Access, Service Capacity, and Quality :


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)

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)

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)

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)

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)

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)

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)

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)

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)

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 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)

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The RESPOND Project Digital Archive, Version 2.0