The promotion of intrauterine contraception in low- and middle-income countries: a narrative review

Context The contribution of copper-bearing intrauterine devices (IUDs) to overall contraceptive protection has declined in many countries, despite their well-known advantages. In response, initiatives to promote this method have been undertaken. Objective To review and interpret the experience of interventions to promote use of IUDs in low- and middle-income countries in order to provide strategic guidance for policies and programs. Methods We conducted a systematic search of Medline, Popline, Embase and Global Health electronic databases for relevant journal papers, reports and gray literature since 2010. Telephone interviews were held with two donors and six international family planning organizations. Results We identified a total of 31 publications. Four reported the results of randomized control trials and three were derived from quasi-experiments. The majority were based on service statistics. Eight publications concerned interventions for HIV-positive women or couples, nine for postpartum or postabortion cases and 14 for general populations. Intervention approaches included vouchers, franchising of private practitioners, mobile outreach services, placement of dedicated staff in high-volume facilities and demand creation. Most publications adduced evidence of a positive impact and some reported impressively large numbers of IUD insertions. Results to date on the uptake of IUDs in postpartum interventions are modest. There is also almost no evidence of effects on IUD use at national levels. Implant uptake generally exceeded IUD uptake when both were offered. Conclusion The evidence base is weak and offers few lessons on what strategies are most effective. The overall impression is that IUD use can be increased in a variety of ways but that progress is hampered by persistent adverse perceptions by both providers and potential clients. Provider enthusiasm is a key to success. The lack of a population impact stems in part from the fact that nearly all interventions are initiated by international organizations, with limited national reach except in small countries, rather than by government agencies

Being-with, authenticity, and the question of community in 'Being and time'

In Being and Time Heidegger posits Dasein's Being as essentially Being-with-Others. However, he only occasionally refers to Dasein's sociality, and throughout Being and Time there are sections where Heidegger seems to be setting out a more robust social structure which would allow us to understand how this Being-with-Others takes place. For example, he talks of solicitude (Fiirsorge) in both division I and II, as well as more oy~dy in §74 of division II where he talks of the community of authentic people (das Volk), but he never expands on these. It will be the purpose of this thesis to ask precisely how we might understand, what he calls, 'the various possibilities of community a well as of society'. Clearly an account of Dasein's sociality must take into account its different modes of Being- with-Others: i.e. indifferent, inauthentic, and authentic. But it is not apparent how Heidegger envisages the development of those social possibilities and what he ultimately sees them as amounting to. I will argue that understanding sociality and community in Being and Time presents us with three formulations that show a tension between authenticity and community. The first is a minimal form of community, conceived as one where Dasein has an inauthentic relation to the Other. The second is a more substantial form where Dasein becomes authentically bound together in a shared 'Destiny'. This conception will be shown to be in tension with the first one. This will lead me to ask whether we can envisage a third option that arguably avoids this tension between a generation of authentic Dasein and those inauthentic ones. I will question whether a viable 'third way' is to posit a formulation where authenticity depends on community, or rather where 'community' is not only compatible, but is a necessary condition of authenticity.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Western Panderings. A record of travel in the evening land.

LEIDSSTELSELOPLADEN-RUG0

Providing safe motherhood services to underserved and neglected populations in Yemen: the case for vouchers

Abstract States of fragility and insecurity often give rise to urgent health needs that need to be met quickly and effectively, particularly for women and adolescents. Vouchers are a demand-side financing mechanism which can be used to address some of the health challenges faced by women under these circumstances. A number of organisations have begun to use vouchers to enable access to reproductive, maternal and newborn care services in conflict-affected countries such as Yemen, Syria and Central African Republic. Vouchers allow health programme implementers to use targeted subsidies to reduce financial and other barriers to accessing care, increasing and catalysing the uptake of specific health services among vulnerable and underserved populations. These subsidies are passed onto public and private providers in the form of service reimbursements and are often used to enhance capacity to meet increased demand for services, as well as to invest in quality improvements. Yemen is one of the poorest countries in the Middle East and North Africa region, and since 2010 has consistently appeared on the lists of fragile states. We present data from the Reproductive Health Voucher Programme in Yemen to show that during 2014, when the conflict was worsening and public facilities faced significant challenges to keep functioning, the vouchers enabled women to continue accessing quality maternal newborn health services. By contracting a range of public and private providers, from referral hospitals to community midwives, the number of services utilised in one governorate in Yemen was consistently higher (17% or more) than the predicted number for all services utilised that make up the safe motherhood voucher package. The programme was able to channel funds to facilities at a time when funds flowing to the governorates were highly erratic, enabling them to address stock-outs of drugs and supplies at the local level and to maximise the supply of critical maternal newborn health services for poor women and their families