Access, Service Capacity, and Quality :

Research Studies and Reports

End-of-Project Evaluation of the RESPOND No-Scalpel Vasectomy Initiative in Uttar Pradesh and Jharkhand States, India (Report No. 15)
Vasectomy is safer, simpler, less expensive, and more effective than female sterilization. However, in both Uttar Pradesh and Jharkhand states in India, male sterilization comprises just over 1% of all modern family planning use, while female sterilization represents 44–70% of modern family planning use in those states. To ensure that men and couples have access to accurate information about and quality services for all methods of family planning, including no-scalpel vasectomy (NSV), RESPOND implemented a four-year technical assistance project to expand awareness and acceptance of and access to NSV services. This end-of-project evaluation was conducted to assess capacity for service delivery and NSV promotion at the state, district, and facility levels in nine project districts. The evaluation, conducted in September and October 2013, included stakeholder, fieldworker, provider, and client interviews, facility audits, and provider and fieldworker observations.
Available in English (PDF, 2.3 MB)

Mobile Outreach Services for Family Planning in Tanzania: An Overview of Financial Costs (Report No. 14)
Mobile outreach is a vital service delivery approach to expand access to long-acting and permanent methods of contraception (LA/PMs), but only limited information is available on the cost efficiency of different outreach service models. The RESPOND Project, through its partner FHI 360, conducted an analysis of the financial costs for different models of mobile family planning services in Tanzania. Limitations in the availability and consistency of data precluded the calculation of representative cost estimates for two models; therefore, this report presents results of the analysis only for a model implemented by Marie Stopes Tanzania. Over a five-month period, six MST teams provided LA/PMs to more than 14,000 women, producing an estimated 76,000 couple-years of protection (CYPs). The average cost per LA/PM acceptor was US $22; the average cost per CYP was about US $4. Labor was the single largest cost component, closely followed by the costs of contraceptives and expendable supplies. Individual expeditions served anywhere from 171 to 829 clients.
Available in English (PDF, 1.8 MB)

Approaches to Mobile Outreach Services for Family Planning: A Descriptive Inquiry in Malawi, Nepal, and Tanzania (Report No. 13)
Mobile outreach services for family planning are widely used in the global South to reach underserved populations, yet documentation on them is sparse. Between 2010 and 2012, The RESPOND Project studied mobile outreach services in Malawi, Nepal, and Tanzania. Observations at 20 facilities and interviews with more than 150 providers, clients, managers, and policymakers led to several key findings: Program managers and staff must ensure quality of care, even under difficult circumstances; attention must be paid to ensuring the availability of contraceptives, equipment, and expendable supplies; supervision is an important component of mobile outreach; mobile services offer opportunities for on-the-job training, coaching, and skills improvement for new staff and for those needing refresher training; and demand creation efforts (particularly by community health workers) are important for reaching underserved populations.
Available in English (PDF, 2 MB)

Acceptability of Sino-Implant (II) in Bangladesh: Final Report on a Prospective Study (Report No. 8)
Bangladeshi women's interest in hormonal implants appears to have risen in recent years. The RESPOND Project and Mayer Hashi were asked by Bangladesh's Directorate General of Family Planning to conduct an acceptability trial of one implant, Sino-implant (II), to inform the decision on whether to introduce this implant into the national family planning program. The noncomparative prospective 12-month observational study was conducted at 10 study sites in Bangladesh, among 595 women who had the device inserted in June and July 2011. Both at baseline and at the 12-month follow-up, most women were satisfied with the implant. The majority (94–97%) said their experience with the method was very or somewhat favorable. No serious adverse events or pregnancies were reported. At 12 months, two-thirds of the women reported no changes in physical or mental health that could be related to the implant use.
Available in English (PDF, 1.9 MB)

Using an Employer-Based Approach to Increase Support for and Provision of Long-Acting and Permanent Methods of Contraceptive: The India Experience (Report No. 7)
An employer-based approach was initiated in Uttar Pradesh, India, to increase workers' awareness of and utilization of family planning. Ten companies participated in the project from January 2011 to June 2012, providing a venue for project activities and allowing employees to attend activities during normal working hours. RESPOND developed and distributed print materials (such as posters, brochures, and self-standing poster displays) to provide employees with information, oriented 27 health coordinators from the participating businesses who implemented health talks and staffed health desks placed in a well-trafficked area of the company, and provided referrals to interested clients. Evaluation results suggest that the initiative helped change attitudes and behaviors around family planning, induced employees to discuss family planning with their spouses, and led users of short-acting methods to switch to more effective methods.
Available in English (PDF, 2 MB)

Kenya Preservice Training for Long-Acting and Permanent Methods of Contraception: Assessment Report
This nationwide assessment was designed to help Kenya’s Division of Reproductive Health and preservice training institutions improve efforts to prepare future health cadres to provide long-acting and permanent methods of contraception, by examining the current status of preservice education for these methods, the extent to which skills labs are able to provide students with quality practice, whether students are trained for the tasks they are expected to perform, and what can be done to improve preservice training for such methods.
Available in English (PDF, 1.4 MB)

Factors Underlying the Use of Long-Acting and Permanent Family Planning Methods in Nigeria: A Qualitative Study (Report No. 5)
Long-acting and permanent methods of contraception (LA/PMs) are safe and cost-effective family planning methods for women who desire to delay or limit births, yet they are often underutilized. In Nigeria, these methods contribute only about 10% of all modern contraceptive use. Qualitative research conducted by RESPOND partner Johns Hopkins Bloomberg School of Public Health Center for Communication Programs (JHU•CCP) revealed some of the attitudes and beliefs that hinder demand for LA/PMs in Nigeria. Despite general awareness about family planning methods, considerable misinformation about specific LA/PMs persists. Fear of side effects is a key factor hindering family planning use. Study participants felt that husbands often resist the idea of modern method use because they lack knowledge about such methods, believe myths and negative rumors about them, and associate family planning with women's infidelity. Women need to learn how to use convincing, evidence-based arguments to counter husbands' resistance to contraceptive use.
Available in English (PDF, 2.1 MB)

Factors Affecting Acceptance of Vasectomy in Uttar Pradesh: Insights from Community-Based, Participatory Qualitative Research (Report No. 3)
India's government has renewed its focus on vasectomy and intends to increase the uptake of this safe and cost-effective family planning method. Vasectomy is, however, highly underutilized in Uttar Pradesh, one of India's largest states. A participatory ethnographic evaluation research was commissioned to understand the reasons for the low prevalence of vasectomy in Uttar Pradesh and to contribute to developing an approach for increasing demand for the procedure. Both men and women reported negative attitudes toward vasectomy, sharing many stories of times when the procedure had not worked or had affected a man's ability to provide for his family. However, positive testimonials about recent NSV experiences appear to be effective in motivating others to obtain the procedure.
Available in English (PDF, 2.6 MB)

Assessment of Rwanda’s National Family Planning Policy and its Five-Year Strategies (2005–2010)
In 2011, RESPOND provided technical assistance to Rwanda’s Ministry of Health (MOH) and to the USAID Mission to develop a five-year national family planning (FP) policy and related strategies. RESPOND worked with the MOH to develop a results framework and assessment scope of work based on Engenderhealth’s SEED Programming Model. As a result, the country has a comprehensive results framework and tools to guide the implementation of its new FP policy and associated strategies, as well as a blueprint for future work plans. The government’s realistic, results-based framework for FP was subsequently approved by Rwanda’s parliament.
Available in English (PDF, 942 KB)

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The RESPOND Project Digital Archive, Version 2.0