Expanding access to family planning for married adolescent girls in the urban slums of Dhaka

Early pregnancy is associated with adverse health, social, and economic consequences for girls, and Bangladesh has an adolescent fertility rate that is among the highest in the region. Poor, slum-dwelling girls are especially vulnerable. This policy brief outlines a project that icddr,b, a STEP UP project partner, initiated to test three innovative strategies aiming to support the unmet family planning needs of these girls. This brief concludes with government-level policy and program recommendations based on the evidence of this project for leveraging existing government health programs to better serve the needs of married adolescent girls and reduce their risks of early pregnancy

Strengthening school-based sexual and reproductive health education and services in Accra, Ghana

This evidence brief presents results of a study aimed to assess the acceptability and feasibility of two proposed solutions for strengthening the content and delivery of in-school sexual and reproductive health (SRH) programs in Ghana. The study was conducted in Nima, a suburb of Accra, where stakeholders agreed there was a need for enhanced SRH services in school. The study explored providing comprehensive in-school SRH education to adolescents using trained psychologists and health workers to deliver and explain comprehensive sexuality education to adolescents and link them as needed to outside services. There was unanimous agreement that adolescent SRH needs are not being met; that schools provide the best opportunity to provide this education and service to adolescents; and that the solutions under discussion were feasible and acceptable

Community health workers for maternal and child health

In this factsheet, the Population Council notes the shortage of trained health professionals in the developing world; virtually all of sub-Saharan Africa stands below the critical threshold of 2.3 doctors, nurses, and midwives per thousand people. Doctors are especially unevenly distributed between urban and rural areas, with shortages being even more acute in rural communities. This document summarizes the important role of community health workers (CHWs) who can considerably increase coverage where access to health facilities is difficult and service utilization is already low. CHWs can play a vital role in increasing access to family planning and work within a community-based team to educate women on the importance of attending antenatal, delivery, and postnatal care with a skilled professional. However, many challenges exist; standardization of training, sustainability of funding, and other obstacles must be addressed for the CHW model to achieve its full potential

Using evidence to improve quality of pharmacy-delivered medical abortion

The goal of family planning and reproductive health operations research is to generate evidence that helps policies and programs maximize access to and quality of services for women and their families. Yet the crucial step of ensuring the utilization of that evidence often receives inconsistent or inadequate attention. The goal of this case study is to document an activity of Marie Stopes International (MSI) in Kenya, part of the STEP UP research program consortium, which resulted in successful evidence utilization. STEP UP research on quality of care for medical abortion, particularly on pharmacy provision of medical abortion, has provided the evidence base for strengthening of MSI’s provision of safe abortion across the globe. STEP UP research has been successfully utilized at wide scale throughout the MSI network and the embedded partnership of research activities and service delivery was the crucial link that offered an effective conduit for research utilization

Bangladesh: Using strong evidence and strategic collaboration to increase access to menstrual regulation with medication

Through close cooperation with the Ministry of Health and Family Welfare of Bangladesh, and other partners, STEP UP generated strong evidence and cultivated ongoing collaboration that contributed to policy changes and program expansions to increase access to menstrual regulation with medication (MRM). Study results demonstrate that MRM is acceptable and effective in Bangladesh, and has thus been legalized and folded into the national FP program and scaled up nationwide. However, ongoing observation and studies are still needed to understand whether the efficacy and acceptability of MRM remains the case when services are delivered at scale on a national level. Furthermore, the role of the private sector in women’s access to MRM, especially considering that the government has little control over the drugs sold in pharmacies, must be considered

Kenya: Helping adolescent mothers remain in school through strengthened implementation of school re-entry policies

By applying robust evidence, securing the support of decisionmakers, and engaging stakeholders, STEP UP enabled national and local decisionmakers to better understand the consequences of unintended pregnancy for adolescent girls’ schooling in Homa Bay County, Kenya. STEP UP is playing an important role in informing the implementation of policies within the Kenyan educational sector that will improve educational opportunities for school-age mothers. Through early stakeholder engagement, strong partnerships, the support of implementers and policymakers, effective communication and dissemination strategies, decisionmaker capacity, and the dedication of the adolescent mothers themselves, evidence generated by STEP UP was successfully utilized by key stakeholders. Through this work, STEP UP has seen a positive shift in the discourse among Homa Bay County stakeholders on the continued education of all girls and the development of culturally appropriate models to better address unintended pregnancy in this population

Country mapping: Senegal

The Population Council embarked on a three-year project to explore the acceptability of the progesterone vaginal ring (PVR) among women in sub-Saharan Africa and its potential introduction. This technical report presents results from assessments undertaken to map the existing landscape of family planning programs and new contraceptive technologies in Senegal in an effort to identify national priorities and assess the level of interest in the PVR among stakeholders and to design appropriate preintroductory activities. This country mapping exercise confirms that Senegal is a promising context for the introduction of the PVR: the government is committed to repositioning family planning and has created an enabling environment and there are various encouraging sociocultural trends which suggest potential for acceptance of the PVR. Some key accompanying measures will need to be taken to ensure proper execution of the acceptability study and subsequent introductory efforts, including early involvement of the Ministry of Health, development and dissemination of literature in French on the PVR and the project, and establishment of an appropriate communication plan to name a few. Its innovative, long- and mid-acting, user-controlled design will introduce a unique dimension to the current method mix and is a promising prospect for provision at the community level in Senegal

How are educated women in Ghana regulating fertility without high levels of modern contraceptive use?

While Ghana has made striking gains in enabling its women to use family planning to reduce family size—the total fertility rate shifted from 7.0 to 4.2 children per woman from the 1970s to the 2010s—the Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) studies found that educated women in Ghana are achieving their fertility goals by limited use of highly effective contraceptive methods. Their fertility regulation strategies involve contraceptive method mosaics that have not been captured by the DHS. This evidence summary aggregates research from the STEP UP Research Programme Consortium along with other related evidence to explore this question of how educated women in Ghana are able to control their fertility. Recommendations include focusing efforts on ensuring that family planning providers explain effects and side effects of contraceptives, integrating effective use of coital and traditional methods into family planning programs, and suggesting that stable couples use a more effective contraceptive regimen, as well as providing abortion services as allowed by law