Role of men in women's health service utilisation in northern Nigeria: a qualitative study of women, men and provider perspectives.

Background: The 2018 Nigeria Demographic and Health Survey shows poor maternal health in northern Nigeria. Contraceptive use remains low and maternal mortality high. Studies show that cultural norms related to men's decision-making role in the family significantly contribute to this phenomenon.

Willingness and ability to pay for health insurance in Afghanistan.

The study assessed willingness to join and willingness to pay for health-insurance in Afghanistan and identified associated determinants. A household survey was conducted. Two health-insurance and two medicine-insurance packages were explained to respondents, who were then asked if they would be willing to join the packages and pay for them.

Efficiency analysis of primary healthcare facilities in Afghanistan.

Background: Afghanistan's health system is unique in that primary healthcare is delivered by non-governmental organizations funded by multilateral or bilateral donors, not the government. Given the wide range of implementers providing the basic package of health services, there may be performance differences in service delivery. This study assessed the relative technical efficiency of different levels of primary healthcare services and explored its determinants.

Documenting HIV research-utilization activities, outputs and outcomes: examples and lessons learned from Project SOAR.

The importance of using research findings to inform policy and program decisions is well recognized, but the literature on measuring research utilization activities is scarce. As funding to support some areas of research wanes or remains stagnant, the need to document the value of investing in research by its' effect on improved programs and policies becomes increasingly necessary. We present the experience of Project SOAR, a six-year USAID-funded project focusing on HIV/AIDS-related implementation research, to demonstrate measurement of research utilization.

Factors associated with the knowledge of obstetric danger signs, and perceptions of the need for obstetric care amongst married young women in northern Nigeria.

Background: Married adolescents contribute to poor maternal health indicators in many low-and middle-income countries, where restrictive social norms hinder access to, and utilisation of maternal health services. Addressing these barriers is key to improving health outcomes of young mothers and their children.

Aim: This study assessed married young women's knowledge of obstetric danger signs and perceptions of the need to attend obstetric services.

Improving Voluntary, Rights-Based Family Planning: Experience From Nigeria And Uganda.

Background: Growing focus on the need for voluntary, rights-based family planning (VRBFP) has drawn attention to the lack of programs that adhere to the range of rights principles. This paper describes two first-of-their-kind interventions in Kaduna State, Nigeria and in Uganda in 2016-2017, accompanied by implementation research based on a conceptual framework that translates internationally agreed rights into family planning programming.

Methods: This paper describes the interventions, and profiles lessons learned about VRBFP implementation from both countries, as well as measured outcomes of VRBFP programming from Nigeria.

Unmet need for family planning and barriers to contraceptive use in Kaduna, Nigeria: culture, myths and perceptions.

In 2017, just one-fifth of all married women of reproductive age reported using contraception in Kaduna state, Nigeria, while many more experienced unmet need for contraception. These realities drive risky fertility behaviours and compromise reproductive rights. This study explored the determinants of low modern contraceptive uptake and persistent unmet need among women in the state.

The experience of men who participated in interventions to improve demand for and utilization of maternal and child health services in northern Nigeria: a qualitative comparative study.

Background: Men in northern Nigeria are considered the leaders and ultimate decision makers, including decisions about health-related behaviours of their wives and children. Yet many men in the region consider pregnancy and childbirth to be in the woman's domain (even if she cannot make related decisions), and may not see a need to educate themselves on the issues. These dynamics directly influence demand for, and utilization of, maternal, newborn, and child health services.

Factors associated with knowledge of obstetric danger signs and perceptions of the need for obstetric care among married men in northern Nigeria: a cross-sectional survey.

Background: Male involvement in maternal, newborn and child health contributes to better health outcomes for women and their children, especially in restrictive societies. There is evidence that when men have better understanding of women's health needs, attitudes toward utilization of maternal and child health services, of both women and men, are improved. Given the role of men as the ultimate decision makers in families in northern Nigerian society, this study assessed the determinants of men's knowledge of danger signs in pregnancy and the continuum of obstetric care, and their perceptions of the importance of antenatal care utilization and health facility delivery.

Emergency transport for obstetric emergencies: integrating community-level demand creation activities for improved access to maternal, newborn, and child health services in northern Nigeria.

Purpose: Ensuring adequate access to skilled birth attendants during and after childbirth is a key strategy to reducing maternal and newborn mortalities. Transportation difficulties in emergency situations continue to be a significant barrier to accessing emergency obstetric care, especially in rural and hard-to-reach areas. Emergency transport schemes (ETS) have been introduced in various settings to increase access to emergency care and reduce the second obstetric delay with varying degrees of success.

Programmatic implications of unmet need for contraception among men and young married women in northern Nigeria.

Purpose: The study was designed to provide programmatic recommendations for interventions to increase contraceptive prevalence in northern Nigeria. Family-planning use in North-East and North-West regions of Nigeria has remained very low, despite years of domestic and donor investments. We examine respondents' perceptions of their own need for contraception and specifically focus on young women because of their higher risk for maternal mortality.

Improving management of tuberculosis in people living with HIV in South Africa through integration of HIV and tuberculosis services: a proof of concept study.

Background: South Africa's tuberculosis burden is the third highest globally and is closely associated with the country's devastating HIV epidemic. The separation of HIV and TB services in primary healthcare services in South Africa hampers TB case finding in patients who are co-infected with HIV and TB. This operational proof of concept study assessed an approach to improving tuberculosis detection and treatment by integrating tuberculosis management into HIV care.

Demand for Women's Health Services in Northern Nigeria: A Review of the Literature.

Demand for and utilization of women's health services in northern Nigeria are consistently low and health indicators in the region are among the poorest in the world. This literature review focuses on social and cultural barriers to contraceptive use, antenatal care, and facility births in northern Nigeria, and influencers of young women's health-seeking behavior. A thorough search of peer reviewed and grey literature yielded 41 publications that were synthesized and analyzed.

Overcoming barriers to access and utilization of maternal, newborn and child health services in northern Nigeria: an evaluation of facility health committees.

Background: Poor quality of health services and socio-cultural dynamics may severely limit utilization of health services. Facility health committees were established in several states in northern Nigeria to reduce these barriers. The committees were charged with mobilizing communities, improving quality of health services, and promoting utilization of maternal and child health services.

A practical alternative to calculating unmet need for family planning.

The standard approach for measuring unmet need for family planning calculates actual, physiological unmet need and is useful for tracking changes at the population level. We propose to supplement it with an alternate approach that relies on individual perceptions and can improve program design and implementation. The proposed approach categorizes individuals by their perceived need for family planning: real met need (current users of a modern method), perceived met need (current users of a traditional method), real no need, perceived no need (those with a physiological need for family planning who perceive no need), and perceived unmet need (those who realize they have a need but do not use a method).

Increasing literate and illiterate women's met need for contraception via empowerment: a quasi-experiment in rural India.

Background: Virtually all the evidence on the relationship between women's empowerment and use of contraception comes from cross-sectional studies that have emphasized macrosocial factors.This analysis tested whether literate and illiterate women are empowered by an intervention designed to provide information addressing technical and gender concerns and expand contraceptive choice, and evaluated the effects of women's decision-making power on contraceptive behavior.

Methods: The data came from a three-year quasi-experiment conducted in two comparable, yet not equivalent, rural blocks in Jharkhand, India.

Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda.

There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections.

Female genital cutting and other intra-vaginal practices: implications for TwoDay Method use.

This report examines the implications of female genital cutting and other intra-vaginal practices for offering the TwoDay Method® of family planning.This fertility awareness-based method relies on the identification of cervicovaginal secretions to identify the fertile window. Female genital cutting and traditional vaginal practices, such as the use of desiccants, may affect the presence or absence of secretions and therefore the woman’s perception of her fertility.

Assessing the effect of introducing a new method into family planning programs in India, Peru, and Rwanda.

Background: Introducing a new method into family planning programs requires careful attention to ensure it meets an actual need and has a positive effect on program goals. The Standard Days Method® is a fertility awareness-based method of family planning that is being introduced into family planning programs in countries around the world. It is different from other methods offered by programs, and may bring new couples into family planning, and increase contraceptive prevalence.

A Bridge for postpartum women to Standard Days Method®: II. Efficacy study.

Background: In a companion article, we described the development of a new fertility-awareness-based Bridge for postpartum women starting with their first postpartum menses and until they are eligible to use the Standard Days Method®. This article presents the results of an efficacy trial to test the Bridge.

Study Design: This was a prospective, nonrandomized, multicenter study following 157 women for up to 9 months.