Materials by Type :

Journal Articles

Progestin-Only Contraception: Injectables and Implants
Progestin-only contraceptive injectables and implants are highly effective, longer-acting contraceptive methods that can be used by a broad range of women. Globally, 6% of women using modern contraception use injectables and 1% use implants. Injectables are the predominant contraceptive method used in Sub-Saharan Africa, and account for 43% of modern contraceptive method use. Implants have the highest effectiveness of any contraceptive method. Commodity cost, which historically limited implant availability in low-resource countries, was markedly lowered between 2012 and 2013. Changes in menstrual bleeding patterns are extremely common with both methods and are a main cause of discontinuation. Whether these methods are associated with HIV acquisition remains controversial, with important implications for Sub-Saharan Africa, which has a disproportionate burden of both human immunodeficiency virus (HIV) and maternal mortality. Best Practice & Research Clinical Obstetrics & Gynaelcology, Volume 28, Issue 6, August 2014, pages 795-806.
Available online in English

Community Mobilization and Service Strengthening to Increase Awareness and Use of Post-abortion Care in Kenya: A Controlled, Pre-Post Assessment
A community engagement and service-strengthening intervention was introduced in Kenya to raise awareness of family planning and the risk of bleeding early in pregnancy bleeding and to increase use of both family planning and postabortion care (PAC) services. The intervention was carried out in three communities in Kenya over 18 months; three additional communities served as the comparison group. A quasi-experimental evaluation showed that awareness of family planning increased in the intervention group. Recognition of early bleeding during pregnancy rose slightly, as did care-seeking for this problem. The intervention appeared to raise awareness of family planning and of bleeding in early pregnancy, but not necessarily the use of related services. International Journal of Gynecology and Obstetrics, Volume 126, Issue 1, July 2014, pages 8–13.
Available online in English

Voluntary, Human Rights–Based Family Planning: A Conceptual Framework
At the 2012 London Summit on Family Planning, world leaders committed to providing effective family planning information and services to 120 million additional women and girls by the year 2020. Some concerns were expressed that setting numeric goals could signal a retreat from the human rights–centered approach that underpinned the 1994 International Conference on Population and Development. Achieving the FP2020 goal will take concerted and coordinated efforts among diverse stakeholders and a new programmatic approach supported by the public health and human rights communities. This article presents a new conceptual framework designed to serve as a path toward fulfilling the FP2020 goal. This new unifying framework incorporates human rights laws and principles within family planning program and quality-of-care frameworks. Studies in Family Planning, Volume 45, Issue 1, March 2014, pages 1-18.
Available online in English

Fostering Change in Medical Settings: A Holistic Programming Approach to “Revitalizing” IUD Use in Kenya
This book chapter discusses strategies to accelerate the rate, extent, and sustainability of change in medical care settings. It uses as a case example a two-year technical assistance project mounted by the RESPOND Project to revitalize use of the intrauterine device (IUD) in Kisii District of Kenya’s Nyanza Province. The project followed a holistic model involving a package of programmatic activities addressing supply, demand, and the policy/advocacy area. IUD use rose as a result of the intervention: An average of 142 IUDs were being inserted monthly at the 13 project sites by the project’s close in 2007, up more than 500% from a baseline average of 28 insertions per month. Despite district restructuring and transfer of skilled staff, increased annual levels of IUD provision were sustained for 30 months after the end of the project. Critical Issues in Reproductive Health: The Springer Series on Demographic Methods and Population Analysis, 2014, Volume 33, pages 243-264.
Available online in English

Meeting the Need for Modern Contraception: Effective Solutions to a Pressing Global Challenge
This article reviews such important topics as the benefits of family planning, trends in modern contraceptive use, the differential effectiveness of various modern methods, unmet need for modern contraception, the purpose and function of family planning programs, barriers to contraceptive access and use, and innovative and high-impact programming practices. The latter include such issues as postpartum family planning, postabortion family planning, task sharing/task shifting, and provision of mobile outreach services. The article also includes capsule summaries of family planning provision in three countries that represent "success stories" (Ethiopia, Malawi, and Rwanda), as well as of in a situation of universal access (in the United Kingdom). International Journal of Gynecology and Obstetrics, Volume 121, Supplement 1, May 2013, pages S9–S15.
Available online in English

Women’s Growing Desire to Limit Births in Sub-Saharan Africa: Meeting the Challenge
Secondary analyses of Demographic and Health Survey data from 18 countries examining the characteristics of Sub-Saharan African women who wish to limit childbearing find that young women often intend to limit their future births. This finding runs counter to the common assumption that only older women have such intentions. Large numbers of women have exceeded their desired fertility but do not use family planning, citing fear of side effects and health concerns as barriers. Moreover, many women who want no more children and who use contraception use short-acting contraceptive methods rather than the more effective long-acting or permanent methods. Analyses restricted to married women show that demand for limiting future births nearly equals that for spacing births. Global Health: Science and Practice, Volume 1, Number 1, March 2013, pages 97–107.
Available online in English

Contraceptive Implants: Providing Better Choices to Meet Growing Family Planning Demand
This commentary discusses the great potential of hormonal implants to help meet the growing demand for family planning in low-resource countries, especially given a recent marked reduction in commodity costs for this method. The authors highlight innovative service delivery approaches that have increased access to and use of implants, as well as programming pitfalls that must be avoided if implant services are to be scaled up widely and well. In particular, they advocate for the importance of taking a client-centered approach, nurturing providers, ensuring clients’ access to removal services, and making implant services available via dedicated providers and mobile services. Global Health: Science and Practice, Volume 1, Number 1, March 2013, pages 11–17.
Available online in English

Lessons From the Recent Rise in Use of Female Sterilization in Malawi
Although female sterilization is the most widely used modern contraceptive method in the world, most family planning programs in Africa have had difficulty providing it. Despite daunting constraints, Malawi has made female sterilization widely and equitably accessible, thereby increasing method choice and helping its citizens better meet their reproductive intentions. Ten percent of currently married Malawian women of reproductive age rely on female sterilization for contraceptive protection, compared with less than 2% across Africa, and demand to limit births now exceeds demand to space births. Female sterilization prevalence in Malawi surpasses that of some high-resource countries. Supportive policies, strong public-private partnerships, and mobile services delivered at no cost by dedicated providers all have contributed to this achievement. Malawi's experience offers lessons for other countries with low female sterilization availability and similar resource constraints. Studies in Family Planning, Volume 44, Number 1, March 2013, pages 85-95.
Available online in English

Contraceptive Security: Incomplete Without Long-Acting and Permanent Methods of Family Planning
This commentary reviews the importance of long-acting and permanent methods (LA/PMs) of family planning and considers why they have been neglected in national contraceptive security strategies and family planning programs. The article also provides recommendations for broadening method choice to include LA/PMs more fully, thereby increasing the ability of women and men to achieve their reproductive intentions. Studies in Family Planning, Volume 42, Number 4, December 2011, pages 291-298.
Available online in English

The Ghana Vasectomy Initiative: Facilitating Client-Provider Communication on No-Scalpel Vasectomy
An initiative to improve client and provider knowledge and acceptance of no-scalpel vasectomy (NSV) was undertaken in Ghana in 2003–2004 and 2007–2008. Implemented at eight facilities, the initiative included the training of physicians in NSV; training of all site staff in the provision of ‘‘male-friendly'' services; and health promotion activities to talk about NSV to prospective clients. Client-provider communication was assessed via a mystery client study, and knowledge and acceptance of NSV among potential clients were assessed with baseline and follow-up surveys. The results suggest that complementary, sustained provider training in client-centered services, coupled with targeted health promotion, can lead to improved client and provider knowledge and acceptance of NSV in an African context. Patient Education and Counseling, Volume 81, Issue 3, December 2010, pages 374–380.
Available online in English

Postabortion Family Planning: Addressing the Cycle of Repeat Unintended Pregnancy and Abortion
Postabortion family planning has always been a key element of postabortion care (PAC) services and provides a powerful rationale for PAC services. In practice, however, PAC care usually focuses on treatment of complications, and family planning is often neglected. It is essential to restore the family planning component to PAC services, not only to prevent repeat unintended pregnancy and abortion, but also because it is integral to achieving the critical health objectives—reducing maternal morbidity and mortality, mother-to-child transmission of HIV, and new HIV infections. Women and communities should demand quality PAC services that provide them with accessible, cost-effective postabortion family planning care that will help them avoid unplanned pregnancy and repeat abortion, avoid HIV infection, improve the health of a woman's next child, and ultimately enhance the health of her family. International Perspectives on Sexual and Reproductive Health, Volume 36, Number 1, March 2010, pages 44-48.
Available online in English

Fostering Change in Medical Settings: Some Considerations for Family Planning Programmes
Most contraceptive methods and services in family planning programs are provided in medical settings. Service provision depends upon the knowledge, skills, and behavior of health care providers in these settings. Those who give technical assistance to family planning programs need to understand the nature of medical settings and the dynamics of behavior change there, so as to increase access to quality family planning services. This peer-reviewed article underscores the importance of understanding the nature of medical settings and the dynamics of behavior change within them to increase access to quality family planning services. IPPF Medical Bulletin, Volume 43, Number 3, September 2009, pages 3-4.
Available online in English

Demographics of Vasectomy—USA and International
In the United States, vasectomies are carried out more often than any other urologic surgical procedure, with approximately half a million procedures performed annually. Worldwide, however, female sterilization is approximately seven times as common as vasectomy, even though vasectomy is less expensive and is associated with less morbidity and mortality than female sterilization. This article provides demographic details about the use of vasectomy in the United States. The August 2009 issue of Urological Clinics of North America focuses on vasectomy and provides the practitioner with the essential information to guide clients’ interest in the procedure. Urological Clinics of North America, Volume 36, Issue 3 , August 2009, pages 295-305.
Available online in English

Blood, Men and Tears: Keeping IUDs in Place in Bangladesh
The intrauterine device (IUD) is an effective method of contraception, but in Bangladesh it is associated with high levels of discontinuation within the first year. Among a retrospective cohort of women who had an IUD inserted 12 months earlier, 330 women were interviewed about factors associated with discontinuation. Nearly half had discontinued use one year postinsertion. IUD discontinuation was strongly associated with side-effects (heavier periods; abdominal pain) and spousal factors (not discussing IUD with husband prior to insertion), but not with service delivery factors. Among those who discontinued, spouses were generally unsupportive and sometimes abusive, particularly when not involved in the decision to use the IUD. Culture, Health & Sexuality, Volume 11, Issue 5, June 2009, pages 543–558.
Available online in English

Fragile, Threatened, and Still Urgently Needed: Family Planning Programs in Sub-Saharan Africa
Using the latest evidence about trends in modern contraceptive use, fertility, unmet need, urbanization, and poverty in eight key African countries (Ghana, Kenya, Malawi, Nigeria, Senegal, Tanzania, Uganda, and Zambia), this commentary discusses the ongoing threats to family planning programs from such factors as HIV and AIDS, inadequacy of the health care workforce, health sector reform, and decreased funding. The article underscores the continuing validity of the health, equity, demographic, and development rationales for increased support to organized family planning programs, many of which are experiencing stagnation or falloff in performance, and also summarizes what service approaches and interventions have been found to be most efficacious in increasing access to such services. Studies in Family Planning, Volume 40, Number 2, June 2009, pages 147-154.
Available online in English

© 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