Materials by Type :

Research Studies and Reports

The Effects of a Gender-Based Violence Awareness Campaign in Luanda, Angola: A Quasi-Experimental Study (Report No. 17)
At the request of the Angola Mission of the U.S. Agency for International Development (USAID), RESPOND developed and implemented a gender-based violence (GBV) awareness campaign in Cazenga, a low-income neighborhood of Luanda, Angola’s capital. The program was created in partnership with two local nongovernmental agencies. A quasi-experimental study conducted before and after the campaign assessed its impact on knowledge and attitudes related to GBV. Women’s attitudes related to GBV improved somewhat, but there was an equivalent change in the opposite direction among men. Most respondents were exposed to some aspect of the awareness campaign, and exposure to the campaign was associated with a reduction in the belief that GBV is justified.
Available in English (PDF, 2.6 MB)

Integrating Intimate Partner Violence Screening and Counseling with Family Planning Services: Experience in Conakry, Guinea (Report No. 16)
In September 2009, the Guinean armed forces repressed a peaceful political demonstration in Conakry; during this action, hundreds of women were subjected to sexual violence. RESPOND conducted an 18-month program to provide support services for these women, build local capacity to prevent gender-based violence, and improved the health sector’s ability to respond to such violence. As a result, RESPOND was asked to help integrate screening and counseling for intimate partner violence (IPV) into family planning services at a facility in Conakry. RESPOND pilot-tested a curriculum and supportive supervision model that trained providers to discuss IPV with FP clients, explore their family planning options, educate them about available medical, legal, and psychosocial services, and discuss personal safety issues and help them develop a safety plan. This report describes results of an assessment following provider training.
Available in English (PDF, 2.4 MB)

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)

Factors Influencing Women’s Reproductive Health Choices in Tirana, Albania (Report No. 12)
Albania has a markedly low prevalence of modern contraceptive use, as well as high abortion rates. In addition, public-sector clients often make informal payments to health care providers for services they should receive free of charge. In 2012, RESPOND interviewed clients and obstetrician-gynecologists in Tirana, Albania, to examine factors related to contraceptive adoption, abortion usage, and the health care system. While a sizable number of abortion clients say they intend to use a modern contraceptive method in the future, many fear potential side effects and hold exaggerated ideas about these. Abortion clients are rarely counseled about contraceptives, and ob-gyns often lack adequate knowledge to provide comprehensive counseling. Providers also sometimes require women beginning use of a modern method to go through an array of tests and make multiple follow-up visits. Future efforts to improve services there should focus on educating both clients and health care providers about contraception, as well as minimizing the financial barriers imposed by excessive tests and procedures.
Available in English (PDF, 1.9 MB)

Reproductive Health and Family Planning Services Received by Public-Sector Clients in Baku, Azerbaijan (Report No. 11)
Azerbaijan has a markedly low prevalence of modern contraceptive use, as well as high abortion rates. In addition, public-sector clients often make informal payments to health care providers for services they should receive free of charge. In 2012, RESPOND interviewed clients and obstetrician-gynecologists in Baku, Azerbaijan, to examine factors related to contraceptive adoption, abortion usage, and the health care system. While a sizable number of abortion clients say they intend to use a modern contraceptive method in the future, many fear potential side effects and hold exaggerated ideas about these. Abortion clients are rarely counseled about contraceptives, and ob-gyns often lack adequate knowledge to provide comprehensive counseling. Providers also sometimes require women beginning use of a modern method to go through an array of tests and make multiple follow-up visits. Future efforts to improve services there should focus on educating both clients and health care providers about contraception, as well as minimizing the financial barriers imposed by excessive tests and procedures.
Available in English (PDF, 1.9 MB) and Azerbaijani (PDF, 2.7 MB)

Encouraging Men’s Participation in HIV and AIDS Prevention and HIV Testing Services: Evaluation of the Men As Partners® (MAP) Approach in Côte d’Ivoire (Report No. 10)
Harmful social norms about masculinity and femininity are associated with high-risk sexual behavior. In Côte d’Ivoire, RESPOND provided technical assistance to build the capacity of local and international organizations to use the Men As Partners® (MAP) approach. By stimulating dialogue around gender and encouraging men and women to reject harmful norms and to promote those that protect health, MAP® trainings helped build the capacity of PEPFAR partners to incorporate gender-transformative messages into ongoing prevention efforts and of facilities to engage men in HIV services. This report highlights the findings and recommendations from a midcourse process evaluation conducted in March 2013.
Available in English (PDF, 5.4 MB) and French (PDF, 5.5 MB)

Replication of the Community Mobilization for Postabortion Care (COMMPAC) Model in Naivasha District, Rift Valley Province, Kenya: An Evaluation Report (Report No. 9)
Maternal health complications, including those arising from unsafe abortion and miscarriage, are a leading cause of morbidity among women in Kenya. In response to this need, the RESPOND Project replicated an existing intervention known as Community Mobilization for Postabortion Care (COMMPAC), which aims to increase awareness and use of postabortion care (PAC) services and improve family planning, reproductive health, and maternal health outcomes. The intervention was carried out in three communities in Naivasha District, Rift Valley Province, over 18 months in 2010 and 2011. By the end of the evaluation, awareness about danger signs in early pregnancy was higher among women in the intervention areas than at comparison sites, women who experienced pregnancy complications in the intervention areas had an increased tendency to seek PAC services at dispensaries, and providers' confidence about offering PAC services increased.
Available in English (PDF, 1.9 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)

Three Successful Sub-Saharan Africa Family Planning Programs: Lessons for Meeting the MDGs
Ethiopia, Malawi, and Rwanda appear to be moving more rapidly than other Sub-Saharan African countries toward Millennium Development Goal 5B, which calls for universal access to reproductive health, including family planning. How did these three countries make such strides? This report examines the similarities and differences among the countries, including the roles of individual leadership, financing systems, and country-specific geopolitical and demographic issues. The report also presents lessons that other countries can learn from experiences in these countries. It was compiled by USAID/Africa Bureau, USAID/Population and Reproductive Health, Ethiopia Federal Ministry of Health, Malawi Ministry of Health, and Rwanda Ministry of Health. The section on Malawi in this report was prepared by RESPOND Project staff.
Available in English (PDF, 1.3 MB)

Services for Sexual Violence Survivors in Kayanza and Muyinga Provinces, Burundi
Burundi is emerging from a long period of civil conflict in which sexual violence was used as a weapon of war. The RESPOND Project worked with government ministries in Burundi to improve efforts both to prevent sexual violence and to respond to sexual violence survivors in two provinces—Kayanza and Muyinga. This study reports on research undertaken to identify ways to strengthen the health sector’s response for survivors of sexual violence, promote gender-equitable norms to prevent sexual violence and to support survivors, and increase the capacity of communities and civil society to prevent sexual violence.
Available in English (PDF, 1 MB) and French (PDF, 1.0 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)

Capacity Building to Prevent and Respond to Gender-Based Violence: Project Description and Evaluation of RESPOND/Guinea (Report No. 6)
Guineans and international observers alike were shocked by the political violence, including brutal rapes, perpetrated on September 28, 2009, in a stadium in Conakry following a political demonstration. RESPOND worked with the Government of Guinea and local organizations to support follow-up services for women who survived the violence, to strengthen local capacity for prevention of gender-based violence (GBV), and to improve the health sector's response to sexual violence. Over the course of 18 months, RESPOND helped 153 survivors receive medical, psychological, social, and/or economic services, trained 10 trainers and 110 community leaders to use Men As Partners® approaches to challenge inequitable gender norms and GBV, reached close to 9,000 men and women with messages against GBV, provided technical assistance to the Ministry of Health to develop a national curriculum on the care of sexual violence survivors, and trained 53 health care providers to respond to sexual violence.
Available in English (PDF, 2.6 MB) and French (PDF, 2.2 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)

Baseline Assessment of the Readiness of Health Facilities to Respond to Gender-Based Violence in Guinea (Report No. 4)
In 2011, the RESPOND Project and local partners initiated a collaborative effort to address the response to gender-based violence (GBV) in Guinea. As a baseline assessment of the readiness of Guinean health centers to respond to sexual violence, interviews were conducted with 141 facility managers and health care providers in three regions to assess services, equipment, supplies, and standard operating procedures, as well as providers’ knowledge, attitudes, and skills. Fewer than one in three providers interviewed had ever received training on GBV. Procedures and/or protocols for addressing sexual violence were not systematically available, and most facilities lacked essential commodities, equipment, and supplies to respond to sexual violence effectively.
Available in English (PDF, 1.8 MB) and French (PDF, 1.7 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)

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)

Long-Acting and Permanent Methods: Critical for Expanding Choice, Increasing Program Impact, and Saving Lives—Findings and Recommendations
In 2010, RESPOND led an assessment of LA/PMs to: 1) assess the use of, unmet need for, trends in, and current programs for LA/PMs in the country; and 2) develop strategic approaches for strengthening access to and availability, quality, and use of these services. RESPOND used the SEED Model to frame the assessment as well as the recommendations, and encouraged collaboration at all levels to realize a synergistic, coordinated, and unified approach to addressing the expansion of LA/PMs. The assessment was used to frame the FP program for the USAID bilateral project’s proposal and SEED now underpins USAID’s bilateral assistance program.
Available in English (PDF, 1.8 MB)

Community Mobilization for Postabortion Care in Kenya: Baseline Evaluation Report (Report No. 2)
Maternal health complications, including those arising from unsafe abortion and miscarriage, are a leading cause of morbidity among women in Kenya. In response to this need, the RESPOND Project replicated an existing intervention known as Community Mobilization for Postabortion Care (COMMPAC), which aims to increase awareness and use of postabortion care (PAC) services and improve family planning, reproductive health, and maternal health outcomes. This report summarizes key results emerging from baseline data collection exercise carried out in 2010, to provide a benchmark against which the RESPOND intervention would be measured.
Available in English (PDF, 2 MB)

Payments in the Public Sector for Reproductive Health Services in Eastern Europe and the Caucasus (Report No. 1)
Informal payments for health care services that clients are entitled to receive for free are highly prevalent in Eastern Europe and the Caucasus. This review of relevant literature on the financial cost to clients in this region and secondary analysis of data from Demographic Health Surveys and Reproductive Health Surveys conducted in Armenia, Azerbaijan, and Georgia examines how financial and nonfinancial factors affect the provision of family planning and obstetric services. Barriers to quality family planning services in these countries are considerable. Contraceptive supplies are limited, method choice is inadequate, providers and consumers lack knowledge about modern contraceptive methods, and governments have shown limited commitment to family planning. In addition, informal payments made to health care providers may act as an incentive encouraging providers to promote and provide abortion over contraception.
Available in English (PDF, 2 MB)

Community-Based Distribution of Misoprostol for the prevention of Postpartum Hemorrhage: Evaluation of a Pilot Intervention in Tangail District, Bangladesh
Hemorrhage is a leading cause of maternal mortality, and deaths related to postpartum hemorrhage are a major challenge in rural areas of Bangladesh, where infrastructure is poor and health 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 postpartum hemorrhage. In 2008, the Mayer Hashi/RESPOND Project implemented a pilot project in the Tangail District to determine the effectiveness of using community-level field workers to distribute misoprostol tablets and ensure that women take the drug immediately postpartum. This evaluation report discusses the implementation of the pilot project and reviews project documents and activity reports, as well as interviews and focus group discussions, to assess the effectiveness of the community-based misoprostol intervention and to provide recommendations for national scale-up.
Available in English (PDF, 2.5 MB)

Synchronizing Gender Strategies—A Cooperative Model for Improving Reproductive Health and Transforming Gender Relations
In exploring gender integration approaches to sexual and reproductive health programs and policies, the authors of this paper coin the term ”gender synchronization” to refer to working with men and women, boys and girls, in an intentional and mutually reinforcing way that challenges gender norms, catalyzes the achievement of gender equality, and improves health. They describe the opportunities missed by the benefits and constraints of approaches to health development that work with women or men alone. Further, they illustrate what separate but aligned programs and policies for both women and men and couple approaches look like and describe the value added from addressing both men and women from a relational perspective. This product was developed by RESPOND and the BRIDGE Project at the Population Reference Bureau (PRB), in consultation with the United States Agency for International Development (USAID) Interagency Gender Working Group (IGWG).
Available in English (PDF, 512 KB)

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Photo credits: M. Tuschman/EngenderHealth; A. Fiorente/EngenderHealth; C. Svingen/EngenderHealth.

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