Spread collaborative: Prevention of unwanted pregnancies, abortion and sexually transmitted diseases among teenagers in Kostroma, Tambov, Ivanovo and Tula regions, Russia
To encourage reduction of abortion through increasing access to information on reproductive health and modern contraceptive methods
To decrease unwanted pregnancies, STDs and abortions among teenagers
Activities aimed at teenagers were adapted from the UNICEF model for Youth-Friendly Health Services, which had been approved by the Russian Ministry of Health and Social Development.
Reproductive health counseling interventions were based on a course developed by USAID partner Healthy Russia Foundation
The collaborative collected four standard indicators from participating facilities, self-reported monthly by the improvement teams:
• The number of girls age 17 and under coming for reproductive health visits. This indicator counted only the first visit of each individual during each calendar year.
• The number of boys age 17 and under coming for reproductive health visits, which similarly included only the first visit during each calendar year
• The number of girls age 17 and under receiving laboratory screenings for STDs. The type of STD covered was not defined in the indicator definition; nor was this limited to asymptomatic individuals. The indicator counted only the first test during each calendar year, in order not to double count individuals receiving tests for multiple types of STDS, or to count repeat tests to assess the effectiveness of treatment.
• The number of boys age 17 and under receiving laboratory screenings for STDs.
At the regional level, we collected numbers of induced abortions among all women and among teens age 15-17 and births among teens age 15-17 from official statistics. We calculated abortion rates and birth rates per 1000 women in the respective age groups using the population as of Jan. 1 of the year in question as a denominator.
Teen-related activities from a related demonstration collaborative on reproductive health were distilled into a written change package, which was implemented region-wide in Kostroma region, through both facility based counseling, the schools, the media, the church and the communitym with the regional Center for Family Planning and Reproduction taking the lead. Facility-based and community activities were also continued at Tambov City Family Planning Center, and spread to five facilities in Tula and Ivanovo Region, including facilities in each region with region-wide responsibilities.
10 facilities were targeted in 4 of Russia's 83 regions. Activities in Kostroma region were spread region-wide.
Each region was designated a quality improvement coach. Coaches included QI specialists from the Russian Institute for Health Care Organization and Information, clinical experts from the Ivanovo Institute for Motherhood and Childhood who had been trained in QI, and a expert clinician from Ivanovo region who had been trained in QI in phase 1 and in reproductive health counseling by the Healthy Russia Foundation. We tested various technical assistance strategies for spread and continuation in the various oblasts during the spread collaborative. The overall strategy was that teams, with basic orientation and training in QI, could use the detailed written change packages and online resources to achieve cost-effective improvement. Having noted the success of the initial intensive team orientation in achieving rapid spread at Galich Hospital in Kostroma region., we attempted to replicate this approach at each of the new hospitals in Ivanovo region. Rather than conducting joint learning sessions, we conducted individual orientations for the regional improvement teams, where collaborative topics were selected, and then for each facility improvement team onsite. In this manner, a larger number of facility staff could be oriented to the project. In Tula region because time was short, we conducted an intensive orientation for all maternal and child health facility leaders in the region, provided training on the web portal and provided a single on-site supportive visit. Support for Kostroma region was provided through intensive on-site supportive visits, as well as through local specialists of the Kostroma Center for Family Planning and Reproduction who had institutionalized training during the demonstration phase. Reproductive health expert Elena Boyko of the Ivanovo Institute continued frequent assistance visits to sites in her role as the Institute's supportive supervisor for the region. In Tambov region, we worked primarily in the capital, at the regional level. Assistance to Tambov was also provided directly by Russia's chief pediatric gynecologist, who is affiliated with the Kulakov Center for Obstetrics, Gynecology and Perinataology.
Spread of the written change package was conducted through learning sessions where the change package was discussed and distributed, the project web portal, QI trainings for the new sites, clinical trainings with participation of physicians and nurses from demonstration collaborative sites, and experience sharing through visits of improvement team members from new sites to model facilities and programs developed during the demonstration phase. An initial learning session was conducted in October 2010, an interim session in May 2011 and a final project conference/video conference in November 2011. The May 2011 learning session was enlivened by the presence of community representatives who participated on the improvement team of Sharya Hospital, Kostroma Region, including a representative of the City Department of Youth and Sport and a representative of the local Russian Orthodox diocese.
A regional training center on teen reproductive health was established in Kostroma
• Change package on prevention of unwanted pregnancies, abortions and STDs among teens published
The collaborative had the following direct results
• Reproductive health visits for teens up 34% for girls, 97% for boys at 8 clinics
The collaborative plausibly contributed to the following overall results
• Teen birth rate in Kostroma Oblast down 19% as abortion rate declines 59% 2008-10; fewer teen abortions than teen births.
The collaborative may have contributed to the following overall results
• Teen abortion rate in 3 regions cut in half, 2008-10
• Overall abortion rates in 3 regions fall faster than overall Russia decline of 17%; declines in 3 regions range from 20% to 28%.
More detailed results are included in the attached report.
A Russian-language written change package on prevention of unwanted pregnancies, abortions and sexually transmitted diseases among teens included the following:
Objective 1. Training staff on counseling teens on reproductive health
Objective 2. Providing information for teens
• Collaboration with the media
• Providing educational lectures at schools
• Development and dissemination of informational materials for teens
• Creating information stands
• Conducting public action campaigns for teens
• Creating a hotline
Objective 3. Develop communication and collaboration with the local community
• Regional or city education departments
• City departments of youth and sport
• Colleges, technical schools and universities
• The church
Objective 4. Reorganizing the clinic so it is youth-friendly
• Organizing an easy-access location for teens
• Providing referral forms from the children’s polyclinic to the youth-friendly clinic
• Including consultation with a gynecologist as part of the annual preventive exams at schools
Objective 5. Introduce mandatory counseling on reproductive health for teens
Objective 6. Intensify work with high-risk groups.
• Identification of high risk groups for pregnancy and STDs
• Assure care for members of these groups free of charge
• Mandatory pre- and post-abortion counseling for teens
• Mandatory postnatal counseling on contraception for teens