Medicine and Health Sciences Commons^™

Social Accountability For Family Planning: A Case Study Of The Healthy Action Project In Uganda, The Evidence Project

Reproductive Health

In July 2014, the Evidence Project gathered 26 experts for a two-day meeting on Strengthening the Evidence Base on Social Accountability for Improving Family Planning and Reproductive Health Programs. Participants included social accountability experts from diverse fields (governance, maternal health, family planning) as well as researchers, implementers, and activists. The meeting was one of the first public discussions that addressed social accountability in the context of family planning and reproductive health (FP/RH). Meeting participants agreed on the need for case studies of FP/RH initiatives to identify “good practices” in order to advance the application of social accountability to the FP/RH …

Understanding Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth-Friendly Service Programming, The Evidence Project

Reproductive Health

In Ethiopia, significant attention has been given to improving youth sexual and reproductive health (SRH) services, including the establishment of youth-friendly services (YFS). Yet high rates of child marriage, unmet need for family planning, and adolescent childbearing persist, particularly in rural areas where over 84 percent of the population lives. Reaching rural youth with timely SRH information and services that are relevant to their varying ages and life stages remains a challenge. The Evidence Project is examining the coverage and reach of public and NGO-supported youth SRH services in several rural regions of Ethiopia. As this activity brief notes, the …

Utilization Of National Health Insurance For Family Planning And Reproductive Health Services By The Urban Poor In Uttar Pradesh, India, The Evidence Project

Reproductive Health

In 2008, the Government of India launched the National Health Insurance program, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in urban and rural areas to access a range of private health services. Enrolled families can access packages of services from RSBY-participating private hospitals, including family planning (FP) and other reproductive health (RH) services. Despite the availability of insurance coverage, poor families’ utilization of RSBY for FP/RH services is believed to be negligible. The Evidence Project is conducting a study in three cities in Uttar Pradesh to better understand the factors affecting utilization of RSBY …

The Raise Health Initiative For Workers, Companies, And Communities, The Evidence Project

Reproductive Health

RAISE Health is an initiative to improve the health of factory and farm workers (women and men) in developing countries through changes in global and corporate policies and workplace practices. Effective management of workplace health is good for companies and workers alike, resulting in better health and morale, better labor-management relations, empowerment of women, and better use of company health investments. Worker health is typically one of the most neglected areas in business operations. As this activity brief notes, RAISE Health is a major activity of the USAID-funded Evidence Project. The goal of the initiative is to utilize the existing …

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 …

Rights-Based Family Planning: 10 Resources To Guide Programming, Jan Kumar, Karen Hardee

Reproductive Health

The FP2020 goal of providing FP services to 120 million more women and girls that emerged from the 2012 London Summit on Family Planning refocused attention on the need to ensure that FP programs respect, protect, and fulfill human rights. The current challenge is how to operationalize human rights in existing FP programs and new projects. This resource guide reviews ten key resources available to guide programming—FP2020: Rights and Empowerment Principles for Family Planning; Ensuring Human Rights in the Provision of Contraceptive Information and Services, Ensuring Human Rights Within Contraceptive Service Delivery: Implementation Guide; Voluntary Family Planning Programs that Respect, …

Anneau Vaginal À La Progesterone: Appel A L'Action Pour Combler Les Ecarts Importants Dans La Planification Familiale Postnatal, Population Council

Reproductive Health

L’anneau vaginal à la progestérone (AVP) est une méthode efficace et sûre de contraception pour les femmes qui allaitent. C’est une médecine prioritaire de la liste des produits médicaux essentiels de l’OMS et elle est inclue parmi les critères médicaux éligibles pour les personnels de la planification familiale. Développé par le Population Council, l’AVP est un anneau intra-vaginal qui donne une option contraceptive aux femmes qui allaitent au moins quatre fois par jour dès la quatrième semaine après l’accouchement. L’AVP apporte une nouvelle option pour réduire les besoins non-satisfaits des nouvelles mères, permet aux femmes d’espacer leurs grossesses sans problème, …

Progesterone Vaginal Ring: A Call-To-Action To Fill Critical Gaps In Post-Partum Family Planning, Population Council

Reproductive Health

The progesterone vaginal ring (PVR) is a safe and effective method of contraception for lactating women. It is a priority medicine on the WHO’s Essential Medicines List and is included in the Medical Eligibility Criteria for family planning providers. Developed by the Population Council, the PVR is an intravaginal ring that provides women who breastfeed at least four times a day with a contraceptive option as early as four weeks after giving birth. The PVR provides a new option to reduce unmet need among new mothers, allow women to safely space their pregnancies, and improve the health of women and …

Willingness To Pay For Contraceptive Vaginal Rings In Senegal, Babacar Mane, Fatou Mbow, Deepa Rajamani, Nafissatou Diop, Saumya Ramarao

Reproductive Health

Contraceptive vaginal rings are an innovative category of products that have not been introduced into any sub-Saharan African country. As a result, there is little experience to guide the introductory pricing for the PVR and the one-year NES/EE CVR when it becomes available. The evidence generated by this consumer willingness to pay, and provider/procurer study has shed light on critical aspects of PVR introduction in Senegal. In general, the results generated here complement and reinforce findings from an acceptability study of the PVR and stakeholder discussions that have been occurring over the past three years. Results confirm that contraceptive vaginal …

L’Anneau Vaginal À Progestérone: Résultats De L’Étude D’Acceptabilité Au Sénégal, Babacar Mane, Papa Chimere Diaw, Nafissatou Diop, Fatou Mbow, Heather Clark, Saumya Ramarao, Deepa Rajamani

Reproductive Health

Le Gouvernement du Sénégal s’est engagé dans une politique volontariste de repositionnement de la planification familiale à travers l’adoption d’un Plan d’Action National de Planification Familiale. Pour mieux adresser les besoins de contraception des femmes et réduire les taux d’abandon, le Population Council a initié le développement d’une gamme d’anneaux vaginaux; le premier produit développé était l’anneau vaginal à progestérone ou AVP, conçu pour les femmes qui allaitent en vue de prolonger la période d’aménorrhée lactationnelle et ainsi promouvoir l’espacement des naissances. Avec l’appui de la Fondation Bill & Melinda Gates, le Population Council a entrepris des activités de pré-introduction …

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 …

Progesterone Vaginal Ring: Results Of An Acceptability Study In Kenya, Francis Obare, Wilson Liambila, Chi-Chi Undie, Harriet Birungi, Shiphrah Kuria, Heather Clark, Deepa Rajamani, Saumya Ramarao

Reproductive Health

The progesterone vaginal ring (PVR) is used to extend the contraceptive effectiveness of lactational amenorrhea among breastfeeding women. 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 Kenya as part of a larger project that was also conducted in Nigeria and Senegal. The specific objectives of the study were to assess the factors influencing the acceptability of the method among clients, their spouses, providers, community members, …

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 …

Gender Considerations Along The Hiv Treatment Cascade: An Evidence Review With Priority Actions, Melanie Croce-Galis, Jill Gay, Karen Hardee, What Works Association, Population Council

Reproductive Health

This treatment brief provides policymakers and program implementers with evidence about the impact of gender dynamics on treatment access and adherence and the gender-related gaps in treatment research and programming. It also includes priority actions that can be taken to better address gender within treatment programming and raises questions for implementation science in order to achieve the global 90-90-90 goal. This brief draws from What Works for Women and Girls: Evidence for HIV Interventions and uses the WHO treatment cascade framework to identify and analyze major gender considerations in providing antiretroviral therapy to those living with HIV in low- and …

Proposed Indicators To Measure Adherence To And Effects Of Rights-Based Family Planning: Resource Guide, Kelsey Wright, Karen Hardee

Reproductive Health

At the London Summit on Family Planning in 2012, the goal of expanding access to FP programs by 120 million additional women and girls by 2020 was established. This goal calls attention to the need for FP information and services to be delivered in ways that are voluntary and respect human rights. While human rights have been codified and affirmed in declarations, conventions, and treaties, operationalizing rights in FP programs is still in an early stage of development. With the recent emergence of global numeric benchmarks for FP programs, there is the risk that the focus will move away from …

Education Sector Response To Early And Unintended Pregnancy: A Policy Dialogue In Homa Bay County, Kenya, Chi-Chi Undie, Ian Mackenzie, Harriet Birungi, Stephen Barongo, Diosiana Ahindukha, Caleb Omondi

Reproductive Health

In collaboration with the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) Research Programme Consortium, the Population Council implemented a project to increase the demand for secondary school education in Homa Bay County, Kenya—an area characterized by high, unintended teenage pregnancy and female school drop-out rates. To foster awareness of the school re-entry policy, the Population Council collaborated with the Homa Bay County Department of Education (Ministry of Education) to convene a policy dialogue for all principals of public, day, girls-only, and co-educational secondary schools in the area. The policy dialogue helped to create visibility around the issue of …

Creating Conditions For Scale Up: Technical Assistance As An Implementation Research Uptake Strategy, Ian Askew

Reproductive Health

No abstract provided.

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 …

Confronting Disrespect And Abuse During Childbirth In Kenya: The Heshima Project, Population Council

Reproductive Health

No woman should be hit, yelled at, or abused in any way during childbirth. However, laboring women in Kenya and elsewhere may experience inhumane treatment in hospitals and clinics. This abuse is a key yet overlooked reason why only four in ten pregnant women in Kenya deliver at health facilities. To increase the number of women delivering in health facilities and thereby reduce maternal deaths, governments, health systems, and practitioners need sound evidence documenting the disrespect and abuse that women experience. Through the Heshima Project, the Population Council is changing how health systems and women think about quality maternity care …

Assessment Of Sex Selection In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Forhana Rahman Noor

Reproductive Health

According to UN estimates, the sex ratio at birth (SRB) has persisted at its natural level of 105 male per 100 female newborns for the past half century in Bangladesh. Generally, the SRB becomes skewed in a setting where fertility is declining or low and where son preference exists. Strong son preference compounded by the availability of measures to implement such preference can lead to increased SRB. For example, the increasing availability of prenatal diagnostic technologies, together with declining fertility desires and persistent son preference, has contributed to increased gender-biased sex selection in several Asian countries, including China and India. …

Education Sector Response To Early And Unintended Pregnancy (Eup): A Review Of Country Experiences In East And Southern Africa, Harriet Birungi, Chi-Chi Undie, Francis Onyango

Reproductive Health

No abstract provided.

Validating Indicators Of The Quality Of Maternal Health Care: Final Report, Kenya, Charlotte E. Warren, James Kelly Kimani, Jackline Kivunaga, Brian Mdawida, Charity Ndwiga, Katharine Mccarthy, Ann K. Blanc

Reproductive Health

Despite widespread use, the majority of indicators proposed as measures of the quality of maternal health services have not been sufficiently validated. To accurately track progress toward national and global maternal health goals, the present study sought to validate and identify a set of maternal health indicators that can be practically applied in facility and population-based surveys. To evaluate indicators, the study employed a facility-based design. The study was conducted in public/government hospital facilities in Kenya and Mexico. Participants included women aged 15–49 who underwent labor and delivery at participating study facilities and the providers who attended them. Women’s self-report …

Achieving Mdgs 4 And 5 In Punjab: The Role Of Family Planning, Population Council

Reproductive Health

This brief focuses on the policy options available to the Punjab government to affect the province’s population growth by 2050 and its potential to achieve MDGs 4 and 5. Maternal mortality is a leading cause of death among women of reproductive age in Punjab—about 16 percent of the deaths in this age group are pregnancy-related. Approximately 6,000 women die each year in Punjab due to pregnancy-related factors. Pregnancies that occur too early, too late, or too frequently increase the risk of maternal death. Lowering fertility rates by increasing the use of family planning can help reduce pregnancy-related deaths. The good …

Training Manual On Basic Monitoring And Evaluation Of Social And Behavior Change Communication Health Programs, Praween Kumar Agrawal, Kumudha Aruldas, M.E. Khan

Reproductive Health

Social and behavior change communication (SBCC) interventions are key for addressing social and cultural barriers and achieving goals laid out for health programs. Often these interventions are not evidence based and monitoring and evaluation (M&E) is limited. Lack of trained and skilled human resources for M&E has been a limitation in general. A serious effort is needed to build the capacity of M&E personnel to monitor and evaluate performance of SBCC interventions in terms of reach and effectiveness among intended audiences. The Improving Healthy Behaviors Program of FHI360 aims to provide technical assistance to strengthen capacities to monitor and evaluate …

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 …

Promoting Respectful Maternity Care (Rmc) At Birth: Orientation For Facility-Based Workshops, Population Council

Reproductive Health

The goal of “Promoting Respectful Maternity Care (RMC) at Birth: Orientation for Facility-Based Workshops” is to orient service providers on the RMC concept along with a set of evidence-based interventions to promote RMC. Objectives of the workshop as indicated in this slide deck are: Outline the current status of maternal and neonatal health in relation to respectful care. Discuss key RMC concepts, terminology, legal and rights-based approaches related to RMC and the RMC Resource Package. Demonstrate knowledge and use of Values Clarification and Attitude Transformation (VCAT) theory and practice. Discuss selected evidence-based strategies that reduce disrespect and abuse. Discuss participants’ …

Expanding The Evidence Base On Comprehensive Care For Survivors Of Sexual Violence In Sub-Saharan Africa, Population Council

Reproductive Health

The Expanding the Evidence Base on Comprehensive Care for Survivors of Sexual Violence in sub-Saharan Africa program was a four-year agreement between the Swedish-Norwegian Regional HIV and AIDS Team for Africa, Embassy of Sweden, Lusaka (the S-N Team), and the Population Council. From 2009 to 2013, the program sought to mitigate the impact and incidence of sexual and gender-based violence (SGBV) in sub-Saharan Africa by strengthening the capacities of medical, legal, and justice sectors to care for survivors of such violence. This approach was intended to serve the S-N Team’s larger development objectives of preventing HIV transmission in sub-Saharan Africa …

Evaluation Of The Impact Of The Voucher Program For Improving Maternal Health Behavior And Status In Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, Benjamin Bellows

Reproductive Health

Vouchers, a demand-side financing (DSF) instrument for health-care services, were introduced in Bangladesh in 2006. The DSF program grants vouchers to pregnant women to receive free antenatal, delivery, and postpartum care services as well as free medicine, and financial assistance is provided for transportation. Deliveries with skilled service providers are financially incentivized and providers are reimbursed for their services from a special fund. After piloting DSF initially in 21 subdistricts (upazilas), the government expanded it to another 12 upazilas in 2007 (the second phase), and in its third phase in 2010 the program was expanded to another 11 upazilas. To …

Barriers To Obstetric Fistula Treatment In Low-Income Countries: A Systematic Review, Benjamin Bellows, Rachel Bach, Zoe Baker, Charlotte E. Warren

Reproductive Health

Obstetric fistula is a maternal morbidity condition that occurs in some low-income countries and is caused by prolonged obstructed labor that results in a hole between the vagina and the bladder or rectum through which urine or feces leak. Unrepaired fistula can lead to lifelong ostracism, stigma, and shame. Obstetric fistula is preventable and treatable, but women in these countries experience delays in seeking repair due to a number of factors including awareness of their condition as well as the potential for treatment, resources necessary for seeking care, lack of skilled fistula surgeons, and long hospital waiting times. UNFPA estimates …

Social Accountability: What Are The Lessons For Improving Family Planning And Reproductive Health Programs?, Victoria Boydell, Jill Keesbury

Reproductive Health

The concept of accountability is increasingly important in the family planning (FP) and reproductive health (RH) field. While much recent discussion has focused on developing global or national-level mechanisms for accountability, less emphasis has been placed on understanding the relevance of “social accountability” approaches for ensuring access to, and quality of, FP/RH services. Social accountability refers to the efforts of citizens and civil society to scrutinize and hold duty bearers (politicians, government officials, and service providers) to account for providing promised services, actions most often at the subnational or community level. In the FP/RH field, this concept builds on a …