Suchergebnisse

Includes bibliographical references (leaves 79-84). ; Voluntary or induced termination of pregnancy (TOP) is a common reproductive health phenomenon worldwide, whether legal or illegal (WHO, 2004; Schenker and Cain, 1999). Although some countries, including South Africa, have liberalized TOP laws to allow legal and safe provision of abortion, many barriers continue to impede successful rollout of services. Key among these are the following: * recruiting and retaining staff to provide such services, * incorporating TOP observation and training into medical training curricula, preventing burnout, * addressing negative attitudes and stigma of health providers, * diminishing professional discrimination and harassment, and * offering more TOP training modules, counselling workshops, and values clarification workshops over a spread of geographic areas (Adamo, 2003). Identifying future health professionals who may be interested in training and eventually providing TOP care has thus been prioritized by the South African Department of Health. Examining the knowledge, attitudes, beliefs, and intentions of medical students in training could make an important contribution to policy initiatives with respect to abortion provision. The current study measured these parameters among medical students in one of the eight medical training institutions in South Africa. With the liberalization of TOP legislation in South Africa, future health professionals' attitudes and intentions towards abortion services is a critical determinant to equity, access, and availability of women's reproductive care and to the successful implementation of TOP law.

OBJECTIVE: To understand the role of county characteristics in the growing divide between rural and urban mortality from 1980 to 2010. DATA SOURCE: Age‐adjusted mortality rates for all U.S. counties from 1980 to 2010 were obtained from the CDC Compressed Mortality File and combined with county characteristics from the U.S. Census Bureau, the Area Health Resources File, and the Inter‐University Consortium for Political and Social research. STUDY DESIGN: We used Oaxaca–Blinder decomposition to assess the extent to which rural–urban mortality disparities are explained by observed county characteristics at each decade. PRINCIPAL FINDINGS: Decomposition shows that, at each decade, differences in rural/urban characteristics are sufficient to explain differences in mortality. Furthermore, starting in 1990, rural counties have significantly lower predicted mortality than urban counties when given identical county characteristics. We find changes in the effect of characteristics on mortality, not the characteristics themselves, drive the growing mortality divide. CONCLUSIONS: Differences in economic and demographic characteristics between rural and urban counties largely explain the differences in age‐adjusted mortality in any given year. Over time, the role these characteristics play in improving mortality has increased differentially for urban counties. As characteristics continue changing in importance as determinants of health, this divide may continue to widen.

Provision of safe, voluntary, termination of pregnancy (TOP) in South Africa is challenged by an insufficient number of TOP-trained clinicians. Medical students' understanding of TOP legality and their attitudes toward TOP training are indicators for future service provision. We administered a 63-item questionnaire to explore these issues at the University of Cape Town and Walter Sisulu University. Ordinary least squares regression assessed predictors of TOP legislation knowledge and training attitudes. Results: Of 1308 students, 95% knew that TOP was legal in South Africa, but few (27%) understood the specific provisions of the legislation beyond 13 weeks' gestation. Sixty-three percent desired more information about TOP. In multivariate models, female, white and sexually experienced students and students more advanced in school had better legislation knowledge (all p <.01). Attending religious services regularly (p <.01) was associated with lack of support for TOP training, whereas being in a relationship (p <.01) was associated with support for TOP training.

Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer‐lasting methods, the women's "switching behavior" indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.

Indonesia established its Village Midwife Program in 1989 to combat high rates of maternal mortality. The program's goals were to address gaps in access to reproductive health care for rural women, increase access to and use of family planning services, and broaden the mix of available contraceptive methods. In this study, we use longitudinal data from the Indonesia Family Life Survey to examine the program's effect on contraceptive practice. We find that the program did not affect overall contraceptive prevalence but did affect method choice. Over time, for women using contraceptives, midwives were associated with increased odds of injectable contraceptive use and decreased odds of oral contraceptive and implant use. Although the Indonesian government had hoped that the Village Midwife Program would channel women into using longer-lasting methods, the women's "switching behavior" indicates that the program succeeded in providing additional outlets for and promoting the use of injectable contraceptives.

High-quality intrapartum care, including intermittent monitoring of fetal heart rates (FHR) to detect and manage abnormalities, is recommended by WHO and the Government of Tanzania (GoT) and creates potential to save newborn lives in Tanzania. Handheld Doppler devices have been investigated in several low-resource countries as an alternative to Pinard stethoscope and are more sensitive to detecting accelerations and decelerations of the fetal heart as compared to Pinard. This study assessed perspectives of high-level Tanzanian policymakers on facilitators and barriers to scaling up use of the hand-held Doppler for assessing FHR during labor and delivery. From November 2018–August 2019, nine high-level policymakers and subject matter experts were interviewed using a semi-structured questionnaire, with theoretical domains drawn from Proctor's implementation outcomes framework. Interviewees largely saw use of Doppler to improve intrapartum FHR monitoring as aligning with national priorities, though they noted competing demands for resources. They felt that GoT should fund Doppler, but prioritization and budgeting should be driven from district level. Recommended ways forward included learning from scale up of Helping Babies Breathe rollout, making training approaches effective, using clinical mentoring, and establishing systematic monitoring of outcomes. To be most effective, introduction of Doppler must be concurrent with improving case management practices for abnormal intrapartum FHR. WHO's guidance on scale-up, as well as implementation science frameworks, should be considered to guide implementation and evaluation.