Access, Service Capacity, and Quality :

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

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 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

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

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

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

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

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