Table of Contents
Long-Acting Reversible Contraception Crucial to Meeting Unmet Need Goals by 2020: Key Papers From the 2016 International Conference on Family Planning
INTRODUCTION
EDITORIALS
- Effective LARC Providers: Moving Beyond Training
Effective and productive providers are the key to successful provision of long-acting reversible contraceptives (LARCs). But LARCs demand more of providers than short-acting resupply methods. In addition to sound training, key elements to developing highly productive providers of LARCs include a thorough understanding of the service delivery system context; selecting providers with the most potential, especially from mid-level cadres; strong mentoring and supportive supervision; and attention to the supply chain and to demand-side support.
ORIGINAL ARTICLES
- Rapid Contraceptive Uptake and Changing Method Mix With High Use of Long-Acting Reversible Contraceptives in Crisis-Affected Populations in Chad and the Democratic Republic of the Congo
Offering a broad choice of contraceptives can rapidly expand use in crisis-affected settings, particularly when the choice includes long-acting reversible contraceptives (LARCs). Over 5 years, the governments of Chad and the Democratic Republic of the Congo, with support from an NGO, provided nearly 85,000 new clients with contraceptives. LARC users, which included an increasing number of IUD users, accounted for 73%.
- Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries
Between 2013 and 2014, IUD services provided to women increased more than threefold–from 22,893 to 79,162–in 417 public facilities in Guatemala, Laos, Mali, and Uganda through a Population Services International pilot that engaged the public sector alongside existing private-sector interventions within an informed choice context. Based on family planning market analyses, the country-specific interventions focused on strengthening policy, service delivery, supply chain management, and demand promotion.
- Mentoring, Task Sharing, and Community Outreach Through the TutoratPlus Approach: Increasing Use of Long-Acting Reversible Contraceptives in Senegal
Mentoring, task sharing, and community outreach at 100 rural facilities in Senegal led to an 86% increase over 6 months in the number of women choosing long-acting reversible contraceptives (from 1,552 to 2,879). Concurrent improvement of facilities and provider skills, coupled with the application of Senegal’s task-sharing policy, are increasing the range of contraceptive methods available to women throughout the country.
- The Tupange Project in Kenya: A Multifaceted Approach to Increasing Use of Long-Acting Reversible Contraceptives
Use of long-acting reversible contraceptives increased significantly among women in a poor, urban setting through training, mentoring, commodity security, quality improvement, multiple service delivery models, and multiple demand-promotion approaches.
- Strengthening Postabortion Family Planning Services in Ethiopia: Expanding Contraceptive Choice and Improving Access to Long-Acting Reversible Contraception
In Ethiopia, a comprehensive strategy to improve postabortion family planning services has produced overall improvement in the uptake of postabortion family planning and a rise in the choice of more effective long-acting reversible contraceptives to produce a more balanced method mix.
- Ugandan Women’s View of the IUD: Generally Favorable but Many Have Misperceptions About Health Risks
Women in Uganda are aware of the IUD and think it is an effective method, but many think it can damage the womb or make a woman infertile. Addressing public misperceptions through interpersonal communication and the mass media, and provider misperceptions through training, can help to build demand for the IUD in Uganda.
- Expanding Access to a New, More Affordable Levonorgestrel Intrauterine System in Kenya: Service Delivery Costs Compared With Other Contraceptive Methods and Perspectives of Key Opinion Leaders
At a public-sector transfer price of US$15 per unit, the direct service delivery cost of Medicines360's levonorgestrel intrauterine system (LNG IUS) per couple-years of protection is comparable with the cost of other contraceptive products commonly procured in Kenya. Interviews with key opinion leaders suggest that introduction of a more affordable LNG IUS could help increase demand for the method.
- Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan
Vouchers for family planning in Pakistan and Yemen reduced barriers, such as cost and availability, and encouraged public and private providers to improve skills, leading to an increase in uptake of long-acting reversible contraceptives and permanent methods.
- Increasing Uptake of Long-Acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence From a Difference-in-Differences Analysis
By reducing financial and information barriers, a family planning voucher program in Cambodia significantly increased contraceptive choice and uptake of more effective long-acting reversible contraceptives among poor women and women with the least education. Without vouchers, many of these women would not have used contraception or would not have chosen their preferred method.
- The Mayer Hashi Large-Scale Program to Increase Use of Long-Acting Reversible Contraceptives and Permanent Methods in Bangladesh: Explaining the Disappointing Results. An Outcome and Process Evaluation
The Mayer Hashi program resulted in a modest increase in use of long-acting reversible contraceptives and permanent methods in Bangladesh, but less of an increase than in comparison nonprogram districts, which appears to have been the result of weaknesses in the health system environment in the program districts. Addressing system issues to support providers beyond training might have led to better results.
FIELD ACTION REPORTS
- Increasing Use of Postpartum Family Planning and the Postpartum IUD: Early Experiences in West and Central Africa
Competency-based training in postpartum family planning and postpartum IUD (PPIUD) service delivery of antenatal, maternity, and postnatal care providers from 5 francophone African countries generated an enthusiastic response from the providers and led to government and donor support for expansion of the approach. More than 2,000 women chose and received the PPIUD between 2014 and 2015. This model of South–South cooperation, when coupled with demand promotion, supportive supervision, and reliable collection of service outcome data, can help to expand PPIUD services in other regions as well.
