Medicine and Health Sciences Commons^™

Demand For And Access To Family Planning Services Among Young Married Women During Covid-19 Crisis, Unicef, Population Council Institute

Poverty, Gender, and Youth

In Bihar, India, as a result of the COVID-19 lockdown and men returning home in large numbers and spending more time at home in high stress conditions, the need for contraceptive services could get greater. March to May are considered the “lean season” when demand is typically low for family planning (FP) programs in states like Bihar. However, higher demand caused by the lockdown and lack of access to health facilities has created a gap between demand and uptake. This could have negative consequences such as high numbers of unintended pregnancies, unsafe abortions, and maternal mortality. Current use of modern …

Fertility Preferences And Behaviors Among Younger Cohorts In Egypt: Recent Trends, Correlates, And Prospects For Change, Nahla G. Abdel-Tawab, Shadia Attia, Nourhan Bader, Rania Roushdy, Shatha El-Nakib, Doaa Oraby

Reproductive Health

After years of steady decline, Egypt experienced an increase in the total fertility rate (TFR) from 3.0 births per woman in 2008 to 3.5 in 2014, which was coupled with an increase in desired family size among young people. To better understand this increase in fertility as well as prospects for change, the Evidence Project/Population Council conducted secondary analyses of quantitative data from the Egypt Demographic and Health Survey (EDHS) and the Survey of Young People in Egypt (SYPE) and collected qualitative data from young people and key informants. This report examines the changes in fertility preferences and behaviors among …

Policy Brief: Fertility Preferences And Behaviors Among Younger Cohorts In Egypt: Recent Trends, Correlates, And Prospects For Change [Arabic], Nahla G. Abdel-Tawab, Shadia Attia, Nourhan Bader, Rania Roushdy, Shatha El-Nakib, Doaa Oraby

Reproductive Health

After years of steady decline, Egypt experienced an increase in the total fertility rate (TFR) from 3.0 births per woman in 2008 to 3.5 in 2014, which was coupled with an increase in desired family size among young people. To better understand this increase in fertility as well as prospects for change, the Evidence Project/Population Council conducted secondary analyses of quantitative data from the Egypt Demographic and Health Survey (EDHS) and the Survey of Young People in Egypt (SYPE) and collected qualitative data from young people and key informants. This brief examines the changes in fertility preferences and behaviors among …

Implementation Process Brief: Integrated Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Charlotte E. Warren, Aparna Jain, Melsa Lutomia, Jane Loech, Elizabeth Washika

Reproductive Health

Enabling women living with HIV to use contraception effectively can decrease unintended pregnancies and in turn reduce maternal mortality and vertical transmission of HIV. This brief describes the implementation process and intervention tested under the Evidence Project for delivering integrated FP and HIV services at the community level in Kenya. It outlines the implementation steps, best practices, and lessons learned of an intervention that was tested within the existing community health structure. Community health volunteers were trained to offer FP as part of their routine services to women living with HIV, and community health units were prepared to sustain those …

Contraceptive Use Dynamics In India: A Prospective Cohort Study Of Modern Reversible Contraceptive Users, Arupendra Mozumdar, Elizabeth Tobey, Kumudha Aruldas, Rajib Acharya, Aparna Jain

Reproductive Health

This report highlights the contraceptive use dynamics among 2,699 married women in India who began using one of four reversible contraceptive methods over one year. Women aged 15-49 were enrolled into the study from Odisha and Haryana states within one month of starting their reversible method—interval intrauterine device (IUD), postpartum IUD (PPIUD), injectable contraceptive, or oral contraceptive pill (OCP)—and were interviewed at four time points: at enrollment into the study, and three, six, and 12 months after enrollment. Study findings include the quality of care received at the time of method adoption, experience and management of side effects, reasons for …

Les Pharmacies Privées Dans L’Offre De Services De Planification Familiale Au Sénégal : Une Étude Pilote, Fatou Mbow, Dela Nai, Sara Chace Dwyer, Aparna Jain, Babacar Mane

Reproductive Health

Sur la base de l'étude exploratoire menée par le Projet Evidence au Sénégal entre 2015 et 2016, avec un soutien financier supplémentaire de la Fondation William et Flora Hewlett, ce rapport technique documente les résultats d'une étude pilote sur l’offre des services de planification familiale (FP) par les pharmacies privées dans la région de Dakar. Le rapport détaille également les enseignements de valeur tirés de la mise en œuvre de l’étude dans le contexte du Sénégal. Ces résultats contribuent aux discussions politiques en cours au Sénégal concernant l'intégration des pharmacies privées dans la prestation des services de PF.

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Gender And Power Metrics Database, Population Council

Reproductive Health

This compendium of gender- and power-related scales used in social health and behavioral science research includes unique scales, many tested in multiple settings, that come primarily from the areas of sexual and reproductive health, family planning, STIs/HIV, and intimate partner violence. The database includes multi-item scales and single-item questions that reflect gender norms, personal views or beliefs about gender roles and norms, related feelings or emotions, gender role stress, gendered-dynamics, power and control in relationships, and individual-level agency and self-efficacy, among others. The database facilitates the identification of validated scales for use in a given population or setting, fosters exchange …

Enhancing Customer Satisfaction For Health Services, Deepa Rajamani, Saumya Ramarao

Reproductive Health

The Family Planning (FP) 2020 global partnership has achieved significant gains since its inception, and while it strives to accelerate uptake of voluntary FP services, women in developing countries continue to face an unmet need for modern contraceptive services. Critical opportunities for action exist in the area of understanding the effects of quality of family planning services and continued contraceptive use. Measuring and tracking the quality of FP services is an important aspect of improving service delivery, and client feedback also offers critical insight into the design of demand generation and uptake strategies for a contraceptive. In this report, we …

Positioning Family Planning Quality Within Health Financing For Uhc: Connecting The Discourse, Gabrielle Appleford, Saumya Ramarao, Benjamin Bellows, Leah Jarvis

Reproductive Health

Financing is a major challenge and concern for the future of the delivery of voluntary family planning (FP) services to clients, particularly in low- and middle-income countries with high unmet need and limited method choice. As countries commit to universal health coverage (UHC), it is crucial that UHC schemes include FP and other reproductive health (RH) services. Strategic purchasing of quality FP services from public and private—including for profit and not-for-profit—health-care providers could accelerate progress toward UHC. It is increasingly recognized that the FP2020 goals will not be met without adequate attention to quality, and that a sustained focus on …

Health Financing And Family Planning In The Context Of Universal Health Care: Connecting The Discourse, Gabrielle Appleford, Saumya Ramarao

Reproductive Health

Financing is a major challenge and concern for the future of family planning (FP) programs. As countries commit to increasing access to and quality of FP services and to universal health care (UHC), it is crucial that UHC schemes include FP and other reproductive health services. While the importance of financing is recognized in relation to quality, the “how” of financing FP within the context of UHC is not well understood. This brief targets the “bridge” constituency that is coalescing between the health financing and FP communities of practice around a shared interest in making access to health services universal. …

Proposed Metrics To Measure Quality: Overview, Anrudh K. Jain, John Townsend, Saumya Ramarao

Reproductive Health

The first quality-of-care framework in family planning was articulated over 25 years ago and a considerable amount of work has been done since then to measure quality in the context of routine service delivery, yet, we do not have agreed-upon indicators to measure quality that can be applied uniformly across different health systems and social contexts. This paper takes a slightly different approach and uses a common definition of quality from the outset. Indicators of quality are required for describing the nature of family planning services and quality of care offered by a health service delivery program, and for improving …

Reducing Early And Unintended Pregnancies Among Adolescents, Francis Obare, Caroline W. Kabiru, Venkatraman Chandra-Mouli

Reproductive Health

Interventions to reduce unmet need for contraception and early and unintended pregnancies among adolescents should be critical components of family planning programs in developing countries. This evidence brief highlights evidence and provides research and program considerations for improving access to family planning and reducing unintended pregnancy. It describes the following five elements that must be in place in order to apply evidence to large-scale, national-level programs: collect, analyze, and use accurate and up-to-date data; formulate or revise national laws and policies; develop national adolescent sexual and reproductive health strategies; implement strategies with careful monitoring; and conduct periodic program reviews.

Accelerating Uptake Of Voluntary, Rights-Based Family Planning In Developing Countries, Kazuyo Machiyama, Francis Obare, Venkatraman Chandra-Mouli, Doris Chou, Mario Festin, Rajat Khosla, James Kiarie, Lale Say, Nandita Thatte

Reproductive Health

This brief summarizes evidence on the benefits of family planning for girls and women, their children, families, and societies. It also provides evidence on the cost-effectiveness of family planning programs; discusses reasons for unmet need for contraception and identifies ways to reduce unmet need and discontinuation; and describes progress in meeting FP2020 and the Sustainable Development Goals (SDGs). To meet the FP2020 and SDGs, significant investments are required by countries and donors in the following priority areas: sustainable financing, reaching all adolescents, expanding availability of services to the poorest and hard-to-reach populations, improving the quality of services, increasing the range …

Using Evidence To Improve Quality Of Pharmacy-Delivered Medical Abortion, Katharine Footman, Nancy Termini Lachance

Reproductive Health

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the …

Ensuring Adequate Financing Of Family Planning Commodities And Services, Moazzam Ali, Benjamin Bellows

Reproductive Health

Increasing efficient and effective investment in family planning (FP) through the public and private sectors is key to meeting the FP2020 goal of helping 120 million additional women become modern contraceptive users. This policy brief identifies several policy and program considerations to ensure adequate financing of family planning commodities and services: sustained fundraising, pooling, and strategic purchasing; reaching new users and improving continuation rates among current users; and conducting further research on family planning quality performance metrics to test their correlation with higher continuation rates. Future efforts to reduce unmet need for FP must consider consumers’ out-of-pocket costs, programmatic cost-effectiveness, …

Expanding Access To Family Planning For Married Adolescent Girls In The Urban Slums Of Dhaka, Fauzia Akhter Huda, Nancy Termini Lachance

Reproductive Health

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of …

Expanding Contraceptive Choice, Heather Clark, Saumya Ramarao, Catherine Unthank, Kazuyo Machiyama, Nandita Thatte

Reproductive Health

Expanding the range of contraceptive options helps individuals to make choices appropriate to their needs and circumstances, allows them to switch from one method to another if desired, and reflects a program focus on quality and rights. This policy brief outlines policy and program considerations in order to establish and maintain well-functioning supply chains for an expanded choice of contraceptives: introducing new contraceptive technologies to satisfy the diverse preferences of women and their partners; overcoming access barriers to existing methods such as adverse economic and social circumstances, including gender norms; and maximizing the potential of expanded contraceptive choice by ensuring …

Are Services Meeting The Holistic Family Planning Needs Of Female Sex Workers Living With Hiv In Tanzania?, Project Soar

HIV and AIDS

Women of reproductive age living with HIV need access to comprehensive, voluntary family planning (FP) services to support their decisions about whether and when to have children. Contraceptive need is particularly acute among HIV-positive female sex workers who are often socially and economically disadvantaged. Furthermore, many HIV-positive female sex workers intend to have children some day, but may not be aware of strategies to minimize the risk of HIV transmission to infants and partners (i.e., “safer conception”). This activity brief describes a Project SOAR study in Tanzania that will contribute to the evidence base by conducting research that describes these …

How Are Educated Women In Ghana Regulating Fertility Without High Levels Of Modern Contraceptive Use?, Kazuyo Machiyama, Cicely Marston, Nancy Termini Lachance, Terence Adda-Balinia, Placide Tapsoba

Reproductive Health

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this …

Strengthening The Integration Of Family Planning And Hiv Services At The Community Level In Kenya, Wilson Liambila, Sara Chace Dwyer, Brian Mdawida, Charlotte E. Warren, Melsa Lutomia, Jane Koech, Elizabeth Washika, Aparna Jain

Reproductive Health

Study findings reveal that many Kenyan women living with HIV are comfortable receiving family planning (FP) services from community health volunteers and with proper training and support, community health volunteers have the potential to provide integrated FP/HIV services. Community-based integrated FP/HIV services could help connect women living with HIV who want to prevent or postpone a pregnancy to contraceptive services, which can reduce unintended pregnancies and in turn maternal mortality and vertical transmission of HIV. This implementation research study offers evidence of the feasibility, quality of care, and acceptability of using community health volunteers to integrate family planning into HIV/AIDS …

Changes In Household Well Being And Resilience: The Role Of Population, Family Planning And Reproductive Health In The Tuungane Project, Kristen P. Patterson

Reproductive Health

Both the family planning sector and the environmental sector will be interested in this synopsis of findings from a study of the first four years of the Tuungane integrated population, health, and environment (PHE) project in Tanzania. The objectives of the Tuungane Project are to achieve healthier families, healthier forests, and healthier fisheries, using an integrated, cross-sectoral approach. Analyses of the 2011 baseline and 2016 midline quantitative data, and additional qualitative data from 2016, measured the project’s progress and shed light on the contribution of the project interventions to building resilience, and on the links between family planning and other …

L’Expérience De Femmes Ayant Subi Une Grossesse Non Désirée Au Sénégal : Une Étude Qualitative, Fatou Mbow, Nafissatou Diop

Reproductive Health

Au Sénégal, l’avortement n’est autorisé que lorsque la vie de la mère est menacée. Depuis 2013, le Comité de plaidoyer pour l’accès à l’avortement médicalisé au Sénégal (plus connu sous le nom de « Taskforce ») mène des activités de plaidoyer pour une révision de la loi. L’avortement est maintenant plus ouvertement discuté, mais la voix des femmes victimes de grossesse non désirée n’est pas entendue. Cette étude documente l’expérience de ces femmes pour fournir des évidences pour le plaidoyer. L’autorisation de l'avortement médicalisée contribuera à respecter les droits humains et de santé des femmes, ainsi qu’à réduire les conséquences …

Advocating Corporate Policy Change On Women's Health And Family Planning: Lessons From The Environmental Movement, Matthew Mcfall, Carolyn Rodehau, David Wofford

Reproductive Health

This brief presents key lessons from the environmental movement on effective strategies for driving changes in corporate policies and practices and creating new mechanisms for holding businesses accountable for environmental impacts. Corporate policies and voluntary and “soft law” standards may be unfamiliar to many women’s health advocates, but they are likely to have increasing importance in the years to come. The global health community can learn from the experience of environmentalists on how to engage businesses on Corporate Social Responsibility (CSR) standards and corporate practices around women’s health. The brief offers six recommendations for moving forward.

Assessment Of The Implementation And The Achievements Of The 3d Approach Within Senegal’S National Family Planning Action Plan (Nfpap), Fatou Mbow, Nafissatou Diop

Reproductive Health

Senegal’s 2012–2015 National Family Planning Action Plan (NFPAP) is based on the 3D approach (Democratization, Demedicalization, and Decentralization). As the plan came to an end and a new one was being developed, the Evidence Project/Population Council conducted a study to document the implementation and achievements of the 3D approach in relation to the NFPAP. This brief offers highlights of the study which used a desk review and qualitative research. It describes lessons learned from the implementation of the approach, and shares good practices that can be adopted by other countries, particularly those of the Ouagadougou Partnership. Finally, the study provides …

Assessment Of The Implementation And Achievements Of The 3d Approach In Senegal’S National Family Planning Action Plan—Part 2: Summary Report, Fatou Mbow, Leslie Dubent, Nafissatou Diop, Fatou Ndiaye Turpin, Bocar Mamadou Daff, Babacar Mane

Reproductive Health

Senegal’s 2012–15 National Family Planning Action Plan (NFPAP) is based on the 3D approach (Democratization, Demedicalization, and Decentralization). As the plan came to an end and a new one was being developed, the Evidence Project/Population Council conducted a study to document the implementation and achievements of the 3D approach in relation to the NFPAP. The study documents the approach using a desk review and qualitative research. It describes lessons learned from the implementation of the approach, and shares good practices that can be adopted by other countries, particularly those of the Ouagadougou Partnership. Finally, the study provides evidence for decisionmaking, …

Ensuring Contraceptive Security Through Effective Supply Chains, Moazzam Ali

Reproductive Health

Establishing and maintaining well-functioning supply chains that meet the needs of public and private sectors, as well as health professionals at all levels in family planning programs, will play a critical role in reducing unmet need for modern contraception in low and middle income countries. This evidence brief identifies two evidence-based solutions to address the challenges faced by these countries: increasing the visibility of product flows and user demand, and leveraging the expertise of the private and public sector to ensure a total market approach to supply-chain management. Strengthening the capacity of public and private-sector family planning providers and managers …

Women's Perceptions And Experiences Of Family Planning By Contraceptive Methods In Kenya And Bangladesh: Preliminary Results, Kazuyo Machiyama, Joyce Mumah, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John C. Cleland, John B. Casterline

Reproductive Health

No abstract provided.

Bangladesh: Using Strong Evidence And Strategic Collaboration To Increase Access To Menstrual Regulation With Medication, Nancy Termini Lachance, Sharif M.I. Hossain

Reproductive Health

Through close cooperation with the Ministry of Health and Family Welfare of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and program expansions to increase access to menstrual regulation with medication (MRM). Study results demonstrate that MRM is acceptable and effective in Bangladesh, and has thus been legalized and folded into the national FP program and scaled up nationwide. However, ongoing observation and studies are still needed to understand whether the efficacy and acceptability of MRM remains the case when services are delivered at scale on a national level. Furthermore, …

Expanding Access To Integrated Family Planning Intervention Packages For Married Adolescent Girls In Urban Slums Of Dhaka, Bangladesh, Fauzia Akhter Huda, Hassan Rushekh Mahmood, Sadia Afrin, Anisuddin Ahmed, Nafis Al Haque, Bidhan Krishna Sarker

Reproductive Health

This research report describes an intervention study conducted among married adolescent girls aged 15–19 years in four urban slums of Dhaka, Bangladesh. Objectives of the study were to examine the acceptability and feasibility of forming married adolescent girls’ clubs, and involving community health volunteers (Shasthya Skebikas) and marriage registrars to increase access to family planning (FP) information and services, to promote the uptake of long-acting reversible contraceptive methods, and to provide FP information to newlywed couples at the time of marriage registration. The study findings revealed that a noteworthy number of married adolescent girls received FP-related information, mostly from the …

Strengthening School-Based Sexual And Reproductive Health Education And Services In Accra, Ghana, Nancy Termini Lachance, Terence Adda-Balinia

Reproductive Health

This evidence brief presents results of a study aimed to assess the acceptability and feasibility of two proposed solutions for strengthening the content and delivery of in-school sexual and reproductive health (SRH) programs in Ghana. The study was conducted in Nima, a suburb of Accra, where stakeholders agreed there was a need for enhanced SRH services in school. The study explored providing comprehensive in-school SRH education to adolescents using trained psychologists and health workers to deliver and explain comprehensive sexuality education to adolescents and link them as needed to outside services. There was unanimous agreement that adolescent SRH needs are …