Knowledge about Sexual and Reproductive Health Services and Practice of What Is Known among Ghanaian Youth, a Mixed Method Approach

Most young person will become sexually active before their 20th birthday having to battle with early and unplanned pregnancies, unsafe abortions, maternal deaths and injuries. This study examined young person’s sexual knowledge, attitudes and practices and their levels of utilization of sexual reproductive health. Our study progresses beyond current research of reporting only sexual behaviour among youth to have insight into sexual and reproductive health update drivers yielding new empirically robust results for the Ghanaian case for sexual and reproductive health service uptake. The descriptively cross sectional design was employed in sampling 170 youth (150 surveyed and 20 Interviewed) using the stratified sampling technique together with a purposive selection of one key informant. Test of significance and associations were performed with the Chisquare test. In all 45.2% (77/170) of youth (10 - 24) had had sexual experience in life time. In respect of in-school youth, 42% (63/150) had had sexual experience whiles 70% (14/20) out-of-school youth had had sexual intercourse in life time. A total of 28.8% (49/170) of all the youth had sexual intercourse in the last six months with only 40.1 (20/49) using condom for protection. Parental discussion of contraceptive methods (29.3%) and sexual and romantic relationship (28.0%) was the least sexual and reproductive health area discussed among in-school youth. Youth knowledge of the available sexual reproductive health service was statistically associated with reproductive health service utilization (X2 = 0.00, P ≤ 0.05). A concerted effort is required from government, NGO, Civil society organizations and religious bodies to help translate youth knowledge about sexual health into responsible sexual life and protective sex.

Youth’s Perspectives on a Sustainable Model for the Provision of Youth Friendly Sexual and Reproductive Health Services in Kenya: A Quantitative Approach

Nearly half of the world’s population comprise youths. However, addressing their Sexual and Reproductive Health (SRH) remains a challenge. Globally countries are mandated to continually provide Youth Friendly Sexual and Reproductive Health services (YFSRHs) to the youth. The objective of this study was to assess and describe youth’s perspectives on a sustainable model for the provision of YFSRHs in Kenya. Data was collected among 400 youths aged 18 - 24 years in Embu and Kirinyaga counties, Kenya. A structured questionnaire was utilized as the data collection tool. Collected data was analyzed using SAS statistical software version 9.4. Statistical threshold of P ≤ 0.05 was used. Overall the mean age of the study participants was ±standard deviation (SD) 21.2 ± 1.86 years. Majority of the participants’ perspective on the health care system sustainability was that the waiting time at the facility should be less than an hour, accessible geographically (less than a kilometre), affordable (≤20 Ksh.), and convenient working hours (weekday and weekends ratio 1:1). Advocacy was on health care provider’s attributes of politeness, welcoming, confidential and non-judgmental. The most preferred locations for the youth friendly centres by the participants were community and school based locations. Similarly, parental and community support was reported to highly contribute to sustained utilization and provision of the YFSRHs (P < 0.001). Unlike popular belief, 99.8% did not see the need for recreational facilities at the youth centres to ensure sustainability of the model. To ensure a sustainable model for the provision of YFSRHs, there is need for a multi-sectoral and stakeholder involvement that is;youth, health care system structure, health care service providers, parents and community. Further research is needed on parents and health care service provider’s perspectives on how to sustain the provision of YFSRH services.

How the Reproductive Health Needs of Unmarried Youth Be Concerned in Quality Services in Family Planning/Reproductive Health?

Objective To understand the reproductive health needs of unmarried youth so as to provide them better quality services. Method Data were drawn from a baseline questionnaire survey of provision of reproductive health information and services for unmarried youth aged 16-20 years in rural areas of Chengdu, Southwest China in 2001-2002. Results The study comprised of 1 895 valid subjects. More than 70% subjects felt that the knowledge, information and services in relation to sexual and reproductive health provided by the society were rather insufficient. Near 95% thought that unmarried young people seeking sexual and reproductive health counseling and services were quite normal, although some of them had different misgivings. Their preferred services in reproductive health included： counseling in relation to sexual and reproductive health, how to cope with unexpected sex and unwanted pregnancy, how to select the appropriate contraceptives for unmarried youth, etc. About 2/3 subjects agreed to provide contraceptive services to unmarried youth actively, by the society. A. nd they thought the difficulties and obstacles in provision of contraceptive services for un- married youth were in the following order.＂ restriction of the traditional conceptions, shyness of unmarried youth in accept of such services, disapproval of parents/school teachers, and so forth. Conclusion To improve reproductive health status of unmarried youth and meet their needs is a challenge to quality service of family planning/reproductive health program in China, The related departments and service providers should pay attention to this matter and take the strategies and measures to provide appropriate, specific, friendly and accessibly services for unmarried young people.

Evaluation of the Functionality of the Networking of Sexual and Reproductive Health Rights Services in the Event of Gender-Based Violence in the Commune of Kpomasse in 2022

Introduction: In developing countries, gender-based violence (GBV) is a real public health problem. In Benin, GBV affects the majority of women and girls (69%). Benin has implemented strategies and set up integrated centers for the management of violence in order to reduce cases of violence and ensure the holistic management of victims. The objective of our study was to assess the functionality of the network of sexual and reproductive health rights (SRHR) in case of GBV in the commune of Kpomasse in 2022. Method: This descriptive and evaluative study was conducted from March 21 to April 11, 2022. The sampling method used was non-probabilistic. Reasoned choice and convenience were the techniques used for the different targets of the study. The functionality of the SRHR service network was assessed first by calculating scores at the structure, process and outcome levels, and then by analysis using the human rights-based approach. Results: Out of the 34 GBV victims identified, only one had received a full response and 54% of the victims had no knowledge of SRHR. The lack of knowledge about health care facilities was 41% for victims and 80% for non-victims in the community who participated in the study. In the case of gender-based violence, the community preferred to settle out of court rather than report it. The functionality of the networking of sexual and reproductive health rights services in the event of the occurrence of gender-based violence in the commune of Kpomassè is insufficient. Lack of knowledge of the roles of rights holders (DD) and duty bearers (DO) explains the insufficient functionality of networking. Conclusion: Training of SRHR service agents and community sensitization are essential to improve the functionality of SRHR service networking in the commune of Kpomasse.

Access to Reproductive Health Services for Adolescents in the Educational System, Phetchaburi Province

This study was based on a descriptive research design. The population comprised of males and females aged between 15 and 19 years studying at the high school, college, and university levels in Phetchaburi, Thailand. The sample group size was calculated by using Taro Yamane＇s formula at a reliability level of .95. The instrument used was the questionnaire of College of Public Health as modified by Chulalongkorn University for use in research. Instrument quality was calculated by using the Kuder-Richardson 20 formula; an internal consistency value of.86 was obtained. According to the findings, the comparison of access to reproductive health services by adolescents at each level of education, the educational levels of the adolescents were similar to one another in that they were found to have received instruction about sexuality and reproductive health. The instruction most frequently received was on reproductive health and the least frequent subject was life skills, ability to adjust to daily lifestyles. The findings suggested that the capacity of medical and academic personnel should be developed in order to gain knowledge, attitudes to provide reproductive health services, especially on subjects concerning life skills and ability to adjust to daily life and interacting with the people surrounding adolescents, including skills on how to refuse sexual activity with partners.

Attitude of Health Care Providers towards Adolescent Sexual and Reproductive Health Services in Developing Countries: A Systematic Review

The aim of the review was to synthesise the best available evidence regarding attitude of health care providers towards adolescent sexual and reproductive health services in developing countries. The review was conducted following qualitative research method. An online search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), EMBASE and MEDLINE databases was conducted to identify relevant studies for the review. There were nine studies that met the inclusion criteria and these were critically assessed by two independent reviewers using the standardised Joanna Briggs Institute (JBI) critical appraisal forms. Data were extracted using the standardised JBI data extraction forms. A narrative synthesis was done on the findings. Key findings from the review indicate that unprofessional attitude of health care professionals and lack of youth friendly reproductive health services, inhibit adolescents from gaining access to sexual and reproductive health services in developing countries. It is recommended that youth friendly reproductive health services be provided to increase uptake of re-productive health services by adolescents.

Availability, Range and Utilization of Sexual and Reproductive Health (SRH) Services for Adolescents at Kinondoni Municipality, Dar es Salaam—Tanzania

Background: It is estimated 1.2 billion of world’s population are adolescents aged 10 - 19 years;80% live in developing countries. Adolescents in developing countries especially Sub-Saharan Africa (SSA) face high burden of sexual and reproductive health problems. Sixteen million girls aged 15 to 19 years give birth every year of which 95% occur in low- and middle-income countries. Twenty five percent of unsafe abortions are in 15 - 19 years in Sub-Saharan Africa. Contraceptive use is low as approximately 10% of adolescents are current users. These problems can be averted if different ranges of Sexual and Reproductive Health Services for adolescent (SRHSA) are available and utilized by adolescents. In Tanzania, there is limited information addressing the availability, types and utilization pattern of sexual and reproductive health services by adolescents. This study investigates the availability, range and utilization of sexual and reproductive health services for adolescents (ASRHS) at Kinondoni Municipality, Tanzania. Method: A cross-sectional study was carried out in April to May 2013. A checklist was used to collect information on the availability and range of services offered at selected health facilities. In depth interviews conducted with in-charges of Reproductive and Child Health (RCH) clinics to explore barriers for provision of Sexual and Reproductive Health Services (SRHS) for adolescents. Adolescents were questioned using a questionnaire on utilization of SRHS and perceived barriers. Descriptive statistics were used to summarize quantitative data and content analysis for qualitative data. Results: On availability and range of adolescents’ sexual and reproductive health services, a total of 25 health facilities were surveyed. Forty four percent of the surveyed facilities did not have the adolescent sexual and reproductive health services (ASRHS). The Adolescents Sexual and Reproductive Health (ASRH) services offered differed greatly between facilities. On utilization of adolescents’ sexual and reproductive health services in total, 204 adolescents from the community were involved in this study. A third of adolescents reported to have ever used ASRH. The adolescents perceived barriers for underutilization of the services were fear of being seen at the clinics (23.3%), lack of money (18.3%), lack of privacy & confidentiality (14.2%) and unfriendly health care providers. Three barriers were perceived by health care providers in the provision of ASRHS: integration of SRHS, lack of training in relation to adolescents SRHS and attitudes of health care providers towards young people. Conclusion: About half of the health facilities did not have the SRH-services to adolescent (44%) and different ranges of services were not offered at the facilities as it was shown in the records. The results from this study show services were underutilized by adolescents. Training, attitudes of health care providers towards young people, & cost influenced ASRHS provision and utilization. Strategies to increase training in ASRHS for health providers including communication skills and scaling ASRH services to all primary care facilities may help to improve availability and access of services to adolescents.

Socio-Cultural Barriers Influencing Utilization of Sexual and Reproductive Health (SRH) Information and Services among Adolescents and Youth 10 - 24 Years in Pastoral Communities in Kenya

Background: As in other developing countries, sexual and reproductive ill-health continues to mostly affect adolescents and youths. Samburu and Turkana counties in Kenya have some of the highest levels of total fertility rates (TFR) at 6.3 and 6.9 respectively placing them well above the national TFR of 3.9. Establishing factors that influence utilization of SRH services among adolescent and youth aged 10 - 24 years is critical in developing an effective program. Method: We used primary data from qualitative and purposeful study design. Data collection used Focus group discussions (FGD), In-depth interviews (IDIs) and Key informant interviews (IDIs). The target groups were adolescents and youth aged 10 - 24 years, health care providers, community health volunteers (CHVs), chemist assistants, parents of adolescents and youth, teachers, spiritual leaders and traditional activists. Findings and Conclusion: Socio-cultural factors were found to influence utilization of SRH services and information. Early marriage, being youth, male only decisions on sexuality matters and fear of family contribute to unprotected sex while myths and misconceptions on contraceptives affected utilization. The findings revealed that youth needs to know sources, how contraceptives work and how to use them. The findings suggest capacity building of health care providers, CHVs, teachers, parents and community leaders on adolescence, sexuality needs of adolescents and disadvantages of female genital mutilation (FGM) including early marriage.

Sexual and reproductive health service needs of university/ college students： updates from a survey in Shanghai, China

Aim： To promote the provision of reproductive health services to young people by exploring the attitudes and perceptions of university students in Shanghai, China, toward reproductive health. Methods： From July 2004 to May 2006, 5 243 students from 14 universities in Shanghai took part in our survey. Topics covered the demands of reproductive health-care services, attitudes towards and experience with sex, exposure to pornographic material, and knowledge on sexual health and sexually transmitted infections （STIs）/AIDS. Results： Of the 5 067 students who provided valid answer sheets, 50.05% were female and 49.95% were male, 14.86% were medical students, and 85.14% had non-medical backgrounds. A total of 38.4% of respondents had received reproductive health education previously. The majority of students supported school-based reproductive health education, and also acquired information about sex predominantly from books, schoolmates, and the Internet. Premarital sexual behavior was opposed by 17.7% of survey participants, and 37.5% could identify all the three types of STIs listed in the questionnaire. Although 83.7% knew how HIV is transmitted, only 55.7% knew when to use a condom and 57.8% knew that the use of condoms could reduce the risk of HIV infection. Conclusion： The reproductive health service is lagging behind current attitudes and demands of university students. Although students＇ attitudes towards sexual matters are liberal, their knowledge about reproductive health and STIs/AIDS is still limited. It is therefore necessary to provide effective and confidential reproductive health services to young people.

Reproductive Health Service Utilization and Social Determinants among Married Female Rural-to-urban Migrants in Two Metropolises,China

Reproductive health（RH） education and services of female migrants in China have become an important health issue.This research aimed to investigate the RH knowledge and utilization among married female migrants,and to explore the influencing factors from the perspectives of population and sociology.We conducted a cross-section survey in Shenzhen and Wuhan,China,using the purposive sampling method.A total of 1021 rural-to-urban married migrants were recruited,with 997 valid survey results obtained.A face-to-face structured questionnaire survey was used,with primary focus on knowledge of fertility,contraception,family planning policy and sexual transmitted diseases/acquired immunodeficiency syndrome（STD/AIDs）,and RH service utilization.The results showed that the RH service utilization（38.0%） was at a low level in married migrants and the accessibility of RH service was poor.Females who migrated to（OR=0.32） Wuhan obtained fewer RH consultations than those in Shenzhen.The workers with high school education received additional RH consultations and checkup services than those with other background education,apart from the white collar workers who received extra RH consultations and checkup services than the blue collar workers（P〈0.05）.We can draw a conclusion that the utilization of RH services in married female migrants remains at a low level in China.RH service utilization can be improved via the relevant health departments by enhancing the responsibility of maternal and health care in the community health service center.

Knowledge and Service Demand of Reproductive Health among Migrant Population

Objective To understand the sexual and reproductive health knowledge among unmarried migrant population and their service demands as well as current services delivered by local family planning departments, so as to provide scientific evidences on conducting reproductive health education and appropriate service for migrant population in the district. Methods A questionnaire survey was conducted among a convenient sample of unmarried young migrant population between 15 and 25 years old in Dongshan District. All data were entered into database with the software Foxpro6.0 and analyzed with the statistics software SPSS10.0. Results Unmarried migrant population had some kinds＇ of sexual and reproductive health knowledge and was eager to access to reproductive health service. They hoped that relevant governmental departments could provide them more information, education and service on sexuality and reproductive health. Conclusion Relevant departments should work together to popularize reproductive health knowledge among unmarried migrant population and meet their demands on reproductive health service, so as to improve their current reproductive health situation.

Improving Health Services for Rural Pregnant and Lying-in Women——Achievements in the Reproductive Health Program of Chinese Women

FROM 1992 to 1997, the All-China Women’s Federation organized and implemented a reproductive health program for Chinese women, which was sponsored by the American Ford Foundation. The program was divided into two phases. The first phase, lasting from 1992 to 1994, focused on locating problems and studying them. Women’s federations from 16 provinces, municipalities and autonomous regions throughout China formed a research group and conducted extensive studies in a variety of fields while cooperating with experts from sociology,

Youth friendly health services and role of outreach activities to improve access to services

An attempt has been made to assess the Youth Friendly Health Services (YFHS) from the clients’ perspectives and the role of outreach community-based approach (Youth Information Center, YIC) in improving access to services. A cross- sectional study was undertaken in Arajiline and Hoskote blocks in Varanasi and Bangalore districts respectively using primarily a quantitative technique. A consecutive sample of 120 clients from 4 selected clinics was interviewed after seeking services from YFHS. Additionally, facility assessment of clinics and 8 FGDs were conducted among community members and the young people in the community. Majority of the clients (90.8%) are aware that YFHS provide services to young males and females separately on specific day and time. Nearly 66% clients visited YFHS to sought treatment for three key health problems i.e. menstruation problems (25.4%) followed by general illness (22.8%) and swelling/itching of private parts (21.1%). In Hos- akote privacy was maintained during the con- sultation with the doctor, however, situation was relatively not better in Arajiline. Out of those clients who had visited YIC atleast once, 49 out of 53 in Arajiline and 51 out of 60 in Hasokote reported that the YIC staff/activities had motivated them to sought services at YFHS. Study concludes that while majority of the clients were satisfied with the services at YFHS, there is a need for strengthening the existing “package” of the services. At facility level, reassurance about the privacy and confidentially and alternative ways to promote access and utilization of services by active involvement of young people is recommended. On the other hand, at outreach level, new technologies should be introduced to generate demand, intensive focus on adults in the community and integration of YIC with local governance and school environment is suggested so as to protect young people against poor health outcomes.

Operationalizing Adolescent Health Services at Primary Health Care Level in India: Processes, Challenges and Outputs

Background: Ministry of Health, Government of India developed the Adolescent Reproductive and Sexual Health (ARSH) strategy and operationalized adolescent health services up to district and sub-district hospital level. Objectives: To operationalize adolescent health services at primary health care level in a block of Maharashtra;assess impact of need based interventions on quality of services;and understand potential for scalability in the state. Methods: Adolescent and Youth friendly centers were established at primary health care settings and interventions such as health system strengthening, sensitizing gatekeepers, involving Accredited Social Health Activist (ASHAs), developing inter and intra-sectoral linkages, improving monitoring and evaluation were tested. Results: Over a period of 2009-2014, there was a steady increase in the number of clients attending the Adolescent and Youth Friendly Health Centers (A&YFHCs). Attitude of providers to address adolescents’ needs improved significantly. Successful interventions were networking with schools, colleges and Non Government Organization (NGOs), linkages with HIV program and Integrated Child Development Services (ICDS), and involvement of ASHAs. Conclusions: The study demonstrates that although health system has the primary responsibility of addressing health issues among adolescents;it has limitations in terms of its reach to adolescents and generating demand for services. There is a need to network with education sector, ICDS, NGOs working for adolescent health and development to work as a team and address the multifaceted needs of the adolescents. Such a strategy will be crucial while implementing the recently launched Rashtriya Kishor Swasthya Karyakram— the new national adolescent health programme in India.

Healthcare Providers' Perceptions of the Sexual and Reproductive Health Needs (Including Family Planning) of Elderly Women from Selected Sites in Botswana

Much of the sexual and reproductive health services and service delivery including family planning target women of child bearing ages (15 - 49 years) and sometimes men. Hardly are there programmes/interventions that specifically target the needs of the elderly women (50 years and above), yet this group has serious sexual and reproductive health needs as many of them are still sexually active. This cross-sectional study obtained the views of a stratified random sample of 169 healthcare providers (doctors, nurses and pharmacists) from four selected sites, Gaborone, Selibe Phikwe, Barolong and Kweneng East health districts in Botswana on how the healthcare system in the selected sites is meeting the SRH/FP needs of the elderly women. The study found out that while overwhelming majority of the healthcare providers feltthat the healthcare system has no programme that specifically target the SRH/FP needs of this significant others and their SRH/FP needs are not being met ,less than 15% indicated that Pap smear screening as well as screening of cervical cancer were on-going. Although there are SRH/FP services available in the healthcare system, the elderly women are minimally accessing these services. Only condom, combined oral contraceptives, progestogen-only pills, treatment of STIs, screening for HIV/AIDS and screening for cervical cancer are accessed and information is also limited to these services. Reasons given by the healthcare providers for the non-accessibility of these services were cultural diversity (80%), people's sexual behavior and perceptions about sex (79%), lack of knowledge about the desired SRH/FP services (76%), religion (73%) and gender issues (62%). The study, advocates as part of policy options to mitigate the obstacles to accessing SRH/FP services, the expansion of counseling programmes, screening and treatment for breast cancer, public awareness campaigns, production and circulation of appropriate educational materials, effective training of healthcare providers and the establishment of separate clinic days for the elderly women' SRH/FP services.

The Ghana Project in Psychiatry: A Systematic Description of the Mental Health Services

Introduction: Mental health is a neglected field within the health care system in Ghana. Studies and public education focusing on mental health remain low, leading to poor knowledge and awareness of mental health among the population. Objective: The overall aim of this study was to provide a systematic description of mental health services in Ghana. Methods: A snowball technique was used to select a total of 42 mental health professionals from six hospitals for interviews. A structured questionnaire was used for data collection. Results: Major findings of this study include inadequate human and material resources;poor knowledge of mental health among the population;weak coordination between general practitioners and mental health professionals;inadequate mental health services in schools and prisons. Additionally, 54.8% of respondents reported limited mental health educational materials, and most schools (54.8%) lacking trained resident mental health professionals. The main interventions for service delivery are taking over activities of daily living by nurses, problem assessment, and psychological interventions which achieved the same results (69%). A tendency to consult faith-based healers and prayer camps;a lack of mental health research capacity, specifically research focusing on policies;and weakness in the organization and decentralization of mental health services in Ghana are among the common challenges to seeking care. Conclusion: Public mental health education on available resources and services is important. Capacity research focusing on dissemination and implementation of mental health policies can serve as the basis for addressing mental health challenges and improving service delivery in Ghana.

Impact of community strategy package on uptake of reproductive tract infections health services among young street females in the municipality of Eldoret,Kenya

Background:Despite the intervention of free medical care services for street children by a dedicated clinic in Eldoret municipality,health care service of young street females(YSFs)is still deficient.The present study aimed to evaluate the impact of the community strategy package on the uptake of reproductive tract infections(RTI)health services among the target population.Materials and methods:A pre-test-post-test quasi-experimental with a qualitative and quantitative approach was applied among the YSFs aged 10-24 years.The study used structured questionnaires and key informant interviews to collect data from the respondents.Results:The study enrolled a total of 77 young street females in Eldoret municipality.A significantly higher proportion of respondents reportedly first sought treatment for RTI at a health facility after the implementation of the community strategy package(97.1%)when compared to the proportion of respondents who first sought treatment at a health facility in the pre-intervention phase(51.0%)(p<0.001).Early seeking of treatment improved significantly after the introduction of the intervention;72.0%and 94.1%of the respondents sought treatment early during the pre-intervention and post-intervention phase,respectively(p<0.011).Conclusion:The study recommends the adoption of the community strategy as an intervention to increase the uptake of RTIs health services and promotion of the reproductive health of young street females.

Contribution of safe motherhood solidarity groups in using and accessing maternity services during a period of armed conflict

This report presents the results of a study on Reproductive Health done in North Kivu in September 2009. It was conducted by HEAL Africa, in partnership with the Provisional Division of Health, and financed by the University of Ottawa, Canada/CRDI with technical assistance from Western Cape University of South Africa. The study was conducted in the health zones of Birambizo and Kayna within the framework of the central office. The focus of the report is on one aspect of Reproductive Health—Low Risk Maternity. This study was conducted in rural areas given that Reproductive Health indicators are much weaker when compared with urban areas, according to EDS RDC, 2007 [1]. This study emphasizes the following points: General characteristics of the participants in the study, and the utilization and accessibility of maternity services in rural areas in conflict situations. The formula SPSS 12.0.1 was used to facilitate data analysis in the study. This study comes at a point in time when its relevance to HEAL Africa’s work will assist HEAL and its partners in determining the focus of interventions done in health zones in order to improve maternal and neonatal health. HEAL Africa firstly stepped into a Safe Motherhood pilot project in June 2006 for 9 months in the Masisi zone, then in 2007 in the Birambizo and Kayna health zones. In November 2007, HEAL expanded into Walikale and in October 2008, into Kirotshe, Binza, and Lubero. The intervention kit consists of reinforcing the capacity of existing health facilities, training traditional midwives who serve as a link between the community and the health structures, the provision of sanitary equipment, medical essentials and community mobilization was done through local leaders about health and reproduction, and organizing women of reproductive age in solidarity groups (SG) to generate maternity insurance. The community approach “Solidarity Groups for Maternity Insurance” constitutes the spine of HEAL Africa within the support it provides in Reproductive Health. The principal idea is to educate and train communities on how to use the MMR services that are available in their community, and to remove financial barriers to accessing health services. The 4 pillars that comprise the Safe Motherhood program are: family planning, prenatal care, safe assisted delivery and essential obstetric care. These four strategic measures are integral in assuring primary health care and equality for women. This study evaluates this approach, keeping in mind local strategies and their effects on improving the utilization and accessibility of reproductive health services.