FRONTIERS
Publications/Resources

West Bank/Gaza: Promote Awareness of the Benefits
of Women's Reproductive Health
OR Summary no. 46

From 2000 to 2002 the Population Council collaborated with the Palestinian Ministry of Health on the Pilot Health Project (PHP), a 28-month intervention to upgrade the reproductive health services in the West Bank and Gaza. One of the PHP’s goals was the establishment of a basic package of high-quality antenatal and postpartum care among participating clinics operated by nongovernmental organizations (NGOs). The package included clinical upgrades, training to improve providers’ skills in maternal care and counseling, a postnatal visit by a community health worker, and counseling on birth spacing, postpartum contraception, and breast self-examination, as breast cancer is the most prevalent cancer among Palestinian women. Providers were trained to encourage women to obtain a postpartum checkup for herself and her new baby.

Photo credit: FRONTIERS West Bank/Gaza

A baseline survey (see OR Summary no. 20) showed that high-quality care was available from the NGOs, and that women frequently used antenatal care services, but rarely sought postpartum care. To assess changes resulting from the PHP intervention, researchers conducted post-intervention surveys of 1,070 antenatal, postpartum, and family planning clients at 26 of the original 27 participating clinics. Nine physicians and 49 nurses and community health workers were interviewed to assess changes in their behaviors and practices.

Findings

Despite the challenges imposed by political
unrest in the region, the intervention produced many positive results:

• Several aspects of providers’ performance improved following the intervention. Nearly twice as many antenatal clients (72% compared to 39% at baseline) said that providers had taken a full nine-item obstetric history. During family planning consultations, nurses and community health workers also gave more detailed information on methods, particularly on the method’s efficacy and side effects.
   
• The intervention effected changes in the use of clinical services and in reasons for seeking services. The proportion of clients seeking postpartum care increased only slightly, from 3 percent to 4 percent. While antenatal care remained the most common reason for clinic visits, the proportion of women using family planning more than doubled from 14 percent at baseline to 32 percent (mainly the IUD) after the intervention (see Figure). This increase was greatest among low-parity women.
   

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• The proportion of women who said that they had heard of maternal warning signs increased from 9 percent to 20 percent for antenatal care and from 4 percent to 24 percent for postpartum care. Though these proportions remain low, almost all women who experienced warning signs before and after birth said that they had sought and received appropriate treatment.
   
• Significantly fewer women (27%) said that they knew how to conduct a breast self-exam compared to baseline (35%). But of those who received the information, 60 percent (compared to 21% at baseline) cited PHP clinics as the source. More women (60%) said that they regularly do a self-exam during the post-intervention survey than in the pre-test (41%).
   
• Men’s involvement in their wives’ reproductive health remained high. Both before and after the intervention, almost all men  supported and discussed antenatal care, and over 90 percent discussed family planning, and whether or not to use it, with their wives.

Policy Implications

• There is a need for public awareness campaigns to promote knowledge about the importance of breast cancer screening, child spacing, and postpartum care.
   
• Clinics should institutionalize continuous training for service providers to ensure that their technical skills remain adequate and up to date. Outreach workers should also participate in such training.
   
• Programs should integrate screening for breast and cervical cancer into routine primary care services, and should continue their efforts to instruct women in breast self-examination.
   
• Three-fourths of Palestinian women rely on the IUD as their contraceptive method, which calls for expanded contraceptive choice. Managers might consider assessments of ways to promote condoms for dual protection against pregnancy and sexually transmitted infections.

August 2004

Sources: Nawar, Laila, Dale Huntington, Ibrahim Kharboush, Nancy Ali, and Mahmoud Shaheen. 2003. "Assessment of pilot health project outcome indicators: West Bank/Gaza," FRONTIERS Final Report. Washington, DC: Population Council. (PDF, 1.9 MB)

"Stress the importance and cost-effectiveness of postpartum care," FRONTIERS OR Summary no. 20. Washington, DC: Population Council, 2001.(PDF, 288 KB)

This project was conducted with support from the U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT under Cooperative Agreement Number HRN-A-00-98-00012-00.
 

For more information contact:
Frontiers in Reproductive Health (FRONTIERS)
Population Council
4301 Connecticut Ave. N.W., Suite 280
Washington, DC 20008 USA
Telephone: +1 202 237 9400
Facsimile: +1 202 237 8410
E-mail: frontiers@popcouncil.org

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This page updated 1 May 2006

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