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Quality of care in contraceptive information and services, based on human rights standards: a checklist for health care providers.
Geneva, Switzerland, WHO, 2017. 32 p.International and regional human rights treaties, national constitutions and laws provide guarantees specifically relating to access to contraceptive information, commodities and services. In addition, over the past few decades, international, regional and national legislative and human rights bodies have increasingly applied human rights to contraceptive information and services. This document presents a user friendly checklist specifically addressed to health care providers, at the primary health care level, who are involved in the direct provision of contraceptive information and services. It is complimentary to WHO guidelines on Ensuring human rights in the provision of contraceptive information and services: Guidance and recommendations, and the Implementation Guide published jointly with UNFPA in 2015. This checklist also builds on WHO vision document on Standards for Improving Quality of Care for Maternal and Newborn Care and its ongoing work under the Quality, Equity and Dignity initiative. The checklist should be read along with other guidance from WHO and also from partners.
Arlington, Virginia, JSI, DELIVER, 2013 Jan.  p.This brief describes the evolution of contraceptive procurement in the Latin America and Caribbean (LAC) region, highlighting how LAC countries monitored and evaluated key data when making performance improvements. By introducing and monitoring key indicators, they were able to smooth the procurement process and improve procurement performance.
Expanding contraceptive choice in West Africa: Building the capacity of local nongovernmental organizations to program holistically.
New York, New York, EngenderHealth, RESPOND Project, 2013 Jun.  p. (Project Brief No. 15)This project brief looks at how nongovernmental organizations can expand access to contraception in West Africa and specifically looks at member associations of the International Planned Parenthood Federation in Benin, Burkina Faso and Togo.
New York, New York, United Nations Commission on Life-Saving Commodities for Women and Children, 2012 Sep.  p.The United Nations Commission on Life-Saving Commodities for Women and Children presents a new plan and set of recommendations to improve the supply and access of life-saving health supplies.
WHO / USAID / FHI Technical Consultation: Expanding Access to Injectable Contraception, 15-17 June 2009, Room M405, WHO, Geneva.
[Unpublished] 2009. 5 p.The agenda for the consultation is presented. The objectives of the consultation were: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely.
[Washington, D.C.], Population Council, Frontiers in Reproductive Health, 2007 Dec. 21 p. (USAID Cooperative Agreement No. HRN-A-00-98-00012-00)Much of the programmatic and research experience gained over the past two decades has focused on increasing understanding of supply-side factors that limit the provision and use of the IUD, for example, developing training programs, demonstrating the ability of lower level medical staff to provide the method, and assessing the interaction between IUDs, STIs and, more recently, HIV. There is now sufficient empirical evidence from a range of settings to allow program managers and technical assistance organizations to develop guidelines and plans for strengthening the systems necessary to support country-level introduction or 'rehabilitation'; of the IUD within a program offering a range of contraceptive choices. The objectives were: To conduct a meeting of researchers and program managers from three continents and several international organizations to review reasons for under-utilization of the IUD and recent experiences in increasing awareness about the IUD; To develop proposals for operations research projects to test the most promising interventions to introduce and expand access to IUD services and to implement the projects with national partner organizations; To disseminate results of the successful strategies. (Excerpts]
Arlington, Virginia, JSI, DELIVER, 2004 Nov.  p. (On Track)El Salvador has already reached several important milestones in its efforts to achieve contraceptive security-the guarantee that all people who wish to use contraceptives can choose, obtain, and use them at all times. With support from the United States Agency for International Development (USAID), the Salvadoran Ministry of Health (MOH) has recently worked to expand people's access to contraceptives, particularly through community-based distribution. It has also helped to improve product management in health facilities by training service providers and by implementing a contraceptive logistics management information system. El Salvador's next challenge on the pathway to contraceptive security is to become financially self-sufficient in procuring reproductive health commodities. USAID is progressively phasing out its contraceptive donations to the country, and is providing technical assistance to guarantee that the MOH will be able to accurately forecast contraceptive demand and manage its own budget for meeting that demand. (author's)
New York, New York, UNFPA, .  p.Each year, more people are living with HIV than the year before. And each year, more people die of AIDS. This growing global tragedy has many faces: The desperation of a teenage orphan struggling to care for her younger siblings by trading sexual favours for food; The sorrow of a young mother who learns she is HIV-positive at a prenatal clinic; The anguish of an unemployed youth who fears he has acquired HIV, but has no access to counselling, testing or condoms. In the absence of a cure, HIV prevention offers the best hope of reversing the epidemic. Prevention works. Sustained political commitment through intensive programmes in diverse settings has reduced HIV incidence. Advances in treatment are reinforcing prevention efforts by encouraging voluntary testing and reducing the stigma associated with AIDS. Nevertheless, the pandemic is outstripping efforts to contain it and is gaining ground globally. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], 2005.  p.Contraceptives, drugs, and medical supplies required for reproductive health services in developing regions cost US$1.84 billion in 2000, will cost $2.34 billion in 2005, and will rise in cost to $3.43 billion by 2015. Annual costs will be 86 per cent higher, in constant dollars, in 2015 than in 2000 (Figure 1). These estimates cover contraceptives for family planning, condoms for protection against HIV and other sexually transmitted infections, and drugs and medical supplies for safe deliveries and other reproductive health services. Drugs and medical supplies make up over half the total cost, contraceptives around one-third, and condoms for protection the remaining one-eighth or so. The estimates are detailed in this report, which attempts to assess the overall costs of reproductive health commodities, which UNFPA has traditionally had a major role in helping provide for developing regions. These commodities are essential to achieve the goal of providing universal access to reproductive health care, as mandated in 1994 by the International Conference on Population and Development. The report is not intended to specify the quantities and cost of commodities needed in particular countries but rather tries to arrive at estimates of global requirements. Nevertheless, the calculations are based on detailed consideration of regional and even country data where they are available. The report assesses the number of cases in developing regions of each relevant reproductive health condition, projects these numbers over 15 years, determines the commodities required as part of appropriate treatment, estimates the proportion of cases that do receive such treatment, specifies how coverage should rise in the future, and calculates the commodity costs for all the cases to be covered. (excerpt)
Contraception Report. 1998 Sep; 9(4): p..In 1995, the World Health Organization (WHO) released revised medical eligibility criteria guidelines to assist family planning agencies and clinicians prescribe contraceptives. By eliminating overly restrictive barriers to use, WHO hopes to increase access to and use of birth control methods. This article briefly reviews some of the important WHO guidelines concerning intrauterine devices. Introduction WHO researchers evaluated the benefits and risks of using IUDs in healthy women and in women with certain medical conditions or individual characteristics, such as parity and exposure or susceptibility to sexually transmitted diseases. A previous article describes WHO's methods for devising the criteria in detail. Briefly, the eligibility criteria were developed by international experts from many organizations. WHO experts reviewed the medical literature from the past 10 years and devised recommended medical eligibility criteria for different contraceptive methods. One main concern was to address outdated contraindications. WHO notes that "The contraindications for many contraceptives tend to become very rigid, resulting in denial of contraceptive access to many women. Relative contraindications tend to become absolute." (excerpt)
Johannesburg, South Africa, University of the Witwatersrand, Reproductive Health and HIV Research Unit, 2006 Oct. 58 p.A systematic review of the literature was conducted, for evidence on whether a policy of providing a wide range of contraceptive methods, as opposed to the provision of a limited range, improves health outcomes such as contraceptive uptake, acceptability, adherence, continuation and satisfaction; reduction of unintended pregnancy; and improved maternal health and wellbeing. Studies of all designs, reviews, reports, policy documents, commentaries, opinion papers and position papers were included in a search of MEDLINE (via Pubmed, Ovid MEDLINE and Old Ovid MEDLINE), All EBM Reviews, POPLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS and Psyc Info. A total of 6977 citations were identified. Of these, 3586 were duplicates, leaving 3391 titles/abstracts for screening. After more sensitive review by three authors (AG, JS, NM), 231 citations were included in the review. Two authors (AG, JS) independently extracted data from full reports or papers of all included studies. In a few instances, the full text could not be accessed and the study was assessed on the abstract only. Not unsurprisingly, this systematic review has failed to find large quantities of high quality evidence that increasing choice has a direct impact on the contraceptive outcomes of interest. The best evidence retrieved is summarised in Table 1. (excerpt)
Best Practice and Research Clinical Obstetrics and Gynaecology. 2006; 20(3):323-338.Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. (author's)
Ensuring women's access to safe abortion: essential strategies for achieving the Millennium Development Goals.
Chapel Hill, North Carolina, Ipas, 2005.  pApproved by world leaders in September 2000, the Millennium Development Goals (MDGs) articulate a series of time-bound, quantitative targets for ending poverty, improving health and promoting gender equality. The MDGs lack, however, any mention of human rights or reproductive and sexual health. In particular, the MDG framework does not include the critical issue of abortion, despite the fact that unsafe abortion leads to the unnecessary and completely preventable deaths of women and is a persistent problem rooted in poverty, gender inequity and the failure to implement human rights. Over the past decade, the international community has committed itself in a series of political and legal agreements to promoting and fulfilling women’s and men’s sexual and reproductive rights. Governments at the International Conference on Population and Development (ICPD) in 1994 agreed to a definition of reproductive health that includes abortion in circumstances where it is legal under national legislation. The MDGs echo elements of the ICPD consensus, but none specifically address its core commitment to ensure universal reproductive-health services. At the Fourth World Conference on Women, held in Beijing in 1995, sexual rights were acknowledged as integral to human rights and women’s empowerment, and countries were encouraged to review restrictive abortion laws. (excerpt)
UN Chronicle. 2004 Mar-May; 41(1): p..When soldiers from Eritrea put on their uniform belts, they not only carry with them hand grenades, ammunition cases and canteens but, since 2003, also a leather pouch that holds four-pack condoms. With distribution ongoing, these pouches are now standard military issue equipment of the Eritrean Defense Force and thus a weapon against HIV/AIDS, which in the last twenty years has claimed more lives in sub-Saharan Africa than all wars on that continent in the last century. More than twenty years since the disease was first identified, the Joint United Nations Programme on HIV/ AIDS (UNAIDS) said that it has continued to spread not only in Africa but also in many parts of the world, killing some 8,000 people each day, while another 14,000 are infected, adding to some 42 million living with the virus. While the fight against the pandemic is pursued on many levels and in many sectors, efforts in recent years of the United Nations and its Member States have begun to specifically target the role that military and police personnel--the so-called "uniformed services"--play in the spread of the infection. The initial focus will be on peacekeepers. With many of them young and sexually active, often deployed to or from regions with high HIV/AIDS prevalence, and by profession inclined to risky behaviour, some consider the peacekeepers to be "more likely to contract or transmit the virus than the average population", Roxanne Bazergan, HIV/AIDS Policy Adviser with UNAIDS and the UN Department of Peacekeeping Operations (DPKO), told the UN Chronicle. (excerpt)
Chinese Journal of Health Education. 2003 Jun; 19(6):457-458.The concept of reproductive health is a new one first advanced by World Health Organization (WHO) human health research plan chairman Barzelatto in 1988. In 1994 the WHO Global Policy Council formally adopted a definition of reproductive health; in 1995 the World Health Congress again stressed the importance of the WHO’s global reproductive health strategy, and proposed an international health struggle goal of “universal access to reproductive health by 2015.” The definition and scope of reproductive health. Reproductive health is a physical, mental and social state of well being, but not only a lack of sickness or debilitation. The particular scope includes having a healthy and harmonious sexual physiology and a regular sex life, free from worry of sexually transmitted disease or unwanted pregnancy; people having the ability to have children, but also having scientific adjustments and control of their own reproduction, to freely decide whether to have children, when to have children and how many to have. It requires that the sexes have equal rights to knowledge to make safe, effective and responsible choices; access to methods of reproductive control; use of appropriate health services; safe and comfortable pregnancy and childbirth, with the best opportunity for the mother and infant’s health. Important contents of reproductive health: sexually mature sperm, ovum, pregnancy, period of nursing after birth, regulation of fertility, cure of infertility, reproductive infection and prevention of disease. (excerpt)
Progress in Reproductive Health Research. 2005; (68):2-3.Service providers need to know what choice of contraceptive methods they can offer to clients, and what medical conditions or personal characteristics might make use of a particular method more of a health risk. While the final specification of criteria for medical eligibility has to be made at country and programme level, to take into account the local situation and setting, WHO’s broad recommendations provide a sound basis for decision-making. The third edition of Medical eligibility criteria for contraceptive use, published in 2004, contains some 1700 recommendations, organized by method of contraception and known pre-existing medical condition or individual characteristic. (excerpt)
Progress in Reproductive Health Research. 2005; (68):3-4.No contraceptive is both 100% effective and totally free of side-effects. In practice, therefore, the choice of a family planning method almost always involves a trade-off between the desired level of protection against pregnancy and the client’s willingness to tolerate the risks and disadvantages associated with any particular method. The level of protection for some methods, however, is a function not only of the method itself but also of how consistently and correctly it is used. Furthermore, the perceived disadvantages of certain methods can be overcome, or at least alleviated, through appropriate counselling. WHO’s Selected practice recommendations for contraceptive use provide guidance on the use of contraceptives, with the goal of maximizing effectiveness and managing side-effects and other problems. The recommendations are not intended for direct application in countries. Rather, they should be used as a basis for the development of national and local guidelines that take into account existing policies, needs, priorities and resources. (excerpt)
Population 2005. 2002 Mar-Apr; 4(1):12-15.In a world where demand for secure reproductive health commodities far exceeds supply, leaving people vulnerable to unwanted pregnancies and diseases, a report from the United Nations Population Fund calls for a secure supply of commodities and effective protection to curb the spread of diseases like HIV/AIDS. The report draws up a "shopping list" of commodities that save lives: pills that allow couples to plan for pregnancy, soap, plastic sheets and razor blades to cut umbilical cords, antiseptics and medical equipment for inserting intrauterine devices, and condoms for protection from HIV/AIDS. Commodity shortages threaten the health and lives of millions in developing countries. Each $1 million shortfall in commodity support for contraceptives means an estimated 360,000 more unwanted pregnancies, 150,000 additional induced abortions, 800 maternal deaths, 11,000 infant deaths and 14,000 additional deaths of children under 5, the report says. Overall, only one third of what the donors promised in Cairo at the International Conference on Population and Development (ICPD) is available now. Specifically, the shortage in funds to purchase contraceptives is projected to reach hundreds of millions of dollars by 2015 – a shortage so severe that it threatens to reverse or stall the world’s progress in reproductive health and rights. (excerpt)
Population 2005. 2002 Nov; 4(4):1, 13.There is both good news and bad news when there is talk among population program experts about how best to respond to the developing world’s demand for contraceptives and other reproductive health commodities and services. The good news is that awareness and demand are in evidence practically everywhere in the world today; this suggests that the United Nations Population Fund (UNFPA) and the rest of the international donor community, as well as other partner organizations and governments, have done their job well in getting out the messages. The bad news is that the demand is far from being filled in many of the least developed countries, especially in Africa, where the situation has been aggravated by the requirement for condoms in HIV/AIDS prevention programs. Conclusion: while the needs are great, there are serious gaps and shortfalls in commodity supplies. (excerpt)
Population 2005. 2004 Sep-Oct; 6(3):12.Notwithstanding major gains made in advancing the globally agreed upon agenda of the 1994 Cairo International Conference on Population and Development, there are today some 123 million couples in the world’s poorer countries who still lack access to contraception. Stated in more graphic terms, men in sub-Saharan Africa only have access to an average of three condoms a year— this despite the fact that the cost of condoms is just about three cents a unit. The issues behind the problem were highlighted at a number of international meetings recently, including the Washington and Wuhan Global Forums on Population and Development, held in May and September, respectively, and the September London Roundtable for Countdown 2015. (excerpt)
Working in partnership to boost reproductive health commodity security. [Trabajar en sociedad para mejorar la seguridad de los productos de salud reproductiva]
Population 2005. 2004 Sep-Oct; 6(3):10-11.As USAID, through its sub-contracted American NGO John Snow Incorporated (JSI), continues to phase out support to developing countries for reproductive health commodities— contraceptives and essential drugs—the UN Population Fund and interested donor bodies are concerned with how best to marshal and direct commodity assistance for the future. The current focus is on nine countries in the Latin American region: Bolivia, the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Paraguay and Peru. To ensure a smooth transition and to help these countries to eventually achieve reproductive health commodity security, or RHCS, USAID and JSI are working closely with partners, including UNFPA, the International Planned Parenthood Federation (IPPF), the Pan American Health Organization (PAHO) and the World Bank. (excerpt)
At ICPD+10 mark, UNFPA intensifies efforts to promote RH commodity security. [Approchant le dixième anniversaire de la CIPD, le FNUAP intensifie ses efforts pour promouvoir la sécurité de la santé de la reproduction]
Population 2005. 2004 Jun; 6(2):13.As the 10th anniversary of the Cairo International Conference on Population and Development (ICPD) approaches, there has been no letup in the UN Population Fund’s efforts to promote reproductive health commodity security around the world. Indeed, the Fund is actually intensifying its activities in this sector, leaving the distinct impression that it is all part of a coordinated and continuing response to the Program of Action of the September 1994 conference, and to the ICPD+5 update by the UN General Assembly in 1999. The impression would be neither casual nor accidental, because UNFPA is acting as the lead international agency that is trying to facilitate the creation and implementation of government strategies to meet the growing need for quality contraceptives, essential drugs and other reproductive health commodities. Special attention is also being devoted to assess future condom needs for HIV/AIDS prevention programs. Reproductive health commodity security (RHCS) is accepted as assured in those countries where the strategy has been successfully integrated into the national health program. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2000 Nov. 49 p. (UNAIDS Best Practice Collection Key Material; UNAIDS/00.37E)Condom Social Marketing: Selected Case Studies presents six applications of different social marketing techniques drawn from among on-going projects in developing countries in the field of reproductive health and prevention of HIV/AIDS and STDs. Individually they illustrate different, real- life approaches to condom promotion through social marketing in response to particular challenges and needs. All describe activities from which significant lessons may be learned. In addition, they demonstrate the flexibility of social marketing and how the technique can be adapted to deal with differing situations and constraints. The booklet is intended mainly for distribution to individuals and organizations, from both the public and private sectors, who are interested in learning more about social marketing, and how its concepts and techniques can be applied in response to the spread of HIV/AIDS and STDs, particularly in developing countries. It is also intended to provide basic information, as an aid to training, programme planning and related activities. (excerpt)
Family Health International focuses on HIV prevention, care and reproductive health in 50 countries.
Global HealthLink. 2001 May-Jun; (109):9-10.Throughout its 30-year history, Family Health International (FHI) has focused on improving reproductive health worldwide through a highly diversified program of research, education and services in family health. For the past 15 years, FHI has expanded its mission to include prevention of sexually transmitted infections. FHI designs, manages and evaluates international HIV/AIDS related programs that are broad in scope, encompassing prevention as well as care and support services for people living with or affected by HIV/AIDS. FHI conducts research to evaluate new approaches for reducing viral spread. FHI also helps assure the availability of effective, safe, acceptable and affordable contraceptive products, methods and services. With an emphasis on developing country programs, FHI responds to many of the world’s most vulnerable groups by promoting better access to quality services and to a range of contraceptive choices. (excerpt)
New York, New York, UNFPA, .  p.This paper contains global estimates for family planning commodities, and condoms for STI/HIV prevention, for the years 2000 to 2015. It combines these two estimates and attempts to show the broad dimensions of commodity shortfalls potentially being experienced for these products in developing countries. It does not include commodities for other components of reproductive health such as maternal care and STI diagnosis and treatment; these estimates will be added to an updated and expanded version of this paper in due course. The estimates of family planning commodities, which do not include costs related to voluntary sterilization, are based on surveys reviewed in a work previously commissioned by UNFPA. The estimates of condoms for STI/HIV prevention were prepared by the Commodity Management Unit of the Inter-country Programmes and Field Support Branch of the Technical Support Division of UNFPA, in conjunction with staff from other Divisions, and in consultation with UNAIDS, the United Nations Population Division and others. (excerpt)