Reduction in anaemia in pregnant women in three Caribbean countries. Possible results of different types of interventions

The Caribbean Food and Nutrition Institute conducted a survey of anemia status of pregnant and/or lactating women in Jamaica (1982), Montserrat (1981), and St. Vincent and the Grenadines (1985). After various interventions designed to reduce the prevalence of anemia in pregnant women, follow-up surveys were conducted in the same countries five years after the initial surveys to determine whether or not the prevalence of anemia in pregnant women did indeed fall after these interventions. As of July 1984, the Jamaica Flour Mills began fortifying all baking flour and counter flour with iron (44 mg/kg) (a 70% increase in the amount of iron added), thiamine (6.3 mg/kg), riboflavin (3.9 mg/kg), and niacin (52.8 mg/kg). During the five year period following the initial survey in Montserrat, health workers had changed the type of iron administered to pregnant women, a constant supply of iron tablets was established, and the economy had improved. The changes in St. Vincent and the Grenadines were that the government provided a constant supply of iron folate (ferrous folate) tablets and there was a 1988 workshop on a manual on the control of anemia where nurses were trained in better clinic management of anemia. The prevalence of anemia (Hb 11 g/dl) in pregnant women fell from 61.6% to 53% (p 0.09) in Jamaica. It fell from 82.3% to 22.1% in Montserrat (p 0.0001). The prevalence of anemia (Hb 10 g/dl) in pregnant women fell from 25% to 14.5% (p 0.001) in St. Vincent and the Grenadines. These findings show that different interventions may have contributed to the reduction in the prevalence of anemia in pregnant women in Jamaica, Montserrat, and St. Vincent and the Grenadines.     

The interpersonal relationship in clinical practice. The Barrett-Lennard Relationship Inventory as an assessment instrument

The biomedical model that has long been central to medical practice is gradually being expanded to a broader biopsychosocial model. Relationship-building skills commensurate with the new paradigm need to be understood by educators and taught to medical practitioners. The person-centered, or humanistic, model of psychologist Carl Rogers provides a theoretical approach for the development of effective biopsychosocial relationships. The Barrett-Lennard Relationship Inventory (BLRI) was developed in 1962 as an assessment instrument for the person-centered model. In this article, the person-centered model and the use of the BLRI as an assessment instrument of this model are discussed. Current and potential uses of the BLRI are explored.     

Contraceptive introduction reconsidered: a new methodology for policy and program development

Although new contraceptive technology has the potential for providing women with expanded options for fertility control, the historical record of international family planning shows that, in practice, introduction of new methods has not always broadened reproductive choice. Using the example of introduction of intrauterine devices into the Indian family planning program in the 1960s, we show that an exclusive focus on the technology itself is problematic and argue that methodologies are needed that relate introduction of new methods to user needs and program capacities. We summarize key findings from the Indonesian experience with Norplant introduction. Although an effort was made to address problems with previous approaches, major deficiencies in both the technical and interpersonal dimensions of care arose when the implants were made broadly available within the program. We subsequently present a methodology for contraceptive introduction developed by the World Health Organization. This methodology emphasizes the social and institutional context in which technology is used and suggests a participatory and research-based approach to program and policy development. We illustrate results from this new approach in its implementation in Vietnam and suggest areas for further evaluation.     

When is research participatory? Reflections on a reproductive health project in Brazil

This article addresses women's participation in an organization development project designed to improve public sector family planning and reproductive health services in Brazil. Although community women collaborated in aspects of the intervention and research, the project nonetheless raises the basic question whether such involvement of community women does or does not correspond to what scientific writers consider to be the essence of participatory research. We review key project features in the context of recent literature and conclude that although the project is committed to the sharing of power and control, it does not fully correspond to the characteristics of participatory research. Moreover, we argue that given the project's central focus on reproductive health outcomes, complete adherence to the process-oriented, pure version of participatory research would have been inappropriate.