Latest Articles
- Birthing Centers Staffed by Skilled Birth Attendants: Can They Be Effective … at Scale?
Peripheral-level birthing centers may be appropriate and effective in some circumstances if crucial systems requirements can be met. But promising models don’t necessarily scale well, so policy makers and program managers need to consider what requirements can and cannot be met feasibly at scale. Apparently successful components of the birthing center model, such as engagement of traditional birth attendants and use of frontline staff who speak the local language, appear conducive to use in other similar settings.
- Is Household Wealth Associated With Use of Long-Acting Reversible and Permanent Methods of Contraception? A Multi-Country Analysis
In general, across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods of contraception instead of short-acting methods. Exceptions are Bangladesh, India, and possibly Haiti.
- Fertility Awareness Methods: Distinctive Modern Contraceptives
Fertility awareness methods—the Lactational Amenorrhea Method, the Standard Days Method, and the Two Day Method—are safe and effective, and they have important additional benefits that appeal to women and men. Including these modern contraceptives in the method mix expands contraceptive choice and helps women and men meet their reproductive intentions.
- Expanding Access to the Intrauterine Device in Public Health Facilities in Ethiopia: A Mixed-Methods Study
Following the introduction of IUDs into the Ethiopian public health sector, use of the method increased from <1% in 2011 to 6% in 2014 in a sample of 40 health facilities. This shift occurred in the context of wide method choice, following provider training, provision of post-training supplies, and community-based awareness creation. The IUD was acceptable to a diverse range of clients, including new contraceptive users, those with little to no education, those from rural areas, and younger women, thus suggesting a strong latent demand for IUDs in Ethiopia.
- The Single-Visit Approach as a Cervical Cancer Prevention Strategy Among Women With HIV in Ethiopia: Successes and Lessons Learned
With the single-visit approach for cervical cancer prevention, women with positive “visual inspection of the cervix with acetic acid wash” (VIA) test results receive immediate treatment of the precancerous lesion with cryotherapy. The approach worked successfully for women with HIV in Ethiopia in secondary and tertiary health facilities, with high screening and cryotherapy treatment rates. Sustainability and appropriate scale-up of such programs must address wider health system challenges including human resource constraints and shortage of essential supplies.
- Results-Based Financing in Mozambique’s Central Medical Store: A Review After 1 Year
The RBF scheme, which paid incentives for verified results, steadily improved the CMS's performance over 1 year, particularly for supply and distribution planning. Key apparent success factors:
1) The CMS had full discretion over how to spend the funds
2) Payment was shared with and dependent on all staff, which encouraged teamwork.
3) Performance indicators were challenging yet achievable.
4) The quarterly payment cycle was frequent enough to be motivating.
Recommendations for future programs: focus on both quality and quantity indicators; strengthen results verification processes; and work toward institutionalizing the approach.
- Pre-eclampsia as Underlying Cause for Perinatal Deaths: Time for Action
Pre-eclampsia is a major underlying cause of late fetal and early neonatal death, accounting for somewhere between 1 in 10 and 1 in 4 perinatal deaths; it warrants greater efforts from the maternal-newborn community.
- Sexual Satisfaction, Performance, and Partner Response Following Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project
Most men and their partners reported increased or the same levels of sexual pleasure and improved or no change in penile hygiene post-VMMC. While half of men reported increased or no change in sexual functioning (orgasm, erections), one-third reported a decrease. Early resumption of sexual intercourse prior to complete healing was most closely associated with adverse outcomes, including decreased sexual functioning, satisfaction, and desire.
- Behavior Change Fast and Slow: Changing Multiple Key Behaviors a Long-Term Proposition?
An intensive radio campaign in rural areas of Burkina Faso addressed multiple key behaviors to reduce child mortality, using a randomized cluster design. After 20 months, despite innovative approaches and high reported listenership, only modest reported change in behavior was found, mainly related to care seeking rather than habitual behavior such as hand washing. Various methodologic difficulties may have obscured a true greater impact. Analysis of the intervention after its full 35-month duration may reveal more impact, including on actual child mortality. Improving a number of key behaviors is essential to child survival efforts, and much of it may require strong and sustained efforts.
- Family Planning Supply Environment in Kinshasa, DRC: Survey Findings and Their Value in Advancing Family Planning Programming
A series of facility-based surveys that mapped all sites providing family planning services and that assessed readiness to provide services, using mobile phones, was feasible in a low-resource setting, contributing to mobilization of partners and increased donor support. Between 2012 and 2013, readiness to provide services increased from 44% of sites to 63%. Three factors most associated with productivity: type of facility (clinics more than hospitals or health centers), more years in operation, and number of methods available.