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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions
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Index
A
Abortion
access to, 108-109
access to contraception and, 112
care for complications of, 112
data collection, 114-115
extent of unsafe practice, 95-96
for gender selection, 109-110
legality, 108-109, 112
maternal morbidity and mortality, 95, 96, 118
as measure of unwanted pregnancy, 95
quality of care, 109
reducing iatrogenic infection in, 6, 72
septic, 79, 80
service linkages, 158
sex-selective, 110
strategies for improving safety, 7
techniques, 109
training of health care professionals, 109
utilization, 2, 15, 95
Accountability, 10, 187
Adolescents
norms for sexual behavior, 25, 26-27
initiation of sexual activity, 64-65
pelvic inflammatory disease risk, 54
Africa, 14
access to maternity care, 130, 131, 138
AIDS/HIV prevalence, 2
fears of STD, 24
female genital mutilation, 32, 33
gender differences in postpartum sex, 22-24
infertility prevalence, 87
maternity care, 139-140
pregnancy outcomes, 116
programs for promoting healthy sexuality, 39
public awareness of contraception methods, 106
reproductive tract disease, 45, 46-48
sexual behavior standards, 28
sexual violence, 30
unmet need for contraception, 100-101
unwanted or mistimed births, 6, 89
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Agency for International Development, U.S., 1
AIDS/HIV
case management, 76
counseling and testing, 69-70
in developed countries, 44-45
in developing countries, 48
educational interventions, 36, 65-66
in pregnancy, 58
prevalence, 2
recommendations for clinical services, 81-82
risk factors, 2
Anemia
pregnancy complications, 120-121
prenatal care, 9, 125-126
Asia, 14
access to maternity care, 131, 137, 138
female genital mutilation, 32
maternal mortality, 116
reproductive tract disease, 46, 47
sex-selective abortion, 110
sexual behavior standards, 25, 27
sexual violence, 30
B
Birth. See Delivery and neonatal care
C
Cancer, 18
cervical, screening for, 80
RTI-related, 58-59
Caribbean basin, 14
access to maternity care, 131
sexual violence, 30
Chancroid, 47
Children, sexual exploitation of, 32
Chlamydia, 43, 44, 47, 54, 55, 57, 77, 128
Circumcision, female. See Female genital mutilation
Circumcision, male, 51, 71
Client-oriented, provider-efficient (COPE) assessment, 82, 105
Commercial sex
condom promotion, 69
cultural trends and, 29
heath risks for workers, 30
sociocultural differences, 29
STD prevention strategies, 67
STD screening, 5
Contraception
abortion demand and, 112
access, 6-7, 103-104
condom promotion, 4
current service delivery, 147-150
demand for subsidized services, 110-111
effects on STDs, 51
emergency methods, 102-103
estimates of unmet need, 100-102
policy obstacles to, 112
as prevention of abortion complications, 96-97
public awareness and understanding, 106-108
quality of family planning services, 103-106
side effects, 107
social marketing, 4, 69, 108
technical innovation, 102
unwanted birth prevalence and, 89, 94-95
user adherence and compliance, 104-105
utilization, 103
women's concerns, 37
women's sexual rights and, 24
women's social status as determinant of, 111-112
COPE assessment, 82, 105
See also Family planning services
Costs
administrative costs, 10
future prospects, 195
health-seeking behavior in pregnancy and, 273
models for estimating, 192-193, 279-294
policy decisions, 188-189
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quality of contraception services and, 104
rationale for reproductive health services, 11
research, 178
STD interventions, 60
subsidization of contraception, 110-111
training costs, 194
See also Contraception
Cost-effectiveness analysis, 189-192, 193, 195
disability-adjusted life year measures, 190-192
D
Delivery and neonatal care
access to care, 130-131, 136-138, 269-273
anemia complications, 120-121
birthing homes for, 144
bleeding symptoms, 134
clinical protocols, 144-145
current program capacity and utilization, 146-150
effective programs, 269-273
essential care, 129-130
family role, 141-142
genital herpes complications, 121-122
genital herpes intervention, 57-58
gonorrhea complications, 57
health-seeking behaviors, 135-136, 261-269
HIV transmission and, 58
maternity waiting homes for, 143-144
obstetric fistula complications and intervention, 121
obstructed or prolonged labor, 128
partograph monitoring, 128
pathways to maternal survival, 132, 140
quality of care, 7-8, 138-140, 144-145, 273-276
recognition of complications, 8-9, 132-135, 141-142, 257-261
role of traditional birth attendants, 141-42, 261-269
RTI risks, 55
settings for 130, 135-136
syphilis intervention, 5-6, 128
user fees for, 187-188
See also Pregnancy and birth;
Prenatal care
Demand for services, 10, 105, 164-166
Disability-adjusted life year measures, 190-192
E
Eclampsia and pre-eclampsia, 126-127
Ectopic pregnancy, 80
Educational interventions
in family planning programs, 107-108
for healthy sexuality, 2-3, 35-37
to improve obstetric quality of care, 8-9
to influence fertility behavior, 111, 112
for STD prevention, 65-66
Essential care for obstetric
complications, 129-130
Europe, RTIs in, 43, 44-45
Expenditures
current health care spending, 178, 179
current reproductive health spending, 179-182
F
Family planning services
client criteria for evaluating, 103
current capacity and utilization, 146-150
current public-sector spending, 179-180
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dissemination of contraception information, 106-108
external financial assistance, 181-182
future challenges, 100
generating demand for services, 164-165
in integrated reproductive health services, 105, 155-163
opportunities to improve contraception services, 100-103
policymaking environment, 110-112
quality of contraception services, 103-106
reproductive health goals, 85
RTI prevention and treatment, 81-82, 105-106
STD management strategies, 4-5
Female genital mutilation
health risks, 3, 33
incidence and prevalence, 3, 32, 33
interventions against, 3
procedure, 32-33
rationale, 3, 32
research needs, 35
trends, 39
Fertility
family size, 88, 95, 97
global patterns, 116, 150
Financing
private sector support, 11
public-private collaboration, 184-186
rationale for public sector financing, 182-183, 195
rationing of services, 189
resources for, 154
sources and distribution of external assistance, 181-182
user fees for, 11, 186-188
G
Gonococcal infection
newborn prophylaxis, 5-6, 78, 128
pelvic inflammatory disease risk, 53-54
in pregnancy, 55-57
prevalence in developed countries, 43-44
prevalence in developing countries, 46-47
screening, 77
H
Health care professionals
access to, for maternity care, 130-131, 136-138, 142-143
outreach activities, 165
training costs, 194
training for abortion procedures, 109
training for maternity care, 144, 262-269
training for obstetric and neonatal care, 8
training for prevention of iatrogenic RTI, 71-72
Health-seeking behaviors, 10
cultural norms for sexual behavior as obstacle to, 25, 26-27
generating demand for reproductive health services, 10, 105, 164-166
maternity care, 135-136, 141-142, 261-269
postpartum care, 131
reproductive tract infection, 74
risk of reproductive tract infection, 51
sexual problems, 37
Healthy People 2000, 166
Herpes, genital, 44, 48, 57-58
HIV. See AIDS/HIV
Human papilloma virus, 44, 58
Human rights, 18
Hypertension
maternal mortality, 118
prenatal care, 9, 126-127
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I
Infant morbidity and mortality
consequences of unwanted pregnancy, 97-99
global patterns, 2, 16, 150
gonococcal eye infection, 5-6, 253
low birth-weight infants, 123
pregnancy outcomes, 122-123
prenatal care benefits, 124
prenatal pathways to prevention, 132
reproductive tract infection and, 55, 57, 58
risk factors in labor, 128
Infertility
global patterns, 54, 87
RTI and, 54-55, 87
International Conference on Population and Development (ICPD), 1, 13, 14, 85, 110, 111, 166, 173
L
Latin America, 14
access to maternity care, 131, 137, 138
demographic trends, 16
quality of maternity care, 139, 140
sex education, 35, 36, 39
sexual violence, 30, 31
unwanted or mistimed births, 89
Legal issues
access to abortion, 108-109
care for complications of illegal abortion, 112
changes for promoting healthy sexuality, 39
conceptualization of sexual violence, 31
cultural perspectives on divorce, 22
legal access for sexual violence victims, 3
obstacles to contraception access, 112
right to refuse sexual relations, 22
M
Malaria, 18-19, 158-160
Maternal mortality
abortion-related, 96, 118
access to care and, 16, 142-144
anemia-related, 120, 125-126
causes, 7, 118
definition, 118
essential care for prevention, 129-130
global patterns, 2, 15, 150
historical trends, 129-130
hypertension-related, 126-127
labor-related, 128
medical audit, 276
pathways to prevention, 132, 140
points of intervention in pregnancy, 123
pregnancy and, 96, 116-118
preventive strategies, 7-8, 123-124, 129-130
risk assessment for medical complications, 124-125, 141-142
tetanus-related, 127-128
Media campaigns
consideration of local values, 38
contraception, 108
for health sexuality, 37-38
social marketing, 4, 69, 108
STD prevention, 4
Mexican example, 173-174
Middle East
female genital mutilation, 32
sexual behavior standards, 22, 25, 27
unwanted or mistimed births, 89
Midwifery, 8, 130, 143, 144, 269
Mother-Baby Package, 154, 192-193, 280-294
N
Neonatal care. See Delivery and neonatal care
North America
reproductive tract infections, 43-45
unwanted/mistimed births, 93-95
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P
Pacific Islands, 14, 30
Pelvic inflammatory disease, 53-54, 55, 249-253
Performance monitoring, 152-153
Population growth, 16-17
Poverty
rationale for public financing of health care, 183
RTI risk, 53
Pregnancy and birth
clinical protocols, 144-145
cultural influences on reproductive decision-making, 88
global patterns, 15
infant morbidity and mortality, 16, 122-123, 152
integrated reproductive health services, 9-10, 155-163
international comparison of outcomes, 150
maternal disabilities, 118-122
maternal mortality, 2, 15, 96, 116-118
See also Delivery and neonatal care;
Maternal mortality;
Unwanted or mistimed births
Prenatal care
access to, 130-131, 150
anemia complications, 120, 125-126
benefits, 124
bleeding symptoms, 134
for complications of existing disorders, 119
current program capacity and utilization, 146-150
ectopic pregnancy, 80
effective programs, 270-271
family role, 141-142
genital herpes intervention, 57-58
goals, 123
gonorrhea complications, 55-57
hypertension complications, 9, 118, 126-127
maternal mortality and, 116-118, 123-124
psychosocial support, 260-261
risk assessment, 124-125
standards of care, 9
STD screening and intervention, 5-6.
See also specific diseases
syphilis intervention, 5-6, 9, 57, 128
user fees for, 187-188
See also Delivery and neonatal care;
Pregnancy and birth
Private sector activities, 11
delivery of publicly-financed health care, 184-186
user fees, 188
Program design and implementation
accountability, 10
administrative structure, 152, 160, 161
breadth of services, 154-158
current capacity and utilization, 146-150
decentralization, 163-164
demographic-specific delivery, 162-163
determinants of success, 152
focused commitment to objectives, 152-153
future needs, 9, 16
gender orientation, 15
for healthy sexuality, 34-38
integrated delivery of services, 9-10, 37, 105, 155-163
limitations of RTI interventions, 60-62
mass treatment for STD, 78-79
maternity care, 7-9, 140-145, 257-276
national priorities and, 188-189
need for experimentation and research, 9, 19
obstacles to evaluation, 62
organizational structure, 155
performance of large-scale programs, 150-152
private delivery of publicly-financed care, 184-186
public sector role, 182, 186, 194
reform strategy, 166-173
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reproductive health goals, 13-14, 166-167
sex education, 2-3, 35-37
STD management, 4-5
STD prevention, 4
vertical organization, 158-160
See also Family planning services
Prostitution. See Commercial sex
Public awareness and understanding
of contraception methods, 106-107
generating demand for health services, 10, 164-166
healthy sexuality education campaigns, 37-38
recognition of pregnancy complications, 132-135
STD prevention strategies, 65-66
Q
Quality control, 105
Quality of care
in abortion, 109
contraception services, 103-106
maternity services, 138-140, 144-145, 273-276
prenatal services, 7-9
quality assurance programs, 105
user fees and, 187
Quality of contraception services, 103-106
R
Reproductive health
barriers to, 16-17
global threats to, 1-2
goals, 1, 13, 14, 85, 166-167
life-cycle perspective, 18
morbidity/mortality, 15-16
rights issues, 18
women's health and, 15
Reproductive tract infection (RTI)
causes, 3, 40
consequence of, 4, 40, 53-55
current service capacity, 150
data quality, 42-43, 61-62
design and implementation of interventions, 4-6, 59-61
effects on sexual behavior, 37
evaluation of interventions, 61-62, 81
family planning services in controlling, 105-106
generating demand for services, 164
health behavior risk factors, 51
health-seeking behaviors, 74
iatrogenic, 6, 40, 63-64, 71-72
infertility and, 54-55
integrated service infrastructure, 161-162
interactions of risk mediators, 48-49
levels of preventive intervention, 62
management strategies for prevention, 73-77
neoplasias related to, 58-59
physiological microenvironment risk factors, 49-50
pregnancy outcomes and, 55-58
prenatal screening, 9, 57
prevalence in developed countries, 43-45
prevalence in developing countries, 45-48
primary prevention strategies, 63-72
recommendations for clinical services, 80-83
research priorities, 83-84
secondary prevention strategies, 72-73
sexual behavior risk factors, 50-51
sexual norms as obstacle to help-seeking, 26-27
sociocultural risk factors, 52-53
tertiary prevention strategies, 79-80
trends, 40-42
RTI. See Reproductive tract infection
S
Salpingitis, 53, 54, 249
Screening programs
cervical cancer, 80
for hypertension in pregnancy, 127
prenatal and neonatal, 5-6, 9, 57
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sex-selective abortion and, 109-110
for STD in sex workers, 5
STD preventive interventions, 69-70, 75-76, 77-78
Sexual behavior. See Sexuality
Sexual violence
child sexual exploitation, 32
health risks of, 31
mortality, 30
prevalence, 30
service needs, 3
sociocultural context, 30, 31
against spouse, cultural perspectives in, 22
Sexuality
abstinence, 24
adolescent, 25, 26-27
AIDS/HIV risk, 2
autonomy in, 20, 21, 38
condom promotion, 4, 68-69, 81-82
cultural context, 2, 20-30
dynamics of partner selection, 66-67
dysfunction, 18
encouraging safer practices, 67-68
gender differences in postpartum sex, 22-24
gender-specific concerns, 37
healthy, 2, 20
initiation of sexual activity, 64-65
need for educational interventions, 2-3, 35-37
norms, 20-21
number of partners, 65
program design for promoting healthy sexuality, 34, 37
public information campaigns, 37-38
reproductive health and, 20, 37
research needs, 34-35
right to refuse sexual relations, 21-24
right to seek sexual relations, 24-29
risk screening, 75-76
RTI prevention strategies, 64-69
RTI risk, 50-51
sex education and, 36
trends in premarital relations, 25-26, 28-29
See also Sexually transmitted disease
Sexually transmitted disease (STD)
adolescent sexual behavior and, 26-27
assessment of lower abdominal pain, 249-253
assessment of urethral discharge, 236-239
behavioral risk assessment, 75-76
chemical barriers, 70-71
condom use and, 51, 68-69
counseling and testing interventions, 69-70
diagnostic procedures, 74, 76, 77-78
educational interventions, 65-66
evaluation of preventive interventions, 60
genital ulcers, 239-240
incidence, 2, 15
inguinal bubo, 240-243
integrated reproductive health services, 9-10, 37, 155-163
male circumcision and, 51, 71
management interventions, 4-5
mass treatment approaches, 78-79
partner notification programs, 78
prenatal and delivery care, 5-6
prevalence in developed countries, 43-45
prevalence in developing countries, 45-48
preventive interventions, 4
rationale for public intervention, 182-183
refusal of sex for fear of, 24
reproductive risks, 2
screening for sex workers, 5
scrotal swelling, 243-245
targeting of interventions, 59-60
treatment algorithms and protocols, 5, 73-77, 235
vaginal discharge, 245-249
women's health and, 15
World Health Organization treatment recommendations, 235
See also Reproductive tract infection;
specific disease
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Sociocultural context
complications of pregnancy, 121-122
divorce and separation, 22
family size decisions, 88, 97
implications for healthy sexuality programs, 34, 38
premarital sexual relations, 25, 28-29
recognition of pregnancy and postpartum complications, 133, 134, 141-142
RTI risk, 52-53
seeking maternity care, 135-136
sexual violence, 3, 30, 31
sexuality in, 2, 20-30
significance of, 14
utilization of postpartum care, 131
women's social status, 38
STD. See Sexually transmitted disease
Substance use, 49
Suicide, 30
Syphilis
in pregnancy, 57, 128
prenatal screening, 5-6, 9, 57, 128
prevalence in developed countries, 43
prevalence in developing countries, 45-46
screening for, 77
T
Tetanus, 127-128
Trichomoniasis, 47
U
Ugandan example, 175-177
Unwanted or mistimed births
abortion as indicator of, 95-96
access to contraception and, 94-95
consequences for infants and children, 97-99
consequences for mother, 96-97
consequences for wanted children, 99-100
contraceptive practices correlated with, 89
definitions, 86, 97
determinants, 93-95
direct measures, 89-90, 114
indirect measures, 93
measurement methodology, 86-87
measurement of intentionality, 87-88, 101, 113-114
as percentage of total births, 1, 6, 15
policymaking environment, 110-112
rate, 89, 90
rationale for preventive intervention, 6
rationale for reducing, 99-100
social support for, 100
Urbanization, 17, 193
User fees, 11
benefits of, 187, 195
charged by nongovernmental organizations, 188
current practice, 186-187
effects on service delivery, 187, 188, 194-195
for maternity care, 187-188
rationale, 187
sliding scale, 187
W
Women's issues
contraceptive use, 37
economic and social status, 38
genital mutilation, 3
interventions against sexual violence, 3
reproductive health and, 15
right to refuse sexual relations, 21-24
right to seek sexual relations, 24-29
sexual norms as obstacle to health, 25, 26-27
social status and fertility behavior, 111-112
World Health Organization, 235
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Selected Publications, Committee on Population
Available from the National Academy Press (2101 Constitution Avenue, N.W., Washington, D.C. 20418; 1-800-624-6242 or 1-202-334-3313); available on-line at http://www.nap.edu.
Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences. J. Trussell and B. Cohen, eds. 1996.
Social Dynamics of Adolescent Fertility in Sub-Saharan Africa. C.H. Bledsoe and B. Cohen, eds. 1993.
Effects of Health Programs on Child Mortality in Sub-Saharan Africa . D.C. Ewbank and J.N. Gribble, eds. 1993.
Factors Affecting Contraceptive Use in Sub-Saharan Africa. Working Group on Factors Affecting Contraceptive Use. 1993.
The Epidemiological Transition: Policy and Planning Implications for Developing Countries, Workshop Proceedings. J.N. Gribble and S.H. Preston, eds. 1993.
Developing New Contraceptives: Obstacles and Opportunities. Institute of Medicine, L. Mastroianni, Jr., P.J. Donaldson, and T.T. Kane, eds. 1990.
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Contraception and Reproduction: Health Consequences for Women and Children in the Developing World. Working Group on the Health Consequences of Contraceptive Use and Controlled Fertility. 1989.
Contraceptive Use and Controlled Fertility: Health Issues for Women and Children. A.M. Parnell, ed. 1989.
Available from the Committee on Population (National Research Council, 2101 Constitution Avenue, N.W., Washington, D.C. 20418; phone: 202-334-3167, fax: 202-334-3768, email: cpop@nas.edu. Also available online at http://www.nap.edu.
Data Priorities for Population and Health in Developing Countries. C.E. Malanick, and A.R. Pebley, eds. 1996.
Reproductive Health Interventions: Report of a Meeting. J.G. Haaga, A.O. Tsui, and J. Wasserheit, eds. 1996.
Resource Allocation for Family Planning in Developing Countries: Report of a Meeting. J.G. Haaga and A.O. Tsui, eds. 1995.
Organizing for Effective Family Planning Programs. R.J. Lapham and G.B. Simmons, eds. 1987.
Available from Plenum Press (233 Spring Street, New York, N.Y., 10013-1578):
Demographic and Programmatic Consequences of Contraceptive Innovations. S.J. Seagull, AO. Sui, and SM. Rogers, eds. 1989.
