Public Health Commons^™

Best Bets For Accelerating Family Planning In Pakistan: Invest In Community Health Workers, Ali M. Mir, Kiren Khan

Reproductive Health

Integration of trained, equipped, and supported community health workers (CHWs) within a health system is recognized as a proven high impact practice for family planning (FP) services, with evidence from around the world confirming the need to complement facility-based FP services with CHW programs, particularly in areas where people’s access to health care is limited. There is also substantial evidence that delivering essential health services through CHWs can be cost-effective in a diversity of contexts, with a review of FP programs in 10 developing countries revealing that the average cost per couple-year of protection (CYP) was considerably lower among programs …

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 …

Breastfeeding: Insights For Improving Malaria, Family Planning, And Maternal And Child Health Outcomes In Northwestern Nigeria Through Social And Behavior Change Research, Breakthrough Research

Reproductive Health

This brief provides evidence for implementers and researchers of social and behavior change programs designed to improve community knowledge, attitudes, norms and behaviors for pregnant and postpartum women's health. The brief focuses on key behaviors including early breastfeeding initiation within one hour of birth and exclusive breastfeeding for the first six months of life, while also discussing breastfeeding barriers and facilitators. This is one of a series of briefs that present findings from a Breakthrough RESEARCH study that captured data on a wide range of psychosocial factors of behavioral outcomes for family planning, malaria, and maternal, newborn and child health, …

Behavioral Sentinel Surveillance Survey In Nigeria: Baseline Technical Report, Emily White Johansson, Paul Hutchinson, Elizabeth Omoluabi, Akanni Akinyemi, Andrea Smith, J. Clint Welty, Udochisom Anaba, Dominique Meekers, Alejandra Leyton, Dele Abegunde, Paul C. Hewett

Poverty, Gender, and Youth

This technical report presents results of the baseline Behavioral Sentinel Surveillance survey by Breakthrough RESEARCH in Nigeria in September and October 2019. From 2019 to 2021, baseline, midline, and endline surveys will assess the effectiveness of Breakthrough ACTION integrated social and behavior change activities for malaria, family planning, and maternal, newborn and child health plus nutrition in Kebbi and Sokoto in comparison to Breakthrough ACTION's exclusively malaria activities in Zamfara state. Malaria activities were initiated in Zamfara in October 2019. This technical report presents detailed baseline results, including comparisons of results for the Breakthrough ACTION integrated and malaria-exclusive program areas. …

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 …

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 …

Evidence Review And Analysis Of Provider Behavior Change Opportunities, Emily Zimmerman, Vivien Caetano, Rachel Banay, Jana Smith

Reproductive Health

This paper reviews the evidence on the promise of behavioral economics to improve health outcomes through service provider interventions in five critical health areas. This analysis utilizes the limited existing evidence to suggest where and how behavioral economics interventions may be most effective and where further research may contribute most.

Strengthening Social And Behavior Change Monitoring And Evaluation For Family Planning In Francophone West Africa, Leanne Dougherty, Martha Silva, Kathryn Spielman

Reproductive Health

This report summarizes findings from a mapping of family planning investments, technical approaches and indicators, identifies indicator gaps, and makes recommendations to governments, donors, researchers and implementers to improve social and behavior change activity measurement in Francophone West Africa.

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 …

Improving Data Reporting To Nhmis From The Private Sector In Nigeria: Lessons From A Dhis2 Pilot With Community Pharmacists And Patent And Proprietary Medicine Vendors, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs]) in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with FP regulations, and report service statistics to the Health Information Management System (HMIS). To achieve this, the project is implementing: a pilot three-tiered accreditation …

The Effects Of A Family Planning Training On Community Pharmacists And Patent And Proprietary Medicine Vendors’ Knowledge In Nigeria: Preliminary Pre And Posttest Results, The Integrate Project, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs]) in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with regulations, and report service statistics to the Health Information Management System. To achieve this, the project is implementing: a pilot three-tiered accreditation system for …

Quality Of Care Received For Family Planning From Community Pharmacists And Patent And Proprietary Medicine Vendors In Lagos And Kaduna, Nigeria: The Integrate Project, Population Council

Reproductive Health

The IntegratE Project is a four-year initiative (2017–21) implemented by the Population Council and partners that seeks to increase access to contraceptive methods by involving the private sector (community pharmacists [CPs] and patent and proprietary medicine vendors [PPMVs] in family planning (FP) service delivery in Lagos and Kaduna States, Nigeria. The project aims to establish a regulatory system with the Pharmacists Council of Nigeria to ensure that CPs and PPMVs provide quality FP services, comply with regulations, and report service statistics to the Health Information Management System. To achieve this, the project is implementing: a pilot three-tiered accreditation system for …

Provider Behavior Change Approaches To Improve Family Planning Services In The Ouagadougou Partnership Countries: A Landscaping Review, Kathryn Spielman, Elizabeth Tobey, Martha Silva, Leanne Dougherty

Reproductive Health

This landscaping review summarizes available evidence (as of 2020) on the effectiveness of provider behavior change interventions for improving family planning services in Ouagadougou Partnership countries and presents current or recent provider behavior change interventions not formally evaluated. The findings are summarized along with reflections about possible research and programming investments to address challenges and opportunities.

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 …

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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The Business Case For Investing In Social And Behavior Change For Family Planning, James Rosen, Nicole M. Bellows, Lori Bollinger, Willyanne Decormier Plosky, Michelle Weinberger

Reproductive Health

Although the development field generally considers social and behavior change interventions essential parts of quality health programs, lack of synthesized information on costs and effectiveness means that decision-makers under-appreciate and under-fund social and behavior change efforts. This business case uses evidence to answer questions about the effectiveness, cost, cost-effectiveness, and return on investment from social and behavior change efforts. To develop this family planning social and behavior change business case, nearly 200 studies were evaluated. All USAID strategic priorities for global health—preventing child and maternal deaths, controlling the HIV/AIDS epidemic, and combating infectious diseases—employ social and behavior change approaches to …

Family Planning And Youth In West Africa: Mass Media, Digital Media, And Social And Behavior Change Communication Strategies, Sarah Castle, Martha Silva

Reproductive Health

This review presents evidence about the impact of mass media and digital media on young people’s family planning attitudes and behaviors. It primarily focuses on the Ouagadougou Partnership countries, but also describes lessons from other initiatives implemented more widely in Africa and elsewhere. Due to the paucity of family planning evidence, the review also includes material from higher income countries where mass and digital media have been used in communication initiatives to prevent non-communicable diseases. In addition, it draws on studies from low- and middle income countries where such media have been used to create demand for maternal and child …

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 …

Engaging Men For Effective Family Planning Through Couple Communication: An Assessment Of Two Mcsp Couple Communication Approaches In Togo, Natacha Stevanovic-Fenn, Bethany Arnold, Sanyukta Mathur, Catherine Tier, Anne Pfitzer, Rebecka Lundgren

Reproductive Health

On behalf of Breakthrough RESEARCH, the Institute for Reproductive Health of Georgetown University, in collaboration with the Population Council, assessed two of three couple's communication approaches for family planning being implemented by Maternal and Child Survival Program in Togo’s Kloto district: in home couple's counseling (either individual in home counseling or with the couple together) and group discussions. IRH’s overall goal was to assess the benefits and feasibility of these two approaches as well as to determine which elements of each are best suited for roll-out on a broader scale. The two models—home-based couple counseling and group discussions—were implemented in …

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. …

Predictors Of Rapid Repeat Pregnancy In Zimbabwe, Thenjiwe Sisimayi

Walden Dissertations and Doctoral Studies

Rapid repeat pregnancy (RRP) is associated with adverse maternal and infant outcomes and a range of undesirable social and economic challenges for the mother, her baby, and society. Although the consequences of RRP are well known, Zimbabwe—a country with some of the poorest maternal health indicators—has not investigated or made efforts to directly address this problem. This is confirmed by the lack of targeted programs to curb RRP, the unavailability of documented evidence regarding RRP significant risk factors, and the lack of understanding of the extent of RRP in the country. Using social cognitive theory as the theoretical framework, an …

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 …

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 …

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 …

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 …

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 …

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 …

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, …