Voluntary family planning brings transformational benefits to women, families, communities, and countries. Investing in family planning is a development “best buy” that can accelerate achievement ...across the 5 Sustainable Development Goal themes of People, Planet, Prosperity, Peace, and Partnership.
Voluntary family planning brings transformational benefits to women, families, communities, and countries. Investing in family planning is a development “best buy” that can accelerate achievement across the 5 Sustainable Development Goal themes of People, Planet, Prosperity, Peace, and Partnership.
The demographic age structure of sub-Saharan Africa contributes significantly to the low morbidity and mortality of COVID-19 compared to other regions in the world.
Evidence suggests the demographic ...age structure of sub-Saharan Africa is the leading factor of the low morbidity and mortality of COVID-19 compared to other regions of the world.
Widespread social mitigation strategies, such as lockdowns, have resulted in severe economic and societal consequences in terms of food security, adolescent pregnancy, gender-based violence, and disruptions in treating other diseases.
It is imperative to weigh the risks and benefits of social mitigation strategies for future waves.
Family planning programs are guided by the principle of informed choice as well as the goal of providing a broad choice of contraceptive methods to clients. Provider bias is an important barrier to ...realizing this goal, but it must be clearly defined and understood to be effectively addressed. This review presents an overview of the concept of provider bias in family planning, focusing on the following issues: (1) what it is, (2) how widespread it is, (3) its underlying causes, (4) its impacts, and (5) how it can be effectively addressed. The definitions of provider bias include common themes about providers creating barriers to choice, typically based on the characteristics of either a client or a contraceptive method. However, an agreed-upon definition is lacking. Measurement of provider bias has often relied on self-reports by providers but has also included observation and use of mystery clients for supplemental data. The general trend in the data is clear: large numbers of providers impose barriers and restrictions beyond those that are in guidelines or are necessary for any medical reasons. This trend indicates the presence of bias. Providers have shown bias based on age, parity, marital status, and other criteria, with a bias against provision of various contraceptive methods to youth being the most common. Provider bias often stems from broader social norms, particularly judgments about sexual activity among youth and concerns about the impact of hormonal methods on future fertility. Little documentation of the impact of provider bias exists, although method mix skew has been identified as a possible red flag for bias. Newer approaches to address bias that have moved beyond traditional training and guidelines development to more fundamental behavior change efforts show promise, and learning from their lessons will be important. A major question is how to scale up such approaches.
Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people’s access to sexual and reproductive health (SRH) services, changing their ...behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents’ needs.
Youth centers, peer education, and one-off public meetings have generally been ineffective in facilitating young people’s access to sexual and reproductive health (SRH) services, changing their behaviors, or influencing social norms around adolescent SRH. Approaches that have been found to be effective when well implemented, such as comprehensive sexuality education and youth-friendly services, have tended to flounder as they have considerable implementation requirements that are seldom met. For adolescent SRH programs to be effective, we need substantial effort through coordinated and complementary approaches. Unproductive approaches should be abandoned, proven approaches should be implemented with adequate fidelity to those factors that ensure effectiveness, and new approaches should be explored, to include greater attention to prevention science, engagement of the private sector, and expanding access to a wider range of contraceptive methods that respond to adolescents’ needs.
Contraception in the Era of COVID-19 Nanda, Kavita; Lebetkin, Elena; Steiner, Markus J ...
Global health science and practice,
06/2020, Volume:
8, Issue:
2
Journal Article
Peer reviewed
Open access
As global health systems and communities prepare to meet an unprecedented threat causing increased demands for the care of people with COVID-19, health care providers should strive to ensure ...continuity of reproductive health care to women and girls in the face of facility service disruption.
In the face of facility service disruptions due to COVID-19, health care providers, particularly in low- and middle-income countries, should strive to maintain continuity of reproductive health care to women and girls as an essential service.
When in-person encounters are limited, health care providers should adapt the way contraceptive services are provided by using telehealth whenever possible for counseling, shared decision making, and side effect management, and should make adjustments to provision of contraceptive methods to ensure access.
This article draws from national surveys of every sub-Saharan African country with at least 1 recent survey published between 2015 and 2017 and 2 prior surveys from 2003 to 2014. Twelve countries ...comprising over 60% of the region's population met these inclusion criteria. The analysis considers recent and longer-term changes in 3 key variables: modern contraceptive prevalence rate (mCPR), method-specific prevalence, and a method's share of the current modern method mix. As recently as 2011, implant CPR in sub-Saharan Africa was only 1.1%. Since then, sizeable price reductions, much-increased commodity supply, greater government commitment to rights-based family planning, broader WHO eligibility guidance, and wider adoption of high-impact service delivery practices have resulted in expanded client access and marked increases in implant prevalence and share of the method mix. Ten of the 12 countries now have an implant CPR around 6% or higher, with 3 countries above 11%. Increased implant use has been the main driver of the increased mCPR attained by 11 countries, with gains in implant use alone exceeding combined gains in use of injectables, pills, and intrauterine devices. In countries as diverse as Burkina Faso and Ethiopia, Democratic Republic of the Congo and Ghana, Kenya and Senegal, implant use now accounts for one-fourth to one-half of all modern method use. Implants have become the first or second most widely used method in 10 countries. In the 7 countries with multiple surveys conducted over a 2- to 3-year span between 2013-14 and 2016-17, average annual gains in implant prevalence range from 0.97 to 4.15 percentage points; this contrasts to historical annual gains in use of all modern methods of 0.70 percentage points in 42 sub-Saharan African countries from 1986 to 2008. Implant use has risen substantially and fairly equitably across almost all sociodemographic categories, including unmarried women, women of lower and higher parity, women in all 5 wealth quintiles, younger and older women, and women residing in rural areas. A notable exception is the category of nulliparous married women, whose implant use is mostly below 1%. These attainments represent a major success story not often seen in family planning programming. With continued program commitment and donor support, these trends in implant uptake and popularity are likely to continue for the next few years. This implies even greater need for the international family planning community to maintain its focus on rights-based programming, ensuring reliable access to implant removal as well as insertion services, and addressing issues of financing and sustainability.
Chronic hepatitis C virus (HCV) infection is a major public health problem in many low- and middle-income countries. In 2015, Egypt's HCV infection prevalence of 7% among adults was among the highest ...in the world and accounted for 7.6% of the country's mortality. In 2014, Egypt embarked on an aggressive screening and treatment program that evolved into a national strategy to eliminate HCV as a public health threat by 2021.
In this qualitative case study, we analyzed Egypt's HCV control strategy using the Kingdon framework to understand how the problem, policy, and political streams merged to create an opportunity to achieve an ambitious elimination goal. We describe key aspects of the implementation, identify lessons learned, and provide recommendations for other low- and middle-income countries aiming to eliminate HCV.
Between 2014 and 2020, Egypt screened more than 50 million and treated more than 4 million residents for HCV. Five key elements contributed to Egypt's successful HCV elimination program: (1) sufficient and reliable epidemiologic data to quantify and monitor public health threats; (2) a robust public health care infrastructure; (3) inclusive care that reached all sectors of society; (4) increased health care spending; and (5) innovative scientific research and use of information technology.
Egypt conducted a successful HCV screening program that covered more than 50 million residents and treated more than 4 million. It is poised to be the first country in the world to eliminate HCV within its borders. The lessons learned from this experience can inform the elimination plans of other low- and middle-income countries with high HCV burden.
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