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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

Improving the health care response to gender-based violence - phase II : project evaluation report

BUDIHARSANA, Meiwita P
TUNG, Mai Quoc
2010

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This report describes phase II of the Population Council Vietnam project on gender-based violence (GBV). The project involves both a hospital and community based intervention to address this problem in Hanoi and to conduct research to assess its effectiveness. This report is useful to practitioners interested in gender-based violence issues in Vietnam

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

The straight talk campaign in Uganda : impact of mass media initiatives

ADAMCHK, Susan E.
et al
September 2007

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This summary report presents the findings of an evaluation of the Straight Talk mass media communication programmes to inform youth in Africa about sexual and reproductive health, which have been implemented in Uganda since 1993. The campaign was delivered through a radio show and two newspapers - one aimed at primary school children and one at secondary school students

Reaching truckers in Brazil with non-stigmatizing and effective HIV/STI services

CHINAGLIA, Magda
et al
May 2007

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In 2001, the Population Council conducted an assessment in Brazilian border areas, commissioned by the Brazilian Ministry of Health, with support from USAID/Brazil, to determine which populations were most in need of HIV prevention activities. The research findings in the southern region revealed the presence of an extremely mobile, international truck driver community with little or no access to HIV prevention, testing and treatment services. In response to this need, Horizons/Population Council implemented an operations research study focused on trucker drivers (2002-2005) in the south of Brazil. In collaboration with the administration of the customs stations, municipal and state STI and AIDS programmes, and Health Ministries, the investigators sought to examine the feasibility and impact of an HIV prevention project targeted at truckers crossing the southern border of Brazil

Continuum of care for HIV-positive women accessing programs to prevent parent-to-child transmission : findings from India

MAHENDRA, Vaishali S
et al
2007

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This is the report of a diagnostic study in 2005 to provide an evidence base to strengthen the national Indian prevention of parent-to-child transmission (PPTCT) initiative. The key research questions were: What are the treatment, care, and support needs of HIV-positive women and what services do the women utilize to meet their needs? What are the different ways (clinic-based, community-based, etc) to link HIV-positive women and their families with treatment and care services? The study indicated that linkages between PPTCT and HIV care services, as well as PPTCT and reproductive health services, were limited

Community advocates training manual : the HIV/AIDS prevention project for vulnerable youth in northern Nigeria

POPULATION COUNCIL
2007

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"The Community Advocates training manual is a curriculum developed by Population Council, Nigeria under the HIV Prevention Project for Vulnerable Youth in Northern Nigeria funded by USAID/Nigeria. The curriculum was developed as a tool for training community advocates to conduct advocacy activities on the issues of early marriage, HIV/AIDS and reproductive health. The curriculum is developed on the premise that community representatives can speak out on issues concerning their lives and community, if given the necessary skills"

Pregnancy-related school dropout and prior school performance in South Africa

GRANT, Monica
HALLMAN, Kelly
June 2006

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Although considerable attention has been paid to the prevalence of adolescent childbearing in the less-developed world, few studies have focused on the educational consequences of schoolgirl pregnancy. Using data collected in 2001 in KwaZulu-Natal, South Africa, this paper examines the factors associated with schoolgirl pregnancy, as well as the likelihood of school dropout and subsequent re-enrollment among pregnant schoolgirls. This analysis triangulates data collected from birth histories, education histories, and data concerning pregnancy to strengthen the identification of young women who became pregnant while enrolled in school and to define discrete periods of school interruption prior to first pregnancy. We find that prior school performance - defined as instances of grade repetition or non-pregnancy-related temporary withdrawals from school - is strongly associated with a young woman's likelihood of becoming pregnant while enrolled in school, dropping out of school if she becomes pregnant, and not returning to school following a pregnancy-related dropout. Young women who are the primary caregivers to their children are also significantly more likely to have left school than are women who shared or relinquished childcare responsibilities. Furthermore, young women who lived with an adult female were significantly more likely to return to school following a pregnancy-related dropout. Given the increasing levels of female school participation in sub-Saharan Africa, our findings suggest that future studies will benefit from exploring the causal relationships between prior school experiences, adolescent reproductive behavior, and subsequent school attendance

Tap and reposition youth (TRY) : providing social support, savings, and microcredit opportunities for young women in areas with high HIV prevalence

ERULKAR, Annabel
et al
March 2006

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Tap and Reposition Youth (TRY) was a multiphase initiative undertaken by the Population Council and K-Rep Development Agency (KDA), the oldest and largest microfinance institution in Kenya. The overall aim of the project was to reduce adolescents' vulnerabilities to adverse social and reproductive health outcomes, including HIV infection, by improving their livelihoods options. The project was launched in low-income and slum areas of Nairobi, Kenya, where rates of HIV infection are alarming and where young women are disproportionately affected

Orphans and vulnerable youth in Bulawayo, Zimbabwe : an exploratory study of psychosocial well-being and psychosocial support programs

GILBORN, Laeila
et al
February 2006

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This is the report of a study to develop a better understanding of psychosocial well-being among vulnerable adolescents and how to measure it, and to explore the effects of participation in psychosocial support programmes on adolescents’ psychosocial well-being. The study focuses on adolescents because of the presence of psychosocial support programmes for this age group in the study area. Adolescence is a distinct stage in psychological development, and vulnerable adolescents, especially those affected by HIV & AIDS, face unique responsibilities and challenges, such as earning wages, managing households, and caring for younger children and sick adults

Yaari dosti : Young men redefine masculinity, a training manual

POPULATION COUNCIL
2006

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This manual was adapted from the Brazilian Program H curriculum and piloted in urban slum communities in India as part of an operations research study aimed at reducing HIV risk among young men by addressing perceptions of gender norms. The manual can be used by health educators, teachers and/or other professionals or volunteers who want to work, or are already working, with young men between 15 and 24 years old. It is divided into four subsections: gender, sexuality and reproductive health, violence, and preventing and living with HIV & AIDS, around each of which there is a series of activities

The changing context of sexual initiation in sub-Saharan Africa

MENSCH, Barbara S
GRANT, Monica J
BLANC, Ann K
November 2005

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During the past 20 years, substantial reductions have occurred in the proportion of young women who report marrying as teenagers in sub-Saharan Africa. An oft-stated consequence of a delay in age at marriage is a rise in the proportion of young women who engage in premarital sex. This paper investigates the links between changing age at marriage and premarital sexual behavior in 27 sub-Saharan African countries in which Demographic and Health Surveys were conducted between 1994 and 2003. Using multiple-decrement life tables to examine the competing risks of premarital sex and marriage without prior sexual experience, we answer the largely unaddressed question of how reductions in the prevalence of early marriage have affected the likelihood of initiating premarital sex. Our analysis reveals that although the age of first sexual activity has either remained the same or increased, a shift in the context of sexual debut from marriage to before marriage has taken place in many countries. We assess whether the increase in the proportion of young women who report premarital sex is influenced by an increase in exposure resulting from delayed marriage or by an increase in the rate of premarital sex. The evidence on this point is mixed; in some settings greater exposure explains more of the increase, whereas in others an increased rate of premarital sex dominates

Trends in the timing of first marriage among men and women in the developing world

MENSCH, Barbara S
SINGH, Susheela
CASTERLINE, John B
August 2005

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The timing of first union merits investigation not only because of the close temporal link between marriage and the onset of childbearing, but also because the age when men and women marry has implications for the organization of family life and for gender relations within society. This paper begins by reviewing the contributions of various social science disciplines to an understanding of the timing of marriage. Using current status data from 73 countries provided by the United Nations Population Division and retrospective data from 52 Demographic and Health Surveys conducted between 1990 and 2001, we then examine recent trends in the timing of first marriage or union for men and women in the developing world. With the exception of South America for both sexes and South and Southeast Asia for men, substantial declines have occurred in the proportion of young men and women who are married. Given the differentials in the timing of marriage by educational attainment and residence, we assess whether the decline in the proportion of young people who are married is related to increases in schooling and urbanization. Expansion of schooling for women has had some impact, but a considerable portion of the reduction in early marriage is not explained by changes in levels of education. We consider other factors that might account for the increase in age at marriage. Finally, we review what is known about the consequences of changing age at marriage with a particular focus on risk of HIV infection.

A client-centered approach to reproductive health : a trainer's manual

POPULATION COUNCIL
February 2005

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'The Population Council has developed a novel framework for training providers to deliver client-centered reproductive health services. The essence of the approach is to bring about behaviour change in providers by making them more receptive and responsive to client needs. Further, providers are taught to treat clients with respect and dignity, to assess their reproductive health needs holistically within the context of their household circumstances, and to negotiate solutions that clients are able to implement. Known by the acronym SAHR, this approach involves four interconnected steps: Salutation, Assessment, Help, and Reassurance. Through operations research, SAHR was successfully tested in Pakistan in 2000-02. The training manual describes the SAHR approach and is meant to facilitate training of reproductive health providers in how to offer client-centered services. The manual is written in fairly generic terms and can be used, with slight modifications, in any setting or country. The manual has three sections. Section One, the introduction, is an overview of the contents. Section Two, the trainer's guide, comprises the training modules. Each module describes the individual components of client-provider interaction and includes learning objectives, key learning points, a schedule, and a list of materials required. Trainer notes and step-by-step instructions for each activity are included within each module. Section Three contains support materials to help trainers prepare for the sessions.'

The effect of a livelihoods intervention in an urban slum in India : do vocational counseling and training alter the attitudes and behaviour of adolescent girls?

MENSCH, Barbara S
et al
2004

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This paper examines whether an experimental intervention for girls aged 14-19 that provided reproductive health information, vocational counseling and training, and assistance with opening savings accounts in slum areas of Allahabad in Uttar pradesh, India, had an effect on their attitudes and behaviours. A quasi-experimental pre- and post-test design was used in which adolescent girls were compared with girls of the same age residing in control-area slums. Although the livelihoods program was acceptable to parents and feasible to implement, the project had only a minimal impact on the behaviour and attitudes of adolescent girls taking part in the project. Girls exposed to the intervention were significantly more likely to have knowledge of safe spaces, be a member of a group, score higher on the social skills index, be informed about reproductive health, and spend time on leisure activities than were the matched control respondents. No effect was found on gender role attitudes, mobility, self-esteem, work expectations, or on number of hours visiting friends, performing domestic chores, or engaging in labour market work

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