Introducing new products provides a key opportunity to not only expand the range of contraceptive options for women and adolescent girls, but also to strengthen family planning delivery systems for all methods.
Expanding access to contraceptive methods through the private sector and community-based sources—which includes task sharing—is an important strategy to help achieve national family planning and development goals and, in particular, aims to reduce barriers to access for youth, lower-income, and other marginalized groups. Private sector pharmacies and drug shops are often the first line of health care in low- and middle-income countries, particularly for many underserved populations and especially in rural areas that have very few private or public clinics. While there are differences between pharmacies and drug shops, there are also common issues around implementation and impact. For both, training and support can improve and expand the range and quality of services they offer and thereby increase access and choice for women.
As part of the Global Health Science and Practice (GHTechX) conference, CHAI, FHI 360, PATH, the Population Council, PSI, and WCG hosted an April 22, 2021 session to synthesize lessons learned across contraceptive introduction of implants, DMPA-SC self-injection, hormonal IUS and other methods. During the session, experts from Kenya, Madagascar, Uganda, and the United States outlined essential steps for the process of contraceptive product introduction, described common challenges, and shared tools and approaches based on experiences with the three methods. Session slides are available below. To watch the recording of this and many other sessions, register for free on the GHTechX website.
The Guttmacher Institute’s Adding It Up study examines the need for, impact of and cost of fully investing in sexual and reproductive health care—services that together ensure people can decide whether and when to have children, experience safe pregnancy and delivery, have healthy newborns, and have a safe and satisfying sexual life. The estimates pertain to women of reproductive age (15–49) in 132 low- and middle-income countries (LMICs) in 2019; they cover the following services: modern contraception, maternal and newborn care, abortion care, and treatment for the major curable STIs.
The World Health Organization (WHO) convened a Guideline Development Group (GDG) meeting from 29 to 31 July 2019 to review global guidance on contraceptive eligibility for women at high risk of HIV acquisition to and determine whether revisions to the fifth edition of the Medical eligibility criteria for contraceptive use (MEC) were needed. The issue was deemed critical, particularly for sub-Saharan Africa, given the high lifetime risk of acquiring HIV alongside the importance of hormonal contraception in offering women and adolescent girls’ choice and in reducing their risk of unintended pregnancy, a common threat to the health, well-being and lives of women and adolescent girls.
The World Health Organization (WHO) Medical eligibility criteria for contraceptive use (MEC) smart phone application facilitates the task of family planning providers in recommending safe, effective, and acceptable contraception methods for women with medical conditions or medically-relevant characteristics. Recommendations on the initiation and continuing use of nine common types of contraceptive methods are covered by the tool. In addition to looking at individual medical conditions or characteristics, users may also easily combine multiple conditions or characteristics and view the guidance on each condition separately or in combination.
The tool also provides a comprehensive list of medical conditions or characteristics for which all methods of contraception may be safely recommended to women provided there are no additional health concerns. Emergency contraception is also included as part of the “Additional information” section. A graphic representation of the effectiveness of different contraceptive methods is also provided.
Quality of family planning counseling is likely associated with whether or not women continue to use the same contraceptive method over time. The Method Information Index (MII) is a widely available measure of contraceptive counseling quality but little is known about its association with rates of method continuation. Using data from a prospective cohort study of 1,998 social franchise clients in Pakistan and Uganda, we investigated the relationship between reported baseline MII and the risk of method continuation over 12 months using survival analysis and Cox proportional hazard models. Higher scores on the 3-question Method Information Index (MII)—measuring client-reported receipt of contraceptive information—was associated with continued use of family planning over 12 months. We recommend incorporating use of the MII in routine assessments of family planning service quality.
Drug shops and pharmacies have long been recognized as the first point of contact for health care in developing countries, including family planning (FP) services. Drug shop operators and pharmacists should not be viewed as mere merchants of short-acting contraceptive methods, as this ignores their capacity for increasing uptake of FP services and methods in a systematic and collaborative way with the public sector, social marketing groups and product distributors. We draw on lessons learned from the rich experience of earlier efforts to promote a variety of public health interventions in pharmacies and drug shops. To integrate this setting that provides convenience, confidentiality, access to user-controlled contraceptive methods (i.e., pills, condoms and potentially Sayana Press®) and a gateway to clinic-based FP services, we propose three promising practices that should be encouraged in future interventions to increase access to quality FP services.
The Implementation Guide for the Medical eligibility criteria for contraceptive use (MEC) and Selected practice recommendations for contraceptive use (SPR) is part of a global initiative to translate guidance into practice, through implementation science principles. The Implementation Guide is designed to provide a structured process to aid countries’ efforts to incorporate the World Health Organization Medical eligibility criteria for contraceptive use (MEC) and Selected practice recommendations for contraceptive use (SPR) (and their updates) into national family planning guidance. The Toolkit provides the practical resources needed to achieve the tasks in the Implementation Guide.
Family Planning: A Global Handbook for Providers first appeared in 2007. It was updated in 2011 and now again in 2018. This update of the Global Handbook has involved a complete review of the contents of the 2011 edition and updating as needed. All chapters reflect the latest relevant WHO guidance. Thus, this update includes the recommendations of the fifth edition of the Medical Eligibility Criteria for Contraceptive Use, published in 2016, and of the third edition of the Selected Practice Recommendations for Contraceptive Use, published in 2016.
The publication is one of WHO’s evidence-based guidance documents to support and strengthen national contraceptive/family planning programmes. The new and updated practice recommendations contained in this guideline contribute to improving the quality of care in family planning by presenting evidence-based guidance on the safe provision of contraceptive methods for both women and men. The guidelines cover method initiation/continuation, incorrect use, problems during use and programmatic issues for family planning methods.