International Public Health Commons^™

Reducing Maternal And Child Mortality In Sindh: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This Population Council/Evidence Project policy brief explains why FP must be prioritized in Sindh, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. Evidence shows that FP is one of the most powerful tools at the government’s disposal for a rapid reduction in maternal, infant, and child mortality. FP’s wider health benefits include reduced anemia among women; lower …

Reducing Maternal And Child Mortality In Khyber Pakhtunkhwa: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family Planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This Population Council/Evidence Project policy brief explains why family planning must be prioritized in Khyber Pakhtunkhwa, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. By fulfilling the existing unmet need for birth spacing and limiting, it is possible to prevent 37 percent of maternal deaths and 57 percent of infant deaths. FP’s wider health benefits include reduced …

Reducing Maternal And Child Mortality In Balochistan: The Untapped Potential Of Family Planning, Zeba Sathar, Maqsood Sadiq, Seemin Ashfaq

Reproductive Health

Family planning (FP) is recognized as a necessary tool for faster fertility decline leading to accelerated economic development. However, its unique and potent role in preserving mother and child health is less well understood. This brief explains why FP must be prioritized in Balochistan, Pakistan’s health strategy as a key intervention for reducing maternal, infant, and under-five mortality in the province. By fulfilling the existing unmet need for birth spacing and limiting, it is possible to prevent 41 percent of maternal deaths, 35 percent of infant deaths, and 74 percent of young child deaths. FP’s wider health benefits include reduced …

Prospects For Economic Growth In Sindh Under Alternative Demographic Scenarios: The Case For A Rapid Fertility Decline, David E. Bloom, Zeba Sathar, Maqsood Sadiq

Reproductive Health

Sindh is currently undergoing a demographic transition from high fertility and high mortality to lower fertility and mortality. The resulting bulge in its working-age population means the province is poised to reap a “demographic dividend.” By 2050, Sindh’s per capita income will be 191 percent higher than today’s levels if there is no decline in fertility, but 426 percent higher if fertility declines rapidly. The scale and effectiveness of efforts to reduce fertility levels in Sindh will determine whether per capita income in the province grows by 328 percent or 426 percent by 2050. The possible demographic dividend of a …

Prospects For Economic Growth In Punjab Under Alternative Demographic Scenarios: The Case For A Rapid Fertility Decline, David E. Bloom, Zeba Sathar, Maqsood Sadiq

Reproductive Health

Punjab is currently undergoing a demographic transition from a situation of high fertility and high mortality to one of lower fertility and mortality. The resulting bulge in its working-age population means the province is poised to reap a “demographic dividend.” By 2050, Punjab’s per capita income will be 210 percent higher than today’s levels if there is no decline in fertility, but 431 percent higher if fertility declines rapidly. The scale and effectiveness of efforts to reduce fertility levels in Punjab will determine whether per capita income in the province grows by 333 percent or by 431 percent by 2050. …

Prospects For Economic Growth In Khyber Pakhtunkhwa Under Alternative Demographic Scenarios: The Case For A Rapid Fertility Decline, David E. Bloom, Zeba Sathar, Maqsood Sadiq

Reproductive Health

Khyber Pakhtunkhwa (KP) is currently undergoing a demographic transition from a situation of high fertility and high mortality to one of lower fertility and mortality. The resulting bulge in its working-age population means the province is poised to reap a “demographic dividend.” By 2050, KP’s per capita income will be 167 percent higher than today’s levels if there is no decline in fertility, but 412 percent higher if fertility declines rapidly. The scale and effectiveness of efforts to reduce fertility levels in KP will determine whether per capita income in the province grows by 316 percent or by 412 percent …

Prospects For Economic Growth In Balochistan Under Alternative Demographic Scenarios: The Case For A Rapid Fertility Decline, David E. Bloom, Zeba Sathar, Maqsood Sadiq

Reproductive Health

Balochistan is currently undergoing a demographic transition from a situation of high fertility and high mortality to one of lower fertility and mortality. The resulting bulge in its working-age population means the province is poised to reap a “demographic dividend.” By 2050, Balochistan’s per capita income will be 165 percent higher than today’s levels if there is no decline in fertility, but 388 percent higher if fertility declines rapidly. The scale and effectiveness of efforts to reduce fertility levels in Balochistan will determine whether per capita income in the province grows by 295 percent or by 388 percent by 2050. …

Family Planning Through The Lens Of Men: Readiness, Preferences, And Challenges, Iram Kamran, Zeba Tasneem, Tahira Parveen, Rehan M. Niazi

Reproductive Health

Family planning (FP) is urgently needed in Pakistan but progress remains slow. In its 2002 Population Policy, the country pledged to reduce its total fertility rate to 2.2 by 2020; at the London Summit in 2012, it committed to increase the contraceptive prevalence rate (CPR) to 55 percent by the same year. Despite important achievements, Pakistan’s current CPR is only 35 percent, the total fertility rate is 3.8, and 20 percent of married couples of reproductive age express unmet need for FP. FP programming has largely been directed at women, and husbands have been regarded, at best, as interested bystanders. …

Expanding The Role Of Research Evidence In Family Planning Policy, Program, And Practice Decisionmaking, Karen Hardee, Kelsey Wright

Reproductive Health

This working paper focuses on the emerging knowledge translation literature to provide lessons learned on ways to increase the role that evidence plays in decision-making for family planning and reproductive health policies, programs, and practices. It is part of a larger synthesis of the literature that explores what “evidence” means, what types of evidence policymakers, program managers, and implementers seek when facing implementation decisions, and how evidence relates to other factors that influence decision-making. This paper and the larger synthesis are based on a literature search whose objective was to locate references on evidence-based policy in health or social science, …

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 …

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. …

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 …

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’ …