Applying a knowledge translation model to the uptake of the Baby Friendly Health Initiative in the Australian health care system

BackgroundThe Baby Friendly Hospital Initiative is a global, evidence-based, public health initiative. The evidence underpinning the Initiative supports practices promoting the initiation and maintenance of breastfeeding and encourages women's informed infant feeding decisions. In Australia, where the Initiative is known as the Baby Friendly Health Initiative (BFHI) the translation of evidence into practice has not been uniform, as demonstrated by a varying number of maternity facilities in each State and Territory currently accredited as ‘baby friendly’. This variance has persisted regardless of BFHI implementation in Australia gaining ‘in principle’ support at a national and governmental level as well as inclusion in health policy in several states. There are many stakeholders that exert an influence on policy development and health care practices.AimIdentify a theory and model to examine where and how barriers occur in the gap between evidence and practice in the uptake of the BFHI in Australia.ResultsKnowledge translation theory and the research to practice pipeline model are used to examine the identified barriers to BFHI implementation and accreditation in Australia.ConclusionAustralian and international studies have identified similar issues that have either enabled implementation of the BFHI or acted as a barrier. Knowledge translation theory and the research to practice pipeline model is of practical value to examine barriers. Recommendations in the form of specific targeted strategies to facilitate knowledge transfer and supportive practices into the Australian health care system and current midwifery practice are included.     

Sexual risk-taking in the slums of Nairobi,Kenya, 1993-8

Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in the sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a sub-population uniquely vulnerable to reproductive health problems and to expend more resources in slum settings.     

Sexual risk-taking in the slums of Nairobi,Kenya, 1993-98

Relatively less attention has been paid to reproductive health problems facing deprived urban residents than to those facing rural residents in sub-Saharan Africa. This is probably because the majority of Africans live in rural areas, where they are presumed to have poorer medical, educational, and other social services. Yet, the unprecedented rate of urbanization and the accompanying disproportionate growth in the proportion of poor city residents pose new challenges for health care in the region. This study examines differences in sexual behaviour between slum residents and non-slum residents in Nairobi city. The results show that slum residents start sexual intercourse at earlier ages, have more sexual partners, and are less likely than other city residents to know of or adopt preventive measures against contracting HIV/AIDS. The findings highlight the need to treat slum residents as a subpopulation uniquely vulnerable to reproductive health problems, and to expend more resources in slum settings.     

中国育龄期女性死因分析

育龄期女性的健康风险远远不只是与生殖和生育相关的风险。将人口统计数据和卫生统计数据相结合分析,发现1990-2000年间,育龄期女性人口死亡概率下降了1/4,主要死因为损伤和中毒、肿瘤、循环系统疾病。但这三种主要死因下降程度慢于其他死因的下降,反映了社会、文化、习俗等因素的改善滞后于经济发展和物质生活条件改善对育龄期女性健康的影响。同时,城乡育龄期女性人口存在不同的死因模式。     

Workshop on promotion of reproductive health and family planning held

Two reproductive health advocacy networks have been established in two districts in eastern Africa to help promote family planning and reproductive health among the people in this area. The districts are the Suhum-Kraboa-Coaltar and the New Juaben Municipality. To enhance the performance of the network, a 4-day workshop was held at Koforidua for the members to prepare an action plan for their advocacy and map out areas of collaboration between the public and the private sector group. The workshop, organized by the Futures Group International based in the US with support from the USAID, was attended by 30 participants from nongovernmental organizations and public offices. In an address, Ms. Patience Adow, the Regional Minister observed that through the idea of family planning has been promoted in the country over the past two decades, the country continues to experience a population growth rate of about 2.8%. She expressed the hope that the workshop will equip the participants with the relevant skills to develop and implement their advocacy strategy effectively. Dr. J. E. Taylor, Medical Administrator of the Koforidua Central Hospital, who chaired the function in a bid to improve the health of women and the quality of life of the people. The Ministry of Health as part of its medium term strategic plan has developed the national reproductive health and service policy.     

Interplay of rights,technology, and services explored

Recent developments in the field of reproductive health and family planning have featured key intersections among technology, services, and rights. In May 1999, the Population Council hosted a two-day meeting on rights, technology, and services in reproductive health to examine more deeply the philosophical underpinnings of the council's work. In many countries, planning pregnancies and exercising reproductive rights have been central tenets of feminist thinking and activism for decades. In other settings, fertility-regulation technologies were introduced primarily for the purpose of controlling population growth rather than facilitating the exercise of individual rights. Much of the critique of population programs has centered on violations of rights and the need to protect women in the process of testing and delivering reproductive technologies. Despite a diversity of opinions on the ethics and appropriateness of specific technologies, there is a growing consensus that women and men have a basic right to control their bodies, reproduction, and sexuality. In many places, however, people have faced barriers as they attempt to exercise these rights. Some obstacles are primarily economic, while others are physical or institutional in nature. During the meeting, participants raised many additional questions, and their exploration of these questions highlighted the ways that rights, technology, and service influence each other.     

Indonesian survey looks at adolescent reproductive health

The Baseline Survey of Young Adult Reproductive Welfare in Indonesia, conducted from September to December 1998, provides information about young Indonesians on topics concerning work, education, marriage, family life, sexuality, fertility, and HIV/AIDS and other sexually transmitted diseases. The survey interviewed 4106 men and 3978 women aged 15-24 years in three provinces of Java. Survey findings showed that 42% of the women and 8% of the men are currently or have been married. There was a strong inverse relationship between marriage and schooling, which suggests that greater educational attainment and a higher average age at marriage are likely to go together. Although most young couples prefer to delay and space births, only half of currently married young women are using any type of contraception. These results indicate that there is a need for better reproductive health care as well as improved reproductive health education. Moreover, the current economic crisis has lead to a decline in the use of the private sector for health care. Instead, young people are using the less-expensive government services, and young women are turning to pharmacies and midwives rather than to private doctors to obtain contraceptives. These findings have several policy implications including the need for reproductive health programs that provide services needed by young people.     

Reproductive health and domestic violence: Are the poorest women uniquely disadvantaged?

We use Demographic and Health Survey data from Cambodia, the Dominican Republic, and Haiti to compare women in different poverty and violence categories in terms of their experience of selected reproductive health outcomes. "Poor" women are those who belong to the bottom quintile of households arrayed according to a widely accepted asset-based wealth index. The results suggest that women who are both poor and have experienced violence are not unique in their reproductive health disadvantage. In particular, for all three reproductive health outcomes we consider the negative association with having experienced violence cuts across all women, poor and wealthy.     

对中国县区级计生机构优质服务中社会性别公平程度的探索性研究——基于对M县计划生育管理与服务机构的调查

为探索中国县区级计划生育/生殖健康机构在优质服务体现社会性别公平的程度,对M优质服务项目县的计划生育管理和服务机构进行了2次共9组典型组专题讨论调查。结果表明,在优质服务目标群体的权益保障和责任分担方面,服务领域明显拓宽,社会性别公平程度有了一定改善。但是由于传统计划生育管理模式与服务观念的影响,计生机构主要关注已婚育龄妇女的权益和风险,未婚、更年期女性和男性的生殖健康服务仍然存在欠缺。在两性共同责任分担方面,男性分担避孕生育责任的趋势开始出现,但现有服务资源与规范仍制约着男性参与的程度。     

The origins of agriculture: Population growth during a period of declining health

The increase in the Neolithic human population following the development of agriculture has been assumed to result from improvements in health and nutrition. Recent research demonstrates that this assumption is incorrect. With the development of sedentism and the intensification of agriculture, there is an increase in infectious disease and nutritional deficiencies particularly affecting infants and children.Declining health probably increased mortality among infants, children and oldest adults. However, the productive and reproductive core would have been able to respond to this increase in mortality by reducing birth spacing. That is, agricultural populations increased in size, despite higher mortality, because intervals between births became shorter.     

Measuring and Analysing the Wellbeing of Australia’s Indigenous Population

According to most standard socioeconomic indicators (for example employment, income and education), Indigenous Australians tend to have worse outcomes than their non-Indigenous counterparts. Most objective health indicators including life expectancy also tend to be worse. Traditionally, these two domains and associated objective indicators have been the focus of research, government policy and evaluation. There has been less research, however, on differences between Indigenous and non-Indigenous Australians in subjective measures of wellbeing. In this paper, I attempt to answer three related research questions on Indigenous wellbeing—What is the average level of emotional wellbeing and satisfaction with life for the Indigenous and non-Indigenous population of Australia? How do the differences between the two populations change once other characteristics have been controlled for? What are the factors associated with emotional wellbeing within the Indigenous population? With regards to the first two questions, Indigenous Australians are less likely to report frequent periods of happiness and more likely to report periods of extreme sadness than the non-Indigenous population. Surprisingly, given these results for emotional wellbeing, a major finding from the analysis was that Indigenous Australians were significantly more likely to report above-average satisfaction with their life. The main finding with regards to the third question is that using retrospective measures, those in remote areas report higher levels of happiness than those in non-remote areas. This is different to the results for socioeconomic status and objective measures of health found elsewhere and has important implications for government policy in Australia.     

The Dynamics of Multidimensional Poverty in Contemporary Australia

Progressively more researchers argue that successfully measuring social inequalities requires moving from income-based to multidimensional poverty indicators, but evidence on Australia is still largely reliant on the former. Using long-running panel data from the Household, Income and Labour Dynamics in Australia Survey we examine trends in multidimensional poverty in Australia between 2001 and 2013. We find that this has been relatively stable, with some evidence of an upwards trend following from the 2008 Global Financial Crisis. However, a closer examination of the individual components reveals a more dynamic picture. Deprivation concerning health, material resources, social support and education increased over the 13-year observation period, offsetting decreases in deprivation concerning safety perceptions, employment and community participation. Additionally, using counterfactual simulations, we examine the relative roles of different poverty domains in explaining changes in Australian multidimensional poverty. We find that recent year-on-year changes in multidimensional poverty are mainly driven by fluctuations in social support, health and material resources. Altogether, our findings suggest that Australian poverty-reduction policies would enhance their effectiveness and efficiency by focusing on improving disadvantage in the domains of health and material resources.     

对我国育龄妇女生育健康状况的分析——个体指标的应用实例

本文利用 1997年全国人口与生殖健康调查数据 ,应用作者提出的育龄妇女生育健康个体指标 ,从人口、社会、经济几个方面对我国育龄妇女生育健康状况的部分影响因素进行了定量分析。分析结果显示 ,我国育龄妇女的生育健康状况及存在主要问题与妇女年龄、文化程度、居住地及社区环境密切相关。文章最后根据分析结果 ,对改善我国育龄妇女生育健康状况提出了几点建议     

对人口和生殖健康领域的社会性别意识调查与思考

社会性别平等是实现人口与发展的有效途径,相关政府部门管理者的社会性别意识对于推进人口与生殖健康领域的性别平等具有重要意义。对30个省、市、自治区人口和计划生育委员会与卫生厅项目管理者的调查显示,大多数项目管理者能够正视传统性别文化对妇女的影响,从不平等的性别关系分析人口与生殖健康领域的突出问题,对于推进性别平等具有一定的社会责任感。但同时也反映出:一部分项目管理者对中国的性别平等发展形势缺乏了解,对现实生活中两性不平等的权责关系缺乏辨析,对女性参与项目决策的必要性认识不足,这容易造成公共政策与项目管理中的性别缺失。为此,应提升项目管理者的社会性别分析能力,建立性别平等咨询机制和监督机制,以促进人口与生殖健康领域的社会性别主流化。     

The experiences of privately practising midwives in Australia who have been reported to the Australian Health Practitioner Regulation Agency: A qualitative study

BackgroundIn Australia the majority of homebirths are attended by privately practising midwives (PPMs). In recent years PPMs have been increasingly reported to the Australian Health Practitioner Regulation Agency (AHPRA) mostly by other health professionals.Purposeto explore the experiences of PPMs in Australia who have been reported to the AHPRA.MethodsA qualitative interpretive approach, employing in-depth interviews with eight PPMs was undertaken and analysed using thematic analysis. A feminist theoretical framework was used to underpin the research.ResultsThe majority of reports made to AHPRA occurred when midwives supported women who chose care considered outside the recommended Australian College of Midwives (ACM) Consultation and Referral Guidelines. During data analysis an overarching theme emerged, “Caught between women and the system”, which described the participants’ feelings of working as a PPM in Australia. There were six themes and several sub-themes: The suppression of midwifery, A flawed system, Lack of support, Devastation on so many levels, Making changes in the aftermath and Walking a tight rope forever. The findings from this study reveal that midwives who are under investigation suffer from emotional and psychological distress. Understanding the effects of the process of investigation is important to improve the quality of professional and personal support available to PPMs who are reported to AHPRA and to streamline processes.ConclusionIt is becoming increasingly difficult for PPMs to support the wishes and needs of individual women and also meet the requirements of the regulators, as well as the increasingly risk averse health service.     

Integrating reproductive health services into family planning programs

A recent Population Council publication, Reproductive Health Approach to Family Planning, discusses integration of reproductive health into family planning programs in a series of edited presentations that Council staff and colleagues gave at a 1994 meeting of the US Agency for International Development (USAID) cooperating agencies. The presentations reflect the Council's view that family planning programs ought to help individuals achieve their own reproductive goals in a healthful manner. The report discusses four areas of reproductive health: reproductive tract infections (RTIs), including sexually transmitted diseases; prevention and treatment of unsafe abortion; pregnancy, labor, and delivery care; and postpartum care. Christopher Elias (Senior Associate, Programs Division) argued that family planning programs ought to provide services that target RTIs, given that these illnesses afflict a significant proportion of reproductive-age women. The family planning community has an ethical responsibility to provide services to women who experience an unwanted pregnancy. They must have access to high-quality postabortion care, including family planning services. Professional midwives are ideally suited to serve as integrated reproductive health workers trained to combat the five major maternal killers: hemorrhage, sepsis, pregnancy-induced hypertension, obstructed labor, and unsafe abortion. This was demonstrated in a highly successful Life-Saving Skills for Midwives program undertaken in Ghana, Nigeria, and Uganda, and soon to start in Vietnam in conjunction with the Council's Safe Motherhood research program. Family planning services should be viewed as part of a comprehensive set of health services needed by postpartum women, which include appropriate contraception, maternal health checks, well-baby care, and information about breastfeeding, infant care, and nutrition. Family planning programs should incorporate breastfeeding counseling into their services. When programs aim to help individuals meet their own reproductive goals in a healthful manner, this implies that services will not increase clients' risk of morbidity.     

计划生育法制建设与生殖健康——兼论生殖健康理念的国际比较

我国的婚育制度为计划生育与生殖健康建立了良好的发展环境,我国相关法律规范中体现了《国际人口与发展大会》对生殖健康的要求,为生殖健康事业的发展提供了有力的法律保障和广阔的发展空间。     

Measurement of Women's Reproductive Health and Reproductive Rights: An Analysis of Developing Countries

This study attempts to develop measurement scales for women'sreproductive health and reproductive rights by using data from125 developing countries. Data were obtained from varioussources, such as the United Nations and the World Bank. Existing studies on women's reproductive rights suggest atwo-factor model. Women's reproductive health is viewed as beingunidimensional. These proposed attributes are evaluated usingconfirmatory factor analysis. Results indicate the presence oftwo sub-dimensions related to women's reproductive rights. Aone-dimension model of women's reproductive health is empiricallysupported. Validity and reliability of the scales are assessed.Limitations of the measurement scales are discussed.     

Reproductive health care in India: a new paradigm

India has adopted a new approach to family planning that locates these services within the reproductive health care context. This means that family planning and reproductive health services will be offered as an integrated package. To implement this approach, the government will follow a framework for reproductive health designed by Saroj Pachauri, director of the Population Council's office in New Delhi, to guide the government's new Reproductive and Child Health Project. This initiative marks a significant paradigm shift in India; away from a population-control approach, implemented through a top-down, bureaucratic, target-driven program, towards a gender-sensitive high-quality services responsive to the health needs of clients, especially the women. Considering the geographical variations in reproductive health, the framework contains two service packages: an essential and comprehensive version, each consisting of broad categories of service and matrix of interventions. To support the transition underway, the Council has launched an advocacy project to educate health care providers and policymakers about reproductive health issues and help them translate the framework into effective programs. In order to successfully implement this initiative, partnerships with the nongovernmental sector, especially at the community level are essential.