Utilization of national health insurance for family planning and reproductive health services by the urban poor in Uttar Pradesh, India

In 2008, the Government of India launched the National Health Insurance program, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in urban and rural areas to access a range of private health services. Enrolled families can access packages of services from RSBY-participating private hospitals, including family planning (FP) and other reproductive health (RH) services. Despite the availability of insurance coverage, poor families’ utilization of RSBY for FP/RH services is believed to be negligible. The Evidence Project is conducting a study in three cities in Uttar Pradesh to better understand the factors affecting utilization of RSBY for FP/RH services. As this activity brief indicates, the study is timely because the government is eager to increase the number of beneficiaries, their uptake of health services, and the number of private hospitals participating. The study is also important given that RSBY is operating in an expanding urban environment, where there is a rapidly growing need for FP/RH services among the urban poor. Study findings will help contribute to India’s FP2020 goals

Social accountability for family planning: A case study of the Healthy Action Project in Uganda

In July 2014, the Evidence Project gathered 26 experts for a two-day meeting on Strengthening the Evidence Base on Social Accountability for Improving Family Planning and Reproductive Health Programs. Participants included social accountability experts from diverse fields (governance, maternal health, family planning) as well as researchers, implementers, and activists. The meeting was one of the first public discussions that addressed social accountability in the context of family planning and reproductive health (FP/RH). Meeting participants agreed on the need for case studies of FP/RH initiatives to identify “good practices” in order to advance the application of social accountability to the FP/RH field. The Evidence Project is conducting a case study—in two districts in Uganda—of one such initiative featured at the meeting, namely the Healthy Action Project (HA). This activity brief summarizes the case study and how the HA project improved clients’ access to FP/RH services at the district level through the use of social accountability mechanisms

Dynamics of postpartum IUD use in India

Evidence suggests that in India, compared to married women in general, postpartum married women have a much higher need for family planning that remains unmet. India’s postpartum IUD (PPIUD) program aims to help postpartum women space pregnancies and prevent mistimed or unwanted births. The majority of PPIUD users in this study were young, educated, and had one child. Most were involved in making the final decision about which family planning method to use after discussions with the provider, and most had spoken with a frontline health worker at least once about family planning methods in the three months preceding birth and about the IUD. Thus, frontline health workers are an important source of family planning information to pregnant women including information about the PPIUD. This brief reports that their interactions with providers at IUD insertion indicate that there is room for improvement in quality of care and includes a number of recommendations that will help strengthen India’s family planning program

Understanding youth sexual and reproductive health-seeking behaviors in Ethiopia: Implications for youth-friendly service programming

In Ethiopia, significant attention has been given to improving youth sexual and reproductive health (SRH) services, including the establishment of youth-friendly services (YFS). Yet high rates of child marriage, unmet need for family planning, and adolescent childbearing persist, particularly in rural areas where over 84 percent of the population lives. Reaching rural youth with timely SRH information and services that are relevant to their varying ages and life stages remains a challenge. The Evidence Project is examining the coverage and reach of public and NGO-supported youth SRH services in several rural regions of Ethiopia. As this activity brief notes, the study focuses on the service utilization patterns, behaviors, and experiences of young people, ages 12–24 years, females and males, unmarried and married, in-school and out-of-school. The study also is assessing providers’ and influential adults’ perceptions of the barriers to and opportunities for services to meet the unique needs of young people. The knowledge generated from this study will provide needed evidence for strengthening youth SRH services in the country

Expanding access to rights-based family planning: Activity brief

The human rights dimensions of family planning programs have been recognized for nearly half a century and affirmed in numerous declarations, conventions, and treaties endorsed by governments and the international community. While discourse about respecting, protecting, and fulfilling these rights is growing, a gap persists between human rights rhetoric and integrating rights in family planning policy, programs, and practice. Governments and programs struggle with defining and operationalizing a rights-based approach to family planning. Overall, there is scant evidence on: how to implement rights-based family planning (RBFP) programming, how to measure rights-based programming and outcomes, and the effect on family planning/reproductive health outcomes of implementing RBFP. Furthermore, literacy about human rights and family planning is generally low at the global, national, and subnational levels. Working with a range of stakeholders, the Evidence Project conducted several activities to address these gaps, and this activity brief outlines these activities: Defining RBFP and synthesizing resources; incorporating and operationalizing rights-based approaches in costed implementation plans; testing an index to measure adherence to RBFP; and defining rights-based indicators for family planning programming and monitoring

The RAISE Health initiative for workers, companies, and communities

RAISE Health is an initiative to improve the health of factory and farm workers (women and men) in developing countries through changes in global and corporate policies and workplace practices. Effective management of workplace health is good for companies and workers alike, resulting in better health and morale, better labor-management relations, empowerment of women, and better use of company health investments. Worker health is typically one of the most neglected areas in business operations. As this activity brief notes, RAISE Health is a major activity of the USAID-funded Evidence Project. The goal of the initiative is to utilize the existing business systems of corporations and their supplier farms and factories to address the health needs of millions of women and men workers in such overlooked areas as family planning, reproductive health, maternal and child health, nutrition, hygiene, and other important health concerns. RAISE Health promotes worker health by developing and advocating for better policies within the global framework of standards, codes, and compliance for corporations and their supply chains, and documenting and disseminating best practices

Dynamics of injectable contraceptive use in India

This brief describes a research study by the Population Council, with support from USAID/India, whose purpose is to provide evidence that can be used to strengthen the family planning program and meet the needs of reversible contraceptive users who want to prevent pregnancy in India. Understanding the experiences of the small but growing population of women choosing the injectable is important as the Government of India continues to roll out injectable contraceptive methods in the public sector. The report’s key recommendations include: disseminating messaging about potential side effects of the injectable, institutionalizing quality of care in pre-service trainings for all family planning providers and frontline health workers, engaging husbands of recent adopters of contraception, and training frontline health workers to visit recent injectable adopters

Uganda retail audit: Analysis and report

This brief presents results of a retail audit, carried out in January 2016, that was commissioned as part of PATH’s work under the USAID-funded Evidence Project to conduct a landscape assessment of the feasibility of a Total Market Approach (TMA) in Uganda. This project also involved key informant interviews with stakeholders on their attitudes toward TMA principles and the collection of a Uganda Market Research Summary of existing family planning knowledge. The approach is based on an understanding that equitably meeting the diverse needs of different population segments requires increased coordination across sectors, including the public, private for-profit, and not-for-profit sectors. This is particularly important in the context of global commitments to increase access to family planning, including the FP2020 goal of reaching 120 million additional women by 2020

Strengthening the role of patent medicine vendors in the provision of injectable contraception in Nigeria

The majority of contraceptive services in Nigeria are offered in private settings, including Patent Medicine (PM) shops. PM shops are informal businesses owned by Patent Medicine Vendors (PMVs) licensed to sell patent or proprietary drugs. Injectable contraception is the most popular modern contraceptive method in Nigeria. However PMVs are not regulated to sell or administer injectable contraceptives because the businesses do not receive formal training. Despite this, some PMVs are selling and administering injectable methods in response to high demand. The Evidence Project, in collaboration with the Federal Ministry of Health, conducted implementation research to: demonstrate the feasibility of PMVs administering all available forms of injectable contraception; and understand women’s experiences using injectable contraception. The brief describes the intervention which included training of PMVs so that they have the necessary skills and information to sell, counsel, and refer for all contraceptive methods, as well as administer all injectable contraceptives

Health needs, health seeking pathways, and drivers of health seeking behaviors of female garment factory workers in Cambodia: Findings from a qualitative study in Phnom Penh and Kandal provinces

Existing information on Cambodian garment factory workers’ (GFWs) barriers to health services has generally come from project implementation documents or general baseline studies of these projects, rather than independent, rigorous studies that specifically examine the health needs and health-seeking behaviors of workers. Since previous studies did not include specific indicators related to workers’ health needs and health-seeking behaviors, they cannot offer a complete picture of these important issues. To fill this critical knowledge gap, in partnership with the National Institute of Public Health, the Evidence Project/Population Council conducted a formative qualitative study under the USAID-funded WorkerHealth project to improve the understanding of health needs, health-seeking pathways, and drivers of health-seeking behaviors of female GFWs in Cambodia. Though the study focused broadly on health needs, the findings emphasize workers’ concerns regarding sexual and reproductive health care and family planning services. This research study offers the first illustrative mapping of the health-seeking pathways of female GFWs, which provides a richer understanding of workers’ perceptions of health care quality and of the values, beliefs, and socioeconomic conditions that shape decisionmaking on how and where to seek health care in communities