Safe Abortion: Technical and Policy Guidance for Health Systems
Forthcoming 2003
In October 2000, at the UN Millennium Summit, all countries agreed on the need to improve maternal health as one of the key Millennium Development Goals. Globally, approximately 13% of all maternal deaths are due to abortion-related complications among women who seek to end unwanted pregnancies but lack access to appropriate services, and tens of thousands more women suffer long-term health consequences. In recognition of this, nearly all countries in the world have passed laws that permit termination of pregnancy under specified conditions. In some settings, abortion is legal only to save the woman's life; in others, abortion is allowed upon request by the woman. Health systems need to respond accordingly.
The role of the World Health Organization is to develop norms and standards and provide advice to Member States in order to strengthen the capacity of health systems. For over three decades, WHO has assisted governments, international agencies and non-governmental organisations to plan and deliver maternal health services, including managing complications of unsafe abortion and providing high quality family planning services.
At the Special Session of the UN General Assembly in June 1999, Governments agreed that “in circumstances where abortion is not against the law, health systems should train and equip health service providers and should take other measures to ensure that such abortion is safe and accessible. Additional measures should be taken to safeguard women's health.” This document provides guidance to turn this agreement into reality. (Text from the pre-publication copy, distributed in Ethiopia, March 2003)
Transforming Health Systems: Gender and Rights in Reproductive Health
2002
Designed for health managers, this excellent course curriculum focuses on improving participants' understanding of gender and rights so that they can plan more effective reproductive health programmes and services. The curriculum has six modules: gender, determinants of health, reproductive rights, evidence, policy and health systems. The course schedule allows for locally determined special sessions and guest lectures on current debates in reproductive health relevant to the institution running the course. Available in print and now in CD format.
Making Decisions about Contraceptive Introduction: A Guide for Conducting Assessments to Broaden Contraceptive Choice and Improve Quality of Care
2002
This field guide is written for programme managers, policymakers and national leaders on the value of a strategic approach to the introduction of contraceptives into health service delivery systems. It provides detailed information on the characteristics of strategic assessment and how to plan and implement it, preparing and conducting the necessary fieldwork, and documentation of the findings to inform the decision-making process.
Selected Practice Recommendations for Contraceptive Use
2002
This is an evidence-based guideline on contraceptive methods and when they are medically appropriate. Its 23 recommendations were drafted by a WHO working group, and and cover when a women can start different types of contraceptives, routine examinations before providing certain contraceptive methods, and how a provider can be reasonably sure that a women is not pregnant. It addresses important inconsistencies in existing guidance from a range of organisations in the field. It is intended for policymakers, programme managers and the scientific community and will be updated at appropriate intervals.
Available from:
Department of Reproductive Health and Research
World Health Organization
Fax: +41-22-71-4171
E-mail: [email protected]
Towards Comprehensive Women's Health Programmes and Policy
Renu Khanna, Mira Shiva, Sarala Gopalan (editors), 2002
The Women and Health Initiative (WAHI) in India grew out of the perceived failure of primary health care to address gender issues and the specific health needs of women. It began in 1993 as an initiative to train women and develop their primary health care management skills, and has taken off as a programme reaching women across India through advocacy, networking, service delivery and empowerment activities. This volume covers training and educational material for women's health, traditional systems of health, national and state policies from a gender perspective, and experiences with decentralisation, democracy and gender mainstreaming. It provides an excellent account of the processes, obstacles, strengths and lessons learned from this comprehensive and participatory initiative.
Available from:
SAHAJ
1 Shrihari Apartments
Behind Express Hotel
Alkapuri
Vadodara 390007, Gujarat, India
E-mail: [email protected]
Engendering International Health: The Challenge of Equity
Gita Sen, Asha George, Piroska Östlin (editors), 2002
The fourth volume in the series Basic Bioethics, this book brings together the work of leading researchers on gender equity in international health. The basic premise of this volume is that unless public health significantly changes its course, it cannot effectively address the needs of the poor and marginalised, many of whom are women. It shows how deep-seated gender biases in health research and in policy institutions downgrade the importance and value of gender perspectives in health. The chapters are divided into two parts: 1) key health areas such as violence against women, mental health, public health, reproductive health and communicable diseases, and 2) research and policy, including social discrimination, policy environments and health sector reforms. They also discuss the way in which gender as well as economic inequity and social injustice intersect and cross-cut to perpetuate inequalities in women's access to health care and services around the world, in spite of the commitments made at various UN conferences in the last decade.
Available from:
MIT Press
Massachusetts Institute of Technology
Cambridge MA 02142, USA
The Gender and Reproductive Health Research Initiative: Mapping a Decade of Reproductive Health Research in India
2002
This series of six annotated bibliographies and two critical reviews examines the body of reproductive health research in India from a gender perspective, and identifies gaps in research and unexplored issues in the following areas: abortion, women's reproductive health, reproductive health services, HIV/AIDS, sexuality and sexual behaviour, and morbidity in women. A gender analysis, e.g. on morbidity in women, is necessary in such research, but this has rarely been achieved. There is therefore a need to eliminate methodological and conceptual biases to make the data more useful for the formation of appropriate policies and interventions.
Available from:
Creating Resources for Empowerment in Action (CREA)
2/14 Shantiniketan, 2nd floor
New Delhi 110021, India
E-mail: [email protected]
Web: www.creaworld.org
Restructuring Health Services: Changing Contexts and Comparative Perspectives
Kasturi Sen, 2003
This collection of papers reviews the rapidly changing context in which the financing of health care and the role of globalisation and privatisation are taking place. Health scholars and policymakers from both industrialised and developing countries show how the restructuring of health service delivery is accelerating as a result of fiscal pressure, privatisation and GATS (General Agreement on Trade in Services). The book mixes analysis, evidence and outrage to explore the consequences of these changes and to detail contrasting experiences across the world.
Available from:
Zed Books Ltd
7 Cynthia Street
London N1 9JF, UK
Abortion and Common Sense
Ruth Dixon-Mueller, Paul KB Dagg, 2002
At a time when the concept of reproductive rights is being challenged by conservatives and religious fundamentalists, here is a common-sense, fact-based account of how and why women have abortions. Case studies based on articles and books from Asia, Africa and Latin America included, although the primary points of reference for policy and service delivery are the US and Canada. The authors describe the concrete dilemmas confronting women who have unwanted pregnancies and pragmatically consider how these dilemmas can be resolved through sound social and medical policies. Issues examined include reproductive rights of women, medical, legal, safety and personal issues, ethics, religion and guilt, social pressure, legal and clandestine options, and methods of pregnancy termination. Also explored are the effects of US foreign policy on women's access to family planning in developing countries, and the question of the rights of the living child to be wanted by its parents.
Available from:
Xlibris Corporation
Tel: +1-888-795-4274
E-mail: [email protected]
Web: www.Xlibris.com
Expanding the Role of Mid-level Providers in Safe Abortion Care
2002
This publication is about training and supporting mid-level health providers to deliver abortion services, including nurses, midwives, clinical officers and physician assistants, who are more numerous, more geographically dispersed and more likely to work at community level than physicians. It deals with the need to remove physician-only practice restrictions, and increase the number of service delivery sites and the range of health care personnel who can be trained and equipped. It looks at the situation in ten countries in Asia, Africa and the West, and makes a clear case that mid-level health care professionals, once trained, are well-positioned to play a part in achieving safe abortion care.
Making Safe Abortion Accessible: A Practical Guide for Advocates
Charlotte E Hord, 2001
This guide is full of easy-to-follow, practical advice on making abortion services safer and more accessible. It includes sections on how to establish working partnerships, ways of influencing public opinion, and ideas for integrating abortion into general health services. It uses an inclusive and participatory approach tailored to local circumstances and reinforces the fact that policy change takes time.
Can Vietnam's Family Planning Collaborators improve Grassroots Reproductive Health Services?
Tuan Anh Nguyen, Heidi Bart Johnston, 2002
In recent years, Vietnam has implemented a family planning programme that has successfully reduced fertility. However, there are still high rates of unwanted pregnancy and abortion, probably due to inadequate contraceptive counselling and lack of access (e.g. of single women) to a range of contraceptive methods. This research looks at the way low pay, the need to concentrate on demographic targets and inadequate training make service providers less effective in promoting women's health, and suggests how service delivery might be improved. In English and Vietnamese.
Available from:
Ipas
300 Market Street, Suite 200
Chapel Hill NC 27516, USA
Fax: +1-919-929-0258
E-mail: [email protected]
Web: www.ipas.org
Post-Abortion Care Supervisory Aid and Evaluation Tool
Critical Issues in Reproductive Health, 2000
This easily modifiable Excel file is intended for data collection and analysis, and contains a checklist to guide the evaluation of facility readiness and provider performance for facility-based post-abortion care services. These include comfort, privacy, cleanliness, infection prevention, dilatation and curettage (D&C) and manual vacuum aspiration (MVA) instruments, laboratory tests, personnel, referrals and educational material.
“What About Us?” Bringing Infertility Into Reproductive Health Care
Quality/Calidad/Qualité, 2002
This publication focuses on an infertility programme in India that treats both men and women. The programme is based in a clinic that is linked to a local women's group where educational and gender awareness activities are carried out. STDs cause infertility in many women, and reducing STD transmission cannot happen without empowerment of women. A shorter case study from Nigeria is also included. These narratives illustrate what is involved in trying to address infertility in developing country settings. Both projects combine education, counselling, history-taking, laboratory testing, minor pharmacological and surgical therapies, and referral. Although clinical and economic factors mean limited success rates, programmes like these are enabling some couples to become parents, and providing information and support to many more.
Available from:
Population Council
One Dag Hammerskjold Plaza
New York NY 10017, USA
Fax: +1-212-755-6052
E-mail: [email protected]
Web: www.popcouncil.org
Violence Against Women
Innovations, Vol. 9, 2001
This volume of the Innovations series looks at integrated in-terventions to address violence against women in Kenya, Malaysia, Thailand and Bolivia. Some of the interventions are carried out by NGOs, others by the public health sector, and some involve collaboration between both sectors. Individuals and organisations involved in the case studies presented here are striving towards providing services that include sensitivity, privacy, referrals to legal and other assistance and to temporary shelters, and counselling. It also includes a select global inventory of initiatives to address violence against women, advocacy strategies, advocacy and training materials, laws and policies of different countries, and policy-oriented research.
Available from:
International Council on Management of Population Programmes (ICOMP)
534 Jalan Lima, Taman Ampang Utama
68000 Ampang, Selangor, Malaysia
Web: www.icomp.org.my
The Watchdog
The Watchdog is the quarterly newsletter of the Youth Coalition, a Canadian-based international coalition of young people promoting adolescent and youth sexual and reproductive rights in Canada and internationally. The summer 2002 issue includes articles on condoms, peer education in Zimbabwe, sexuality in Trinidad & Tobago, HIV/AIDS among the aboriginal peoples in Canada, and the importance of youth participation in HIV/AIDS prevention. A new website 〈www.youngpositive.com〉 was launched at the Barcelona AIDS Conference 2002.
ADOLesson: Young People's Voices
2002
This booklet is about young people's sexual and reproductive health and rights. It is composed of the life stories of eight young people from around the world, discussing teen pregnancy, sex education, religion, peer pressure, safe sex, and relationships with peers and parents.
Available from:
Youth Coalition
205-260 Dalhousie Street
Ottawa, Ontario, Canada K1N 7E4
Fax: +1-613-562-9502
E-mail: [email protected]
Prospects for the Public Health Approach to the Prevention and Care of Sexually Transmitted Infections in Countries of Eastern Europe and Central Asia
2002
Measures implemented in the mid- to late-1990s to address the rise of sexually transmitted infections in the newly independent states of Eastern Europe and Central Asia may be responsible for the recent overall decline in STIs there. This publication reports on a meeting that discussed successes and obstacles in the region, and highlights unresolved problems.
Available from:
World Health Organization
Regional Office for Europe
Scherfigsvej 8
DK-2100 Copenhagen Ø, Denmark
E-mail: [email protected]
Web: www.who.dk
Tanzania Fistula Survey 2001
Maggie Bangser, 2002
Many women across the world live with the shame and isolation of vesico-vaginal fistulae. This survey of fistula care in Tanzania shows that although repairs are done in a number of hospitals, many women do not have access to these services, either because of distance to the nearest centre or the financial costs involved. Nor do existing centres have sufficient surgeons with appropriate expertise, equipment or supplies to cater for unmet need. The report recommends training midwives in the prevention and management of obstructed labour, developing an appropriate national referral system, and increasing capacity for prevention, early management, and vaginal and anal repair.
Available from:
Women's Dignity Project
PO Box 79402
Dar es Salaam, Tanzania
Fax: +255-22-215-2986
Women's Health and Medical Education
The American Journal of Obstetrics and Gynecology 2002;187(3), Part 2, focuses on how and why women's health and gender-based competencies should be woven into the fabric of undergraduate medical education. It discusses appropriate components of the health and medical curriculum, and combining health care competencies with educational objectives and models for teaching reproductive health.
Available from:
Web: www.mosby.com/ajog
Female Fertility and the Body Fat Connection
Rose E Frisch, 2002
This book show how and why body fat in women influences the onset of menstruation and menopause, and the reproductive system and fertility. The author takes the reader through her quest over the years to prove her theory that too low levels of body fat are associated with infertility and other health-related problems, supported by evidence from around the world. She also describes the crucial role played by diet and exercise for women's reproductive health, and how the reproductive life span is influenced by food intake and energy output.
Available from:
University of Chicago Press
1427 East 60th Street
Chicago IL 60637, USA
Bahia, Salvador, Brazil, 2002
