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Baltimore, Maryland, Advance Family Planning, Bill & Melinda Gates Institute for Population and Reproductive Health, 2018 Jan. 4 p.This case study explores that, despite Lagos State’s investment in family planning, hidden, out-of-pocket costs prevented achieving the goal. Moreover, the advocates’ attainment of a policy directive to address this lacked additional funding to carry it out. The study highlights the importance of advocates’ follow-through--and how the SMART approach enabled them to carry a commitment toward implementation.
Durham, North Carolina, FHI 360, 2018 Apr. 6 p.Since the London Summit on Family Planning (FP) in 2012, more than 40 countries have committed to making high-quality, voluntary FP services, information, and supplies more available, acceptable, and affordable for an additional 120 million women and girls in the world’s 69 poorest countries by 2020. Meeting the commitments of this initiative, known as FP2020, will ensure that every woman and every girl has the right, and the means, to shape her own life-to grow, to thrive, and to plan the family she wants. Costed implementation plans (CIPs) are multi-year action plans that contain detailed resource projections for achieving the goals of a FP program, thus enabling countries to operationalize and monitor progress toward their FP2020 commitments. Thus far, close to 30 countries in Africa and Asia have developed CIPs at either a national or subnational level, with new CIPs being developed on an ongoing basis. Translating CIPs into action, and ultimately into results, requires a sustained deliberate approach to the execution process throughout the plan. This notion may sound simple and straightforward, but it can be complex. Strategic planners agree that planning seldom fails; it is the execution that fails. Extensive literature describes the factors that can stall a plan, including lack of buy-in and ownership, unclear lines of responsibility and accountability, lack of dedicated efforts to mobilize resources, inability to recognize and facilitate change processes, poor communication and coordination among stakeholders, and inadequate leadership and management skills to effect execution. This case study describes the process of translating the plan into sustained action and measurable results-execution, challenges, and lessons learned. It is based on consultations with stakeholders, conducted in August 2016 to understand the execution process, and is enriched by reports from performance-monitoring efforts and follow-up with in-country stakeholders. (excerpt)
Barriers to utilization of long acting reversible and permanent contraceptive methods in Ethiopia: Systematic review.
Ethiopian Journal of Reproductive Health. 2018 Jul; 10(3):1-24.BACKGROUND: Globally the use of Long-Acting Reversible and Permanent Methods (LARPMs) has been recommended as the first-line, highly effective options for pregnancy prevention. They have greater efficacy than short acting contraceptive methods and are associated with lower rates of unwanted pregnancy. Ethiopia has made significant progress in family planning (FP); however, one fourth of married women still have unmet need for FP and nearly three-fourth of family planning users depend on short acting injectable contraceptives. The aim of this study was to review existing researches to identify barriers to long acting reversible and permanent contraceptive use in emerging regions of Ethiopia. METHOD: Published and unpublished literatures were searched using major search engines and different search terms related to the topic. Literature search was carried out from March to May 2016. Six selection criteria were prepared to summarize the findings using PRISMA protocol. A checklist of eight-item quality assessment criteria was used to rate the quality of studies independently by two investigators, and the third investigator cross checked and decided on agreements. The studies were critically appraised, and thematic analysis was used to synthesize the data. RESULTS: Using the screening criteria, 69 eligible full-text articles and reports were reviewed; of which 34 articles and 8 policy/strategy documents were considered for data synthesis. The review has included policy related, individual, socio-cultural and health facility related barriers/factors affecting LARPMs use in emerging regions. Lack of strategies to reach the mobile population of emerging regions, facility readiness to provide LARPMs and quality of care were major policy and health care factors contributing for the low utilization of LARPMs. Low knowledge of LARPMs, health concerns, fear of side effects, and lower education were among individual level barriers identified through the review. Moreover, the review showed that men’s (partner’s) objection, desire for more children (especially by the male partner), absence of male involvement, lack of women’s decision-making power and lack of discussion with partners were gender related barriers. CONCLUSION: The regional disparity in LARPM use, particularly in emerging regions, requires targeted policy and strategic direction to address the prevailing inequality in family planning use and method mix. To improve the utilization of LARPMs, efforts should be made to address the key demand and supply side barriers. More context specific research evidences should be generated to understand barriers that are specific to these regions.
Neurology. 2016 Aug 23; 87(8):e85-8.Add to my documents.
Journal of Population Research. 2018 Jan; 35(1):23-40.Using data from China Family Panel Studies 2010, we evaluate the role of the Birth Planning Policy (BPP) in altering decisions to have another child by birth parity, and the relationship of life satisfaction with the gender structure of the children of Chinese residents. We find strong positive effects of the BPP on the decision of having an additional child for Chinese residents, particularly if the previous children were girls. In spite of strong son preference in fertility behaviour, residents whose children are all daughters are found to be more satisfied with their lives than with other gender structures. The empirical findings support the view that daughters are more helpful in providing assistance to parents and in mitigating family conflicts hence increasing life satisfaction, while son preferences may be pursued reasons of lineage and hence do not result in more satisfied lives. We also find evidence that the BPP penalty might be a reason why having more sons could reduce life satisfaction.
Four years of the FIGO postpartum intrauterine device initiative in Sri Lanka: pilot initiative to national policy.
International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):28-32.Objective: To analyze the difficulties and challenges arising from introduction of postpartum intrauterine device (PPIUD) services into the Sri Lankan health system. Methods: Phase I of a FIGO PPIUD initiative was implemented in 2013 in six hospitals; phase II began in 12 hospitals in 2015. During this period, 915 Medical Officers were trained in PPIUD insertion and 5370 personnel were trained in PPIUD counseling. Women were followed up at 4–6 weeks after insertion. Results: A total of 184 433 women (62.4% of hospital deliveries) were interviewed about PPIUD as a method of contraception. Of those interviewed, 116 159 (63.0%) received counseling on PPIUD and 11 339 (6.1%) consented to PPIUD insertion. Of consenting women, 9346 (82.4%) had a PPIUD inserted. There were no significant complications reported at insertion. Expulsion rates were 2.9% and removal rates were 4.1%. Conclusion: PPIUD as a method of contraception was successfully introduced into the 18 participating hospitals. Given the success of this pilot intervention and the safety profile demonstrated, PPIUD was added to the national family planning program in 2017.
International Journal of Gynecology and Obstetrics. 2018 Sep; 143(Suppl 1):1-3.The International Federation of Gynecology and Obstetrics (FIGO) recognized the potential public health impact that the postpartum IUD (PPIUD) could have, particularly in LMICs, and to this end embarked on an initiative that began in 2013.The positive experience of the FIGO PPIUD project is distilled in this Supplement. We urge governments to take on board the lessons learnt and described here, and to appreciate the enormous benefits that offering PPIUD could bring to women around the world. The Supplement is a tool book on how to introduce PPIUD into different health systems and expand contraceptive choices. The work at FIGO and with the six participating national societies will continue in the years ahead; the respective governments have welcomed continuation of the initiative with a view to sustainability and further embedding the practice of offering postpartum contraception as part of routine postpartum care. (excerpt)
BJOG. 2016 Sep; 123 Suppl 3:7-9.Add to my documents.
Patients at a London integrated sexual health clinic are concerned at redirection of contraceptive prescriptions.
BMJ Sexual and Reproductive Health. 2018 Apr; 44(2):146-147.Add to my documents.
Journal of Human Lactation. 2018 Aug; 34(3):433-437.Add to my documents.
Washington, D.C., Population Council, The Evidence Project, 2018 Jan. 31 p. (Resource Guide)The ambitious FP2020 goal of providing family planning services to 120 million more women and girls that emerged from the Family Planning Summit in London in 2012 has refocused attention on the need to ensure that family planning programs respect, protect and fulfill individual’s human rights and that programs are implemented using a rights-based approach. The current challenge is how to operationalize human rights in existing family planning programming. A number of resources are available to do so and the purpose of this paper is to review 10 key resources currently available to guide family planning programming.
Rights-sizing family planning. A toolkit for designing programs to respect, protect, and fulfill the rights of girls and women.
Washington, D.C., Population Council, The Evidence Project, 2018 Jan. 78 p. (CIP Resource Kit)The Rights-Sizing Family Planning toolkit was developed primarily to provide guidance and background on rights-based family planning with the aim of helping stakeholders in FP2020 Commitment Countries develop a Costed Implementation Plan (CIP) that includes a rights frame calling for respectful and client-focused care. We have found that the material in the toolkit is useful to those who want a clearer understanding of what is meant by rights and how this can be operationalized. The toolkit includes: 1) Brief, 2) Human Rights Conventions that Apply to Family Planning, 3) Examples of Human Rights International Consensus Documents, 4) Case Studies, 5) Tools & Templates, and 6) Resource Guide.
Washington, D.C., The Evidence Project, Population Council, 2018 May. 8 p. (Synthesis Brief)In Senegal, the National Action Plan for Family Planning (NAPFP) 2012–2015 and the National Strategic Framework for Family Planning 2016–2020 adopted a multi-sectoral approach to broaden access to family planning (FP) services and to reach 45% modern contraceptive prevalence (mCPR) by 2020 (NAPFP, 2012). The private sector and community actors are key partners with the public sector in implementing this approach. However, private pharmacies have not been actively involved in the provision of FP services due to legal and nonlegal barriers that limit their role to selling contraceptives and providing method-specific advice. As Senegal seeks to involve the private sector in improving access to FP, this study found that the country is in an optimal position to increase the role of private pharmacies in FP, which could contribute to the country reaching its mCPR goals. The brief includes policy recommendations for the Government of Senegal, for pharmacists and their professional organizations, and for technical and financial partners.
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.
Review of Economics of the Household. 2018; 1-29.While studies of birth order effects on human capital formation for developed countries abound, less is known about these effects in a developing country context. Harnessing rich childbearing history data on senior parents in China, I provide within-family estimates of the impact of birth order on adult children’s completed schooling, emphasizing heterogenous effects across gender. I find evidence that, holding the size of the family fixed, a daughter’s schooling decreases with the number of younger siblings, while a son’s schooling increases with the number of younger siblings. Birth order differences in age at marriage and provision of intergenerational support to parents are possible explanations for the observed patterns in schooling. My findings suggest that the one-child policy, despite having contributed to worsening the sex-ratio imbalance in China, could have helped reduce the gender gap in educational attainment. © 2018 Springer Science+Business Media, LLC, part of Springer Nature
A retrospective cohort survey of problems related to second childbirths during the 2-child policy period in Jiangbei District of Ningbo City in China.
Medicine. 2018 May; 97(18):e0604.From 1979 to 2014 in China, a 1-child policy was imposed to control population growth. During 2014 to 2015, families in which 1 spouse was only 1 child were eligible to apply for planning a second child. To foresee issues affecting obstetrical departments related to the introduction of the universal 2-child policy in 2016, we retrospectively investigated the demographics and health-related outcomes of second pregnancies in families applying for a second child in Jiangbei District of Ningbo City during January 17, 2014, to January 14, 2016.A retrospective cohort survey was conducted for Jiangbei District of Ningbo City from January 17, 2014, to January 14, 2016, with reference to data from 2012 to 2014.Applications for a second birth increased after implementation of the 2-child policy, from 505 in 2012 to 2013, to 1222 in 2014 to 2015. Until the end of this study (December 31, 2016), 739 women gave birth to a second child, among whom 21.38% were aged >/=35 years. Rates of cesarean deliveries (59.68%) and gestational diabetes mellitus (14.21% of women) were each positively associated with the age of the mother. Among women aged >/=35 years, 37.97% refused prenatal screening.Introduction of the 1-child policy encouraged more families to apply for a second child, with many women aged >/=35 years, leading to higher rates of cesarean deliveries and adverse complications. A high percentage of eligible older women refused prenatal screening. Obstetric departments should adjust perinatal health management schemes to prepare for similar probable changes associated with the universal 2-child policy.
Washington, D.C., Population Reference Bureau [PRB], 2018 Mar. 150 p.The Population Reference Bureau (PRB) has developed a “Youth Family Planning Policy Scorecard” to measure and compare countries’ youth FP policies and programming. The scorecard compiles and analyzes the evidence that identifies the most effective national policies and program interventions to promote uptake of contraception among youth, defined as people between the ages of 15 and 24. This report details the purpose of the new scorecard, describes its methodology and indicator selection process, and summarizes results for 16 countries.
Washington, D.C., Population Reference Bureau [PRB], 2018 Apr. 8 p. (Policy Brief; USAID Project No. AID-I-0304)This policy brief explores wealth-based disparities in the modern contraceptive prevalence rate, total fertility rate, and demand satisfied for modern methods of family planning in Ethiopia, Ghana, Malawi, and Tanzania.
Rural History. 2018; 29(1):99-112.The one-child era, which lasted thirty-five years (1980-2015), was a unique period in Chinese (and even world) history. With the introduction of the universal two-child policy in 2016, China put an end to the age of the one-child policy. Since the policy change has come into effect, China's rural areas, which contain approximately 800 million people, have experienced a very particular historical phenomenon. Due to the changes in China's family planning policy, slogans painted on walls have evolved in terms of the messages they carry to grassroots rural areas. Once conveying China's family planning policy propaganda with, at times, a shocking and controversial tone, the wall slogans in rural areas have evolved with the wider changes to the country's family planning policy. However, this dying, unique way of communication between the government and rural areas is being consigned to the memory of the times of rural policy advocacy in China. Copyright © 2018 Cambridge University Press.
Journal of Economic Perspectives. 2017; 31(4):205-28.Add to my documents.
A demographic dividend of the FP2020 Initiative and the SDG reproductive health target: Case studies of India and Nigeria.
Gates Open Research. 2018 Feb 22; 2:11.Background: The demographic dividend, defined as the economic growth potential resulting from favorable shifts in population age structure following rapid fertility decline, has been widely employed to advocate improving access to family planning. The current framework focuses on the long-term potential, while the short-term benefits may also help persuade policy makers to invest in family planning. Methods: We estimate the short- and medium-term economic benefits from two major family planning goals: the Family Planning 2020 (FP2020)'s goal of adding 120 million modern contraceptive users by 2020; Sustainable Development Goals (SDG) 3.7 of ensuring universal access to family planning by 2030. We apply the cohort component method to World Population Prospects and National Transfer Accounts data. India and Nigeria, respectively the most populous Asian and African country under the FP2020 initiative, are used as case studies. Results: Meeting the FP2020 target implies that on average, the number of children that need to be supported by every 100 working-age people would decrease by 8 persons in India and 11 persons in Nigeria in 2020; the associated reduction remains at 8 persons in India, but increases to 14 persons in Nigeria by 2030 under the SDG 3.7. In India meeting the FP2020 target would yield a saving of US$18.2 billion (PPP) in consumption expenditures for children and youth in the year 2020 alone, and that increased to US$89.7 billion by 2030. In Nigeria the consumption saved would be US$2.5 billion in 2020 and $12.9 billion by 2030. Conclusions: The tremendous economic benefits from meeting the FP2020 and SDG family planning targets demonstrate the cost-effectiveness of investment in promoting access to contraceptive methods. The gap already apparent between the observed and targeted trajectories indicates tremendous missing opportunities. Accelerated progress is needed to achieve the FP2020 and SDG goals and so reap the demographic dividend.
International Journal of Gynaecology and Obstetrics. 1995 Oct; 50 Suppl 2:S27-S34.Africa lags behind the rest of the developing world in most demographic, health and economic indicators of social development, but some progress has been made in contraceptive prevalence and fertility decline. Many challenges remain for governments on that continent to meet the basic reproductive health needs of their rapidly growing populations. With the sustained support of the international community, there is reason to be hopeful. (c) 1995 International Federation of Gynecology and Obstetrics.
Bioethics. 2017 Oct; 31(8):582-589.Several philosophers have recently argued that policies aimed at reducing human fertility are a practical and morally justifiable way to mitigate the risk of dangerous climate change. There is a powerful objection to such "population engineering" proposals: even if drastic fertility reductions are needed to prevent dangerous climate change, implementing those reductions would wreak havoc on the global economy, which would seriously undermine international antipoverty efforts. In this article, we articulate this economic objection to population engineering and show how it fails. We argue, first, that the economic objection paints an inaccurate picture of the complicated relationship between demographic change and economic growth, and second, that any untoward economic effects of fertility reduction can be mitigated with additional policies. Specifically, we argue that supplementing fertility reduction with policies that facilitate the emigration of younger people from developing nations to developed nations could allow for both global reductions in GHG emissions and continued economic stability. Further, we show that moral arguments against such unprecedented increases in immigration are unsuccessful. We conclude that population engineering is a practical and morally justifiable tool for addressing the twin evils of climate change and global poverty. (c) 2017 John Wiley & Sons Ltd.
American Journal of Obstetrics and Gynecology. 2018 Jun; 218(6):590.e1-590.e7.Rates of short-interval pregnancies that result in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception methods have annual failure rates of <1%, compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to long-acting reversible contraception in the immediate postpartum period, several State Medicaid programs, which include those in Iowa and Louisiana, recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum long-acting reversible contraception insertion. We used a mixed-methods approach to analyze 2013-2015 linked Medicaid and vital records data from both Iowa and Louisiana and to describe trends in immediate postpartum long-acting reversible contraception provision 1 year before and after the Medicaid reimbursement policy change. We also used data from key informant interviews with state program staff to understand how provider champions affected policy uptake. We found that the monthly average for the number of insertions in Iowa increased from 4.6 per month before the policy to 6.6 per month after the policy; in Louisiana, the average number of insertions increased from 2.6 per month before the policy to 45.2 per month. In both states, the majority of insertions occurred at 1 academic/teaching hospital. In Louisiana, the additional increase may be due to the engagement of a provider champion who worked at both the state and facility level. Recruiting, training, engaging, and supporting provider champions, as facilitators, with influence at state and facility levels, is an important component of a multipart strategy for increasing successful implementation of state-level Medicaid payment reform policies that allow reimbursement for immediate postpartum long-acting reversible contraception insertions. Published by Elsevier Inc.
What influences a woman's decision to access contraception in Timor-Leste? Perceptions from Timorese women and men.
Culture, Health and Sexuality. 2018 Mar 6; 1-16.Timor-Leste's Maternal Mortality Ratio remains one of the highest in Asia. There is ample evidence that maternal deaths may be reduced substantially through the provision of good-quality modern methods of contraception. Many Timorese women wish to stop or delay having children. However, even when health services make contraception available, it does not mean that people will use it. Collaborating with Marie Stopes Timor-Leste, this qualitative research project used decolonising methodology to explore perceived influences contributing to contraceptive choices, and gain insight into how women's decisions to access contraception in Timor-Leste occur. Over two fieldwork periods (2013 and 2015), we used focus group discussions and structured interviews to speak with 68 women and 80 men, aged 18-49 years, across four districts of Timor-Leste. Findings demonstrate that the decision to access contraception is often contentious and complicated. These tensions echo concerns and ambiguities contained within global and national reproductive health policy. Overwhelmingly, participants emphasised that despite her wishes, a woman can only rarely exercise her right to access contraception freely and independently. She is most often constrained by family, cultural, traditional and educational influences.