This systematic review evaluates the strength of the evidence that community health workers' (CHW) provision of family planning (FP) services in low- and middle-income countries is effective. In a search of eight databases, articles were screened by study design and outcome measure and ranked by strength of evidence. Only randomized trials, longitudinal studies with a comparison group, and pre-test/post-test studies met inclusion criteria. A total of 56 studies were included. Of those studies with relevant data, approximately 93 percent indicated that CHW FP programs effectively increased the use of modern contraception, while 83 percent reported an improvement in knowledge and attitudes concerning contraceptives. Based on these findings, strong evidence exists for promoting CHW programs to improve access to FP services. We recommend a set of best practice guidelines that researchers and program managers can use to report on CHW FP programs to facilitate the translation of research to practice across a wide range of settings.

This article provides updated estimates of trends in modern contraceptive use among young adult women (aged 15–24) who have had sex, using Demographic and Health Survey data from 23 sub‐Saharan African countries (1990–2014). In East/South Africa, parous women had higher modern contraceptive use than nulliparous women and larger increases in modern contraceptive use over time. In the West/Central region, nulliparous women had higher modern contraceptive use than parous women and larger increases in modern contraceptive use over time. Most of the increase in modern contraceptive use was driven by an increase in short‐acting—rather than long‐acting—methods across regions and parity groups. Although parous women had higher unmet need for family planning in both regions, nulliparous women had larger increases in unmet need for family planning over time in the East/South region. Decomposition analysis suggests that increases in use of modern contraceptives are largely driven by increases in the rate of contraceptive use rather than changes in the parity composition of women.

Since the early 2000s, the Standard Days Method (SDM) of family planning has been tested, introduced, and scaled up in countries around the world. SDM is a fertility awareness-based method for avoiding unprotected intercourse during the fertile period, days eight through 19 of a woman's menstrual cycle (for women whose cycles range from 26 to 32 days). Most SDM users utilize a visual aid-CycleBeads ®-to assist their correct use of SDM. In a 2002 trial, the method's first year failure rate (5 per 100 woman years with correct use and 12 per 100 woman years for typical use) was established, commensurate with certain other modern methods of contraception; since then, SDM has been introduced as well as studied in a variety of low and middle income countries (LMIC), and has been scaled up in some. This working paper summarizes the results of a structured review on SDM by the Evidence Project in 2014. This review utilized standardized search strings and systematic screening and abstracting criteria for reviewing available peer-reviewed and grey literature reports on SDM outcomes. Fifty-two reports and peer-reviewed articles were included and abstracted for data and information on client outcomes, provider outcomes, SDM service delivery characteristics, cost effectiveness, and implementation and scale up documentation. The included literature covered SDM implementation, scale up, social marketing, provider training, costing, and studies of most significant change in 23 countries from 1999 to 2014. This review of evidence on SDM tells us that the method appeals to a specific tranche of womenthose with unmet need, who desire to use non-hormonal contraception, and who are new to the use of effective modern FP methods. SDM as a method has correct and typical failure rates on par with some other modern methods of contraception (diaphragms, female condoms, and male condoms) and its prevalence is similar to some other modern methods that have been around for longer periods of time (female condoms, implants, IUDs, and male sterilization). SDM is easy to use and satisfying to users, it increases knowledge about the fertile period among both women and men, and it promotes male engagement in FP. It can be offered by a range of public and private providers throughout the health system. Scale up of SDM use requires stakeholder buy in and participation, early introduction of SDM into policies, guidelines, norms and curricula, inclusion of SDM into HMIS, procurement, and training systems, supportive supervision and refresher training, and publicprivate partnerships. In order to facilitate sustainable and systematic scale-up, particular attention needs to be to the procurement and availability of CycleBeads ® , agreement within the international community that SDM is a modern method, inclusion of SDM in national surveys, and the expansion of cadres providing SDM. IRH SDM Implementation and Scale up Studies Special studies undertaken within IRH Implementation and Scale up Studies 2 Other 3 Efficacy Trial Method Working Paper ▪ 45

Few large, longitudinal studies document multiple contraceptive methods' effects on sexual functioning, satisfaction, and well-being. We leveraged data from the HER Salt Lake Contraceptive Initiative, a prospective cohort study with patient surveys at baseline, one month, and three months. Surveys assessed bleeding changes, contraceptive-related side effects, sexual functioning and satisfaction, and perceptions of methods' impact on sexual well-being. Individuals in the final sample (N = 2,157) initiated either combined oral contraceptives, levonorgestrel intrauterine devices (IUDs), copper IUDs, implants, injectables, or vaginal rings. Across methods, participants exhibited minimal changes in sexual function (Female Sexual Function Index-6 scores) or satisfaction (New Scale of Sexual Satisfaction scores) over three months. However, many perceived contraception-related changes to sexual well-being. Half (51%) reported their new method had made their sex life better; 15% reported it had made their sex life worse. Sexual improvements were associated with decreased vaginal bleeding, fewer side effects, and IUD use. Negative sexual impacts were associated with physical side effects (e.g., bloating and breast tenderness), increased bleeding, and vaginal ring use. In conclusion, contraceptive users did not experience major changes in sexual functioning or satisfaction over three months, but they did report subjective sexual changes, mostly positive, due to their method.

The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations, or those of the Executive Directors of the World Bank or the governments they represent.

BackgroundGrowing focus on the need for voluntary, rights-based family planning (VRBFP) has drawn attention to the lack of programs that adhere to the range of rights principles. This paper describes two first-of-their-kind interventions in Kaduna State, Nigeria and in Uganda in 2016–2017, accompanied by implementation research based on a conceptual framework that translates internationally agreed rights into family planning programming.MethodsThis paper describes the interventions, and profiles lessons learned about VRBFP implementation from both countries, as well as measured outcomes of VRBFP programming from Nigeria.ResultsThe intervention components in both projects were similar. Both programs built provider and supervisor capacity in VRBFP using comparable curricula; developed facility-level action plans and supported action plan implementation; aimed to increase clients’ rights literacy at the facility using posters and handouts; and established or strengthened health committee structures to support VRBFP. Through the interventions, rights literacy increased, and providers were able to see the benefits of taking a VRBFP approach to serving clients. The importance of ensuring a client focus and supporting clients to make their own family planning choices was reinforced. Providers recognized the importance of treating all clients, regardless of age or marital status, for example, with dignity. Privacy and confidentiality were enhanced. Recognition of what violations of rights are and the need to report and address them through strong accountability systems grew. Many lessons were shared across the two countries, including the need for rights literacy; attention to health systems issues; strong and supportive supervision; and the importance of working at multiple levels. Additionally, some unique lessons emanated from each country experience.ConclusionThe assessed feasibility and benefits of using VRBFP programming and outcome measures in both countries bode well for adoption of this approach in other geographies.

Objectives Sexuality-related preferences have been understudied in contraceptive selection and uptake. Investigators endeavored to assess contraceptive preferences among patients selecting new methods at family planning clinics and to evaluate the degree to which two sexuality-related preferences are (a) valued and (b) associated with method selection. Study design Data were derived from the HER Salt Lake Contraceptive Initiative, a longitudinal cohort nested in a quasi-experimental, observational study enrolling 18–45-year-old patients at four family planning health centers in Salt Lake County. At the time of selecting the new method of their choice, participants reported the importance of nine factors in contraceptive method selection, including two sexuality-related preferences: a method's lack of impact on libido and its lack of sexual interruption. Analyses involved multinomial logistic regression with method selected as the outcome, sexuality-related factors as the main explanatory variables, and a range of controls and covariates. Results Among 2188 individuals seeking new contraceptive methods, the factors most frequently cited as quite or extremely important were safety (98%), effectiveness (94%), not interrupting sex (81%), not impacting libido (81%) and lack of side effects (80%). Less frequently cited factors included partner acceptability (46%), lack of hormones (39%), friend recommendation (29%) and alignment with religious beliefs (11%). Multivariate models documented no significant associations between sexual-related priorities and method selection. Conclusions Many contraceptive seekers rank sexual-related priorities alongside safety and efficacy as very important, but a range of methods align with people's sexual priorities. Implications Since patients endorse the importance of sexual-related contraceptive factors (impact on libido, impact on sexual interruption) alongside safety and efficacy, contraceptive research, counseling and care should attend to people's sexuality.

Objective This study examines the schemas that women employed during the COVID‐19 pandemic to make sense of their reproductive desires. Background Existing research on reproduction during epidemics suggests that there are variable population responses to periods of long‐term social uncertainty. However, less is known about how individuals make sense of maintaining or adapting their reproductive desires during periods of social upheaval. Method Twenty‐nine women aged 25–35 from a mid‐sized Midwestern county in the United States were recruited and interviewed about their experiences during the first 8 months of the COVID‐19 pandemic. They were asked about their daily lived experiences and their reproductive desires during in‐depth interviews. These interviews were transcribed and analyzed using thematic coding. Results Participants used three normative schemas to describe their reproductive desires during the COVID‐19 pandemic. Heteronormative schemas were used by many participants to articulate their commitment to a heteronormative aged‐staged timeline of life events. Schemas of social support around being pregnant and giving birth were used by participants, primarily those who were currently or recently pregnant, to express grief and loss over the relational experience of having a new baby. Medicalized schemas were expressed by most participants to describe feelings of fear and risk at real or imagined encounters with medical institutions. Conclusion The schemas that participants used to make sense of their reproductive desires demonstrate how sense‐making during a profound event that affects everyday realities allows participants to (re)articulate commitments to existing narratives that reinforce heterosexual, social, and medicalized hierarchies in reproduction.