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AFRICA Much of the Population Council’s work in Zambia relates to operations research in the area of prevention of sexually transmitted infections, especially HIV and AIDS, and is carried out by staff of the Council's Horizons Program. Horizons staff conduct operations research on HIV and AIDS-related issues and are working with international and Zambian organizations. Additional Council research in Zambia is concerned with expanding contraceptive choice, particularly emergency contraception. Evaluating the
effect of expanding
The Council reviewed and documented the introduction of new and/or underutilized contraceptive methods into two peri-urban health care facilities. Using both quantitative and qualitative methodologies, research was undertaken in three rural districts to examine women’s motives for method choice, continuation, and discontinuation. Researchers also analyzed providers' perspectives on available family planning methods and the service delivery system in general. A related study evaluated the effect of adding new contraceptives to the method mix at three kinds of clinics: one group provides oral contraceptives, IUDs, male and female condoms, foam, injections, and Norplant®; a second group has all of these methods, except for Norplant; a third group has all of these methods except for Norplant and injections. The greater contraceptive choice options available at the first two groups of clinics allowed clients to switch methods when their contraceptive needs change rather than discontinue use altogether. The study findings provided the Ministry of Health and others with continuation rates for specific methods as well as causes for discontinuation due to, for example, side effects, pregnancy, bleeding, or other causes. The Population Council also assisted in the introduction of Norplant implants into selected family planning clinics in urban areas. The implants were introduced first in established family planning clinics in urban areas where health facilities are able to provide quality service and follow-up clients, and later in urban family planning clinics in the provincial capitals. By the project’s end, it was anticipated that at least one family planning clinic in each of 61 health districts would provide Norplant as one of the choices of long-term family planning methods. HIV/AIDS-related activities Horizons, in collaboration with its research partners, also conducted an HIV and Infant Feeding Study in Ndola, Zambia. The study assessed the nutritional status and incidence of illnesses among children of women who choose to breastfeed or bottlefeed by HIV status of mother and baby. Based on the initial research, researchers scaled up the study activity. Additionally, Horizons staff conducted an intervention study to assess the effects of training youth to provide home-based care and support to people living with HIV/AIDS (PLHA), in partnership with Care International and Family Health Trust. The study team compared the effects of standard HIV prevention training to an enhanced curriculum that trained youth in providing care and support to PLHA and supported their ongoing home-based care activities. Study findings provide a promising picture of young peoples' potential to contribute to community-based care activities. Youth caregivers were warmly welcomed by PLHA and their families, and showed adaptability and creativity in their activities, such as organizing stigma reduction campaigns and recreational activities involving orphans and vulnerable children. Youth caregivers showed impressive skills in networking and collaborating with other community care resources, which was instrumental in addressing challenges, enhancing credibility and providing motivation. Following gender-sensitive training to address initial concerns about care-giving roles, male and female caregivers reported providing similar types of care and support. Results suggest that there were declines in stigma in the communities where youth received enhanced training in care and support. A follow-up study will develop and assess community mechanisms to help sustain efforts to involve youths in the care and support of PLHA. Researching emergency contraceptive pills Results from this study show that providing clients with emergency contraceptive pills (ECPs) before they are needed can reduce dramatically the length of time between unprotected intercourse and taking the first dose of pills. But it can also have the unintended effect of encouraging women to use ECPs at the expense of more routine family planning methods. In some cases, advance provision creates new pressures (such as enhancing men’s ability to negotiate condom use), and in others, it makes it easier to respond to those pressures by abandoning routine methods in favor of ECPs. Giving women ECP before provision also seems to draw increased attention to the perceived inconveniences of other hormonal methods, particularly the pill. In another study, researchers compared the introduction of two emergency contraception pills: the combined oral contraceptive PC-4, introduced into Zambia in 1997, and the progestin-only contraceptive, Postinor-2, which was introduced the following year. Study results indicate that, at the service delivery level, the similarities between PC-4 and Postinor-2 greatly overshadow their differences. Family planning users adopt the two at comparable rates and, after having used them, manifest few, if any, differences in their appreciation of either product, in their decision to adopt a family planning method, or even in their choice of method itself. An important finding of research on emergency contraception was the reluctance of young people to obtain ECPs via traditional service delivery outlets. A small study is being conducted to gauge youth preferences for alternative sources of emergency contraception information and services. This project will train peer counselors, community based distribution agents, pharmacists, and general outpatient health care providers to provide youth with information on emergency contraception. Developing policy Projects
Publications/Resources on Zambia See Also
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