Suchergebnisse

Despite the centrality of pharmacists in the provision of abortion services in Kenya, little is known about their medical abortion (MA) knowledge, attitudes, or practices. This policy brief reports on a study that set out to bridge this gap in the evidence. The report concludes that comprehensive training for pharmacy workers could improve the quality of MA provision and referrals, and help pharmacy workers identify opportunities to simultaneously provide clients with information on contraception and STI prevention. Such efforts would be in line with current Kenyan government policies to reduce the public health burden caused by the prevalence of unsafe abortion and HIV, and within the boundaries of the current legal framework.

Silent suffering from unrepaired fistula—a condition that causes women to leak urine or feces—burdens women living in low- and middle-income countries. In Kenya, while many women experience delays in seeking repair due to a number of factors, others demonstrate resilience in accessing care. This mixed methods concurrent design draws on structured questionnaires and case studies with women affected by fistula (n = 82) and 16 focus group discussions (FGDs) with men and women in Central, Eastern, and Coastal Kenya. Factors associated with repair care-seeking include telling a spouse, positive spousal reaction, and financial and psychosocial assistance of spouse or siblings (p < 0.05). Loss of dignity and self-worth, feeling rejected, household gender imbalance, beliefs about witchcraft, spousal or familial abandonment, silence around condition, embarrassment to seek care, poverty, cost of transport, husband accompaniment policies, and past unsuccessful repairs represent barriers to care-seeking. In contrast, women who were knowledgeable about treatment, had financial and psychosocial support from spouses and family members, and felt sympathetic altruism of their community were better able to access repair care, adequate follow-up, and reintegrate into social life. In summary, findings show that multiple factors in women's lives—including their awareness, resolve, and contextually derived support—simultaneously affect their resilience to access free care opportunities. These opportunities may be further modified by health facility and health system factors, and political leadership that shapes the provision and organization of repair services. This implies a need to focus interventions on educating and awareness-raising to destigmatize the condition, empower women, and enhance collective agency.

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.