International Perspectives on Sexual and Reproductive Health最新文献

{"title":"Intervention Improved Health Workers' Neonatal Resuscitation Skills and Knowledge, but Not Neonatal Mortality","authors":"J. Rosenberg","doi":"10.1363/intsexrephea.42.3.165","DOIUrl":"https://doi.org/10.1363/intsexrephea.42.3.165","url":null,"abstract":"Health care workers who participated in a mobile phone-based safe delivery intervention had greater skills and knowledge regarding neonatal resuscitation than control workers, according to a cluster-randomized clinical trial conducted at 70 health care facilities in rural Ethiopia. (1) Neonatal resuscitation skills scores six months and 12 months after implementation of the safe delivery app intervention were higher among intervention health care workers than among controls (mean differences, 6.0 and 8.8 points, respectively); neonatal resuscitation knowledge was higher among intervention health care workers than among controls at six months postimplementation (mean difference, 1.7 points), but not at 12 months. The intervention was not associated with a significant change in perinatal mortality of infants delivered at study health care facilities. The safe delivery app was designed to provide health care workers in low-income countries with the knowledge and skills to manage obstetric and neonatal emergencies; the app consisted of videos on topics such as neonatal resuscitation, as well as a catalog of essential obstetric drugs and equipment. To examine whether use of the app was associated with changes in perinatal mortality rates and in health care workers' knowledge and skill levels, researchers conducted a cluster-randomized clinical trial of health care facilities in five rural districts of Ethiopia's Oromiya region. Of the 131 facilities that were screened, 70 met the study's eligibility criteria (i.e., having a midwife or health extension worker on staff and having been the site of deliveries in the previous year) and were included in the study sample. Half of eligible facilities were randomly selected to the intervention group and were supplied with smartphones loaded with the safe delivery app; health care workers at intervention facilities received a one-day training session on how to use the phones and app. The other half of facilities were selected to the control group, and did not receive phones or additional training; the researchers ensured that both intervention and control facilities had an adequate package of drugs and equipment. Between September 2013 and February 2015, data were collected on women delivering at study facilities and on their birth outcomes; women were contacted in person or by phone seven days after delivery to follow up about perinatal mortality. In addition, facility health care workers' knowledge and skills regarding neonatal resuscitation were assessed by questionnaire and structured assessment tools (e.g., simulated scenarios using mannequins) before implementation of the intervention and at six and 12 months afterward. Descriptive and logistic regression analyses were used to compare perinatal mortality rates at intervention and control facilities, and to compare health care workers' neonatal resuscitation knowledge and skills index scores over time. The analysis sample included 1,474 women in the interv","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 1","pages":"165"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67047819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Estimated Incidence of Induced Abortion in Ethiopia, 2014: Changes in the Provision of Services Since 2008.","authors":"Ann M Moore,&nbsp;Yirgu Gebrehiwot,&nbsp;Tamara Fetters,&nbsp;Yohannes Dibaba Wado,&nbsp;Akinrinola Bankole,&nbsp;Susheela Singh,&nbsp;Hailemichael Gebreselassie,&nbsp;Yonas Getachew","doi":"10.1363/42e1816","DOIUrl":"https://doi.org/10.1363/42e1816","url":null,"abstract":"<p><strong>Context: </strong>In 2005, Ethiopia's parliament amended the penal code to expand the circumstances in which abortion is legal. Although the country has expanded access to abortion and postabortion care, the last estimates of abortion incidence date from 2008.</p><p><strong>Methods: </strong>Data were collected in 2014 from a nationally representative sample of 822 facilities that provide abortion or postabortion care, and from 82 key informants knowledgeable about abortion services in Ethiopia. The Abortion Incidence Complications Methodology and the Prospective Morbidity Methodology were used to estimate the incidence of abortion in Ethiopia and assess trends since 2008.</p><p><strong>Results: </strong>An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 women aged 15-49, an increase from 22 per 1,000 in 2008, and was highest in urban regions (Addis Ababa, Dire Dawa and Harari). Between 2008 and 2014, the proportion of abortions occurring in facilities rose from 27% to 53%, and the number of such abortions increased substantially; nonetheless, an estimated 294,100 abortions occurred outside of health facilities in 2014. The number of women receiving treatment for complications from induced abortion nearly doubled between 2008 and 2014, from 52,600 to 103,600. Thirty-eight percent of pregnancies were unintended in 2014, a slight decline from 42% in 2008.</p><p><strong>Conclusions: </strong>Although the increases in the number of women obtaining legal abortions and postabortion care are consistent with improvements in women's access to health care, a substantial number of abortions continue to occur outside of health facilities, a reality that must be addressed.</p>","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 3","pages":"111-120"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/42e1816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35336651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing a Referral System for Safe and Legal Abortion Care: A Pilot Project on the Thailand-Burma Border.","authors":"Angel M Foster,&nbsp;Grady Arnott,&nbsp;Margaret Hobstetter,&nbsp;Htin Zaw,&nbsp;Cynthia Maung,&nbsp;Cari Sietstra,&nbsp;Meredith Walsh","doi":"10.1363/42e1516","DOIUrl":"https://doi.org/10.1363/42e1516","url":null,"abstract":"The decades-long conflict in Eastern Burma,* and the continued human rights violations and lack of development and economic opportunities there, have led to the displacement of millions of people in the region. Some have been internally displaced, others live in conflictaffected communities in Eastern Burma, and approximately 1.5 million are either residents of nine unofficial refugee camps along the border with Thailand or undocumented migrants concentrated in Tak Province in northern Thailand.1–3 For these displaced populations, the overarching political, development and human rights context has had a significant impact on health in general, and on reproductive and maternal health in particular.4 Individuals in the affected regions of Thailand and Burma face significant barriers to accessing reproductive health services on both sides of the border, and are at an increased risk of rape and sexual exploitation.5–10 Although the maternal mortality ratio for Burma overall has remained relatively constant over the last decade (at 320 deaths per 100,000 live births), it is estimated to be substantially higher (approximately 1,000) in conflictaffected Eastern Burma.11 Limited access to contraceptives and the consequent risk of unintended pregnancy continue to be public health issues for women living in Eastern Burma.5 Although the national contraceptive prevalence rate is only 34%, the rate is likely much lower in conflict-affected areas;12–14 some reports suggest that 80% of women in Eastern Burma have never used a modern method.11,15 Abortion has long been severely legally restricted in Burma. The 1860 Burma Penal Code—incorporated into the law of independent Burma in 1947 and still in effect—is based on British law and prohibits abortion unless the procedure is performed to save the life of the woman; this exception is narrowly interpreted.16 A person who performs an unauthorized abortion and the woman herself may face imprisonment, fines or both; both criminal and civil penalties increase if the abortion takes place after “quickening,”17 an archaic term for when a pregnant woman first perceives fetal movement. Like women in other settings where abortion is legally restricted, women in Burma who want to terminate a pregnancy often resort to unsafe methods.6,7,16,18,19 The national restrictions on abortion, combined with the heightened unintended pregnancy risk, have had","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 3","pages":"151-156"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/42e1516","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35338002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining Progress and Equity in Information Received by Women Using a Modern Method in 25 Developing Countries.","authors":"Anrudh K Jain","doi":"10.1363/42e1616","DOIUrl":"https://doi.org/10.1363/42e1616","url":null,"abstract":"<p><strong>Context: </strong>The information exchanged during a contraceptive visit is important because providers need to understand clients' reproductive intentions and clients need to receive adequate information about methods and possible method-related side effects and problems. Little is known about how information exchange has changed over time and how it might vary across countries or subgroups within a country.</p><p><strong>Methods: </strong>Demographic and Health Survey data from 25 developing countries were used to calculate the Method Information Index (MII), a Family Planning 2020 indicator that reflects some aspects of contraceptive information exchanged between providers and clients. For each country, the MII was calculated from each of two surveys about five years apart to examine change in the indicator over time. In addition, the MII was examined for all countries combined and by region.</p><p><strong>Results: </strong>The average MII for all 25 countries increased from 34% at the earlier survey time to 39% at the later survey time; the index values of individual countries ranged from 19% to 64% at survey time 1 and from 13% to 65% at survey time 2. The MII increased over time in 15 countries and declined in 10. In analyses by contraceptive method type, the MII tended to be highest among implant users and lowest among women relying on sterilization. The index was generally higher among women living in urban areas than among those in rural areas, and tended to rise with increases in women's education and household wealth.</p><p><strong>Conclusions: </strong>On the basis of the MII, developing countries have room to improve information exchange between providers and clients. Such improvements would require concerted efforts by programs and donors.</p>","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 3","pages":"131-140"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/42e1616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35338000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Burkina Faso, a Sharp Decline in HIV Prevalence Coincides with a Shift toward Safer Sexual Behaviors","authors":"S. London","doi":"10.1363/intsexrephea.42.3.159","DOIUrl":"https://doi.org/10.1363/intsexrephea.42.3.159","url":null,"abstract":"HIV prevalence in Burkina Faso has declined sharply in recent decades in tandem with a shift toward safer sexual practices, finds an analysis of data from antenatal care surveillance and population-based surveys. (1) The proportion of pregnant women aged 15-49 testing positive for HIV fell by roughly 70% overall between 1998 and 2014, with the greatest reductions seen in younger age-groups; declines were also evident among men, but were more marked in older age-groups. In addition, there was an increase in the proportion of never-married 15-24-year-olds who delayed sexual debut and a decrease in the share having multiple sexual partners in the past year, as well as an uptick in condom use at last sex with nonmarital, noncohabiting partners among 15-49-year-olds with such partners. Investigators analyzed data on HIV prevalence from nine antenatal care surveillance sites in Burkina Faso that were consistently included in surveillance between 1998 and 2014 (totaling 2,010-3,129 pregnant women aged 15-49 per year). In addition, they analyzed data on HIV prevalence and sexual behaviors from three population-based Demographic and Health Surveys (DHS) conducted in 1998-1999, 2003 and 2010, mainly among men and women aged 15-49. With the DHS data, the researchers assessed five sexual behavior indicators (sexual inexperience among never-married youth; multiple partners in the past year among sexually active youth; sex with a nonmarital, noncohabiting partner among all sexually active respondents; condom use at last sex with a nonmarital, noncohabiting partner among all sexually active respondents with such partners; and sexual debut before age 15 among youth) and two general HIV-related indicators among youth (ever having been tested for the virus and knowledge of a formal source of condoms). They calculated survey-specific HIV prevalence, and used chi-square tests to compare HIV prevalence across survey years and to ascertain trends in sexual behaviors. Results of analyses of the antenatal care surveillance data indicated that the proportion of pregnant women aged 15-49 testing positive for HIV fell dramatically in Burkina Faso between 1998 and 2014, by 72% in urban areas (from 7% to 2%) and by 75% in rural areas (from 2% to less than 1%). The greatest reductions during 2007-2014 (the years when age-specific data were available) occurred among younger women: some 55% among 15-19-year-olds, 72% among 20-24-year-olds and 40% among 25-29-year-olds, compared with just 7% among those aged 30 years or older. Analyses of the DHS data showed a similar pattern among women between 2003 and 2010: HIV prevalence fell by 89% among women aged 15-19 (from 1% to nearly zero), by 78% among those aged 20-24 (from 2% to less than 1%) and by 52% among those aged 25-29 (from 3% to 1%), with minimal change among those aged 30 or older. However, the pattern among men was somewhat different, as reductions were more marked in older age-groups: For example, HIV prevalence fell by","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 1","pages":"160"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67047605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in Morbidity and Abortion Care in Ethiopia After Legal Reform: National Results from 2008 and 2014.","authors":"Yirgu Gebrehiwot, Tamara Fetters, Hailemichael Gebreselassie, Ann Moore, Mengistu Hailemariam, Yohannes Dibaba, Akinrinola Bankole, Yonas Getachew","doi":"10.1363/42e1916","DOIUrl":"10.1363/42e1916","url":null,"abstract":"<p><strong>Context: </strong>In Ethiopia, liberalization of the abortion law in 2005 led to changes in abortion services. It is important to examine how levels and types of abortion care-i.e., legal abortion and treatment of abortion complications-changed over time.</p><p><strong>Methods: </strong>Between December 2013 and May 2014, data were collected on symptoms, procedures and treatment from 5,604 women who sought abortion care at a sample of 439 public and private health facilities; the sample did not include lower-level private facilities-some of which provide abortion care-to maintain comparability with the sample from a 2008 study. These data were combined with monitoring data from 105,806 women treated in 74 nongovernmental organization facilities in 2013. Descriptive analyses were conducted and annual estimates were calculated to compare the numbers and types of abortion care services provided in 2008 and 2014.</p><p><strong>Results: </strong>The estimated annual number of women seeking a legal abortion in the types of facilities sampled increased from 158,000 in 2008 to 220,000 in 2014, and the estimated number presenting for postabortion care increased from 58,000 to 125,000. The proportion of abortion care provided in the public sector increased from 36% to 56% nationally. The proportion of women presenting for postabortion care who had severe complications rose from 7% to 11%, the share of all abortion procedures accounted for by medical abortion increased from 0% to 36%, and the proportion of abortion care provided by midlevel health workers increased from 48% to 83%. Most women received postabortion contraception.</p><p><strong>Conclusions: </strong>Ethiopia has made substantial progress in expanding comprehensive abortion care; however, eradication of morbidity from unsafe abortion has not yet been achieved.</p>","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 3","pages":"121-130"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/42e1916","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35337999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Health Care Facilities in Sub-Saharan Africa Found to Provide Poor Basic Maternal Care","authors":"P. Doskoch","doi":"10.1363/intsexrephea.42.3.161","DOIUrl":"https://doi.org/10.1363/intsexrephea.42.3.161","url":null,"abstract":"The quality of basic maternity care in primary care facilities--where a substantial proportion of deliveries in many low-income countries take place--is much lower than that in secondary care facilities, according to an analysis of data from five Sub-Saharan African countries. (1) In both types of facilities, greater delivery volumes were associated with higher scores on an index of quality of care. However, primary care facilities--even those with the highest delivery volume--had lower quality-of-care scores than secondary care facilities, and frequently lacked even such basic elements of infrastructure as electricity. Efforts to reduce maternal mortality in developing countries often have focused on increasing the proportion of births that take place in facilities; however, improving the quality of obstetric care has received less attention from policymakers and researchers. Because studies from high-income countries have found that maternal outcomes tend to be worse at facilities with lower delivery caseloads, the authors of the current study examined the relationship between delivery volume and quality of care in five low- and middle-income Sub-Saharan African countries (Kenya, Namibia, Rwanda, Tanzania and Uganda). All five had maternal mortality rates far higher than the Sustainable Development Goal target of 70 deaths per 100,000 live births; Namibia, the only middle-income country in the group, had by far the lowest maternal mortality rate (130 per 100,000, compared with 320-410 per 100,000 in the other countries) and the highest proportion of deliveries in facilities (87% vs. 50-69%). The analysis used data from service provision assessment surveys conducted between 2006 and 2010 as part of the Demographic and Health Survey program. The surveys collected information on facility characteristics and services through standardized questionnaires and through structured interviews of health care workers; for each country, the sample of facilities either was nationally representative or included nearly all facilities in the health system. Analyses examined secondary care facilities--those with the capacity to perform caesarean deliveries--separately from primary care facilities. The researchers used a categorical variable for annual delivery volume, although to account for differences in capacity the category thresholds were smaller for primary facilities (from [less than or equal to]52 to >500) than for secondary facilities (from [less than or equal to]500 to >4,000). Assessing quality of care was trickier; although maternal mortality is often used as an indicator of quality, this approach can be misleading unless analyses adjust for the greater severity of cases typically treated by higher-level facilities. Because severity data were unavailable, the researchers created a 12-item index of quality of maternal care that indicated the number of basic care elements provided at each facility. Items ranged from simple structural indicators (e.g., t","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 1","pages":"161"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1363/intsexrephea.42.3.161","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67047685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Costs of Postabortion Care in Developing Countries Are Substantial and Vary across Settings","authors":"L. Melhado","doi":"10.1363/intsexrephea.42.3.163","DOIUrl":"https://doi.org/10.1363/intsexrephea.42.3.163","url":null,"abstract":"163 technical personnel, such as laboratory technicians, were more involved in postabortion care in Colombia than in the three African countries. Overall, salaries of health personnel were highest in Colombia and lowest in Uganda. The total labor cost per case for postabortion care was considerably higher in Colombia (I$301) than in the African countries (Uganda, I$43; Ethiopia, I$45; and Rwanda, I$58). There was less variation by country in the remaining components of direct costs: The average cost of drugs and supplies per case ranged from I$79 in Colombia to I$115 in Rwanda. The researchers also examined the indirect costs of postabortion care in the four countries; however, data for Ethiopia were deemed “deficient” and were excluded. The total indirect costs per postabortion care case were highest in Colombia (I$618), followed by Uganda (I$270) and Rwanda (I$150). The researchers summed the direct and indirect costs to calculate the total cost per postabortion care case in each country, which was I$972 for Colombia, I$407 for Uganda and I$334 for Rwanda. Labor and overhead accounted for 81% of the total cost of postabortion care in Colombia, but only 22% and 46% in Uganda and Rwanda, respectively; drugs and supplies and capital costs accounted for larger proportions of the total cost in the two African countries than in Colombia. The cost of treating one postabortion patient was 11% of the annual per capita income in Colombia, 29% in Rwanda and 35% in Uganda. The researchers note several limitations of the Post-Abortion Care Costing Methodology. Because the methodology has evolved over time, comparison across studies is somewhat restricted. In addition, although the results of abortion incidence studies conducted in the four countries were available for comparison, the inherent difficulty of collecting data on abortion means that some uncertainty remains (for example, on the proportion of women with postabortion complications not treated in the health system). Despite these limitations, the researchers note, the The Costs of Postabortion Care in Developing Countries Are Substantial and Vary Across Settings","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 1","pages":"164"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67047760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Experience and Impact of Contraceptive Stockouts Among Women, Providers and Policymakers in Two Districts of Uganda.","authors":"Kate Grindlay,&nbsp;Eleanor Turyakira,&nbsp;Imelda T Kyamwanga,&nbsp;Adrianne Nickerson,&nbsp;Kelly Blanchard","doi":"10.1363/42e2016","DOIUrl":"https://doi.org/10.1363/42e2016","url":null,"abstract":"<p><strong>Context: </strong>Little is known about the impact of contraceptive stockouts on women and health care providers, or how policymakers perceive and handle such stockouts.</p><p><strong>Methods: </strong>In May-July 2015, a qualitative study on experiences of contraceptive stockouts was conducted in two districts of Uganda. It comprised three data collection components: eight focus groups with 50 women, 24 individual in-depth interviews with family planning service providers and facility managers, and 11 in-depth interviews with district-level policymakers and decision makers. Data analysis followed the content analysis approach.</p><p><strong>Results: </strong>Contraceptive stockouts were common, particularly for long-term methods and oral contraceptives. For women, the consequences included stress, increased costs, domestic conflict, and unwanted or unplanned pregnancies. Providers reported emotional distress, blame from clients, deterioration of skills and lower demand for their services as a result of stockouts; they also felt unable to address stockouts under current supply systems. Despite the widespread prevalence and adverse impact of stockouts, policymakers reported being unaware of the scope of the problem.</p><p><strong>Conclusions: </strong>The findings suggest there is a critical need to raise awareness of the issue, reduce stockouts and mitigate their negative consequences. Efforts to eliminate stockouts should include addressing supply chain issues. Raising community awareness and engaging with men on family planning may be ways to deal with the consequences of stockouts.</p>","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 3","pages":"141-150"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35338001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilical Cord Cleansing May Not Be Effective in Reducing Neonatal Mortality in African Settings","authors":"J. Rosenberg","doi":"10.1363/intsexrephea.42.3.157","DOIUrl":"https://doi.org/10.1363/intsexrephea.42.3.157","url":null,"abstract":"","PeriodicalId":46940,"journal":{"name":"International Perspectives on Sexual and Reproductive Health","volume":"42 1","pages":"157"},"PeriodicalIF":4.4,"publicationDate":"2016-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67047958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}