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From words to actions: systematic review of interventions to promote sexual and reproductive health of persons with disabilities in low- and middle-income countries

HAMEED, Shaffa
MADDAMS, Alexander
LOWE, Hattie
DAVIES, Lowri
KHOSLA, Rajat
SHAKESPEARE, Tom
2020

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Persons with disabilities have the same sexual and reproductive health and rights (SRHR) as non-disabled persons. Yet they face numerous barriers in their access to sexual and reproductive health services and their rights are often not met. Evidence on SRHR for persons with disabilities is sparse, particularly evaluations of interventions demonstrating ‘what works.’ This systematic review assessed interventions to promote SRHR for persons with disabilities in low- and middle-income countries.

The method involved searching for qualitative, quantitative or mixed method observational studies representing primary research, published between 2010 and 2019, using MEDLINE, Embase, PubMed, Global Health and CINAHL Plus

 

BMJ Global Health 2020;5:e002903.

http://dx.doi.org/10.1136/bmjgh-2020-002903

The grace of motherhood: disabled women contending with societal denial of intimacy, pregnancy, and motherhood in Ethiopia

TEFERA, Balaynesh
et al
September 2017

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Ethiopian disabled women’s experiences of intimacy, pregnancy and motherhood are reported. Qualitative, in-depth, and semi-structured interviews along with personal observations were used to explore the full experiences of participants. Interview data revealed that mothers experienced significant challenges with regard to accessibility of health centers, physician’s lack of knowledge about and problematic attitudes toward them and more general societal prejudices towards individuals with disability. The 13 participants were employed women with physical or visual disabilities, and the interviewees were from the Addis Ababa metropolitan area, Ethiopia.

 

Disability & Society, 32:10, 1510-1533

DOI: 10.1080/09687599.2017.1361385

The grace of motherhood: disabled women contending with societal denial of intimacy, pregnancy, and motherhood in Ethiopia

TEFERA, Belaynesh
VAN ENGEN, Marloes
VAN DER KLINK, Jac
SCHIPPERS, Alice
2017

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This study aimed to provide better understanding of intimacy and marriage, pregnancy, birth, and motherhood experiences of women with disability in Ethiopia. Qualitative, in-depth, and semi-structured interviews along with personal observations were used to explore the full experiences of participants, as told in their own words. The result of the interviews indicated that relationships and motherhood proved a very rewarding option for women with disabilities. They also expressed their need for intimacy regardless of society’s denial. Challenges identified include negative societal attitudes toward women with disabilities regarding relationship, pregnancy, and child-rearing. Accessibility of health centers in addition to the ignorance and negative attitudes of the physicians are also reported to be major challenges for the interviewees. This study highlights how rewarding the experience of motherhood was for the interviewees and also shows that women with disabilities face challenges at every step of their experiences, because of society’s prejudices toward disability.

Human Rights

www.macao-tz.org
December 2014

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Malezi AIDS Care Awareness Organization (MACAO) is a non-profit organization reaching out to neglected Indigenous people in Ngorongoro District, Arusha Region of Northern Tanzania.  Macao founded in 2003, Macao is a humanitarian organization that provides assistance to approximately 200,000 Indigenous Maasai community in Ngorongoro district for addressing needs of water and sanitation, food security, health Care Research, Education, Research environment, Maasai Traditional Research, Human Rights and sustainable economic development by strengthening their livelihoods.  In addition to responding to major relief situations, MACAO focuses on long-term community development through over 4 Area Development Project. We welcome the donors and volunteers to join us in this programs, we are wolking in ruro villages.

Access to health care, reproductive health and disability: A large scale survey in Sierra Leone

GROCE, Nora
TRANI, Jean-Francois
BROWN, Joyce Brown
KETT, Maria
BAH, Osman
MORLAI, Teddy
BAILEY, Nicki
2011

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This is the first study to compare health status and access to health care services between disabled and non-disabled men and women in urban and peri-urban areas of Sierra Leone. It pays particular attention to access to reproductive health care services and maternal health care for disabled women. A cross-sectional study was conducted in 2009 in 5 districts of Sierra Leone, randomly selecting 17 clusters for a total sample of 425 households. All adults who were identified as being disabled, as well as a control group of randomly selected non-disabled adults, were interviewed about health and reproductive health. As expected, we showed that people with severe disabilities had less access to public health care services than non-disabled people after adjustment for other socioeconomic characteristics (bivariate modelling). However, there were no significant differences in reporting use of contraception between disabled and non-disabled people; contrary to expectations, women with disabilities were as likely to report access to maternal health care services as did non-disabled women. Rather than disability, it is socioeconomic inequality that governs access to such services. We also found that disabled women were as likely as non-disabled women to report having children and to desiring another child: they are not only sexually active, but also need access to reproductive health services.

The balanced counseling strategy plus : a toolkit for family planning service providers working in high HIV/STI prevalence settings

POPULATION COUNCIL
2011

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"This "is an interactive, client-friendly approach for improving counseling on family planning and prevention, detection, and treatment of sexually transmitted infections (STIs) including HIV. The BCS+ was adapted from the Balanced Counseling Strategy, an evidence-based and well-researched tool for improving counseling on contraceptive methods. The BCS+ toolkit, developed and tested in Kenya and South Africa, provides the information and materials needed for health care facility providers to provide complete and high-quality family planning counseling to clients who live in areas with high rates of HIV and STIs.The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts
This second edition toolkit includes the following: * BCS+ Trainer’s Guide: Supervisors and others can use this to train health care facility directors and service providers on how to use the BCS+ for counseling family planning clients. * BCS+ User’s Guide: This guide focuses on how to implement the Balanced Counseling Strategy Plus. It can be distributed during training or used on its own with the BCS+ job aids. * BCS+ job aids comprising: - BCS+ algorithm that summarizes the 19 steps needed to implement the BCS+ during a family planning counseling session. These steps are organized into four stages: pre-choice, method choice, post-choice, and STI/HIV counseling. - BCS+ counseling cards that the provider uses during a counseling session. There are 26 counseling cards, the first of which contains six questions that the service provider asks to rule out the possibility a client is pregnant. Each of the next 16 cards contains information about a different family planning method. The next 3 cards provide advice on pregnancy and the postpartum period. The last 6 cards provide essential information for counseling on preventing, detecting, and treating STIs and HIV. - BCS+ method brochures on each of the 16 methods represented by the counseling cards. The brochures provide counseling to clients on the method they have chosen and then are given to clients for later reference. This means clients do not have to rely on their recollection of what was discussed with the provider. - WHO Medical Eligibility Criteria Wheel (offsite link) guides providers through medical conditions and medications that may be contraindications to use of particular contraceptive methods. The BCS+ tools are generic and can be revised according to national and/or regional guidelines and different contexts"
A video describing use of the BCS+ toolkit in South Africa also is available. To obtain Microsoft Word versions of BCS+ files to modify or revise according to your local setting, please contact the publisher

A book for midwives : care for pregnancy, birth and women's health|Un libro para parteras : atencion del embarazo, el parto y la salud de la mujer

KLEIN, Susan
MILLER, Suellen
THOMPSON, Fiona
2009

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Originally published in 1995, A Book for Midwives has been a comprehensive resource for practicing midwives and midwifery training programmes around the world. This new edition has been extensively updated and revised to reflect new WHO/UNICEF guidelines and standards for mothers and newborn children.This book covers the essentials of care before, during, and after birth, providing a variety of designs for low-cost equipment and training materials. It includes new information on helping women stay healthy during pregnancy; helping mothers have safer labors and births; preventing, managing, and treating obstetric emergencies; breastfeeding; the health needs of new babies; and involving the community in improving the health of mothers and pregnant women. It also includes new information about treatment and medications for HIV and other sexually transmitted infectons; vaccinations, medicines, and drug interactions; infection prevention; improved methods for dealing with complicated deliveries; and new and updated information on family planning

A report card on maternal mortality

UNITED NATIONS CHILDREN'S FUND (UNICEF)
2008

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‘Progress for Children’ is a series that monitors progress towards the Millennium Development Goals. This edition focuses on maternal health and, in particular, maternal mortality. It considers general progress and then examines particular regions. The report card acknowledges progress in improving maternal health, but argues that it is not sufficient to meet the MDG target of reducing maternal mortality by three quarters between 1990 and 2015

Taking critical services to the home : scaling-up home-based maternal and postnatal care, including family planning, through community midwifery in Kenya

MWANGI, Annie
WARREN, Charlotte
2008

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This publication is the report of a project to scale-up a community-based model, in Kenya, that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community. The findings of the project were that community midwifery contributed to increasing the proportion of women assisted by skilled attendants during birth in the four districts in which the scheme was trialed, amounting to just under half of all skilled attended births in the districts. Although the skilled birth attendant rate in these districts was well below the national average of 42 percent, there was a steady increase in the proportion of attended deliveries since CMs were introduced in 2005. The districts also reported an increase in postnatal assessments in the first 48 hours and increase in immunization coverage

Repositioning postnatal care in a high HIV environment : Swaziland

WARREN, Charlotte
et al
2008

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This report arose from recognition of the need to provide better care and follow up of mothers and infants in the postnatal period in order to improve maternal and neonatal outcomes in Swaziland. The objectives of the study were to determine if changes to the guidelines on postnatal care would result in improvements to provision of of maternal and newborn care in the postnatal period, increase utilization of postnatal care services among all postpartum (PP) women, and improve the care and follow up of HIV-positive postpartum women and their infants. The study confirmed that the introduction of an improved postnatal package with revised timing and content provided key components of maternal, newborn, and HIV care, and increased the utilization of services among postpartum women and their infants. An assessment of the quality of care during client-provider interactions for all postpartum women demonstrated a fourfold increase in the proportion that included all aspects of care: maternal and newborn health, counseling for HIV, family planning, and improved provider-client relationships

Sexual health for people with intellectual disability

EASTGATE, Gillian
2008

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This article explores how people with intellectual disability often experience difficulties meeting their sexual needs and desires due to poor education and social isolation. However, the article highlights that people with intellectual disability are capable of safe, constructive sexual expression and healthy relationships with appropriate education and good social support. It emphasises that providing this support is an essential part of supporting people with intellectual disability
Salud Publica Mex, 50 suppl 2

Women, harm reduction, and HIV

PINKHAM, Sophie
MALINOWSKA-SEMPRUCH, Kasia
September 2007

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This report looks at factors that reduce women drug users’ access to health care including punitive policies, discrimination by police and health care providers, the intense social stigma attached to drug use by women, a preponderance of harm reduction and drug treatment programmes directed primarily toward men, an absence of sexual and reproductive health services for drug users, and poor access to effective outpatient drug treatment. Pregnant drug users are particularly vulnerable. In too many instances, they receive little or no accurate information about drug use during pregnancy or prevention of mother-to-child transmission of HIV. In some countries pregnant drug users are rejected by health care providers, threatened with criminal penalties or loss of parental rights, or coerced into having an abortion or abandoning their newborns to the state. Poor access to medication-assisted treatment jeopardises the pregnancies of opiate-dependent drug users. It includes recommendations for consideration when designing services for women drug users and also examines issues around policies to protect women's health

Women and HIV : questions answered

RICHEY, Catherine
SHETTY, Vidya
August 2007

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Questions and answers are grouped into 4 sections: basic facts about HIV; family planning and HIV; health of mother and infant; and mother-to-child transmission of HIV

Uganda demographic health survey 2006

UGANDA BUREAU OF STATISTICS (UBOS)
MACRO INTERNATIONAL INC
August 2007

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The 2006 Uganda Demographic and Health Survey (UDHS) is a nationally representative survey of 8,531 women age 15-49 years and 2,503 men age 15-54 years and is the first such survey to cover the entire country. The primary purpose of the UDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. In addition, in one in three households selected for the survey, women age 15-49, men age 15-54, and children under age 5 years were weighed and their height was measured to assess their nutritional status. Women, men, and children age 6-59 months, in this subset of households were also tested for anemia, and in addition the women and children were tested for vitamin A deficiency. In addition to the main report, the key findings, a preliminary report, a wall chart and fact sheet are also available online

Family planning : a global handbook for providers

World Health Organization Department of Reproductive Health and Research (WHO/RHR)
Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), Info Project CCP
United States Agency for Inernational Development (USAID)
2007

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This is a quick-reference resource for health care workers at all levels. It reflects the family planning guidance developed by the WHO and expands on the coverage of 'The essentials of contraceptive technology' (CCP:1997) to address other needs of clients that come up during the course of family planning. Coverage includes different methods of contraception, sexually transmitted diseases, maternal and new born health, reproductive health issues, family planning provision and serving diverse groups; e.g. adolescents, men, and women near menopause . The handbook is one of the WHO's 'four cornerstones of family planning guidance'

Research issues in sexual and reproductive health for low- and middle-income countries

DE FRANCISCO, Andres
DIXON-MUELLER, Ruth
D'ARCANGUES, Catherine
2007

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This paper outlines a conceptual framework and a number of thematic and cross-cutting research issues in sexual and reproductive health as a first step in a consultative process towards the identification of gaps and priorities for research in this field. The themes of social equity, poverty and gender addressed in this paper are of particular relevance to the field of sexual and reproductive health. So, too, are the challenges of collaborating with in-country partners to identify context-specific research priorities that address the many and varied dimensions of sexual and reproductive health and its determinants and correlates in order to build the evidence base and put policy and programmatic evidence into practice in low-resource settings

Better breastfeeding, healthier lives [whole issue]

March 2006

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This issue looks at the merits of breastfeeding and suggests ways for programmes and providers to help women improve breastfeeding practices. Breastmilk offers infants and young children complete nutrition and early protection against illness, increasing their chances of survival. National governments need to devise and implement comprehensive strategies to promote optimal practices and advise women about the benefits of breastfeeding. Includes an outline of Madagascar's policy approach and a discussion on breastfeeding as a contraceptive option

17 fact sheets on gender-related aspects of HIV/AIDS | Resource pack on gender and HIV/AIDS

UNAIDS Inter-Agency Task Team on Gender and HIV/AIDS
2005

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These fact sheets aim to provide policy makers with concise information about gender related aspects of the HIV/AIDS pandemic. They deal with core facts and issues in thematic areas and are underpinned by an analysis which clarifies how gender issues are fuelling the crisis. Each theme presents a self-contained set of issues and recommendations and many of the themes are interlinked. All of them are connected by a concern to promote a gender-enlightened and comprehensive response to HIV/AIDS and its impacts

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