More articles from ORIGINAL ARTICLE
- Expanding Access to Injectable Contraception: Results From Pilot Introduction of Subcutaneous Depot Medroxyprogesterone Acetate (DMPA-SC) in 4 African Countries
Nearly half a million doses of DMPA-SC were administered over 2 years in Burkina Faso, Niger, Senegal, and Uganda, with 29% of doses provided to first-time family planning users and 44% (in 3 countries) to adolescent girls and young women under age 25. Switching from intramuscular DMPA (DMPA-IM) was not widespread and generally decreased over time. Community health workers provided a higher proportion of DMPA-SC than DMPA-IM injections. Stock-outs in 2 countries hindered product uptake, highlighting the need to strengthen logistics systems when introducing a new method.
- Rapid Uptake of the Subcutaneous Injectable in Burkina Faso: Evidence From PMA2020 Cross-Sectional Surveys
Availability and use of the subcutaneous injectable increased rapidly during national scale-up in 2016. Substantial increases were found in rural areas, where unmet need for family planning is higher. Since the method is amenable to community-based distribution, a new pilot is testing provision by community health workers to further improve access.
- Using Program Data to Improve Access to Family Planning and Enhance the Method Mix in Conflict-Affected Areas of the Democratic Republic of the Congo
Analysis of program data and a formative assessment informed several program changes, including improved coaching and supportive supervision, introduction of postpartum IUDs and the levonorgestrel-releasing intrauterine system, and enhanced behavior change communication. These changes substantially increased family planning adoption, from a monthly average of 14 adopters per facility to 37 per facility. Implants continued to be the most popular method, but the percentage of adopters choosing the IUD increased from 2% in 2012 to 13% in 2016, and it was the most popular method among postabortion care clients.
- Building Support for Adolescent Sexuality and Reproductive Health Education and Responding to Resistance in Conservative Contexts: Cases From Pakistan
While there is no one-size-fits-all approach to building community support for such programs, key strategies in Pakistan included: (1) sensitizing and engaging key stakeholders, including religious groups, schools, health and education government officials, parents, and adolescents themselves; (2) tactfully designing and framing the curricula with careful consideration of context and sensitive topics; (3) institutionalizing the programs within the school system; (4) showcasing school programs to increase transparency; and (5) engaging the media to build positive public perceptions.
- Effective Collaboration for Scaling Up Health Technologies: A Case Study of the Chlorhexidine for Umbilical Cord Care Experience
Facilitating factors for the Chlorhexidine Working Group: (1) strong, transparent leadership by a neutral broker, promoting shared ownership among all members; (2) reliable internal and external communication; (3) well-defined terms of reference building on common interest around a simple, effective health intervention; (4) clear benefits of participation, including access to evidence and technical assistance; and (5) adequate resources to support the secretariat functions.
- Medical Education Partnership Initiative (MEPI) in Zimbabwe: Outcomes and Challenges
The 5-year medical education and research strengthening initiative in Zimbabwe increased faculty retention and student enrollment, improved information technology infrastructure, provided mentoring for postgraduates and clinical training in specialty areas, instituted a competency-based curriculum reform process, and created new departments and centers to institutionalize health education and research implementation. A comprehensive review of the curriculum is still underway and uptake of technology-assisted teaching has been slower than expected.
- Evolution and Resistance to Sexuality Education in Mexico
Mexico's efforts at sexuality education have progressively evolved, from a biological focus in the socialist era in the 1930s, to adding a demographically concerned family planning component in the 1970s and including a wider reproductive health perspective in the 1990s, and finally shifting to a broader sociological context in the early 21st century. Opposition to sexuality education rose steadily in the time period considered, with a growing range of more organized and well-financed actors. Despite this opposition, alliances between academic, government, civil society, and NGO champions have helped ensure sustainability.
- Let's Stop Trying to Quantify Household Vulnerability: The Problem With Simple Scales for Targeting and Evaluating Economic Strengthening Programs
Simple scales developed to measure broad constructs of household economic vulnerability in 3 countries did not accurately measure susceptibility to negative economic outcomes or generate valid classifications of economic status to use for targeting and monitoring and evaluation. We recommend designing tailored monitoring and evaluation instruments to capture narrower definitions of economic vulnerability based on characteristics that economic strengthening programs intend to affect and using separate tools for client targeting based on presence of context-specific “red flag” indicators.
- Maternal and Neonatal Directed Assessment of Technologies (MANDATE): Methods and Assumptions for a Predictive Model for Maternal, Fetal, and Neonatal Mortality Interventions
MANDATE is a mathematical model designed to estimate the relative impact of different interventions on maternal, fetal, and neonatal lives saved in sub-Saharan Africa and India. A key advantage is that it allows users to explore the contribution of preventive interventions, diagnostics, treatments, and transfers to higher levels of care to mortality reductions, and at different levels of penetration, utilization, and efficacy.
- Re-Evaluating the Possible Increased Risk of HIV Acquisition With Progestin-Only Injectables Versus Maternal Mortality and Life Expectancy in Africa: A Decision Analysis
Our model suggests that removing progestin-only injectables in Africa would have a net negative effect on maternal health, life expectancy, and mortality under a variety of scenarios.