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The objectives of this study were to assess the Kenyan Ministry of Health's capacity to adapt focused antenatal care (ANC) at the service delivery level so that it can be sustained, and to examine the extent to which adaptation of the package has increased coverage and quality of key ANC services and the overall quality of care received by pregnant women. The study showed that focused ANC is acceptable to both clients and providers and the approach has also received tremendous support from both the government and health development partners. However, the sustainability of the focused ANC package is contingent upon availability of funding, availability of a minimum level of equipment and supplies, competent providers, and a clear policy direction. The study recommends further consultation with key actors (such as pre-service training institutions and professional bodies) to ensure institutionalization and standardization of focused ANC; community mobilization to create awareness about the new services being offered; reorganizing service delivery and client flow within clinics to reduce client waiting time; and training providers in the concept of focused ANC.

Despite revising their reproductive health policies in line with the 1994 International Conference on Population and Development (ICPD) Programme of Action, a major challenge facing many developing countries is the inability to fully implement the policies owing to lack of funds, bureaucratic delays, and limited awareness among various stakeholders. In some countries, the policies fail to adequately address sexual and reproductive health (SRH) needs of vulnerable groups. This study examines the barriers to SRH programming for adolescents living with HIV from the perspectives of key stakeholders involved in SRH issues in Uganda. The data are from qualitative interviews conducted in 2007 with 23 key informants from bilateral institutions, government ministries, and civil society organizations. The study findings confirm that policy and programmatic gaps exist in addressing the SRH needs of HIV-positive adolescents. This is attributable to: (1) lack of clear guidelines on how to address the SRH of HIV-positive adolescents; (2) challenges of dealing with adolescent SRH in general; (3) HIV/AIDS treatment, care, and support services that are either pediatric- or adult-oriented; and (4) limited institutional and provider capacity to offer SRH services to HIV-positive adolescents despite recognizing that this is an emerging area that requires intervention. These results suggest the need for: (1) clear guidelines on dealing with SRH of HIV-positive adolescents; (2) establishing transition clinics or youth-friendly corners to cater for the needs of adolescents who cannot fit in either pediatric or adult clinics; and (3) providing training and reorientation on SRH of HIV-positive adolescents to service providers/counsellors.

In April 2019, the International Conference on the Great Lakes Region's Regional Training Facility (ICGLR-RTF) organized a regional meeting entitled "Sensitization Meeting for Police Chiefs and National Reproductive Health Heads in the Great Lakes Region." Held in Kigo, Uganda, the meeting brought together chiefs of police and heads of reproductive health departments (Ministries of Health) from nine ICGLR member states, namely: Burundi, Central African Republic, Democratic Republic of Congo, Kenya, Republic of Congo, South Sudan, Sudan, Uganda, and Zambia. The meeting was sponsored by the Population Council, Kenya. Sauti/VOICE Program Brief 2 describes the preamble to ICGLR-RTF's meeting resolutions and the ten resolutions made. Regional resolutions will be employed as an advocacy tool by ICGLR-RTF and its partners (including the Council) to promote utilization of the police emergency contraception provision model in the region, including in refugee contexts.

For over a decade, the Population Council and its partners (the Africa Regional SGBV Network) have provided technical assistance and conducted research to strengthen the evidence base of sexual and gender-based violence (SGBV) programming in Africa's East, Horn, and Great Lakes regions. Under the Africa Regional SGBV Network, the Council and partners developed and tested an intervention including police response to sexual violence survivors, with police provision of emergency contraception (EC) for survivors and referrals to health facilities. This model has been successfully tested in Zambia and Malawi. Studies reveal that EC provision by trained police to sexual violence survivors is both feasible and effective. Results from these studies prompted the Government of Zambia to request Council technical assistance to scale this model nationally, and a meeting was co-convened by the Council and the East African Community Department of Peace and Security in 2014. This meeting report (Sauti/VOICE Program Brief 1) describes meeting objectives and regional recommendations.

Over the past decade, adolescent sexual and reproductive health (ASRH) concerns have increasingly been on the development agenda of the government of Ghana. This concern has been driven by such factors as early age of sexual debut, early childbearing, and prevalence of HIV/AIDS among this subgroup of the population. The overall objective of the study was to generate evidence on the knowledge, perceptions, and practices regarding ASRH among slum communities in Ghana. The findings of the study indicate a need for intensifying efforts to inform and educate adolescents living in the slums about responsible and healthy attitudes toward sexuality, delaying the onset of sexual activity, and reducing risky sexual behaviors; incorporating sex education appropriate for each educational level; and involving all stakeholders including parents/guardians and community leaders in addressing adolescent SRH needs which will, in turn, enhance community participation and address cultural barriers and inhibitions to the optimum realization of ASRH.

The progesterone vaginal ring (PVR) is a ring-shaped device designed for use by women in the postpartum period to regulate fertility by complementing and extending the contraceptive effectiveness of lactational amenorrhea to suppress ovulation.1 It is available in eight Latin American countries for use by breastfeeding women who want more effective modern contraceptives in addition to contraceptive benefits provided by lactational amenorrhea alone.1 The PVR is a method that can be suitable to women in sub-Saharan Africa, given the near-universal practice of breastfeeding and the current level of unmet need for contraception in the postpartum period. Efforts are currently underway to introduce the PVR in Africa and south Asia. To ensure a seamless introduction, scale up and sustainability of the PVR in the region, the Population Council conducted pre-introductory activities with stakeholders in Kenya, Nigeria and Senegal to determine the level of interest in the ring, potential facilitating and mitigating factors and identify solutions to address challenges. The research team combined three approaches: in-depth interviews with family planning stakeholders; desk review of reports and policy guidelines; and in-group meetings. The stakeholders reached included public sector officials including policy makers and program managers, implementing partners, regulators, women and religious networks. All three countries had a promising policy and programmatic context that was supportive to PVR introduction. The exercise provided insights on socio-cultural and religious factors that could potentially impact how the PVR is perceived within communities and identified possible remedies to address misperceptions. It also paved the way for the conduct of an acceptability study of the PVR among breastfeeding women in these countries. The high acceptability rate in each country and the support expressed by government and other stakeholders have provided impetus for registration of the product in each country. Learning from this ...

AbstractThe progesterone vaginal ring (PVR) is a contraceptive designed for use by breastfeeding women in the first year postpartum. This Report presents results of an acceptability study of the PVR in Kenya, Nigeria, and Senegal. Women seeking postpartum family planning services were offered various contraceptive options including the PVR. Of the 174 participating women, 110 (63 percent) used one ring and 94 (54 percent) completed the study by using two rings over a six‐month period. Women were interviewed up to three times: at the time they entered the study, at 3 months (the end of the first ring cycle), and at 6 months (the end of the second ring cycle or when they exited if they had discontinued earlier). Many participants found the ring to be acceptable, with over three‐quarters reporting that it was easy to insert, remove, and reinsert. While a small proportion of women experienced ring expulsion, the majority did not. These findings suggest that even in countries with little or no use of vaginal health products, contraceptive vaginal rings offer women a new option that they are able and willing to use.

The Population Council's Frontiers in Reproductive Health Program and the Program for Appropriate Technology in Heath collaborated with three Government of Kenya ministries—Education; Health; and Gender, Sports, Culture and Social Services—to design and implement the Kenya Adolescent Reproductive Health Project with the goals of: improving knowledge about reproductive health and encouraging a responsible and healthy attitude toward sexuality among adolescents, delaying the onset of sexual activity among younger adolescents, and decreasing risky behaviors among sexually active adolescents. Key findings from the pilot project showed that the three ministries could successfully implement these interventions with high participation among parents and youth. For these efforts to be sustainable, partners should be involved and willing to integrate activities within their respective programs, share costs, and create a favorable policy and legislative environment.

In April 2016, the Population Council, in partnership with the World Health Organization (WHO) and the International Consortium for Emergency Contraception, convened a regional meeting in Lusaka, Zambia, geared toward supporting countries in East and Southern Africa in meeting their obligations under the Maputo Protocol. These obligations include expanding access to women's reproductive health services—especially women survivors of sexual violence. Government and civil society representatives from six countries participated: Botswana, Ethiopia, Kenya, Malawi, Rwanda, and Zambia. Countries were selected based on to their being priority settings for the projects that sponsored the meeting, coupled with the fact that they were each far enough along in addressing post-rape care to be able to develop concrete policy, programming, and/or legal action plans by the end of the meeting. The meeting was the first activity in a joint project of technical assistance by the conveners, aimed at strengthening access to comprehensive post-rape care for survivors of sexual violence. It aimed to sensitize Member States to their obligations under the Maputo Protocol to expand women's access to emergency contraception (EC) and safe abortion services, and to inspire them to do so by providing information, research evidence, and a platform for discussion. The meeting deliberations fostered a better understanding of opportunities to broaden access to EC and safe abortion for survivors in the region. Discussions on EC in this regard centered on strengthening EC delivery in the clinical context, decentralizing EC services, increasing community awareness, and overcoming policy barriers. Safe abortion discussions focused primarily on legislation, policy, and integrating these services into existing services for sexual violence survivors. Country-specific action plans were developed to address gaps and weaknesses. The regional technical meeting concluded with a discussion of practical steps that participants could take to facilitate legal, ...

International health planners often design programs based on the assumption that recipient nations share the same "level playing field" with regard to conceptions of health, illness, and at-risk populations. This volume challenges that perception, analyzing the outcomes of humanitarian projects that fail to recognize local ethnic and national identities, as well as the tensions between international health agencies' mandates and powerful centralized government agendas. Case studies are drawn from Africa, Asia, and the Caribbean