The potential impact of community-based distribution programmes on contraceptive uptake in resource-poor settings: evidence from Ethiopia.

Community-based reproductive health services (CBRHS) have been in implementation in Ethiopia for over a decade. This paper assesses the impact of such programmes on contraceptive use. The data were obtained from the 2000 Ethiopian Demographic and Health Survey (DHS) and the 2003 Contraceptive Prevalence Survey (CPS). While the 2000 DHS contained a nationally representative random sample of women of reproductive age, the 2003 CPS focused on areas with active CBRHS programmes. The findings indicate that expanding the current CBRHS programme has the potential of doubling the current national contraceptive prevalence rate.

Parental presence and adolescent reproductive health among the Nairobi urban poor.

PURPOSE: To investigate whether the presence of parents constitute a protective factor against adverse reproductive health outcomes for adolescents living in slums of Nairobi, Kenya. METHODS: The data come from a cross-sectional survey that canvassed a random sample of 4564 households representative of all Nairobi slums in February-June 2000. Structured questionnaires on household census, reproduction and adolescent health were verbally administered to household heads, women of reproductive ages, and adolescents, respectively. We restrict the analysis to a sub-sample of 788 never-married adolescent girls aged 12-19 years. We compare reproductive health outcomes of adolescents who live with neither parent, father only, mother only, and both parents. Data were analyzed using simple descriptive analysis and logistic regression models of three outcome variables: ever sexually active, ever experienced an unplanned pregnancy, and sexually active within the past 4 weeks. For each of the outcome variables, two models, one with and one without a proxy for adolescents' disorderly behavior are presented to establish whether parental presence affects adolescents' reproductive health. RESULTS: When the father is present in the household (i.e., father only or both parents present), adolescent girls are 42% less likely to have ever had sex (p<.05), 45% less likely to have been sexually active in the most recent 4-week period (p<0.1), and 59% less likely to have ever experienced an unwanted pregnancy (p<.05) than when neither parent, or only the mother, is present in the household. CONCLUSIONS: In the slums of Nairobi, father's presence, unlike that of the mother, is associated with stronger resilience among adolescents. When programming for adolescents in these resource-constrained settings, it is important, therefore, to involve parents.

Global Equity Gauge Alliance: reflections on early experiences.

The paper traces the evolution and working of the Global Equity Gauge Alliance (GEGA) and its efforts to promote health equity. GEGA places health equity squarely within a larger framework of social justice, linking findings on socioeconomic and health inequalities with differentials in power, wealth, and prestige in society. The Alliance's 11 country-level partners, called Equity Gauges, share a common action-based vision and framework called the Equity Gauge Strategy. An Equity Gauge seeks to reduce health inequities through three broad spheres of action, referred to as the 'pillars' of the Equity Gauge Strategy, which define a set of interconnected and overlapping actions. Measuring and tracking the inequalities and interpreting their ethical import are pursued through the Assessment and Monitoring pillar. This information provides an evidence base that can be used in strategic ways for influencing policy-makers through actions in the Advocacy pillar and for supporting grassroots groups and civil society through actions in the Community Empowerment pillar. The paper provides examples of strategies for promoting pro-equity policy and social change and reviews experiences and lessons, both in terms of technical success of interventions and in relation to the conceptual development and refinement of the Equity Gauge Strategy and overall direction of the Alliance. To become most effective in furthering health equity at both national and global levels, the Alliance must now reach out to and involve a wider range of organizations, groups, and actors at both national and international levels. Sustainability of this promising experiment depends, in part, on adequate resources but also on the ability to attract and develop talented leadership.

Gate-keeping and women's health seeking behaviour in Navrongo, northern Ghana.

Among the Kassena-Nankana of northern Ghana, compound heads and husbands impede women's prompt access to modern health care. This paper shows that such gate-keeping systems have a negative effect on child survival. To investigate the social construction of compound-based gate-keeping systems, the authors relied on a series of qualitative interviews conducted in the Kassena-Nankana district These data reveal that whilst compound heads are gate-keepers for spiritual reasons, husbands play such role for economic reasons. But more important, this article presents health interventions that are on trial in Navrongo (northen Ghana) and how they undermine such gate-keeping systems.

The impact of the Navrongo Project on contraceptive knowledge and use, reproductive preferences, and fertility.

The Navrongo Community Health and Family Planning Project is a quasi-experimental study designed to test the hypothesis that introducing health and family planning services in a traditional African societal setting will introduce reproductive change. This article presents the impact of the initial three years of project exposure on contraceptive knowledge, awareness of supply sources, reproductive preferences, contraceptive use, and fertility. Findings show that knowledge of methods and supply sources increased as a result of exposure to project activities and that deployment of nurses to communities was associated with the emergence of preferences to limit childbearing. Fertility impact is evident in all treatment cells, most prominently in areas where nurse-outreach activities are combined with strategies for involving traditional leaders and male volunteers in promoting the program. In this combined cell, the initial three years of project exposure reduced the total fertility rate by one birth, comprising a 15 percent fertility decline relative to fertility levels in comparison communities.