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Global Health: Global Reproductive Health

Global Health Programs: Participating Agency Program Agreement with USAID

The Division of Reproductive Health (DRH) is in the final year of a 3-year, $10.5 million Participating Agency Program Agreement (PAPA) with USAID’s Office of Population and Reproductive Health that expires in 2011. The PAPA is the most recent (and last) of a series of agreements with USAID dating back to 1974. DRH has collaborated with USAID on reproductive health issues for over 30 years, and under the current agreement provides technical assistance to and build capacity in developing countries in the areas of: Reproductive Health Surveys; contraceptive safety and effectiveness; and reproductive health of women in refugee, conflict, and other crisis situations.

  • Reproductive Health Surveys (RHS): provision of technical assistance for the collection and analysis of family planning, maternal and child, and other reproductive health data through national-level population-based surveys. Current and recent RHS in: Russia, Republic of Georgia, Guatemala, El Salvador, Jamaica, Paraguay, and Guinea-Bissau.
  • RHS capacity building and sustainability in Latin America and the Caribbean: Conducting Survey Sustainability Assessments and preparing Survey Continuity Plans to help countries build institutional capacity to independently collect and analyze maternal and health data in order to monitor and improve their health services.
  • Capacity building on Monitoring and Evaluation: Conduct, with MEASURE Evaluation regional, training workshops on monitoring and evaluation for public health professionals in Latin America and Asia
  • Assistance to WHO for development of contraceptive guidelines: monitoring, assessment, and synthesis of information on contraceptive safety and efficacy using a system developed by DRH. WHO uses this information to update guidelines on Medical Eligibility for Contraceptive Use and Selected Practice Recommendations for Contraceptive Use.
  • Reproductive Health Assessment Toolkit for Conflict-Affected Women: Developed a toolkit to assess the reproductive health needs of women in crisis settings (refugees, conflict, etc.). Fielded in 8 countries and adopted by refugee assistance NGOs, it is currently undergoing an evaluation.

Where We Work

  • Republic of Georgia
  • Guatemala
  • El Salvador
  • Jamaica
  • Paraguay
  • Guinea Bissau
  • Afghanistan
  • Russia
  • Ukraine
  • China
  • Colombia
  • Tanzania
  • Kenya
  • Ghana
  • Malawi
  • Ethiopia
  • Zambia


CDC/DRH provides scientific guidance and technical assistance to Ministries of Health, National Statistics Organizations, and other government agencies to document the magnitude and characteristics of maternal mortality globally. They have worked on both Reproductive Age Mortality Studies (RAMOS) and on implementation of routine maternal mortality (MM) surveillance.

  • El Salvador and Guatemala: CDC/DRH has promoted innovative strategies to make MM surveillance more efficient, and to increase the availability of information to inform MM reduction efforts in these two countries. These have focused on moving MM surveillance beyond enumeration to capture information about the causes and circumstances of deaths in order to strengthen prevention strategies. In Guatemala, a RAMOS study was conducted, followed by establishment of on-going surveillance of maternal mortality.
  • Colombia: CDC/DRH is working with the Ministry of Social Protection and the Pan American Health Association to develop a web-based, innovative maternal mortality surveillance system, to increase accuracy of the reporting and analysis of maternal mortality data. This system, if effective, will be expanded to other countries in the region.
  • Ghana: CDC/DRH has been asked by the Government of Ghana to provide assistance in the establishment of a complete and effective maternal mortality surveillance system.


  • Obstetric Fistula: CDC/DRH leads the Fistula Data, Indicators, and Research Group (DIRG) of the Global Alliance to Eliminate Fistula and is leading the development of a compendium of obstetric fistula (OF) indicators to be used worldwide to monitor and evaluate fistula programs. The compendium is intended to guide the collection and use of data to document the burden of OF on individuals and communities, identify effective interventions, and foster evidence-based decision making and political action.
  • Field Epidemiology Training Programs: Development of FE(L)TP tracks in maternal and child health in several countries, primarily in sub-Saharan Africa. Possible sites include Tanzania, Kenya, Ethiopia, and Afghanistan.
  • Kenya: Prospective pregnancy tracking in a Demographic Surveillance Site, to assess use of emergency obstetric care and other services, including unmet need for services;
  • Tanzania: Subject matter expertise to support CDC/Tanzania monitoring and evaluation of a task shifting project to provide emergency obstetric services in 4 areas;
  • Malawi: Provision of technical support to H4 (WHO, UNICEF, UNFPA, World Bank) in developing the use of implementation science to improve maternal and neonatal outcomes.
  • Ethiopia: Participation in a joint USAID/CDC effort to integrate PMTCT and family planning activities. Technical assistance to improve service utilization to reduce maternal and neonatal mortality in hospitals;
  • WHO: Assisting WHO in analysis of multinational data on cesarean sections and birth outcomes.


The USHIR Team conducts epidemiologic, clinical and behavioral research integrating the study of prevention (HIV, STIs, and unintended pregnancy) with promotion of health among women of reproductive age, their partners, and their children. The main goals of the USHIR Team are to conduct research that is interdisciplinary, multi-focused and relevant programmatically, domestically and internationally. Global activities of the team include:

  • The Breastfeeding, Antiretrovirals and Nutrition (BAN) Study recently completed enrollment in Malawi; analyses are ongoing. This study evaluated the safety and efficacy of maternal or infant antiretroviral prophylaxis and maternal nutritional supplementation during 6 months of breastfeeding in preventing infant HIV infection and maternal nutritional depletion among 2,360 HIV-infected women in Malawi.
  • The Accessing Counseling Message Effectiveness (ACME) Study in Jamaica is evaluating and comparing the effectiveness of patient counseling messages to promote avoidance of unprotected intercourse during the period of prescribed syndromic treatment for cervicitis or vaginal discharge, using biological markers of semen exposure. Recruitment began in July 2010.
  • The Tenofovir in Pregnancy (TIP) Study is preparing to start enrollment in Guangxi, China, and will evaluate the safety of a tenofovir-containing triple prophylactic regimen during pregnancy for HIV and HBV-co-infected pregnant women and their infants, with a view to future evaluation of its efficacy in reducing breakthrough HBV transmission to the infant.
  • Russia and Ukraine: The team has been engaged in several activities related to contraception, HIV/STD prevention and other issues among vulnerable populations, including:
    • Prospective Contraceptive Effectiveness and Safety Study among HIV-Infected Women;
    • WHO Strategic Components of Preventing Mother-to-Child HIV Transmission, has implemented numerous reproductive health projects in each of the four WHO strategic components of prevention of mother-to-child transmission of HIV (primary prevention of HIV infection in women of childbearing age, prevention of unintended pregnancy in HIV infected mothers; prevention of HIV transmission from mothers to infants; providing care for HIV infected mothers and their infants.
  • Modeling and Reinforcement to Combat HIV/AIDS (MARCH): CDC/DRH has worked with CDC colleagues and staff from partner organizations in Botswana, Ethiopia, Zambia, Guyana and Zimbabwe to adapt the strategy to local needs and plan for implementation. The Modeling and Reinforcement to Combat HIV/AIDS (MARCH) strategy includes two program components: role models in broadcast or print serial dramas and reinforcement activities at the community-level. CDC/DRH provides training and technical assistance and assists with program monitoring and outcome evaluations.

Key USG Agency and/or Multilateral Partners:

  • WHO and PAHO


The AHI is designed to support the Afghanistan Ministry of Public Health’s (MOPH) plans for improvements in public health and clinical practice. These improvements include developing an integrated health system, reducing maternal and newborn mortality, improving child health and reducing mortality for children under age 5, reducing malnutrition, and developing comprehensive health and safety programs for both patients and workers. Clinical practice improvement activities for AHI are located at Rabia Balkhia Hospital (RBH), a large tertiary care maternal hospital in Kabul, Afghanistan, one District Hospital, and two comprehensive health clinics in its catchment area. Current clinical practice activities at RBH include strengthening the OB/GYN residency training program, developing a faculty mentoring program to improve obstetrics training capacity, and implementing a fellowship program for advanced training in high-risk obstetrics. Public Health activities, pending anticipated funding, include expansion of the CARE OMID project, a community-based health education program for pregnant and lactating women and new mothers. AHI is working to establish Kabul-wide community and facility based surveillance systems to review all maternal and newborn deaths (≥2500 grams). AHI will also work with the Kabul Medical University and the Gulsfar Institute for Health Sciences to introduce basic principles of epidemiology, quality assurance/quality improvement, and public health informatics into the curriculum of these institutions.

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  • Page last reviewed: April 18, 2011
  • Page last updated: April 18, 2011
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