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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[Unpublished] 2009. 5 p.The agenda for the consultation is presented.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.
[Contraceptive fact sheets. A tool for advisors in logistics] Fiches factuelles sur les contraceptifs. Un outil pour les conseillers en logistique.
Arlington, Virginia, JSI, Family Planning Logistics Management Project, 1998.  p. (USAID Contract No. CCP-C-00-95-00028-04)This guide lists the visual indicators of eventual quality problems, special considerations, donors, manufacturers, brands, shelf life, primary and secondary conditioning, units per shipping crate, and the dimensions and weights of boxes of the following contraceptive methods: condoms, oral contraceptive pills, IUDs, injectables, contraceptive implants, spermicides, and other vaginal barrier methods. These methods are presented in different categories according to donor: USAID, IPPF, or FNUAP. These data are provided as a tool to consultants in logistics. References are given for additional information on each method discussed.
FAMILY PLANNING WORLD. 1993 Jul-Aug; 3(4):7, 21.The discussion focused on the variations in purchasing agreements for the injectable Depo-Provera. Negotiations are in process between the manufacturer in the US (the UpJohn Company) and USAID regarding size of purchase, prices, and time schedules. A glitch is that the US production plant provides a two-year shelf life for the product, while the Belgian plants provide a three-year shelf life. The one year difference could be significant in the distribution to hard-to-reach places, but the balancing point is that USAIDs effort are a positive development for expanding distribution. The UN Population Fund (UNFPA) and the International Planner Parenthood Federation (IPPF) already distribute Depo-Provera and were charged 72 and 75 cents, respectively; UpJohn recently increased the prices to 80 and 85 cents. The UNFPA prices were slightly lower due to larger purchases, and both concerns will be awaiting the outcome of USAID's price negotiations. Other manufacturers are a company in Indonesia, which sells only within the country, and Organon in Holland, which produces the drug under the name Megstron. UpJohn has the major share of the market. The cost of supplying Depo-Provera also includes the purchase of needles and syringes. Other international agencies are not limited by anything other than finding the lowest cost. UNFPA buys its supplies in Belgium at low cost and its contraceptives in Holland. USAID, however, must purchase needles and syringes from American facilities. IPPF will be watching to assure international organizations that no duplication of effort will occur with the USAID distribution and expects the shelf life problem to be resolved. The issue may be cleared up when UpJohn has sufficient time to resubmit its application with enough research to support the 3-year shelf life; the FDA had rejected Depo-Provera repeatedly since 1961, and the approval was granted on a rushed application that only included some of the Belgian research and could empirically only support a 2-year shelf life.
GLIMPSE. 1994 Sep-Oct; 16(5):4.A workshop was held on 28 September 1994 at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to share the lessons learned on door step delivery of injectable contraceptives in eight rural thanas in Bangladesh. The workshop was organized jointly by the Directorate of Family Planning, Government of Bangladesh (GOB) and the maternal-child health-family planning (MCH-FP) Extension Project (Rural) of ICDDR,B. A total of 150 participants from the Centre, the national family planning program, different NGOs, and donor agencies attended the workshop. The Minister for Health and Family Welfare, GOB, inaugurated the function as the chief guest. The director of the MCH-FP Extension Project (Rural) welcomed the guests. The Secretary of the Ministry thanked the Centre for its role in the national family planning program, and reiterated that the extension project is a collaborative project of the GOB and the Centre. The Minister emphasized that the population boom is a major problem of the nation. He thanked the Centre for helping the government in seeking solutions to this problem. The UNFPA Country Director expressed his happiness about the implementation and progress of the injectable contraceptive project. David Piet of USAID recommended that equal attention be given to all family planning methods, and not just to injectables. Also, he emphasized the quality of care and the sustainability of the method. The Director General of the Directorate of Family Planning thanked the implementors of this program at different levels for their contribution, and expressed his satisfaction over the activities of the project. The director of the Centre said that the Centre was proud to be involved in this project with the Bangladesh government. He thanked the donor agencies for supporting the Centre in providing family planning services to the nation.
Washington, D.C., DKT International, 1992 Jun.  p.1991 statistics form various contraceptive social marketing programs are presented in a 5-page leaflet complete with a table and 2 bar graphs. The table consists of program sales and couple years of protection (CYP) data for 32 social marketing programs in developing countries ranging from Bangladesh to Zimbabwe. 1 CYP is defined as 100 condoms or foaming tablets, 13 cycles of oral contraceptives (OCs), 0.53 IUDs, and 4 injectables. All but 2 programs distribute condoms. Peru's social marketing program markets only OCs and vaginal foam tablets. The program in Thailand just sells OCs. 12 programs distribute only condoms, including programs in Burkina Faso, Cameroon, Costa Rica, Ivory Coast, Ethiopia, Mexico, Nigeria, Pakistan, Philippines, Turkey, and the Nirodh program in India. Other contraceptives distributed by various programs are IUDs and injectables. Only the program in Sri Lanka markets Norplant. It also provides condoms, OCs, vaginal foam tablets, IUDs, and injectables. In 1991, India had by far the highest CYPs at around 3.28 million followed by Bangladesh at 1.44 million. Bolivia had the lowest CYPs (10,608), CYPs (10,608). CYPs as percentage of target market (80% of 15-44 year old women in a union) statistics do not exhibit the same pattern, however. Jamaica had the highest share (15.9%) followed relatively closely by Egypt (14.8%). 2 other outstanding countries in terms of CYPs as percentage of target market were Colombia (11.7%) and Bangladesh (9.2%). India had only 2.8% and the 3 lowest were Turkey (0.3%), Philippines (0.1%), and Nigeria (0.1%). Leading funding supporters of social marketing programs include USAID, country governments, and IPPF.
Science. 1982 Jul 30; 217(4558):424-8.The record of the U.S. Food and Drug Administration's (USFDA) actions regarding Depo-Provera, a medroxyprogesterone acetate, as an injectable contraceptive and the international implications are reviewed. In September 1982 a special panel of scientists began deliberations to recommend whether Depo-Provera should be approved for use as an injectable contraceptive. The U.S. Agency for International Development (USAID) has been asked by developing countries to furnish the drug but will not export drugs that are not approved by USFDA. More than 80 countries have approved the drug. Advocates for USFDA approval include the Upjohn Company (manufacturer of the drug), World Health Organization, International Planned Parenthood Federation, Population Crisis Committee, and the American College of Obstetrics and Gynecology. The opposition includes the Health Research Group affiliated with Ralph Nader, the National Women's Health Network, and several right-to-life groups. Hesitation by USFDA is related to laboratory animal studies which suggest that Depo-Provera is a potential human carcinogen. Upjohn conducted a 7 year study with 16 beagles and a 10 year study with Rhesus monkeys; both of the test animals developed more tumors than the controls. Questions were raised about using the animals since the response of these two species to the drug and the human response are not necessarily comparable. Limited approval has been recommended twice by expert advisory committees in 1974 and 1975, but USFDA refused both times. It is suspected that Korea, Taiwan, Egypt, Jordan, and Yemen reversed their approval as a result of the latest USFDA rejection. This final decision will have major economic and social implications and will assume international importance.
In: Santamaria J, Richards P, Gibbon W, eds. The dignity of man and creative love: selected papers from the Congress for the family of the Americas, Guatemala, July 1980. New Haven, Connecticut, Knights of Columbus, 1980. 188-95.The USAID (U.S. Agency for International Development) has since 1960 promoted abortion worldwide, without concern for the laws, customs, or mores of foreign lands. USAID still promotes the sale and the use of Depo-Provera in Latin America. Depo-Provera, a drug that acts as a contraceptive and abortifacient, is considered by the U.S. Food and Drug Administration to be unsafe for birth control in the U.S. USAID also promotes the sale and the use of the Dalkon Shield type of IUD, which was recalled in the U.S. in 1975 for its hazardous side effects. Moreover, USAID supports abortion research worldwide; for example, there are 3 main USAID funded university research projects in the U.S., beside the London-Based IPPF, and the Boston-based Pathfinder Fund. It is about time that the American people, and the Prolife movement in particular, realize USAID's abortion activities, and act to have Congress pass the Helms Amendment of 1973, which intented to rid USAID of any involvement in abortion related activities.
New Scientist. 1980 Sep 25; 87(1220):945-6.Women in Bangladesh are under pressure to participate in a mass program that uses injectable contraceptives. The reason is that the big aid donors, particularly the World Bank, are pressuring Bangladesh to show quick results in its family planning program. In many areas of Bangladesh, the women who are sterilized or on injectables receive 6 kg of wheat a month, plus oil, powdered milk, and fish meal. These incentives are taken from the United Nations World Food Program. United States law bars the United States Agency for International Development (USAID) from supplying Depo-Provera because it has been banned in the United States as it causes cancer in animals. As there are no restrictions preventing United Nations agencies from supplying potentially dangerous drugs, the United Nations Fund for Population Activities provides Depo-Provera to Bangladesh. 1/3 of the women suffer unacceptable side effects from the Depo-Provera, particularly irregular menstruation. 5% have serious bleeding. With Depo-Provera, women cannot stop and permit the side effects to go away; they have the unexpected problems for the 3-month duration of the shots.
Report to USAID of the Ad Hoc Consultative Panel of Depot Medroxyprogesterone, New York City, December 7-8, 1978.
[Unpublished] . 59 p.An Ad Hoc Consultative Panel on Depot Medroxyprogesterone Acetate (DMPA) reviewed the results of animal toxicology studies and available information on the use, benefits, and risks of DMPA in humans in the U.S. and abroad. It also reviewed the conclusions of the World Health Organization (WHO) Toxicological Review Panel. Based on the information available, the Ad Hoc Consultative Panel recommended that the USAID make DMPA available to nations which request it. At present, DMPA is approved in the U.S. for treatment of endometrial cancer, but not for use as a contraceptive. It is approved for contraception in 76 developed and developing countries and has unusual popularity in many settings. The Panel found that DMPA has been used widely for clinical gynecologic uses at doses higher than that recommended for contraception, and no reports have been made of significant adverse effects. DMPA is the only available long-acting injectable contraceptive and has a higher use effectiveness than any other reversible contraceptive method. It has no relation to coitus, requires infrequent administration, and is provided outside the home. There is a mild effect on carbohydrate tolerance and a mild adrenal suppressive effect, but these are probably less than similar effects caused by oral contraceptives. Menstrual side effects are the most important complaints. Initially, there is irregular spotting, staining or bleeding; later, amenorrhea develops in 60% of women. No reason was found to support the Federal Drug Administration's decision not to approve DMPA as a contraceptive in the U.S.
In: Watson, W.B., ed. Family planning in the developing world: a review of programs. New York, Population Council, 1977. p. 54-55The government of Honduras included a population policy in its National Development Plan for the period 1974-1979. This policy will be implemented by providing information regarding responsible parenthood, by using natural and technical resources to produce a well-nourished and creative population, and by applying the principles of voluntary participation in family planning programs. The 2 family planning programs in Honduras are the government maternal and child health program and the Family Planning Association of Honduras program. The government program, initiated in 1968, operates 34 clinics which offer family planning along with prenatal and postnatal care, child care, and nutrition education services. The Family Planning Association, established in 1961, operates 2 clinics and served 42,000 people during 1975. 9000 of this group were 1st acceptors. Oral contraceptives were chosen by 80% of the new acceptors; 13% chose IUDs and 5% chose injectables. The Association's information and education activities included conferences, talks, courses, seminars, and home visits. Additionally, the Association is operating a demonstration community-based distribution program with financial assistance from the International Planned Parenthood Federation. 40 workers in each of 2 cities provide contraceptives in their own neighborhoods.
[Unpublished] 1975. 21 p.Depo-Provera has not been used on a widespread basis in the Philippines because the Federal Drug Administration has not approved it, and a large share of their family planning budget is funded by USAID. Although Governor Luiz made Depo-Provera available to 800 acceptors; it was too expensive to compete with free contraceptives. On a trip to Thailand Governor Luiz witnessed the long-term effects of a Depo-Provera program begun in 1965: fewer children and better living conditions. Laparoscopy is too expensive an operation in training and instruments required to be used in the Philippines. Mini-lap is effective and inexpensive. A Thai doctor taught a Philippine doctor the procedure in only 2 operations. The Philippine doctor can train many others quickly, and equipment can be manufactured locally.
IPPF Situation Report, February 1974. 6 p.Laos has been so torn by war and continuing waves of refugees that i t has been difficult to provide basic medical services to the population . In 1969 Laos had 53 medical doctors, 40 of whom were foreign instructors at the School of Medicine, 676 practical nurses, and 400 trained midwives. Before 1971 the government was opposed to family planning. A study commission in that year, however, examined population growth problems and recommended support for family planning. The voluntary association had been formed in 1966 and had sent representatives to international workshops. After the change in government attitude, the association has actively acted to distribute family planning supplies to villages, train midwives as motivators, and give additional training to public health center heads, home economists, medical assistants, and refugee village heads. The governmental emphasis is on better spacing of births rather than limitation. It took over operation of 7 association clinics in 1973 and now helps provide contraceptive services. The association still has 5 fixed and 6 mobile clinics. A refugee pilot program which opened in 1971 now has a permanent building and a full-time rural midwife. The association also stresses influencing opinion leaders through lecture forums, pamphlets, radio commercials, and film shows. Information and Education teams were formed to conduct 2-3 day seminar-lectures in other provinces to diverse groups like village headmen, town influentials, teachers, and other leaders. Many foreign groups have provided assistance, supplies, training, and other aid. WHO is helping with the integration of family planning into the nursing and midwifery curricula in the schools of Laos.
IPPF Situation Report, September 1972. 7 pHong Kong, with 3858 people/sq km, is 1 of the world's most densely populated areas. Family planning was introduced in 1936 by the Hong Kong Eugenics League and 5 clinics were operating by 1940. The Family Planning Association (FPA) was formed in 1950 and was a founder member of IPPF in 1952. Interest in family planning increased as massive immigration from China added to overcrowding. The government supports FPA (in 1972 the grant was U.S.$254,545) and houses 80% of the FPA clinics in government properties. At present there are 46 female clinics providing 189 sessions per week and 2 male clinics operating eac h week. The decline from 54 to 48 clinics is due to the new emphasis on full-time rather than part-time clinics. In 1971 there were 347,894 attenders, an increase of 18% over 1970, and 31,898 new acceptors, an increase of 4%. There has been continued increase in the number of patients requesting oral contraceptives (70.6% in 1971). The IUD began to decline after bad publicity surrounded a large number of loops which had broken in the uterus; in 1971 only 6% of acceptors asked for IUDs. Condoms account for 11.5% and injectables, 3.6%. FPA offers subfertility and marriage guidance services and is extending its Papanicolaou smear service. An active media campaign, exhibitions, and seminars are conducted. Until 1967 fieldwork consisted of random home visits. An efficiency study led to concentration on maternal and child health clinics, postnatal clinics, and follow-up home visits. Home visi ts are still made on request. A number of international trials for various contraceptives have been run in Hong Kong. Many church and international organizations are helping to finance family planning activities, both through FPA and through their own organizations.