Family, Life Course, and Society Commons^™

Introduction Of Dmpa In Public Health Facilities Of Uttar Pradesh And Rajasthan: An Evaluation, M.E. Khan, Anvita Dixit, Jaleel Ahmad, G. Pillai

Reproductive Health

India is committed to achieving the goals of FP2020, which, besides substantially increasing new contraceptive users, also demands adopting a rights-based approach and ensuring easy access, choice, and good quality services. The contraceptive method mix in India has been dominated by female sterilization for a long time. No new contraceptive method has been added to the national family welfare program for decades. Use of injectable contraceptives was approved in 1994 in the private sector, but is still not part of the national program. Recently some initiatives have been taken to make Depo Medroxyprogesterone Acetate (DMPA) available through the public sector …

Investigating The Low Patterns Of Modern Contraceptive Use In Pakistan, Iram Kamran, Zeba Tasneem, Tahira Parveen, Yasmin Zehra Zaidi

Reproductive Health

This report documents the study “Investigating the Low Patterns of Modern Contraceptive Use in Pakistan” conducted by the Population Council Pakistan in 2014 as part of an extensive research project to determine why use of modern contraceptives in the country remains so low despite large unmet need. The family planning (FP) scenario in Pakistan has changed significantly in recent years, and it is now recognized that the reasons most often cited for unmet need require reappraisal, with qualitative research required for a deeper understanding of the attributes, experiences, reservations, and preferences that women, men, and service providers associate with specific …

Delivering Contraceptive Vaginal Rings—Task Sharing Policies And Practices In The Delivery Of Family Planning Services: Experiences From Nigeria, Godwin Unumeri, Salisu Mohammed Ishaku

Reproductive Health

Despite tremendous progress over the past decades in family planning and fertility reduction, more than 220 million women have unmet need for contraception globally. The government of Nigeria pledged over $11 million to procure contraceptive commodities for distribution in the public sector from 2011–2015, to increase the contraceptive prevalence rate (CPR) that had stalled at 10 percent for almost two decades. The Population Council is facilitating the registration, introduction, and scale-up of the Progesterone Contraceptive Vaginal Ring (PCVR), designed particularly for breastfeeding women, in the sub-Saharan African countries of Kenya, Nigeria, and Senegal. In Nigeria, restrictive policies regarding matching health …

L’Offre Des Anneux Vaginaux Contraceptifs— La Planification Familiale Postpartum: Experience Du Sénégal, Fatou Mbow, Babacar Mane, Saumya Ramarao

Reproductive Health

Le Gouvernement du Sénégal, à travers l’adoption du Plan National d’Action pour la Planification Familiale, s’est résolument engagé dans une politique de repositionnement de la planification familiale (PF) qui s’est fixé comme objectif d’augmenter le taux de prévalence contraceptive. L’introduction de l’anneau vaginal à progestérone (AVP) dans la gamme des méthodes contraceptives devra apporter une perspective intéressante pour la promotion de la planification familiale post-partum (PFPP). Pour faciliter cette introduction, il demeure important de bien comprendre le contexte dans lequel évolue le programme national de PF en général et celui de la PFPP en particulier. Grâce à un financement de …

Standard Days Method Of Contraception: Evidence On Use, Implementation, And Scale Up, Kelsey Wright, Hiba Iqteit, Karen Hardee

Reproductive Health

In 2002, an article in Contraception reported on a trial for a new method of contraception, the Standard Days Method (SDM). SDM is a fertility awareness-based family planning (FP) method that identifies the eighth through nineteenth days of a woman’s menstrual cycle as the fertile window. SDM users abstain or use barrier methods during their fertile periods to prevent pregnancy. The trial established a first-year method failure rate of 5 per 100 woman years with correct use, and 12 per 100 women for typical use. Over the decade since the publication of the original efficacy trial, the Georgetown University Institute …

Progesterone Vaginal Ring: Results Of A Three-Country Acceptability Study, Saumya Ramarao, Heather Clark, Deepa Rajamani, Salisu Mohammed Ishaku, Babacar Mane, Francis Obare, Harriet Birungi, Nafissatou Diop, Wilson Liambila, Fatou Mbow, Chi-Chi Undie, Godwin Unumeri, John Townsend

Reproductive Health

Global and national policies have refocused attention on postpartum family planning as an important component of ensuring healthy outcomes for women and babies. The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. Clinical trials have proven the PVR to be safe and effective; it is currently registered in eight Latin American countries. There is a need to assess acceptability prior to introduction into country programs, and the Population Council conducted PVR acceptability studies in Kenya, Nigeria, and Senegal. This report represents the results from a pooled analysis of data from the …

Progesterone Vaginal Ring: Results Of An Acceptability Study In Nigeria, Salisu Mohammed Ishaku, Afolabi Kayode, Godwin Unumeri, Ayodeji Oginni, Adekunle Adeyemi, Deepa Rajamani, Heather Clark, Naomi Rijo, Saumya Ramarao

Reproductive Health

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. The PVR was first registered in Chile and Peru in 1998 for use by postpartum women and has since been expanded to other Latin American countries. Previous studies have shown that contraceptive vaginal rings are safe, effective, and well accepted in varied cultural settings. However, the extent to which the ring is acceptable in the sub-Saharan African context is unknown. This study examined the acceptability of the PVR in Nigeria as part of a larger project that was also conducted in Kenya …

Anneau Vaginal À Progestérone: Aussi Sûr Pour Maman Que Pour Bébé, Population Council

Reproductive Health

Cette fiche d'information fournit des informations de base sur l'innocuité et l'efficacité de l'anneau contraceptif vaginal à la progestérone (AVP). Son effet contraceptif fonctionne en renforçant les effets inhibiteurs de l'allaitement maternel sur l'ovulation, et en étendant l'aménorrhée post-partum. L'AVP est un contraceptif sûr et efficace pour les mamans, leurs bébés et leurs partenaires sexuels. Cette méthode étend largement le gamme de contraceptifs à la disposition des femmes qui allaitent.

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This fact sheet provides basic information on the safety and effectiveness of the progesterone vaginal contraceptive ring. It works as a contraceptive by reinforcing the inhibitory effect of breastfeeding …

Progesterone Vaginal Ring: Beneficial Role In Birth Spacing, Population Council

Reproductive Health

As a result of growing urbanization and changing social norms concerning the role of women in developing countries, the duration of exclusive breastfeeding and its impact as a contraceptive strategy has been reduced. This has given rise to the need for a contraceptive method that can extend the infertile period following delivery, especially in countries where access to other contraceptives is limited and where longer duration of breastfeeding is a social norm and a major benefit to infant health. This project brief provides information on the progesterone vaginal ring (PVR), which can enhance the effect of breastfeeding on birth spacing. …

Reasons For Low Modern Contraceptive Use—Insights From Pakistan And Neighboring Countries, Batool Zaidi, Sabahat Hussain

Reproductive Health

This literature review forms part of an extensive research project to determine why, despite evident demand, contraceptive prevalence remains so low in Pakistan, especially for modern methods. The research has been conducted by the Population Council with the support of the Research and Advocacy Fund (RAF) and comprises four component studies: review of relevant academic, program, and policy literature; qualitative study of perspectives of men, women, and service providers in the country on family planning; situation analysis of contraceptive quality, supply, and access factors at health facilities; and examination of supply-chain issues affecting the availability of contraceptives. This review presents …

Strengthening The Role Of Patent Medicine Vendors In The Provision Of Injectable Contraception In Nigeria, Population Council, The Evidence Project

Reproductive Health

The majority of contraceptive services in Nigeria are offered in private settings, including Patent Medicine (PM) shops. PM shops are informal businesses owned by Patent Medicine Vendors (PMVs) licensed to sell patent or proprietary drugs. Injectable contraception is the most popular modern contraceptive method in Nigeria. However PMVs are not regulated to sell or administer injectable contraceptives because the businesses do not receive formal training. Despite this, some PMVs are selling and administering injectable methods in response to high demand. The Evidence Project, in collaboration with the Federal Ministry of Health, conducted implementation research to: demonstrate the feasibility of PMVs …

Utilizing Social Marketing And Social Franchising Models To Expand Access To The Progesterone Contraceptive Vaginal Ring, Ishita Chattopadhyay, John Townsend, Saumya Ramarao

Reproductive Health

The Population Council’s Progesterone Contraceptive Vaginal Ring (PCVR) is an effective, user-initiated contraceptive option that helps meet the need for postpartum family planning (PPFP). It is exclusively designed for postpartum breastfeeding women who want to space or delay pregnancies the first year following childbirth. This technical report describes a social marketing and social franchising model that will be adopted for the introduction and scale-up of the PCVR. A methodology for implementation of this model, also referred to as the PCVR–Social Marketing and Social Franchising (PCVR-SM/SF) Model, has been designed to introduce the PCVR in the context of choice among other …

Unintended Pregnancies In Kenya: A Country Profile, Joyce Mumah, Caroline W. Kabiru, Carol Mukiira, Jessica Brinton, Michael Mutua, Chimaraoke O. Izugbara, Harriet Birungi, Ian Askew

Reproductive Health

This research report presents a country profile of Kenya, and looks at differential access to and quality of family planning (FP) and abortion/post-abortion services to assess their current situation, as well the various financing and delivery mechanisms for these crucial services. Since 2000, Kenya has passed several new sexual and reproductive health (SRH) and population-related policies, including a new population and development policy that addresses rapid population growth. Results of this country profile highlight the need for further research on: 1) innovative ways through which SRH information can be brought to schools; 2) FP/SRH indicators in people living with disabilities; …

Reduce Contraception Discontinuation In Bangladesh By Improving Counseling On Side Effects, Fauzia Akhter Huda, Sabiha Chowdhuri

Reproductive Health

High rates of contraceptive discontinuation and method failure could cause Bangladesh to lose the progress made in increasing contraceptive use over the past 20 years. This policy brief concludes that if women are adequately counseled and supported to sustain their use of more effective contraceptive methods, they will need less medical attention, have fewer unintended pregnancies, and reduce the workload for medical clinics. Furthermore, if providers are adequately trained and supported in counseling and managing side effects and in helping women to switch methods when they do have a problem, the Family Planning Clinical Contraception Services Delivery Program would meet …

Measuring The Impact Of Contraceptive Use On Unintended Pregnancy And Other Health Outcomes, Step Up Research Programme Consortium

Reproductive Health

This brief describes several statistical models that have been developed to estimate the number of health outcomes that will be averted because of contraceptive use. Concerns have been expressed that this range of approaches—which overlap in the impacts they estimate, but sometimes use different inputs, mathematical algorithms, and assumptions, and may produce different results—may be confusing for policymakers, managers, and donors who want to measure or evaluate these impacts. To address these concerns, the STEP UP consortium convened two expert meetings to review the estimation methods used; come to consensus on methodologies and assumptions, where possible; and provide guidance to …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape: A Review Of Policies, Programmes And Country Experiences In Sub-Saharan Africa, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

This study examined how pregnancy prevention and management services (specifically, the provision of emergency contraception, pregnancy testing and counseling, and termination or referral for termination of pregnancy services) feature within post-rape care services in sub-Saharan Africa. The study drew on a range of sources via a desk review, as well as on information provided through key informant interviews. The existence of numerous national guidelines in the region demonstrates countries’ desire to respond to this public health and legal challenge. However, if left in their current state, the gaps and inconsistencies observed across most national guidelines contribute to a violation of …

Analyse Des Besoins Non Satisfaits Au Sénégal, Kazuyo Machiyama, John C. Cleland

Reproductive Health

Cette étude vise à établir l’importance relative d’un manque d’accès et d’attitudes de résistance envers l’utilisation de la contraception dans les strates géographiques et de population du Sénégal. Elle est destinée à informer les décideurs politiques sur la priorité à accorder à la communication pour le changement de comportement ou pour l’amélioration de l’accès/de l’information, et également à aider lors de la conception d’interventions pour réduire les inquiétudes par rapport à la santé et la peur des effets secondaires, tels que la provision d’une gamme de méthodes plus élargie et le counseling amélioré. Plus de la moitié des femmes ayant …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In India: Final Survey Report, M.E. Khan, Deepthi S. Varma, Isha Bhatnagar, Anvita Dixit, Martha Brady

Reproductive Health

The Population Council undertook this study to assess the knowledge, attitudes, and practices regarding emergency contraception (ECPs) among providers in public and private facilities and pharmacies in India. This study’s objectives were: 1) to assess providers’ knowledge of ECP’s biological mechanism; 2) to understand providers’ knowledge and attitudes about ECP’s safety, effectiveness, and availability as an over-the-counter drug; and 3) to identify providers’ definitions of “repeated use” and profiling of women who are “repeated users” of ECP. The study recommends intervention programs and advocacy strategies to increase knowledge and access to ECP.

Le Consensus De Bellagio : Recommandations Pour Améliorer L'Accès Aux Méthodes De Contraception Efficaces, Réversibles À Longue Durée D'Action, Population Council

Reproductive Health

Ce communiqué et cette déclaration proposent des recommandations pour améliorer l'accès aux méthodes de contraception efficaces, réversibles à longue durée d'action (LARC) et accélérer les progrès vers la réalisation de l'Objectif du Millénaire pour le développement relatif à l'accès universel aux services de santé reproductive.

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This brief and statement offers recommendations for action to increase access to highly effective, long-acting, reversible contraception (LARCs) and accelerate progress toward meeting the Millennium Development Goal of universal access to reproductive health services.

Country Mapping: Kenya, Francis Obare, Wilson Liambila, Harriet Birungi, Eseoise Itombra, Heather Clark, Saumya Ramarao

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and to develop a strategic plan for its introduction. This technical report presents the findings of the assessments in Kenya with specific focus on: (1) the country’s demographic profile; (2) the health systems, health policy, and family planning program context; and (3) stakeholder perspectives regarding the PVR. The findings suggest that the introduction of the PVR would fill a gap in the family planning needs of breastfeeding women in Kenya, and there is strong support from stakeholders …

Country Mapping: Senegal, Babacar Mane, Nafissatou Diop, Nancy Termini Lachance, Saumya Ramarao, Heather Clark

Reproductive Health

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and its potential introduction. This technical report presents results from assessments undertaken to map the existing landscape of family planning programs and new contraceptive technologies in Senegal in an effort to identify national priorities and assess the level of interest in the PVR among stakeholders and to design appropriate preintroductory activities. This country mapping exercise confirms that Senegal is a promising context for the introduction of the PVR: the government is committed to repositioning family planning and …

Country Mapping: Nigeria, Salisu Mohammed Ishaku, Saumya Ramarao

Reproductive Health

The Population Council conducted a three-year acceptability study of the progesterone vaginal ring (PVR) in three sub-Saharan African countries. This technical report presents results from Nigeria, laying out the country’s demographics and high fertility rates; describing the family planning program and policy context; and, finally, revealing the stakeholder support thus far with a discussion on how best to proceed with introduction activities. This country mapping confirms the likelihood that the PVR would be well received in Nigeria and fill a large need in family planning. The PVR is a safe, long-acting, user-controlled product that can be easily inserted and removed …

Injectable Contraceptives: Perspectives And Experiences Of Women And Health Care Providers In India, Shireen J. Jejeebhoy, A.J. Francis Zavier

Poverty, Gender, and Youth

This report is the result of a study that aimed to shed light on the feasibility and acceptability of making injectable contraceptives more widely available to women in India. The study focused on injectable contraceptive users, new method adopters, and healthcare providers drawn from the facilities of a range of reproductive health. Healthcare providers were, for the most part, in favor of offering injectable contraceptives, however, they argued strongly for certain prerequisites, such as comprehensive and sensitive counseling and effective follow-up. Findings further suggest that there is a demand for injectable contraceptives among women, and that both women and healthcare …

Levels, Trends And Determinants Of Contraceptive Use Among Adolescent Girls In Kenya, Francis Obare, Harriet Birungi, Chi-Chi Undie, Monica Wanjiru, Wilson Liambila, Ian Askew

Reproductive Health

In Kenya, recent trends in contraceptive use among currently married women aged 15–49 years show that after experiencing a stall between 1998 and 2003, the contraceptive prevalence rate (CPR) increased between 2003 and 2008–2009. Although the increase in CPR after 2003 is encouraging, there is limited understanding of how these changes affected adolescents, especially girls, given the unique sexual and reproductive health challenges that they face. This report is based on a secondary analysis of the Kenya Demographic and Health Surveys (KDHS) data to understand the trends, differentials, and determinants of contraceptive use among adolescent girls aged 15–19 years in …

Day Of Dialogue: Sharing Insights And Evidence On The Female Condom In Ghana, Population Council

Poverty, Gender, and Youth

This report details a female condom meeting hosted by the Population Council in Ghana on November 24, 2008. Twenty-eight participants representing 17 organizations were in attendance. Meeting presentations included: Female Condom for Programs: Historical Overview; Considerations for Female Condom Strategic Planning; FC-2 Female Condoms; The Female Condom in Ghana: Current State of Affairs; Strategic Planning for FC: What Makes Success? A question-and-answer session was included, as was an analysis exercise, in which participants discussed and outlined the strengths, weaknesses, opportunities, and threats that should be considered as we move forward with the development of a strategic plan to promote the …

Female-Initiated Prevention: Integrating Female Condoms Into Hiv Risk-Reduction Activities In Kenya, Population Council, Liverpool Vct Care & Treatment

Poverty, Gender, and Youth

The Female Condom (FC) is the only female-initiated prevention product on the market today that provides simultaneous protection against STIs, including HIV, and unintended pregnancy. However, the FC remains limited in supply, not widely available, and underutilized in many settings. Improvements in FC programming are essential to achieve increased uptake and public health impact, and to pave the way for future women’s HIV prevention products. The Population Council’s Female-Initiated Prevention Methods project aimed to stimulate action and generate evidence around FC access through innovative program experimentation. The study was conducted to understand the challenges and opportunities these different access models …

The Female Condom In Ghana: Exploring The Current State Of Affairs And Gauging Potential For Enhanced Promotion, Reshma Naik, Martha Brady

Poverty, Gender, and Youth

The female condom (FC) is the only safe and effective female-initiated method that provides simultaneous protection against unintended pregnancy as well as sexually transmitted infections, including HIV. An exploratory exercise was conducted by the Population Council to gain an understanding of the current and historical landscape of FC procurement, distribution, and programming in Ghana and to explore the viability of enhancing national FC promotion. The exercise revealed that a large-scale launch of the FC occurred in Ghana in 2000 and was largely successful in raising product awareness; however, uptake remained low. Momentum has waned since the initial launch and financial …

Female-Initiated Prevention Methods (Fipm) In Kenya: Focus On The Female Condom, Martha Brady

Poverty, Gender, and Youth

As noted in this brief, the female condom (FC) is the only female-initiated prevention product that provides simultaneous protection against pregnancy and sexually transmitted infections, including HIV. Although available for more than a decade, the FC remains limited in supply, not readily available, and underutilized. Obstacles to widespread availability and use are often generalized (e.g., high costs, resistance of partners, or unavailability). With the upcoming second generation of FCs—and ultimately microbicides—being added to female-initiated prevention methods, the need to overcome these impediments with concrete solutions is critical. Government and donor commitment to long-term, sustained supply and program support is essential. …

Exploring The Choices Of Contraception And Abortion Among Married Couples In Tret, Rural Punjab, Pakistan, Muhammad Shafique Arif, Iram Kamran

Reproductive Health

In Pakistan, the contraceptive prevalence rate is 28 percent, unmet need for family planning services is 33 percent, and unwanted pregnancies are on the rise. A national study showed a fairly high induced abortion rate of 29 per 1,000 married women of reproductive age, and 1 out of 6 pregnancies resulted in induced abortion. This study explored how contraception and induced abortion are perceived as options for avoiding unwanted births by Pakistani men and women, to what extent they deliberately choose one over the other, and the language they use to talk about reproductive behavior decision-making. As noted in this …

In Our Own Hands: Swaa-Ghana Champions The Female Condom, Kathleen Cravero, Michelle Skaer, Victoria Ebin, Martha Brady

Poverty, Gender, and Youth

This issue of Quality/Calidad/Qualité describes the vital role played by the Ghana branch of the Society for Women and AIDS in Africa (SWAA) in introducing the female condom, the only female-controlled method for protection from HIV. By addressing issues of gender inequity and communication within relationships, SWAA used the female condom to empower women to regain control of their bodies. Also in this issue are profiles of three other approaches to programming for the female condom from Brazil, South Africa, and Zimbabwe.