 Rebecka I. Lundgren is Director of Operations and Behavioral Research, Institute for Reproductive Health, Georgetown University, 4301 Connecticut Avenue, NW, Suite 310, Washington, DC 20008. James N. Gribble is Senior Scientist, Futures Group, Washington, DC. Margaret E. Greene is Director, Center for Global Health, George Washington University, Washington, DC. Gail E. Emrick is Technical Advisor for Central America, Project Concern International El Salvador, San Salvador, El Salvador. Margarita de Monroy is Regional Coordinator for Central America, Institute for Reproductive Health, Georgetown University, Santa Tecla, El Salvador. E-mail: lundgrer@georgetown.edu. A pilot project in rural El Salvador tested the integration of family planning into a water and sanitation program as a strategy for increasing male involvement in family planning decisionmaking and use. The organizations involved posited that integrating family planning into a resource management and community development project would facilitate male involvement by diffusing information, by referring men and women to services, and by expanding method choice to include the new Standard Days Method through networks established around issues men cared about and were already involved in. This article examines data from a community-based household survey to assess the impact of the intervention and finds significant changes in contraceptive knowledge, attitudes, and behavior from baseline to endline. Because the differences between baseline and endline are greater than the differences between participants and nonparticipants at endline, the study demonstrates the power of informal networks for spreading information. (Studies in Family Planning 2005; 36[3]: 173–188)
- Evaluating Abortion-care Programs: Old Challenges, New Directions
Janie Benson is Vice President, Research and Evaluation, Ipas, 300 Market Street, Suite 200, Chapel Hill, NC 27516. E-mail: bensonmj@ipas.org. The evaluation of abortion-care programs and policies has been largely neglected by both national governments and international organizations. This article provides a conceptual framework for evaluating the intermediate outcomes of a safe abortion program, including laws and policies, women’s care-seeking behavior, and the quality of, access to, and use of services. The methodological challenges in evaluating these outcomes are described. For each outcome, key indicators for measuring progress in program implementation are offered, along with country examples of successful evaluation approaches. The article concludes with recommendations for improvements in infrastructure, resource availability, and political commitment to support evaluation of safe abortion programs. (Studies in Family Planning 2005; 36[3]: 189–202)
- The India Local Initiatives Program: A Model for Expanding Reproductive and Child Health Services
At the time this study was written, John M. Paxman was Principal Program Associate, Management Sciences for Health, Cambridge, MA, and Adjunct Professor of International Health, Boston University School of Public Health. Abu Sayeed is Director, Technical Assistance Incorporated, Dhaka, Bangladesh. Ann Buxbaum and Charles Stover are Principal Program Associates, Management Sciences for Health. Sallie Craig Huber is Program Manager for Planning, Monitoring, and Evaluation, Management Sciences for Health, REACH Program, Kabul, Afghanistan. Correspondence should be directed to John M. Paxman, c/o Barbara Timmons, Deputy Director of Publications, Management Sciences for Health, 784 Memorial Drive, Cambridge, MA 02139–4613. E-mail: btimmons@msh.org. The India Local Initiatives Program adapted a model used in Indonesia and Bangladesh to implement the government’s reproductive and child health strategy. From 1999 to 2003, three Indian nongovernmental organizations (NGOs) provided services for 784,000 people in four northern states. The program established health committees in 620 villages, recruited and trained 1,850 community health volunteers, and added 232 sites to extend government services. Using three strategies—demand creation, increased access to services, and local capacity building—the NGOs increased contraceptive-use rates by 78 percent, on average; child immunizations by 67 percent; and antenatal care by 78 percent among the populations served. Community resources—such as local health personnel, community-supplied clinic sites, and community drug funds—added 40 cents to every dollar provided by donors. This model proved to be a suitable platform upon which to build health-care service delivery and create behavioral change, and the NGOs quickly found ways to sustain and expand services. (Studies in Family Planning 2005; 36[3]: 203–220)
Zeba Sathar is Country Director and Senior Program Associate and Minhaj ul Haque is Program Manager, Population Council, Islamabad. Anrudh Jain is Acting Vice President, Saumya RamaRao is Program Associate, and, at the time of the study, Jacqueline Kim was Data Analyst, Population Council, New York. E-mail: sramarao@popcouncil.org. Pakistan is a high-fertility country with elevated levels of maternal mortality and unmet need for family planning. Limited access to and poor quality of reproductive health services and gender-related problems comprise the major explanations for these poor indicators. The authors designed an intervention to address some of these issues and implemented it on a quasi-experimental basis in Bhalwal Tehsil of the Sargodha district of Punjab. The intervention introduced a client-centered approach to providing reproductive health services, including family planning and infant, child, and maternal health care. The intervention consisted of training health-care providers based in fixed-location clinics and in communities. It introduced the concept of SAHR (an acronym for salutation, assessment, help, and reassurance), to inculcate a client-centered approach to care that acknowledges explicitly and addresses a client’s gender and power relations within her family and household. Results of the intervention indicate significant effects on providers’ behavior related to SAHR elements. The changes provide demonstrable evidence that the public sector can shift toward client-centered services in reproductive health care in a challenging setting. (Studies in Family Planning 2005; 36[3]: 221–234)
- Field Experiences Integrating Family Planning into Programs to Prevent Mother-to-Child Transmission of HIV (PDF)
Naomi Rutenberg is Program Director, Horizons, and Carolyn Baek is Staff Program Associate, Population Council, Washington, DC. E-mail: nrutenberg@popcouncil.org. This article reviews field experiences with provision of family planning services in prevention of mother-to-child transmission (PMTCT) programs in ten countries in Africa, Asia, and Latin America. Family planning is a standard component of most antenatal care and maternal–child health programs within which PMTCT programs are offered. Yet PMTCT sites often miss opportunities to provide HIV-positive clients with family planning counseling. Demand for family planning among HIV-positive women varies depending on the extent of communities’ openness about HIV/AIDS, fertility norms, and knowledge of PMTCT programs. In Kenya and Zambia, no differences were observed in use of contraceptives between HIV-positive and HIV-negative women in the study communities, but HIV-positive women have more affirmative attitudes about condoms and use them significantly more frequently than do their HIV-negative counterparts. In the Dominican Republic, India, and Thailand, where HIV prevalence is low and sterilization rates are high, HIV-positive women are offered sterilization, which most women accept. This article draws out the policy implications of these findings and recommends that policies be based on respect for women’s right to informed reproductive choice in the context of HIV/AIDS. (Studies in Family Planning 2005; 36[3]: 235–245)
- Burkina Faso 2003: Results from the Demographic and Health Survey
- Philippines 2003: Results from the National Demographic and Health Survey
Book Reviews Panel on Transitions to Adulthood in Developing Countries, National Research Council, and Institute of Medicine of the National Academies, Cynthia B. Lloyd, Editor
Growing Up Global: The Changing Transitions to Adulthood in Developing Countries
John C. Caldwell is Professor Emeritus, Demography and Sociology Program, Research School of Social Sciences, The Australian National University, Canberra
Department of Reproductive Health and Research, World Health Organization
Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer
Cynthia Stanton is Assistant Professor, Department of Population and Family Health Sciences, The Johns Hopkins Bloomberg School of Public Health
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