Context-specific, evidence-based planning for scale-up of family planning services to increase progress to MDG 5: health systems research

Abstract

BackgroundUnmet need for family planning is responsible for 7.4 million disability-adjusted life years and 30% of the maternity-related disease burden. An estimated 35% of births are unintended and some 200 million couples state a desire to delay pregnancy or cease fertility but are not using contraception. Unmet need is higher among the poorest, lesser educated, rural residents and women under 19 years. The barriers to, and successful strategies for, satisfying all demand for modern contraceptives are heavily influenced by context. Successfully overcoming this to increase the uptake of family planning is estimated to reduce the risk of maternal death by up to 58% as well as contribute to poverty reduction, women’s empowerment and educational, social and economic participation, national development and environmental protection.MethodsTo strengthen health systems for delivery of context-specific, equity-focused reproductive, maternal, newborn and child health services (RMNCH), the Investment Case study was applied in the Asia-Pacific region. Staff of local and central government and non-government organisations analysed data indicative of health service delivery through a supply–demand oriented framework to identify constraints to RMNCH scale-up. Planners developed contextualised strategies and the projected coverage increases were modelled for estimates of marginal impact on maternal mortality and costs over a five year period.ResultsIn Indonesia, Philippines and Nepal the constraints behind incomplete coverage of family planning services included: weaknesses in commodities logistic management; geographical inaccessibility; limitations in health worker skills and numbers; legislation; and religious and cultural ideologies. Planned activities included: streamlining supply systems; establishment of Community Health Teams for integrated RMNCH services; local recruitment of staff and refresher training; task-shifting; and follow-up cards. Modelling showed varying marginal impact and costs for each setting with potential for significant reductions in the maternal mortality rate; up to 28% (25.1-30.7) over five years, costing up to a marginal USD 1.34 (1.32-1.35) per capita in the first year.ConclusionLocal health planners are in a prime position to devise feasible context-specific activities to overcome constraints and increase met need for family planning to accelerate progress towards MDG 5.

Use of modern family planning methods among Saudi women in Taif, KSA

“…27 Specific emphasis must be directed to women under 25 years of age who are more likely to request premature discontinuation of their IUDs and may benefit from additional counselling. 28 (Byrne et al, 2012 andMostafa Kamal, 2012) 29,30 added that women with the lowest education level and poorest quintile were least likely to use any contraception method. The lack of knowledge about contraceptives was rarely cited as a reason for non-use.…”

Informing family planning research priorities: a perspective from the front line in Asia

“…Despite its importance, the health information systems of the four countries included in the study entirely overlook service quality in their composition of indicators. Our study revealed that the quality of government family planning services was a major factor limiting utilisation in Indonesia, Nepal, the Philippines (Byrne et al 2012) and India. Complications from incorrect insertion of intrauterine devices, poor counselling for appropriate methods and mismanagement of side effects were frequently reported (Aldaba et al 2011;Morgan et al 2011;Trisnantoro et al 2011;Varghese et al 2011Varghese et al , 2012.…”

“…Several studies have explored the effects of internal migration on various health issues (Abas et al 2009;Ebrahim et al 2010;Lu 2010), and our study revealed that temporary migration, for both work and cultural purposes, can also have a large effect on requirements for family planning service delivery and effective use of methods. For example, in Nepal, significant male migration for work means that different sexual and reproductive needs exist for the short time in which men return home and for those periods when they are separated (Morgan et al 2011).…”

“…Our study revealed that the quality of government family planning services was a major factor limiting utilisation in Indonesia, Nepal, the Philippines (Byrne et al . ) and India. Complications from incorrect insertion of intrauterine devices, poor counselling for appropriate methods and mismanagement of side effects were frequently reported (Aldaba et al .…”

What is needed for taking emergency obstetric and neonatal programmes to scale?

“…Methods of strengthening may include expanding the capacity of the organisation and staff to implement a programme -a critical factor in success of scale up [5]. Running a specific programme within a broader group of health services [53] may in some instances result in a more efficient use of existing resources.…”