Table of Contents
EDITORIALS
- Taking Exception. Reduced mortality leads to population growth: an inconvenient truth
Reduced mortality has been the predominant cause of the marked global population growth over the last 3/4 of a century. While improved child survival increases motivation to reduce fertility, it comes too little and too late to forestall substantial population growth. And, beyond motivation, couples need effective means to control their fertility. It is an inconvenient truth that reducing child mortality contributes considerably to the population growth destined to compromise the quality of life of many, particularly in sub-Saharan Africa. Vigorous child survival programming is of course imperative. Wide access to voluntary family planning can help mitigate that growth and provide many other benefits.
- Urban health: it's time to get moving!
The global health community should mainstream urban health and implement urban health programs to address the triple health burden of communicable diseases, noncommunicable diseases, and injuries in low- and middle-income countries.
VIEWPOINTS
- Local markets for global health technologies: lessons learned from advancing 6 new products
Key components to support local institutional and consumer markets are: supply chain, finance, clinical use, and consumer use. Key lessons learned: (1) Build supply and demand simultaneously. (2) Support a lead organization to drive the introduction process. (3) Plan for scale up from the start. (4) Profitability for the private sector is an absolute.
ORIGINAL ARTICLES
- Are pregnant women prioritized for bed nets? An assessment using survey data from 10 African countries
Women of reproductive age are generally more likely to sleep under an insecticide-treated net (ITN) than other household members. Universal coverage increases ITN use by all family members, including pregnant women. However, BCC efforts are needed to achieve desired levels of bed net use, which is especially important for pregnant women.
- The quality–coverage gap in antenatal care: toward better measurement of effective coverage
The proportion of pregnant women receiving 4 or more antenatal care (ANC) visits has no necessary relationship with the actual content of those visits. We propose a simple alternative to measure program performance that aggregates key services that are common across countries and measured in Demographic and Health Surveys, such as blood pressure measurement, tetanus toxoid vaccination, first ANC visit before 4 months gestation, urine testing, counseling about pregnancy danger signs, and iron–folate supplementation.
- Preferences for a potential longer-acting injectable contraceptive: perspectives from women, providers, and policy makers in Kenya and Rwanda
High effectiveness, predictable return to fertility, and a single, prepackaged, disposable delivery system ranked high. Side effects were generally acceptable to women if they did not last long or disrupt daily activities. Cost was considered important for providers but not so much for most potential users.
- Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002–2012
Cesarean deliveries nationally in Jordan have increased to 30%, including substantial increases among births that are likely low risk for cesarean delivery for the most part. This level is double the threshold that WHO considers reasonable.
- Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India
Emergency contraceptive pills (ECPs) are extremely safe and do not interfere with implantation. Yet many surveyed physicians in India did not know that there are no contraindications to using ECPs, and many had negative attitudes about ECP users. Most were against having ECPs available over-the-counter and wanted to impose age restrictions. Efforts are needed to address such misconceptions that might lead to limiting ECP availability.
- Evaluation of community-based interventions to improve TB case detection in a rural district of Tanzania
Enlisting traditional healers and pharmacists to improve TB detection contributed 38% to 70% of new smear-positive case notifications per quarter in a rural district of Tanzania.
- Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda
Scaling-up lessons included: (1) simplifying provider training and client materials; (2) ensuring core aspects of the intervention, for example, that the CycleBeads client tool was integrated into the supply chain system; (3) addressing provider-generated medical barriers; and (4) managing threats from changing political and policy environments. A focus on systems, the use of multiple M&E data sources, maintaining fidelity of the innovation, and ongoing environmental scans facilitated scale-up success.
FIELD ACTION REPORTS
- Informed push distribution of contraceptives in Senegal reduces stockouts and improves quality of family planning services
Dedicated logisticians restocked contraceptives monthly at facilities to maintain defined minimum stock levels, freeing up clinic staff. High stockout rates were virtually eliminated. Also, quality and timely data on contraceptives distributed allowed for better program management.
COMMENTARIES
After a generation of partial neglect, renewed attention is being paid to population and voluntary family planning. Realistic access to family planning is a prerequisite for women's autonomy. For the individual, family, society, and our fragile planet, family planning has great power.