The goal of this study is to assess the quality of family planning services in rural areas of Virginia. Through interviews with the public and not-for profit clinics, I collected various facts and through client survey, I obtained women's perceptions and feeling about the services provided to them. The goal was to reconcile responses wherever possible, and furthermore, identify differences between facts provided by the clinics and perceptions of clients. From the client surveys, I found that the majority of women are satisfied with the family planning services. Moreover, Appalachian women report higher satisfaction with the family planning services than non-Appalachian women. However, accessibility remains one of the major problems and obstacles to the family planning services. Women that report long waiting time and lack of transportation also have lower satisfaction scores with the services. From qualitative interviews, it is apparent that staff is doing a good job at assisting rural Appalachian women. However, as in client survey, staff reported problems with access to family planning services, such as transportation, unawareness of women of existing services, financial difficulties, and the need of more days and hours of clinic operation. / Master of Science

From Policy to Practice: Implementation of Georgia’s Medicaid Family Planning Waiver Program Sarah C. Blake, MA 282 pages Directed by Dr. John Thomas The purpose of this research was to examine the implementation of Georgia’s Medicaid family planning program, known as Planning for Healthy Babies® or P4HB®. This program is the first such program to provide both family planning services and inter-pregnancy care services through a Medicaid expansion to low-income, uninsured women. An evaluative case study design was employed using mixed methods. These methods incorporated process measures to study the implementation of P4HB® and to assess whether P4HB® was implemented as planned We incorporated theory from the policy implementation and health care access literatures to understand what served as facilitators or barriers to successful implementation. Findings suggest that despite precise goals and objectives, formal guidance about the program did not incorporate clear implementation planning. Many stakeholders, including advocates, providers, and representatives from implementing agencies felt left out of the implementation process and did not feel invested in the program. Considerable confusion existed among eligible clients and providers about the nature and scope of the P4HB® program. This lack of awareness and understanding about P4HB® likely contributed to the program’s low enrollment and participation in the first year of its implementation. As many states prepare to expand their Medicaid programs under the Patient Protection and Affordable Care Act (ACA), this study provides important lessons for policy planning and implementation.

No description available.

The decision to have a child is one of the most significant two people can ever make. Specifically, couple can typically plan when to begin a family, how large a family they want. Thus if a couple is planning on having a child, they have the responsibility to consider and discuss many things involved in parenting such as family planning. The main purpose of this study is to assess the extent of spousal communication about family planning by focusing on the preferences concerning family size and the desire of additional children. Drawing on the literature review; the study address the conceptual definitions and notions of spousal communication about family planning, attitudes towards family planning and desired fertility, communication and desired fertility, and economic value of children. Using data from the 2000 Rwanda demographic and health survey, the study analyzed a set of selected socio-demographics factors and its correlation with the desire of more children within married people in Rwanda. The results reveal that husbands are more likely to desire additional children compared to their wives. Women in urban areas are more likely to stop childbearing compared to those who live in rural areas and the reverse for man. However education and employment are also associated to the desire for no more children and are significant in the multivariate analysis. As expected son preference is important and affect the desire for additional children, then within any given parity, couples with one or more sons are more likely to stop childbearing compared to those who have no sons. The analysis of the impact of spousal communication about family planning shows that partner who discuss on family planning are more likely to desire no more children than their counterparts who have never discussed the issue. In order to enhance the spousal communication about family planning in Rwanda and improve attitudes towards family planning, it is proposed to promote IEC as a tool of intervention to increase the awareness of spacing and limitation of childbearing. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2006.

No description available.

No description available.

Thesis (M.Sc. (Biostatistics))--Mahidol University, 1983.

Thesis (M.A.)--Georgia State University, 2006. / Title from title screen. Michael Bruner, committee chair; Merrill Morris, Marian Meyers, committee members. Electronic text (138 p.) : digital, PDF file. Description based on contents viewed July 19, 2007. Includes bibliographical references (p. 112-128).

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / The preconception care for women with Pregestational Diabetes Mellitus (DM) is recognized for its benefits to the woman and the fetus in several countries, and must be guaranteed as a strategy to reduce maternal-fetal morbidity and mortality. We aimed to analyze the preconception care for women with pregestational DM assisted at SUS, aiming to describe the specific route of pregnant women with DM in the SUS health system in Fortaleza, know the clinical and reproductive profile, check the care received in preconception and identify the knowledge regarding maternal and fetal risks. Descriptive and exploratory qualitative study carried out in four reference units for high-risk pregnancies that compose the SUS-Fortaleza, CearÃ, Brazil. Data were collected from April to September 2012, involving 41 pregnant women with pregestational DM. We used the triangulation techniques of data collection: interviews, free observation with field notes and revision of the motherâs card and/or of the medical record. The data were organized in tables and received descriptive statistical treatment; the information learned in the field notes complemented the discussion of results. The project was approved by the Ethics Committee of the Universidade Federal do CearÃ, according to Protocol number 90/12 and one met the recommendations of Resolution 196/96. The average age of the group corresponded to 30.3  5.3, age of risk for developing DM type 2, the average of education level was 9.4  3.3 years, facilitator aspect for the practice of contraceptive care by women, 76.7% did not plan the current pregnancy, 26.7% were unaware of their type of DM. The prevalent time of diagnosis of DM was up to 10 years, comorbidities were reported by 33.4% of pregnant women; 56.7% of the respondents had between two and four pregnancies, with parity not over four births. The history of miscarriage and stillbirth was expected among women with pre-gestational DM who did not adopt preconceptional care and was present in 40%. About the preconception care needed for this group, the Ministry of Health recommends: glycemic control, replacement of oral hypoglycemic for insulin, control of comorbidities, monitoring of A1C, guidance on hypoglycemia and use of folic acid. Among these, the use of folic acid was being practiced by 10% of pregnant women and glucose monitoring for 6.6% of respondents. Out of these, 10% were receiving the necessary inputs to self-monitoring, when 100% should have it to recognize the best time to gestate. Regarding knowledge about maternal and fetal risks, 60% reported having gotten it in the current pregnancy. We suggest the managers of local public policies to restructure the municipal health system regarding the prenatal care of high-risk and to rescue the preconception attention in primary care. / O cuidado prÃ-concepcional de mulheres com Diabetes Mellitus (DM) prÃ-gestacional à reconhecido pelos benefÃcios à mulher e ao concepto em vÃrios paÃses, devendo ser garantido como estratÃgia para reduÃÃo da morbidade e mortalidade materno-fetal. Objetivamos analisar a atenÃÃo prÃ-concepcional de mulheres com DM prÃ-gestacional assistidas no Sistema Ãnico de SaÃde (SUS), tendo como objetivos especÃficos descrever o percurso de gestantes com DM na rede de saÃde do SUS-Fortaleza, conhecer o perfil clÃnico e reprodutivo, verificar os cuidados recebidos na prÃ-concepÃÃo e identificar o conhecimento quanto aos riscos maternos e fetais. Estudo descritivo e exploratÃrio qualitativo, realizado em quatro unidades de referÃncia para gestaÃÃo de alto risco que compÃe o SUS-Fortaleza, CearÃ, Brasil. Os dados foram coletados de abril a setembro de 2012, envolvendo 41 gestantes com DM prÃ-gestacional. Utilizamos a triangulaÃÃo de tÃcnicas de coleta de dados: entrevista, observaÃÃo livre com anotaÃÃes de campo e revisÃo do cartÃo da gestante e/ou do prontuÃrio. Os dados foram organizados em tabelas e receberem tratamento estatÃstico descritivo; as informaÃÃes apreendidas nas anotaÃÃes de campo complementaram a discussÃo dos resultados. O projeto foi aprovado pelo Comità de Ãtica em Pesquisa da Universidade Federal do CearÃ, conforme protocolo n 90/12 e foram atendidas as recomendaÃÃes da ResoluÃÃo 196/96. A mÃdia da idade do grupo correspondeu a 30,35,3, faixa etÃria de risco para o desenvolvimento do DM tipo 2; a mÃdia da escolaridade foi de 9,4Â3,3anos, aspecto facilitador a prÃtica dos cuidados prÃ-concepcionais pelas mulheres, 76,7% nÃo planejaram a gestaÃÃo atual; 26,7% desconheciam o tipo de DM. Predominou o tempo de diagnÃstico do DM atà 10 anos, as comorbidades foram referidas por 33,4% das gestantes; 56,7% das entrevistadas tinham entre duas e quatro gestaÃÃes, com paridade nÃo superior a quatro partos. O histÃrico de aborto e natimorto foi previsto entre mulheres com DM prÃ-gestacional que nÃo adotaram cuidados prÃ-concepcionais e estava presente em 40%. Sobre os cuidados prÃ-concepcionais necessÃrios a este grupo, o MinistÃrio da SaÃde preconiza: controle glicÃmico, substituiÃÃo do hipoglicemiante oral por insulina, controle das comorbidades, acompanhamento da A1C, orientaÃÃo sobre hipoglicemia e uso de Ãcido fÃlico. Entre estes, o uso de Ãcido fÃlico estava sendo praticado por 10% das gestantes e o monitoramento glicÃmico por 6,6% das entrevistadas. Destas, 10% recebiam os insumos necessÃrios ao auto monitoramento, quando 100% deveriam possuir para o reconhecimento do melhor momento de gestar. Quanto ao conhecimento sobre os riscos maternos e fetais, 60% referiu tÃ-lo adquirido na gestaÃÃo atual. Sugerimos aos gestores das polÃticas pÃblicas locais a reestruturaÃÃo da rede municipal de saÃde no que concerne à assistÃncia prÃ-natal de alto risco e ao resgate da atenÃÃo prÃ-concepcional pela atenÃÃo bÃsica.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A hansenÃase acomete, principalmente, pessoas jovens em plena capacidade reprodutiva, que necessitam de cuidados no campo da anticoncepÃÃo, uma vez que a gestaÃÃo e a lactaÃÃo podem agravar o quadro clÃnico de mulheres e representar riscos para o bebÃ. Estabeleceu-se como objetivos descrever o perfil reprodutivo e o perfil da hansenÃase em um grupo de mulheres em idade fÃrtil; conhecer a prÃtica anticonceptiva do grupo pesquisado e sua adequabilidade com relaÃÃo à presenÃa da hansenÃase; avaliar o conhecimento de mulheres com hansenÃase sobre as particularidades do uso de MÃtodos Anticoncepcionais (MAC) relacionadas à patologia e sobre os riscos maternos e fetais associados à mesma; e verificar associaÃÃo estatÃstica entre o intervalo de tempo atà o diagnÃstico de hansenÃase e o Grau de Incapacidade FÃsica (GIF) apresentado pelas mulheres no momento do diagnÃstico; surgimento do diagnÃstico da hansenÃase com o perÃodo da gravidez e/ou lactaÃÃo e pÃs-parto imediato; e ser usuÃria de Anticoncepcional Hormonal Combinado e apresentar reaÃÃo hansÃnica. Tratou-se de estudo avaliativo, transversal, realizado com 200 mulheres com hansenÃase, em idade fÃrtil, acompanhadas no Centro de ReferÃncia Nacional em Dermatologia SanitÃria Dona LibÃnia de Fortaleza-CE. Os dados foram coletados de marÃo a outubro de 2011, por meio de entrevista e revisÃo de prontuÃrios. Para avaliar o conhecimento foram utilizadas escalas Likert. Foi realizada anÃlise estatÃstica descritiva utilizando freqÃÃncia absoluta e relativa, mÃdia, desvio padrÃo e intervalo de confianÃa, e anÃlise estatÃstica bivariada, sendo as associaÃÃes entre as variÃveis categÃricas verificadas por meio dos testes de Qui-Quadrado, Qui-Quadrado com correÃÃo de continuidade e Qui-Quadrado de tendÃncia. Para todas as anÃlises foram consideradas como estatisticamente significantes aquelas com p=0,05. O projeto de pesquisa foi submetido ao Comità de Ãtica em Pesquisa do local do estudo, segundo ResoluÃÃo n 196/96, aprovado conforme protocolo 012/2011, e as participantes assinaram o Termo de Consentimento Livre e Esclarecido. As mulheres apresentaram mÃdia de idade de 39 anos, predomÃnio de relacionamento com parceiro fixo, e renda per capita de R$ 170,74. Predominou a forma clÃnica dimorfa (86 â 43%), a poliquimioterapia multibacilar (111 â 55,5%) e o GIF zero no diagnÃstico (160 â 80%). O surgimento e/ou diagnÃstico de hansenÃase durante a gravidez ou lactaÃÃo dÃi afirmada por 50 (25%) mulheres, sendo que no perÃodo de fertilidade Ãtima (16 a 35 anos) foi afirmada por 31 (40,2%). Quanto à prÃtica anticoncepcional, 163 (81,5%) mulheres usavam algum MAC, sendo os mais citados laqueadura (71 â 43,5%), o anticoncepcional oral combinado (41 â 25,1%) e o preservativo masculino (30 â 18,4%); 58 (35,3%) faziam uso de MAC contra-indicado para sua condiÃÃo clÃnica. Predominou o nÃvel de conhecimento limitado (114 â 57%) na avaliaÃÃo sobre os riscos para o bebÃ, moderado (95 â 47,5%) na avaliaÃÃo sobre os risco para a mÃe, e limitado (107 â 53,5%) na avaliaÃÃo sobre o uso de MAC seguros. NÃo foi encontrada associaÃÃo estatÃstica significante entre o tempo atà o diagnÃstico e o GIF (p=0,0461), entre surgimento dos sinais e sintomas da hansenÃase ou diagnÃstico com gestaÃÃo/lactaÃÃo, sendo os valores de p= 0,335 e 0,871, respectivamente; e entre o uso de MAC hormonal combinado e o surgimento ou diagnÃstico de reaÃÃo hansÃnica (p=0,156). Concluiu-se que mulheres com hansenÃase necessitam de atenÃÃo anticoncepcional, com orientaÃÃo eficaz para os MAC indicados para sua condiÃÃo clÃnica, de modo a contribuir para o alcance do nÃvel de conhecimento extenso. Apesar do estudo nÃo ter revelado associaÃÃo estatÃstica significante entre gravidez/lactaÃÃo com o surgimento/diagnÃstico da hansenÃase, a busca de casos suspeitos em consultas de prÃ-natal, especialmente em Ãreas hiperendÃmicas, deve ser rotina na atenÃÃo bÃsica. / Leprosy affects mainly young people in their reproductive capacity, requiring care in the Field of contraception, as pregnancy and lactation may aggravate the clinical presentation of women and pose risks to the baby. The main objective was to describe the reproductive and leprosy profile in a group of women at childbearing age, to know the practice of contraceptive research group and the suitability for the presence of leprosy; to assess the knowledge of women with leprosy on the specifics of the use of Contraceptive Method (CM), and on maternal and fetal risks associated with it, and verifying statistical association between the interval until the diagnosis of leprosy and the Degree of Disability(DD) at diagnosis, onset/diagnosis of leprosy with the period of pregnancy/lactation and the immediate postpartum period, and be combined hormonal contraceptive user and present leprosy reaction. It was an evaluative study, cross-sectional, conducted with 220 women with leprosy at childbearing age, accompanied by the Center of Dermatology Dona LibÃnia, in Fortaleza, CearÃ. Data were collected from March to October 2011, through interview and records review. To assess the knowledge Likert scales were used. Descriptive statistical analysis was performed using absolute and relative frequency, mean, standard deviation and confidence intervals, and bivariate statistical analysis, and the associations between categorical variables were verified by the chi-square, chi-square with continuity correction and chi square trend. For all tests were considered statistically significant p =0.05. The research was submitted to the Ethics Committee of Center of Dermatology Dona LibÃnia, according to Resolution nÂ196/96, approved according to the protocol 012/2011 and participants signed a consent form. Women had a mean age of 39 years, predominantly in stable relationships, and per capita income of R$ 170.74. Boderline clinical forms predominated (86 â 43%), multibacilary multidrug therapy (111 â 55.5%) and zero degree of disability at diagnosis (160 â 80%). The onset/diagnosis of leprosy during pregnancy/lactation was affirmed by 50 (25%) women, and in the period of optimum fertility (16 to 35 years) was affirmed by 31 (40.2%). As to the contraceptionâs practice 163 (81.5%) women used a CM, the most cited was tubal ligation (71 â 43.5%), the combined oral contraceptive (41 â 25.1%) and male condom (30 â 18.4%), and 58 (35.3%) women were using a contraindicated CM for their condition. Limited knowledge level was predominated (114 â 57%) in the assessment of risks to the baby, moderate (95% - 47.5%) in the assessment of risks to the mother, and limited (107 â 53.5%) in assessment of safe use of CM. There was no statistically significant association between time to diagnosis and DD (p = 0.0461) between appearance of signs and symptoms of leprosy diagnosis with pregnancy or lactation, the values of p= 0.335 and 0.871, respectively, and between the use of combined hormonal contraceptive and the onset/diagnosis of leprosy reaction (p = 0.156). It was concluded that women with leprosy requires contraceptive care with effective guidance for the CM indicated for their condition to contribute to achieving the level of extensive knowledge. Although the study doesnât establish a statistically significant association between pregnancy/lactation with the onset/diagnosis of leprosy, the search for suspects in cases in prenatal consultations, especially in hyperendemic areas, should be a routine in primary care.