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Recommendations to Promote Safe and Effective Use of Contraceptives: World Health Organization [letter]
CHRISMED Journal of Health and Research. 2017 Oct-Dec; 4(4):291.The authors discuss the need to support and strengthen national family planning programs through more investment and better awareness to address the 220 million women who have an unmet need for family planning.
Geneva, Switzerland, WHO, 2017. 12 p. (Summary Brief WHO/RHR/17.20)Contraception is an inexpensive and cost-effective intervention, but health workforce shortages and restrictive policies on the roles of mid- and lower-level cadres limit access to effective contraceptive methods in many settings. Expanding the provision of contraceptive methods to other health worker cadres can significantly improve access to contraception for all individuals and couples. Many countries have already enabled mid- and lower-level cadres of health workers to deliver a range of contraceptive methods, utilizing these cadres either alone or as part of teams within communities and/or health care facilities. The WHO recognizes task sharing as a promising strategy for addressing the critical lack of health care workers to provide reproductive, maternal and newborn care in low-income countries. Task sharing is envisioned to create a more rational distribution of tasks and responsibilities among cadres of health workers to improve access and cost-effectiveness.
Washington, D.C., PAI, 2016 Oct. 2 p.When the Global Financing Facility (GFF) was announced in 2014, it promised a “pioneering” way to finance and improve the lives of women, adolescents, children and newborns through provision of reproductive, maternal newborn and child health programs and policies. Family planning advocates and implementers were interested in the possibility of additional funds particularly as a global contraceptives funding crisis is looming, and the Sustainable Development Goals (SDGs) are being operationalized. To date, the GFF has had three rounds of countries selected to receive funding. In the first round, Democratic Republic of the Congo, Ethiopia, Kenya and Tanzania were selected. In the second round, Bangladesh, Cameroon, Liberia, Mozambique, Nigeria, Senegal and Uganda were selected. In the third round, Guatemala, Guinea, Myanmar and Sierra Leone were selected. To better understand the role of the GFF in filling funding gaps for family planning and contraceptive procurement, we analyzed the four published investment cases for Kenya, Tanzania, Ethiopia and Uganda.
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.Unmet need for contraception remains high in many settings, and is highest among the most vulnerable in society: adolescents, the poor, those living in rural areas and urban slums, people living with HIV, and internally displaced people. The latest estimates are that 225 million women have an unmet need for modern contraception, and the need is greatest where the risks of maternal mortality are highest. There is increasing recognition that promotion and protection of human rights in contraceptive services and programs is critical to addressing this challenge. However, despite these efforts, human rights are often not explicitly integrated into the design, implementation and monitoring of services. A key challenge is how to best support health care providers and facility managers at the point of service delivery, often in low-resource real-world settings, to ensure their use of human rights aspects in provision of contraceptive services. The point of service delivery is the most direct point of contact where potential violations/omissions of rights come into play and requires special attention. This checklist covers five areas of competence needed by health care providers to provide quality of care in contraceptive information and services including: respecting users’ privacy and guaranteeing confidentiality, choice, accessible and acceptable services, involvement of users in improving services and fostering continuity of care and follow-up. 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. They recommend, among other actions, that states should ensure timely and affordable access to good quality sexual and reproductive health information and services, including contraception, which should be delivered in a way that ensures fully informed decision making, respects dignity, autonomy, privacy and confidentiality, and is sensitive to individuals’ needs and perspectives. 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.
The Botswana Medical Eligibility Criteria Wheel: Adapting a tool to meet the needs of Botswana's family planning program.
African Journal of Reproductive Health. 2016 Jun; 20(2):9-12.In efforts to strive for family planning repositioning in Botswana, the Ministry of Health convened a meeting to undertake an adaptation of the Medical eligibility criteria for contraceptive use (MEC) wheel. The main objectives of this process were to present technical updates of the various contraceptive methods, to update the current medical conditions prevalent to Botswana and to adapt the MEC wheel to meet the needs of the Botswanian people. This commentary focuses on the adaptation process that occurred during the week-long stakeholder workshop. It concludes with the key elements learned from this process that can potentially inform countries who are interested in undergoing a similar exercise to strengthen their family planning needs.
Programmatic and research considerations for hormonal contraception for women at risk of HIV and women living with HIV.
Geneva, Switzerland, WHO, Department of Reproductive Health and Research, 2012 May.  p. (Policy Implications; WHO/RHR/12.09)Between 31 January and 2 February 2012, the World Health Organization (WHO) convened a meeting of experts to discuss recent research on use of hormonal contraception by women at high risk of HIV and those currently living with HIV and its implications. The purpose of the meeting was to review all available published evidence on the relationship between the use of hormonal contraceptives and the risk of HIV acquisition, HIV disease progression, and HIV transmission to uninfected partners, and to determine whether any change in the WHO recommendations on hormonal contraceptive use by women at high risk of, or living with, HIV-infection was needed. During the discussion on the balance of risks and benefits of hormonal contraceptive use among women at high risk of, or living with, HIV infection, multiple programmatic and research issues emerged, including priority knowledge gaps. This brief serves to highlight actions that programmes providing sexual and reproductive health and HIV-prevention services should undertake, in order to complement the Consultation’s recommendations. Directions for future research to address current gaps are noted. (Excerpts)
Improving access to quality care in family planning: WHO's four cornerstones of evidence-based guidance.
Journal of Reproduction and Contraception. 2007 Jun; 18(2):63-71.The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainly face to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the clinicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grass-root providers. (author's)
Evaluation of the World Health Organization's family planning decision-making tool: Improving health communication in Nicaragua.
Patient Education and Counseling. 2007 May; 66(2):235-242.The World Health Organization has led the development of a Decision-Making Tool for Family Planning Clients and Providers (DMT) to improve the quality of family planning counseling. This study investigates the DMT's impact on health communication in Nicaragua. Fifty nine service providers in Nicaragua were videotaped with 426 family planning clients 3 months before and 4 months after attending a training workshop on the DMT. The videotapes were coded for both provider and client communication. After the intervention providers increased their efforts to identify and respond to client needs, involve clients in the decision-making process, and screen for and educate new clients about the chosen method. While the DMT had a smaller impact on clients than providers, in general clients did become more forthcoming about their situation and their wishes. The DMT had a greater impact on sessions in which clients chose a new contraceptive method, as compared with visits by returning clients for a check-up or resupply. The DMT proved effective both as a job aid for providers and a decision-making aid for clients, regardless of the client's level of education. Job and decision-making aids have the potential to improve health communication, even or especially when clients have limited education and providers have limited training and supervision. (author's)
IPPF COUNTRY PROFILES. 1994 Jan; 25-30.The government of Sri Lanka has made progress in its population program, but it remains concerned that Sri Lanka continues to be one of the world's most densely populated countries. Population growth has an adverse effect upon efforts to improve the quality of life and alleviate poverty. The government, therefore, in 1991 implemented a population policy designed to limit population growth to a level feasible given available resources. The policy also calls for replacement level fertility by the year 2000. Emphasizing motivation and contraceptive distribution, Family Planning Association of Sri Lanka (FPASL) projects support and complement the government's family planning program. Specifically, FPASL operates two clinics and provides educational programs on sexual health and population issues, contraceptive social marketing, sterilization programs, and the rural IEM project Praja Shanthi. FPASL total funding in 1992 was $828,560. 1987 Demographic and Health Survey data indicate that 62% of married women practice contraception. 40% use modern methods, with female sterilization being the most popular at 24.8%, followed by male sterilization (4.9%), and the pill (4.1%). Only 1.9% use condoms. Rhythm is the most popular traditional method with 15% of users. Abortion is legal only to save a women's life. Trained nurses, midwives, and chemists are allowed to distribute oral contraceptives, and both male and female sterilization are permitted without restriction. The paper also reports demographic statistical data and information on social and health aspects of the country.
Journal of Biosocial Science. 2002 Jul; 34(3):379-94.This article examines the provision of family planning (FP) services in selected countries in the Caribbean. The potential impact of the funding shortfall resulting from the phasing out of funding by the International Planned Parenthood Federation (IPPF), and the strategies being adopted by the selected countries to cope with this, are considered. Stratified random sampling methods were employed to select eight Caribbean countries and a pre-designed questionnaire was administered to the agency responsible for FP services in each country. The sample was stratified geographically to include countries from different parts of the Caribbean. The questionnaire was designed to collect information on the services provided, the name of the agency responsible for the provision of services and, where possible, the number of users of each type of service in 1998 and 1997. Vast disparities were found in the provision of FP services in different Caribbean countries, in terms of the groups involved, the services available in each country, as well as methods of data collection and compilation. Anguilla and Bermuda were found to provide only limited FP services, while Barbados, Jamaica and Grenada provide much more sophisticated services. A salient finding was the innovative approaches that various countries in the region have adopted to fund FP programs in anticipation of the phasing out of IPPF funding. The standpoint taken in the study is that countries such as Anguilla and Bermuda must strive to improve their provision of FP services, and that they could learn from Barbados, Grenada and Jamaica, which provide much more comprehensive services. It is also concluded that, unless alternative funding sources are identified and accessed, the provision of FP services in the Caribbean is likely to decline in the future. (author's)
New WHO medical eligibility criteria for contraceptives: adaptation for use in a local service in UK.
Journal of Family Planning and Reproductive Health Care. 2001 Jul; 27(3):149-52.The WHO has published an updated edition of the document entitled "Improving Access to Quality Care in Family Planning: Medical Eligibility Criteria for Contraceptives." The aim of the WHO initiative is to establish international norms for the medical eligibility criteria for contraceptive methods in the context of emerging evidence. The data are presented in a user-friendly format for local application and are based on the work of a group of international experts who reviewed all the clinical evidence on methods of contraception. The guidance consists of a series of tables, one for each method type, with a list of conditions and diseases, the advice given, which is based on a balance of benefits and risks, and the reason for the advice. It aims to provide guidance to family planning and reproductive health programs, and the scientific community, in the preparation of guidelines for service delivery of contraceptives. The publication of the evidence supporting the recommendations and formal linking of advice to the evidence is necessary, and would make their adaptation for local use an easier task. This edition has been used to revise the contraceptive policies and prescribing practices in West London, in order to help improve access to, and quality of, family planning services for all clients.
London, England, International Planned Parenthood Federation [IPPF], 1997. viii, 379 p. (IPPF Medical Publications)The "Family Planning Handbook for Health Professionals" is based on the concepts of sexual and reproductive health. It replaces the "Family Planning Handbook for Doctors" (1988) by emphasizing the role of a team of professionals, including medical doctors, nurses, midwives, and counselors. In addition to covering available contraceptive methods, the handbook includes chapters on infertility, sexually transmitted diseases, routine reproductive health screening, and cervical cytology. It is intended for use by health care professionals in association with IPPF's "Medical and Service Delivery Guidelines," but offers more in-depth explanations of the background, techniques, and methods.
London, England, International Planned Parenthood Federation [IPPF], 1997. xxii, 298 p. (IPPF Medical Publications)Consistent with the framework adopted at the 1994 International Conference on Population and Development, this second edition of "Medical and Service Delivery Guidelines for Family Planning" emphasizes the reproductive health needs of couples rather than family planning (FP) program targets. The focus of the guidelines is on providing services that reach essential standards of quality and are scientifically, socially, and operationally sound. They can be utilized as a guide for the delivery of FP services, a reference document for assessing quality of care, an outline for pre-service and in-service training, and as a tool for supervisors. In addition to updating information on specific contraceptive methods, this second edition includes new chapters on emergency contraception, pregnancy diagnosis, reproductive tract infections and STDs, and infection prevention and control. Intended users include program planners and users, as well as clinical and community-based services providers, trainers, and supervisors.
STUDIES IN FAMILY PLANNING. 1997 Jun; 28(2):79-94.In response to difficulties associated with the introduction of new contraceptive technologies to public sector service systems, the UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction has formulated a new model. The strategic approach to contraceptive introduction shifts the emphasis from the promotion of a particular technology to quality of care issues, a reproductive health focus, and users' perspectives and needs. It further entails a participatory approach with collaboration among governments, women's health groups, community groups, nongovernmental providers, researchers, international donors, and technical assistance agencies. The underlying philosophy is that method introduction should proceed only when a system's ability to provide high-quality services exists or can be generated. Since 1993, WHO has provided support for the implementation of this perspective in public sector programs in Bolivia, Brazil, Burkina Faso, Chile, Myanmar, South Africa, Viet Nam, and Zambia. Preliminary assessments in these countries revealed major structural, managerial, and philosophical barriers to high-quality family planning services. In cases where assessments have indicated the feasibility of new method introduction, this has been implemented through a carefully phased, research-based process intended to encourage the development of appropriate managerial capacity and to promote a humanistic philosophy of care.
Expanding family planning options through the systematic introduction and appropriate management of contraceptive methods.
In: Challenges in reproductive health research: biennial report 1992-1993, edited by J. Khanna, P.F.A. Van Look, P.D. Griffin. Geneva, Switzerland, World Health Organization [WHO], Special Programme of Research, Development and Research Training in Human Reproduction, 1994. 151-60.The UNDP/UNFPA/WHO/World Bank Special Program of Research, Development, and Research Training in Human Reproduction over 1992-93 continued researching the introduction of new and underused methods of fertility regulation into family planning programs with the goal of helping governments expand the selection of available contraceptive options. The program first researched introducing the once-a-month injectable contraceptive, Cyclofem, in several developing countries based upon the introduction of Norplant. This study led to a new introduction strategy based on the realization that product-specific approaches do not necessarily help family planning programs assess the ability of the service system to provide new methods with the appropriate quality of care under routine conditions. The new three-stage strategy implemented at the country level is described. It is designed to assist decision making by focusing upon users' needs for fertility regulation methods and the capability of services to provide these methods with appropriate quality of care, addressing the interfaces between use, the service delivery system, and technology. The three stages are as follows: assessment of user needs and service delivery needs and capabilities, service delivery and other introductory research, and use of the research findings for decision-making, policy formulation, and strategic planning. Closing sections consider regional centers and technical assistance; information, education, and communication; and product management and the transfer of technology.
[Unpublished] 1992 Apr 2. iv, 37,  p. (PN-ABL-448)The family planning (FP) program sponsored by the National Family Planning Board (NFPB) of Jamaica has proved a successful example to other countries in the Caribbean. New challenges, however, face the Board and the Jamaican government. Specifically, the government wishes to realize replacement fertility by the year 2000; USAID/Kingston will phase out assistance for FP over the period 1993-98, while the UNFPA and the World Bank will also reduce support; the high use of supply methods such as the pill and condom is less efficient than the use of longterm methods; and legal, economic, regulatory, and other operational barriers exist that constrain FP program expansion. A new implementation strategy is therefore needed to address these problems. The NFPB is the best suited body to develop and implement this strategy. Accordingly, it should work to garner the support of and a partnership with the public and private sectors to mobilize resources for FP. Instead of being the primary provider of FP for all consumers, the public sector must start providing for users who cannot pay for services and leave those who can pay to the private sector. This approach will diversify the burden of financing services while expanding the pool of service providers. Recommendations and next steps for the NFPB are offered in the areas of population targets to be served; the role and function of the NFPB to reach and serve various targets; and how to sustain beyond the cessation of donor inputs.