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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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 in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions This page in the original is blank.

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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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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Reproductive Health in Developing Countries: Expanding Dimensions, Building Solutions 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.