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Holistic Approach Enhances Family Planning Programs: RESPOND’s Experience with the SEED Programming Model™ (Project Brief No. 27)
The Supply–Enabling Environment–Demand (SEED™) Programming Model is a holistic model developed by EngenderHealth to apply globally and locally to guide the design, implementation, and evaluation of family planning programs. RESPOND designed and implemented its activities using the SEED model as its principal programming and conceptual framework. This paper describes how SEED was used to frame global initiatives to advocate, promote, and support family planning as an essential primary health care intervention. It also presents specific country examples of how SEED enhanced and improved the outcomes of family planning programming, especially when all three elements worked in synergy.
Available in English (PDF, 3.1 MB)

Expanding Access to Modern Contraception Using Advocacy to Spur Action: RESPOND’s Experience in Malawi (Project Brief No. 26)
In Malawi, use of modern contraception among married women increased from 28% to 42% between 2004 and 2010, yet the number wanting to use modern methods will continue to increase, as nearly half of all married women and men state that they want no more children. RESPOND provide the government and local partners with technical assistance to advance access to and use of family planning—particularly long-acting reversible contraceptives and permanent methods—to support their ongoing on-the-ground efforts. As the result of a combination of gathering stakeholders, introducing Reality Check tool to advance understanding of the importance of providing family planning, strengthening district planning efforts, improving contraceptive security, inspiring local champions, and preparing providers to offer permanent methods, the country now has multiple tools, models, and approaches with which to expand access to and use of a wide range of family planning methods.
Available in English (PDF, 3.1 MB)

Increasing Male Engagement in HIV Prevention in Côte d’Ivoire (Project Brief No. 25)
Harmful gender norms and inequalities continue to fuel the HIV epidemic in Côte d’Ivoire. Socially constructed expectations about men’s and women’s responsibilities, roles, and attitudes are a root cause of men’s and women’s differential risk of HIV infection. Qualitative research explored reasons for lack of male engagement and perceptions about gender roles. Using EngenderHealth’s Men As Partners® (MAP®) approach, RESPOND worked with health care providers and with religious and community leaders to make health services more male-friendly and increase male engagement in HIV prevention. From 2011 to 2014, RESPOND engaged with seven pilot facilities, training providers and community leaders and providing informational materials to increase male engagement and promote couples testing for HIV. By the end of the project, the percentage of people being tested for HIV at the facilities who were men increased 5% to more than 20%.
Available in English (PDF, 3.2 MB)

Improving Clients’ Access to Long-Acting Methods: Enhancing the Capacity of IPPF Member Associations in West Africa (Project Brief No. 24)
Contraceptive use in West Africa is very low, and long-acting and permanent methods (LA/PMs) in particular are underutilized. To address this need, the RESPOND Project launched an initiative in 2011 in collaboration with the International Planned Parenthood Federation (IPPF) to build the capacity of six West African member associations (MAs). The first three MAs were supported through a six-step process of self-assessment, capacity building, contraceptive technology updating, and action planning, using the Organizational Capacity Assessment Tool (OCAT). Use of LA/PMs and overall contraceptive use increased significantly during the initiative. These three MAs also led an additional three MAs through an abbreviated version of the same process, sharing their experiences and building their own capacity for facilitation and assessment. The latter group of MAs reported finding the OCAT process both helpful and necessary, said they would continue to use OCAT, and reported that the process had improved their ability to offer LA/PM services.
Available in English (PDF, 3.1 MB)

Prevention of and Response to Gender-Based Violence in Two Provinces of Burundi (Project Brief No. 23)
Gender-based violence (GBV)—defined as physical, psychological, and/or sexual violence—is pervasive in Burundi. In 2012, RESPOND Project began working with the government to strengthen GBV prevention and response efforts in two provinces—Kayanza and Muyinga. Strategies included initiating complementary interventions to strengthen health facilities’ capacity to provide services to GBV survivors, promoting gender-equitable norms at the community level, and strengthening linkages between communities and the health care system to facilitate access to services. Evaluation results suggest that providers became more knowledgeable about GBV case management, more likely to refer clients for other services, and more likely to have the appropriate supplies and equipment at their disposal. In addition, surveys and interviews suggested a shift toward more gender-equitable norms.
Available in English (PDF, 3.2 MB) and French (PDF, 3.3 MB)

Reality Check Experiences: Use of a Program Planning and Advocacy Tool for Family Planning Initiatives (Project Brief No. 22)
Reality Check is an easy-to-use tool that family planning (FP) programs can use to set realistic FP goals and plan for service expansion to meet them, as well as to generate data for advocacy purposes. Between 2010 and 2014, RESPOND conducted Reality Check activities in Bangladesh, Burkina Faso, Ghana, Kenya, Malawi, Senegal, Tajikistan, and Togo. This brief summarizes outcomes from and experiences in these countries and identifies keys to successful adoption.
Available in English (PDF, 3.2 MB)

The Female Sterilization Standardization Plus Initiative: Building Capacity for Providing Minilaparotomy in Four Countries (Project Brief No. 21)
While a large number of couples in developing countries have an unmet need to limit future births, many of these countries lack easy access to female and male sterilization services. RESPOND undertook an activity to increase service providers’ capacity to deliver high-quality female sterilization services in four countries in Africa. Its objective was to standardize the skills of minilaparotomy trainers in Ethiopia, Ghana, Kenya, and Malawi, who would then conduct cascade trainings with additional providers in their home countries.
Available in English (PDF, 3.4 MB)

Improving and Sustaining Contraceptive Security in Tanzania (Project Brief No. 20)
For contraceptive security to exist (i.e., when people are able to choose, obtain, and use the contraceptive methods and services they desire from among a full range of methods), three basic elements are needed at a service delivery point: contraceptives themselves; necessary medical equipment, instruments, and supplies; and trained staff. EngenderHealth’s COPE® for Contraceptive Security was tested in Newala and Meru districts in Tanzania, to document its impact on districts’ and facilities’ capacity to forecast, budget, requisition, and manage their inventory and to test the tool’s effectiveness in increasing access to all family planning methods. The tool helped facility staff to identify and resolve challenges to contraceptive security. Its use both increased contraceptive availability at the participating facilities and boosted providers’ and clients’ confidence that methods would be available.
Available in English (PDF, 3.3 MB)

Breaking Down Barriers to Contraceptive Choice in the Public Health Sector in Burkina Faso and Togo (Project Brief No. 19)
Married women in Burkina Faso and Togo have very low rates of contraceptive use (particularly long-acting methods) and comparatively high rates of unmet need for family planning. Between 2010 and 2013, the RESPOND Project worked to build public-sector capacity in Burkina Faso and Togo to overcome barriers to contraceptive choice. The Ministry of Health in each country received technical assistance to strengthen the supply of family planning services, foster an enabling environment, and cultivate demand for services. Access to a wide range of methods increased dramatically in the areas of the intervention. Clients came in large numbers for long-acting methods: By the end of the intervention, facilities in the two countries had provided more than twice as many implants per month as they had in the same month of the prior year.
Available in English (PDF, 3.5 MB)

Reaching Young Married Couples in Bangladesh: An Underserved Population for Long-Acting Methods of Contraception (Project Brief No. 18)
In Bangladesh, more than 70% of married adolescents become pregnant before their first anniversary, and the mean age at first pregnancy is 16.4. Young couples rarely use contraception before the birth of their first child. An 18-month project to provide young married couples with better information and services on family planning trained peers to be the main source of information for young men and women in the community and to serve as a link between the community and a facility. An evaluation revealed a small increase in contraceptive use and a shift to more effective methods (the intrauterine device [IUD] and hormonal implants), as well as higher levels of communication about family planning between spouses.
Available in English (PDF, 3.4 MB)

Introducing Postpartum Family Planning in Maternal Health Services in Low-Performing Areas of Bangladesh (Project Brief No. 17)
A holistic programming effort to mainstream postpartum family planning services through the public-sector health care system was implemented between June 2009 and September 2013 in 21 disadvantaged project districts in Barisal, Chittagong, and Sylhet divisions in Bangladesh. A total of 111 facilities introduced postpartum family planning services where these were previously not available. Overall, uptake of these services increased over time (particularly for tubal ligation), due both to increased demand and to greater availability at more facilities. Integrating postpartum family planning with maternal health services can contribute significantly to increasing postpartum contraceptive use.
Available in English (PDF, 3.3 MB)

Strengthening National Family Planning Information Systems through Data Quality Assessment: Lessons from Bangladesh (Project Brief No. 16)
Data quality assessment (DQA) was used in Bangladesh to strengthen the public-sector management information system (MIS). An auditing process for assessing the quality of the reported data/statistics, DQA identified duplication of LA/PM performance reporting; transcription errors and data inconsistencies; and weak record keeping and reporting of drop-out. DQA also revealed that the MIS underreported use of long-acting and permanent methods. EngenderHealth provided technical assistance to help strengthen the capacity of Directorate General of Family Planning staff to manage and report data.
Available in English (PDF, 3.4 MB)

Expanding Contraceptive Choice in West Africa: Building the Capacity of Local Nongovernmental Organizations to Program Holistically (Project Brief No. 15)
Between 2011 and 2013, member associations of the International Planned Parenthood Federation (IPPF) in Benin, Burkina Faso, and Togo received technical assistance to expand people’s access to a wide range of family planning options. The MAs assessed their capacity to provide long-acting reversible contraceptives using RESPOND’s Organizational Capacity Assessment Tool. Managers from the MAs participated in an organizational capacity-building and design workshop, and providers and supervisors from the MAs received training to improve family planning services. The initiative also involved the MAs’ developing holistic action plans, conducting a second self-assessment, and sharing their experiences with each other at a South-to-South consultative meeting. Over the course of the intervention, all three MAs saw marked increases in the number of couple-years of protection they provided.
Available in English (PDF, 3.3 MB) and French (PDF, 3.2 MB)

Using a Quality Improvement Approach to Improve Contraceptive Security in Tanzania (Project Brief No. 14)
The Tanzanian health ministry has made great strides toward achieving contraceptive security at the national and regional levels, but contraceptive security is weaker at lower-level health facilities, due to stock-outs of contraceptives and their related supplies, as well as human resource constraints. RESPOND developed a variation of EngenderHealth’s COPE® tools and approach focused on contraceptive security, with self-assessment guides and facility checklists to guide facility staff in thinking through all of the necessary elements to support contraceptive security. An assessment showed that COPE for Contraceptive Security was an effective and low-resource intervention to mobilize facility staff to identify and to begin to resolve challenges to contraceptive security.
Available in English (PDF, 3.4 MB)

Communities Take Action in Kenya: Strengthening Postabortion Care (Project Brief No. 13)
In Kenya, abortion-related complications are a leading cause of morbidity among women. RESPOND designed an intervention package, the Community Mobilization for Postabortion Care (COMMPAC) project, to increase awareness and use of postabortion care (PAC) services and improving family planning, reproductive health, and maternal health outcomes. After the intervention, women in the project areas were more likely to seek PAC services at dispensaries when they experienced pregnancy complications than those in comparison areas, and providers became more confident about offering such services.
Available in English (PDF, 3.7 MB) and French (PDF, 3.4 MB)

Views on Family Planning and Long-Acting and Permanent Methods: Insights from Cambodia (Project Brief No. 12)
Contraceptive prevalence has increased in Cambodia in recent years, with current method use twice as high in 2010 as in 2000 and knowledge of family planning methods at an all-time high. Yet Cambodia missed its Millennium Development Goal (MDG) target for modern method prevalence in 2010, the contraceptive method mix remains limited, and reliance on traditional methods is growing. As part of a broader study of attitudes about contraception, RESPOND conducted qualitative research among current female users of long-acting and permanent methods, postpartum women not practicing contraception, women who had discontinued method use, married men, and health care providers. Results revealed a need to increase the knowledge and training of providers, do more to dispel myths about family planning methods, strengthen outreach and counseling, and improve messaging about contraception.
Available in English (PDF, 3.5 MB)

Views on Family Planning and Long-Acting and Permanent Methods: Insights from Malawi (Project Brief No. 11)
Despite high levels of contraceptive knowledge in Malawi and a recent climb in the contraceptive prevalence rate, fertility rates remain elevated. As part of a broader study of attitudes about contraception, RESPOND conducted qualitative research among current female users of long-acting and permanent methods, postpartum women not practicing contraception, women who had discontinued method use, married men, and health care providers. Results revealed concerns and misunderstandings about modern contraceptives, particularly about permanent methods. Gender norms were seen as hindrances to contraceptive adoption. Satisfied clients could be deployed to talk about their chosen method, explain their reasons for adopting it, and discuss the advantages they derive from it.
Available in English (PDF, 3.5 MB)

Views on Family Planning and Long-Acting and Permanent Methods: Insights from Nigeria (Project Brief No. 10)
Nigeria, the most populous nation in Africa, has high levels of fertility and maternal mortality and very low levels of contraceptive use, with just 10% of married women of reproductive age using a modern contraceptive method. Thus, unmet need for family planning is high, especially unmet need for spacing births. As part of a broader study of attitudes about contraception, RESPOND conducted qualitative research among current female users of long-acting and permanent methods, postpartum women not practicing contraception, women who had discontinued method use, married men, and health care providers. Results revealed negative attitudes toward couples with few children, misinformation about long-acting methods, and gender norm–related barriers to contraceptive adoption. Stock-outs and provider biases also were noted as problems.
Available in English (PDF, 3.3 MB)

Adapting an Employer-Based Approach to Support Increase Access to and Use of LA/PMs (Project Brief No. 9)
The RESPOND Project implemented an employer-based approach in Kanpur, Uttar Pradesh, India, that sought to increase workers' awareness of and utilization of family planning, particularly long-acting and permanent methods (LA/PMs). 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. The approach proved successful at reaching employees with information about LA/PMs. Employers were generally supportive of the initiative. Moreover, clients reported that the workplace is a good setting for reaching men with information about family planning. Workplace initiatives have great potential for increasing information about and use of LA/PMs.
Available in English (PDF, 3.8 MB) and French (PDF, 3.4 MB)

Achieving Positive Policy Changes for Family Planning in Bangladesh (Project Brief No. 8)
While contraceptive prevalence in Bangladesh has increased nearly eight-fold over the past 30 years and the total fertility rate has fallen, policy barriers and outdated medical eligibility criteria still sometimes impede clients' access to the method of their choice—particularly long-acting and permanent methods. Using EngenderHealth's Supply-Enabling Environment-Demand (SEED) programming model, the RESPOND/Mayer Hashi project worked with the Directorate General of Family Planning to improve the policy environment around LA/PM use, through a careful, structured process that relied heavily on consultation with local partners about critical obstacles in the field. Regulations on access to tubal sterilization and to implants were loosened, clinic registration procedures were streamlined, and postpartum family planning services were introduced into private facilities.
Available in English (PDF, 3.2 MB)

Acceptability of Sino-Implant (II) in Bangladesh: Six-Month Findings from a Prospective Study (Project Brief No. 7)
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. As of the midpoint of the one-year study, users of Sino-implant (II) appear to have found it acceptable, with relatively few discontinuing its use and most users reporting their general satisfaction with the method.
Available in English (PDF, 3.2 MB)

Making Family Planning Accessible, and Affordable: The Experience of Malawi (Project Brief No. 6)
Malawi has made notable strides in the provision of family planning services. In addition to a dramatic increase in the use of modern contraceptive methods overall, Malawi has seen sustained use of injectable contraceptives and of long-acting and permanent methods. This review of Malawi's family planning program provides a better understanding of the factors that underpin its recent successes, by highlighting key achievements, relaying the story behind the program's success, and examining plans for sustaining and building on its recent achievements.
Available in English (PDF, 3.6 MB)

Building the Capacity of IPPF Affiliates in West Africa: Use of a New Tool for Program Assessment (Project Brief No. 5)
Although some African countries have seen substantial increases in family planning use, relatively few people in many francophone West African countries use modern methods. This project brief describes technical assistance provided by the RESPOND Project to the International Planned Parenthood Federation (IPPF) member associations (MAs) in Benin, Burkina Faso, Mali, and Togo to strengthen their provision of long-acting family planning methods. Specifically, through the use of an Organizational Capacity Assessment Tool, the MAs appraised key programming components, systems, and functions at the organizational level and developed an overview of their organizational strengths and weaknesses that will serve as a starting point for planning to improve their capacity to offer access to a greater variety of family planning methods.
Available in English (PDF, 3.2 MB) and French (PDF, 3.0 MB)

Kenyan Family Planning Providers Leverage Local Resources to Train Their Peers on Long-Acting and Permanent Methods (Project Brief No. 4)
In response to declining use of long-acting and permanent methods (LA/PMs) in Kenya, the Ministry of Health's Department of Reproductive Health asked the RESPOND Project to help them implement their strategy for improving the uptake of LA/PMs in the family planning program. RESPOND implemented an innovative approach designed to quickly and sustainably increase the number of providers prepared to offer LA/PMs, while fostering ownership and sustainability by leveraging local resources for training. As a result, at the facilities where providers were trained, family planning clients adopted 25 times more implants and seven times more IUDs in May 2011 than in May 2010.
Available in English (PDF, 3.5 MB)

Factors Affecting Acceptance of Vasectomy in Uttar Pradesh: Insights from Community-Based Participatory Qualitative Research (Project Brief No. 3)
After interest in vasectomy ebbed following controversies in the 1970s, the Indian government has renewed its focus on vasectomy and intends to increase the uptake of this family planning method. RESPOND provided technical assistance to the government of the state of Uttar Pradesh to expand awareness of, acceptance of, and access to no-scalpel vasectomy (NSV) services. A qualitative anthropological approach was used to determine barriers to NSV use, people's perceptions about NSV and family planning, and how these affect decision making on whether to use this permanent method. The findings offer crucial insights for understanding the low prevalence of vasectomy in Uttar Pradesh and recommendations for how to expand awareness about, acceptance of, and access to NSV services in the future.
Available in English (PDF, 3 MB)

Preventing Postpartum Hemorrhage: Community-Based Distribution of Misoprostol in Tangail District, Bangladesh (Project Brief No. 2)
Deaths related to postpartum hemorrhage (PPH) present a major challenge to health systems, particularly in rural areas of Bangladesh, where infrastructure is poor and health care facilities often lack skilled staff, drugs, and equipment. Misoprostol is a proven uterotonic drug that is increasingly used in clinical and home delivery settings to prevent and manage PPH. This project brief discusses the implementation of a pilot project in the Tangail District of Bangladesh to determine the effectiveness of using government and nongovernmental field workers at the community level to distribute misoprostol tablets and ensure that women take the drug immediately postpartum. In addition to the programmatic intervention strategies, it looks at health outcomes, women's views and experiences, as well as lessons learned and recommendations for moving forward.
Available in English (PDF, 3.3 MB)

Promoting Hormonal Implants within a Range of Long-Acting and Permanent Methods: The Tanzania Experience (Project Brief No. 1)
One of the challenges to increasing the availability of implants has been ensuring sufficient commodities to meet demand—an issue that many family planning programs face. EngenderHealth supported the Tanzanian Ministry of Health and Social Welfare in introducing and expanding access to long-acting and permanent methods of contraception (LA/PMs), focusing specifically on hormonal implants. Implant use has increased steadily in Tanzania since 2004, and among LA/PMs, implants have become the method with the largest uptake. These results demonstrate the positive effect of expanding services to lower- level facilities and the importance of implementing task sharing. During this process of expansion, nurse practitioners have become the primary providers of implants in Tanzania.
Available in English (PDF, 4.2 MB)

Hormonal Implant Services: Delivering a Highly Effective Contraceptive Method Now Available at Reduced Cost (Technical Brief No. 2)
The three brands of hormonal implants currently available—Implanon®, Jadelle®, and Sino-implant (II)®—are all convenient, highly effective, long-acting, and reversible methods of contraception. It is expected that more than 40 million implants will be made available at reduced cost to low-resource countries between 2013 and 2018. Lowered cost will not necessarily lead to wider access and use, however; for that to happen, programs will also have to ensure informed choice, careful client selection, an adequate, well-deployed complement of skilled and motivated providers, good counseling, capable management of side effects, adequate follow-up, and reliable availability of prompt removal services. This Technical Brief reviews the characteristics of the hormonal implant, programmatic considerations for service delivery and scale-up, and the potential health benefits of improved access to implants.
Available in English (PDF, 2.9 MB) and French (PDF, 2.9 MB)

Hormonal Implants: Service Delivery Considerations for an Improved and Increasingly Popular Method (Technical Brief No. 1)
Hormonal implants are a highly effective, very safe, and reversible form of progestin-only contraception that is quickly and easily provided by a trained provider in a few minutes via a minor surgical procedure. Nearly all women can use this long-acting method, at any stage in their reproductive life. This Technical Brief provides an overview of the characteristics of this method, as well as of the programmatic considerations for service delivery, including client eligibility, providers' ability to offer implants, service quality, and access, to name a few.
Available in English (PDF, 2.9)

© 2009-2014 EngenderHealth/The RESPOND Project.
COPE, Men As Partners, and MAP are registered trademarks of EngenderHealth. SEED is a trademark of EngenderHealth.
Photo credits: M. Tuschman/EngenderHealth; A. Fiorente/EngenderHealth; C. Svingen/EngenderHealth.

This web site was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID), under the terms of the cooperative agreement GPO-A-000-08-00007-00. The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the USAID or the U.S. Government.

The RESPOND Project Digital Archive, Version 2.0