1997. In spite of the anticipated benefits to women's health, however, public reaction has been mixed. In the country's most populous province, KwaZulu/Natal, opposition is strong and most health care providers have refused to provide the service. This study explored attitudes and beliefs about abortion and the Termination of Pregnancy Act among primary care nurses and community members in a rural district in order to better understand barriers to implementation of the new law. As part of a community survey on women's reproductive health (n = 138), questions on knowledge, attitudes and beliefs about abortion were asked, as well as awareness of the provisions of the Termination of Pregnancy Act. To better understand the perspectives of health care workers, a survey among primary care nurses on duty (n = 25) was also conducted. In-depth interviews were conducted with both nurses and women in the community to further pursue issues raised in the two surveys. Support for the Act was low (11%) among both community members and nurses, and few supported abortion on request (18% and 6%, respectively). Within each group, however, a clear hierarchy of support was observed: a majority of nurses (56%) and community members (58%) supported abortion in the case of rape of incest, or if the continued pregnancy would endanger a woman's health (61% and 56%, respectively), few supported abortion for social or economic reasons. In-depth interviews revealed that abortion is seen as contrary to prevailing community norms; nurses were poorly informed about the Termination of Pregnancy Act and felt confused in their professional responsibilities. Legalization alone cannot ensure implementation of abortion services. In South Africa, extensive media coverage prior to passage of the law ensured almost universal awareness of the Act, but little public education took place at the same time. In spite of general opposition to the law, however, there is an encouraging level of support for abortion in some circumstances. These findings suggest that abortion services can be implemented, even in conservative rural areas, but that a process of information dissemination and community consent prior to implementation is essential. Locating abortion within broader reproductive health services could be an effective way to improve access and acceptability. (author's)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed Target based activity to client-centred-demand driven quality services. An attempt is being made by the GOI to not only reorient the programme and the service providers? attitude at grassroots level but also to strengthen the services at outreach level. The new approach requires decentralization of planning, monitoring and evaluation of services. To achieve such an objective, the GOI is interested in generating district level data, other than service statistics, on the utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey in all the districts in the country. About 50 per cent of the districts have been covered in 1998. The remaining 50 percent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunization services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires the decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested in generating district level data, other than service statistics, on utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in 1998. The remaining 50 per cent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires the decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested in generating district level data, other than service statistics, on utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in 1998. The remaining 50 per cent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested to generate district level data other than service statistics on utilistion of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake rapid household survey for all the districts in the country. About 50 per cent of the districts are covered in 1998. Jaisalmer is one of the 15 districts in Rajasthan to be covered in the first year. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunization services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from a Method-Mixed-Target based activity to a client-centered demand-driven quality services. An attempt is being made by the GOI to not only reorient the programme and service providers attitude at the grassroots level but also to strengthen the services at the outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, the district being the basic nucleus of administration, the GoI has been interested in generating the district level data other than service statistics on the utilisation of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in the first phase in 1998 and the remaining districts have been covered in the second phase. Jaipur is one of the 15 districts in Rajasthan covered in the second phase. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed Target based activity to client-centred-demand driven quality services. An attempt is being made by the GOI to not only reorient the programme and the service providers? attitude at grassroots level but also to strengthen the services at outreach level. The new approach requires decentralization of planning, monitoring and evaluation of services. To achieve such an objective, the GOI is interested in generating district level data, other than service statistics, on the utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey in all the districts in the country. About 50 per cent of the districts have been covered in 1998. The remaining 50 percent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunization services 2. Proportion of safe deliveries 3. Contraceptive prevalence rate 4. Unmet need for family planning 5. Awareness about RTI/STI and HIV/AIDS 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centred demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested to generate district level data other than service statistics on utilistion of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake rapid household survey for all the districts in the country. About 50 per cent of the districts are covered in 1998. Ganganager is one of the 15 districts in Rajasthan to be covered in the first year. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilisation of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed Target based activity to client-centred-demand driven quality services. An attempt is being made by the GOI to not only reorient the programme and the service providers? attitude at grassroots level but also to strengthen the services at outreach level. The new approach requires decentralization of planning, monitoring and evaluation of services. To achieve such an objective, the GOI is interested in generating district level data, other than service statistics, on the utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey in all the districts in the country. About 50 per cent of the districts have been covered in 1998. The remaining 50 percent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunization services 2. Proportion of safe deliveries 3. Contraceptive prevalence rate 4. Unmet need for family planning 5. Awareness about RTI/STI and HIV/AIDS 6. Utilization of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested to generate district level data other than service statistics on utilistion of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake rapid household survey for all the districts in the country. About 50 per cent of the districts are covered in 1998. Jodhpur is one of the 15 districts in Rajasthan to be covered in the first year. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilisation of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from a Method-Mixed-Target based activity to a client-centred demand-driven quality services. An attempt is being made by the GOI to not only reorient the programme and service providers attitude at the grassroots level but also to strengthen the services at the outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, the district being the basic nucleus of administration, the GoI has been interested in generating the district level data other than service statistics on the utilisation of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in the first phase in 1998 and the remaining districts have been covered in the second phase. Churu is one of the 15 districts in Rajasthan covered in the second phase. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from a Method-Mixed-Target based activity to a client-centred demand-driven quality services. An attempt is being made by the GOI to not only reorient the programme and service providers attitude at the grassroots level but also to strengthen the services at the outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, the district being the basic nucleus of administration, the GoI has been interested in generating the district level data other than service statistics on the utilisation of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in the first phase in 1998 and the remaining districts have been covered in the second phase. Dausa is one of the 15 districts in Rajasthan covered in the second phase. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed-Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested to generate district level data other than service statistics on utilistion of the services provided by government health facilities. It is also of interest to access people's perceptions on quality of services. Therefore, it was decided to undertake rapid household survey for all the districts in the country. About 50 per cent of the districts are covered in 1998. Sawai Madhopur is one of the 15 districts in Rajasthan to be covered in the first year. The main focus of the rapid household survey was on the following aspects : 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilisation of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed Target based activity to client-centred-demand driven quality services. An attempt is being made by the GOI to not only reorient the programme and the service providers? attitude at grassroots level but also to strengthen the services at outreach level. The new approach requires decentralisation of planning, monitoring and evaluation of services. To achieve such an objective, the GOI is interested in generating district level data, other than service statistics, on the utilisation of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey in all the districts in the country. About 50 per cent of the districts have been covered in 1998. The remaining 50 percent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilisation of health services and user satisfaction. (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed- Target based activity to client-centered demand-driven quality services. An attempt is being made by GOI to not only reorient the programme and service providers, attitude at grassroot level but also to strengthen the services at outreach level. The new approach requires the decentralisation of planning, monitoring and evaluation of the services. Under such objectives, district being the basic nucleus of administration, GOI has been interested in generating district level data, other than service statistics, on utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey for all the districts in the country. About 50 per cent of the districts were covered in 1999. The remaining districts were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunisation services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction (excerpt)

The Reproductive and Child Health (RCH) interventions that are being implemented by the Government of India (GOI) are expected to provide quality services and achieve multiple objectives. There has been a positive paradigm shift from Method-Mixed Target based activity to client-centred-demand driven quality services. An attempt is being made by the GOI to not only reorient the programme and the service providers? attitude at grassroots level but also to strengthen the services at outreach level. The new approach requires decentralization of planning, monitoring and evaluation of services. To achieve such an objective, the GOI is interested in generating district level data, other than service statistics, on the utilization of the services provided by government health facilities and also people?s perceptions on quality of services. Therefore, it was decided to undertake a rapid household survey in all the districts in the country. About 50 per cent of the districts have been covered in 1998. The remaining 50 percent were covered in 1999. The main focus of the rapid household survey was on the following aspects: 1. Coverage of ANC and immunization services; 2. Proportion of safe deliveries; 3. Contraceptive prevalence rate; 4. Unmet need for family planning; 5. Awareness about RTI/STI and HIV/AIDS; 6. Utilization of health services and user satisfaction. (excerpt)