This operations research project evaluated the effect and impact of a basic education program, developed by TOSTAN, a non-governmental organization based at Thiès, Senegal. The basic education program consists of four modules: hygiene, problem solving, women's health, and human rights. Through these four themes, emphasis was placed on enabling the participants, who were mostly women, to analyze their own situation more effectively and thus find the best solutions for themselves. The Supra Regional Project for the Elimination of Female Genital Cutting of GTZ funded implementation of the program in 90 villages in Kolda Region, and the Population Council's Frontiers in Reproductive Health Program, with funding from USAID, used this opportunity to evaluate the program in 20 villages.All women and men participating in the education program were interviewed before and after the intervention, and again two years later, to measure women's and men's awareness, attitudes and behavior concerning reproductive health (RH) and female genital cutting (FGC). A group of women and men from 20 similar villages that did not receive the education program were interviewed at the same time to serve as a comparison group. To test the impact of the program on community members' willingness to abandon FGC, the proportion of respondents' daughters aged 0 to 10 years whose parents reported they had been cut was used as the primary outcome indicator.The education program significantly increased the awareness of women and men about human rights, gender-based violence, FGC and reproductive health, but awareness of human rights, violence and FGC also increased in the comparison site, although to a lesser extent. The consequences of FGC were better known, as were issues concerning contraception, pregnancy surveillance and child survival. In general, women's knowledge improved more than men's, except for STI/HIV. Diffusion of information from the education program within villages worked well, as other women and men living in the intervention villages also increased their knowledge on most indicators. For all indicators, apart from those concerning violence, the experimental group improved significantly more than the comparison group.Attitudes improved significantly in the experimental group, with women and men denouncing discrimination, violence and FGC. Attitudes towards FGC also improved significantly in the comparison group, but to a lesser extent than in the experimental group. There was a dramatic decrease in the approval of FGC, although a small proportion of women (16%) participating in the program did not change their attitude. Regret for having cut their daughters increased and fewer women were willing to cut their daughters in the future. Women perceived men's attitudes towards contraception as improving. However, the intervention group showed higher levels of positive attitudes than the comparison group.There also appears to have been a positive improvement in behavior in terms of FGC and some aspects of reproductive health. The preval...

The progesterone vaginal ring (PVR) is a contraceptive designed for use byC ontraceptive vaginal rings are a new product category in many developing countries. There are two contraceptive vaginal rings on the market: a three-monthly progesterone-containing ring available in a few countries in Central and South America under the brand name Progering R ; and a monthly etonogestrel/ethinyl estradiol ring sold under the brand name NuvaRing R in Europe, the United States, and other industrialized countries. Contraceptive vaginal rings offer particular benefits to users and health systems: users can self-insert and remove the ring, giving them greater control over how the product is used, while health systems benefit from the limited need for extensive clinical training, equipment, and supplies.

This study was funded by the U.S. AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) under the terms of Cooperative Agreement Number HRN-A-00-98-00012-00 and Subproject number A199.92A. The opinions expressed herein are those of the authors and do not necessarily reflect the view of USAID.

BackgroundMaking misoprostol widely available for management of postpartum haemorrhage (PPH) and post abortion care (PAC) is essential for reducing maternal mortality. Private pharmacies (thereafter called “pharmacies”) are integral in supplying medications to the general public in Senegal. In the case of misoprostol, pharmacies are also the main supplier to public providers and therefore have a key role in increasing its availability. This study seeks to understand knowledge and provision of misoprostol among pharmacy workers in Dakar, Senegal.MethodsA cross-sectional survey was conducted in Dakar, Senegal. 110 pharmacy workers were interviewed face-to-face to collect information on their knowledge and practice relating to the provision of misoprostol.ResultsThere are low levels of knowledge about misoprostol uses, registration status, treatment regimens and side effects among pharmacy workers, and corresponding low levels of training on its uses for reproductive health. Provision of misoprostol was low; of the 72% (n = 79) of pharmacy workers who had heard of the product, 35% (n = 27) reported selling it, though rarely for reproductive health indications. Almost half (49%, n = 25) of the respondents who did not sell misoprostol expressed willingness to do so. The main reasons pharmacy workers gave for not selling the product included stock outs (due to product unavailability from the supplier), perceived lack of demand and unwillingness to stock an abortifacient.ConclusionsKnowledge and availability of misoprostol in pharmacies in Senegal is low, posing potential challenges for delivery of post-abortion care and obstetric care. Training is required to address low levels of knowledge of misoprostol registration and uses among pharmacy workers. Barriers that prevent pharmacy workers from stocking misoprostol, including weaknesses in the supply chain and stigmatisation of the product must be addressed. Low reported sales for reproductive health indications also suggest limited prescribing of the product by health providers. Further research is needed to explore the reasons for this barrier to misoprostol availability.

In Senegal, the current positive political climate for family planning provides a good opportunity for strengthening EC programming to address knowledge and attitudinal barriers among providers, key opinion leaders and communities.