Medicine and Health Sciences Commons^™

Pattern And Determinants Of Contraceptive Use Among The Muslim Women In Wajir And Lamu Counties In Kenya: A Cross-Sectional Study., Batula Abdi, Jerry Okal, Gamal Serour, Vincent Were, Marleen Temmerman, Peter Gichangi

Centre of Excellence in Women and Child Health

Background; Improving access to family planning (FP) is associated with positive health benefits that includes averting nearly a third of all maternal deaths and 10% of childhood deaths. Kenya has made great strides in improving access to family planning services. However, amid this considerable progress, regional variation has been noted which begs the need for a clearer understanding of the the patterns and determinants that drive these inconsistencies.

Methods; We conducted a cross-sectional study that involved 663 Muslim women of reproductive age (15–49 years) from Wajir and Lamu counties in Kenya between March and October 2018.The objective of this study …

“We Have To Improve Our Culture About This”: Family Planning Decision-Making Among Women And Men Living In Florence, Italy, Alyssa Amidei, Taylor Raff, Andrea L. Demaria

Health Behavior Research

The male condom is the most widely used family planning method in Italy and Southern Europe. Most family planning research is focused on women and, therefore, could be missing significant gender differences in behavior, as male partners play a critical role in decision-making and pregnancy prevention. This study aimed to explore attitudes toward contraceptive methods, including decision-making and desired improvements related to family planning in Italy. Semi- structured interviews with 42 men and women aged 18–50 years (29.1±7.9) living in or near Florence, Italy, were conducted between May and June 2019. Techniques from thematic analysis allowed for a constant comparative …

The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber

The Review: A Journal of Undergraduate Student Research

The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …

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 …

Evaluating Providers’ Perceptions On Preconception Care For Women With Sud, Corinna Hughes

DNP Projects

Background: Substance use disorders (SUDs) has become an epidemic. Women of reproductive age with SUDs have particularly complex healthcare needs including an increased risk of having an unintended pregnancy and associated sequela of negative birth outcomes (NBO). Little is known about how medication assisted treatment (MAT) providers are adequately addressing their unique needs. Identifying provider barriers and tools to address the reproductive needs of women with SUDs can optimize their health outcomes and prevent NBOs.

Purpose: The purpose of this study was to evaluate MAT Nurse Practitioners’ (NPs) knowledge and perceptions of providing preconception care to women with …

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 …

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 …

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 …

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 …

Family Planning Dynamics In Zimbabwe, Heidi Weidele

Senior Honors Projects

Almost 90 percent of all women in Zimbabwe lack health insurance. Most are undereducated or underemployed, and only have access to maternal and contraceptive care via public clinics. There is a large gap in family planning services in both rural and urban areas, which leads to a lack of necessary care in many communities. Bivariate and multivariate analyses on demographic data (Zimbabwe Demographic and Health Survey 2015) collected by the Zimbabwe National Statistics Agency and compiled by the United States Demographic and Health Surveys Program were performed to determine the relationships among public health services and female demographics (including education, …

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.

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 …

Introduction And Approval Of Menstrual Regulation With Medication In Bangladesh: A Stakeholder Analysis, Fauzia Akhter Huda, Sadia Afrin, Bidhan Krishna Sarker, Hassan Rushekh Mahmood, Anadil Alam

Reproductive Health

Despite the significant progress that the government of Bangladesh has made toward introducing menstrual regulation with medication (MRM) into the national health program, there has been no systematic documentation on the introduction of MRM in Bangladesh, and on the approval process of local manufacturing of the mifepristone-misoprostol combination for menstrual regulation. This Research Report presents findings from the stakeholder analysis which was initiated to document the entire process of introducing MRM in the country. Findings from key informant interviews indicated some crucial factors that facilitated the process; these are presented here according to a four-part policy analysis framework: context, content, …

Reasons For Unmet Need For Family Planning, With Attention To The Measurement Of Fertility Preferences In Kenya And Bangladesh, Joyce Mumah, Kazuyo Machiyama, Caroline W. Kabiru, George Odwe, Francis Obare, Fauzia Akhter Huda, John B. Casterline, John C. Cleland

Reproductive Health

No abstract provided.

Improving Family Planning Service Delivery In Humanitarian Crises, Chi-Chi Undie, Rajat Khosla, Karl Blanchet

Reproductive Health

Meeting family planning (FP) needs in humanitarian emergencies is challenging but feasible, and could present opportunities for reaching marginalized, remote, or otherwise underserved populations. Although high-quality evidence on family planning in emergencies is needed to improve access to voluntary FP services in humanitarian settings, this evidence brief identifies several promising, evidence-based interventions that can help improve uptake: provide comprehensive SRH services in line with global norms, provide a full range of family planning methods via mobile clinics, train mobile health workers to provide short-acting methods, second refugee providers to health facilities to provide FP in humanitarian settings, train community health …

Evaluation Of The Herhealth Intervention In Bangladesh: Baseline Findings From An Implementation Research Study, Md. Irfan Hossain, Abdullah Al Mahmud Shohag, Ashish Bajracharya, Ubaidur Rob, Laura Reichenbach

Reproductive Health

The Business for Social Responsibility's (BSR) HERproject is a collaborative initiative that strives to empower low-income women working in global supply chains in 14 countries worldwide. One of the HERproject’s three pillars is HERhealth, which seeks to improve the health-related knowledge and behaviors, and access to health services and products, of low-income working women. In Bangladesh, HERhealth specifically addresses reproductive health and family planning needs. BSR asked the Evidence Project/Population Council to conduct an implementation science study assessing the effectiveness of BSR’s HERhealth model in Bangladesh. This study is one of the first studies of female garment workers in Dhaka …

Increasing Access To Reproductive Health Care Through Improved Service Delivery, Gul Rashida, Iram Kamran, Muhammad Khalil, Zeba Tasneem, Rehan M. Niazi, Mumraiz Khan, Tahira Parveen

Reproductive Health

The study documented in this report examines the provision and utilization of public and private sector maternal and child health services in Punjab, Pakistan with a focus on family planning (FP) services. It is aimed at enabling a better understanding of the specific demand and supply dynamics leading to low contraceptive prevalence despite unmet need, and the opportunities that must be seized to enhance access to quality family planning services. The report is part of a larger project being implemented by the Population Council with the assistance of the Department for International Development, UK entitled “Sustaining Focus on Provincial Governments …

Adolescent Friendly Health Corners (Afhcs) In Selected Government Health Facilities In Bangladesh: An Early Qualitative Assessment, Sigma Ainul, Iqbal Ehsan, Tasmiah Tanjeen, Laura Reichenbach

Reproductive Health

With high rates of early marriage, especially among girls, a significant proportion of adolescents in Bangladesh need sexual and reproductive health services (SRH), including contraceptive information. To address this gap and ensure that adolescents throughout the country, including unmarried adolescents, have access to SRH services through public health facilities, the Maternal and Child Health Services Unit of the Directorate General of Family Planning, with financial and technical assistance from development partners, has begun establishing Adolescent Friendly Health Corners (AFHCs) at selected government facilities at district and union levels. The Evidence Project/Population Council was asked to assess the implementation of the …

Indicators For Measurement And Improvement Of The Quality Of Family Planning Programs: The Philippines, 1997–1998, Population Council

Reproductive Health

Quality is a critical dimension of health service provision and this brief aims to highlight the creation and use of indicators for quality of care to enhance the achievement of the reproductive health goals in the Philippines and beyond. In response to the need for program managers to understand the quality of services at the field level, the Situation Analysis approach was developed. The research underscores the importance of a composite index when measuring quality. In the case of the Philippines, the evidence suggests the need for more quality-of-care monitoring in addition to expanded access to contraceptives. Investment in counseling …