Women's Health Commons^™

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 …

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; …

Unmet Need And Unintended Pregnancy: The Bigger Picture, Ian Askew

Reproductive Health

No abstract provided.

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 …

Barriers And Perceptions Regarding Different Contraceptives And Family Planning Practices Amongst Men And Women Of Reproductive Age In Rural Pakistan: A Qualitative Study, Syed Khurram Azmat, Ghulam Mustafa, Waqas Hameed, Muhammad Ali, Aftab Ahmed, Mohsina Bilgrami

Community Health Sciences

Background: Pakistan ranks as one of the most poorest and most populous in the world with poor reproductive health indicators. This study helps in understanding barriers and perceptions regarding Family Planning (FP), modern contraception, quality of care and free of charge FP services amongst men and women in rural Pakistan.
Methods: Employing purposive sampling and Focus Group Discussion (FGD) technique, this qualitative study was conducted with men and women of reproductive age in Pakistan. A total of eight FGDs were conducted in Sindh and Punjab provinces. Being descriptive in nature, the study provided a thematic analysis of the relevant health …

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.

Attitudes, Beliefs, And Practices Of Providers And Key Opinion Leaders On Emergency Contraception In India, 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 (ECP) among providers in public and private facilities and pharmacies in India. The objectives of the study were to: assess providers' knowledge of ECP's biological mechanism; understand providers' knowledge and attitudes about ECP's safety, effectiveness, and availability as an OTC drug; and identify providers' definitions of “repeated use” and profiling women who are “repeated users” of ECP. This study's findings show that most providers, including doctors and some KOLs, were incorrectly informed about ECP's mechanism of action. Service guidelines are necessary for accurate and …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In Nigeria, Babatunde A.O. Ahonsi, Salisu Mohammed Ishaku, Araoyinbo Idowu, Ayodeji Oginni

Reproductive Health

Despite significant progress in product development, procurement, and distribution in the past few decades, emergency contraception’s (EC) capacity to benefit many women in countries such as Nigeria is hampered by a number of potential barriers, that are not well understood. The Population Council, with support from the International Consortium for Emergency Contraception, documented EC-related knowledge, attitudes, and practices among providers in Nigeria as well as perceptions of key opinion leaders who help shape the policy environment for EC and family planning in general. Findings suggest significant gaps in Nigeria, potentially necessitating continuous training and re-training to help dispel misperceptions and …

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.

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 …

Introduction Of Emergency Contraceptive Pills (Ecps) Through Lady Health Workers (Lhws) Program In Pakistan: Findings Of An Evaluation Study, Arshad Mahmood, Yasir Bin Nisar

Reproductive Health

This report documents the findings from a five-day study tour of Pakistani officials to Bangladesh, organized by the Population Council, to afford an opportunity for representatives of both the Ministry of Health and Population Welfare to learn from the experience of Bangladesh in introducing emergency contraceptive pills (ECPs) through their National Public Health System. One of the recommendations was to enhance the availability of emergency contraception in Pakistan by making it available through outlets of the health system, especially through the network of the community-based Lady Health Workers (LHWs). There is a high unmet need for ECP in LHW areas, …

Key Opinion Leaders' Views Regarding Emergency Contraception In India, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief explores the views of key opinion leaders (KOLs) in the field of reproductive health and family welfare on provision of emergency contraception (ECPs). The study’s objective was to gain a better understanding of how the attitudes and beliefs of KOLs might influence policy and program implementation, either encouraging or opposing ECP promotion and service delivery. Results suggest strong support by the majority of KOLs to continue the sale of ECP as an over-the-counter drug. KOLs also emphasized the importance of comprehending and addressing the main barriers to ECP provision and use: poor knowledge, lack of training, moral …

Providers' Attitudes And Practices Regarding Emergency Contraception In India: Key Findings, M.E. Khan, Isha Bhatnagar, Deepthi S. Varma, Anvita Dixit

Reproductive Health

This policy brief reports key findings of a study in India that explored providers’ knowledge of how emergency contraception (ECP) works and its safety and effectiveness, their perceptions of the frequency of repeat use, their provision of ECP, and their attitudes toward women who seek it. Many of the findings of this study are encouraging. Most providers believed that ECP is an effective and safe method to prevent pregnancy and that it cannot induce abortion, and half supported the over-the-counter provision of ECP. Nevertheless, the study revealed many biases and gaps in knowledge. Recommendations include a number of ways to …

Providers' And Key Opinion Leaders' Attitudes And Practices Regarding Emergency Contraception In Senegal: Key Findings, Babacar Mane, Martha Brady, Saumya Ramarao, Fatou Bintou Mbow

Reproductive Health

This study examines providers’ and key opinion leaders’ knowledge, attitudes, and practices regarding the emergency contraceptive pill (ECP) in Senegal, and synthesizes the findings to suggest program and policy recommendations. Analysis of providers’ opinions and beliefs reveals that although many providers believe ECP is a safe product, persistent negative views remain. KOLs and providers recognize the importance of ECP for preventing unintended pregnancy and are supportive of the integration of ECP into national guidelines. They note, however, the need to improve accessibility and quality of provision. Given the magnitude of sexual violence and abuse, considerable interest exists in devising strategies …

Attitudes, Croyances Et Pratiques Des Leaders D'Opinion Clés (Loc) Et Des Prestataires Sur La Contraception D'Urgence (Cu) Au Sénégal, Babacar Mane, Saumya Ramarao, Martha Brady, Fatou Bintou Mbow, Ababacar Thiam

Reproductive Health

In Senegal, initiatives for mainstreaming the emergency contraceptive pill (ECP) in the family planning program are fairly recent. Service statistics indicate, however, that ECP distribution through the public sector is very low. While most users access ECPs through the private sector, the volume of sales is not clear, due to the absence of an operational information system of EC distribution through pharmacies. In an effort to strengthen EC provision in Senegal and reposition EC within the FP program, the Population Council conducted a study in collaboration with the Reproductive Health Division of the Ministry of Health, Senegal to document the …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Regarding Emergency Contraception In Nigeria: Key Findings, Babatunde A.O. Ahonsi, Salisu Mohammed Ishaku, Araoyinbo Idowu, Ayodeji Oginni

Reproductive Health

This brief reports on a study in Nigeria to document provider attitudes, beliefs, and practices regarding emergency contraception (ECP), and to identify key opinion leaders’ opinions and insights pertaining to policy and programmatic issues in that country. Findings reveal that ECP is well known in urban Nigeria. Its provision is controlled mainly by the largely unregulated and unmonitored private sector. Government plays a distant role, thereby leaving family planning and ECP supply almost entirely in the hands of donor agencies. For wider availability and affordability of ECP products in both the private and public sectors, official policy action is required, …

Providers' And Key Opinion Leaders' Attitudes, Beliefs, And Practices Concerning Emergency Contraception: A Multicountry Study In India, Nigeria, And Senegal, Martha Brady, M.E. Khan, Babatunde A.O. Ahonsi, Babacar Mane, Ian Askew, Saumya Ramarao

Reproductive Health

The Population Council conducted a cross-sectional, descriptive, multicountry study in India, Nigeria, and Senegal aimed at understanding the attitudes, beliefs, and practices of providers and key opinion leaders (KOLs) regarding the provision and use of emergency contraception (ECP). The overarching goal of this study was to investigate and document providers’ attitudes, beliefs, and practices regarding ECP, and to capture the opinions and insights of providers and KOLs on a range of policy and program issues. Findings indicate that many provider-related barriers can be overcome through implementation of targeted interventions such as training and values clarification, whereas other barriers will require …

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: 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 …

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 …

Contraceptive Use Dynamics In Pakistan 2008-09, Arshad Mahmood, Syeda Saman Naz

Reproductive Health

This report looks at contraceptive use dynamics in Pakistan, focusing on contraceptive discontinuation, method failure, and contraceptive switching, as well as the reasons for discontinuation. The study found that almost one-third of discontinuations were due to side effects followed by one-fifth of them by the method failure. Side effects were the most common reason for discontinuing modern methods (IUDs and hormonal methods), while failure was the most common reasons for discontinuing barrier and traditional methods (condom, rhythm, withdrawal). Based on the findings of this study, this report suggests that better training of health providers and better information and counseling of …

Bellagio Consensus: Recommendations For Action To Increase Access To Highly Effective, Long-Acting, Reversible Contraception, Population Council

Reproductive Health

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.

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 …

Mainstreaming Emergency Contraception Pills In Kenya, Jill Keesbury, Monica Wanjiru, Katherine Maina

Reproductive Health

To improve access to emergency contraception (ECP) and ensure that adequate information is provided to all users, the Kenyan Ministry of Public Health and Sanitation, the Population Council, and Population Services International-Kenya undertook a three-year effort to mainstream ECP in Kenya. This brief presents the results of this initiative and discusses strategies for further strengthening ECP provision. Kenya has emerged as a leader in ECP programming in the region and has demonstrated that it is possible to strengthen ECP services in both the public and private sectors while at the same time increasing public awareness, knowledge, and use of the …

Emergency Contraception: Idea To Program, Saumya Ramarao, John Townsend, Sarah Raifman

Reproductive Health

This report summarizes the role of the Population Council in generating evidence, providing technical leadership, and demonstrating at scale that emergency contraception (EC) can be easily integrated into national family planning programs and other reproductive health services. Since the 1990s, the Population Council, along with other partners, has contributed to the changes seen in the provision and availability of EC, now available in over 140 countries around the world. While much progress has been made in the campaign for access to EC, the Council is committed to improving existing methods of service delivery and to leading advocacy efforts and research …

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 …

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. …

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 …

Comparing The Effectiveness And Costs Of Alternative Strategies For Improving Access To Information And Services For The Iud In Ghana, Ivy Osei, Gertrude Voetagbe, Moses Aikins, John Gyapong, Philomena Nyarko, Harriet Birungi, Gloria Quansah Asare, Henrietta Odoi-Agyarko, Olivia Aglah

Reproductive Health

The Ghana Health Service (GHS) was prompted to explore ways of increasing interest in the IUD through increasing awareness of this and other long-acting and permanent methods via interpersonal channels and by intensifying campaigns to dispel rumors about the method. The Health Research Unit of the GHS, EngenderHealth’s Quality Health Partners project, and the Population Council’s Frontiers in Reproductive Health (FRONTIERS) project collaborated with the GHS to test innovative approaches to increase awareness of the IUD and to improve access to the method. The study examined the general and method-specific knowledge of long-acting family planning methods among clients and providers, …