We have begun to realize that to achieve uptake and user satisfaction, contraceptive method acceptability must be integrated into the product development cycle.
This piece was originally published by the CTI Exchange blog, Exchanges.
While contraceptive technology development rightly focuses on product safety and efficacy, we continually learn—sometimes the hard way—that acceptability factors play a major role in determining whether women or men use family planning (FP) methods over the long-term. Research on method acceptability is both complex and nuanced since members of the study population – current or potential contraceptive users – bring unique life situations, country context, product preferences and tolerance levels to the discussion. Recently, the CTI Exchange invited several thought leaders to share their insights on this important topic in a recently completed blog series.
Sixteen-year-old Aisha Lausali (right) after delivering her first child at a hospital in Gusau, Nigeria. (Courtesy of Karen Kasmauski/MCHIP)
Thirteen million adolescents will give birth this year. And their challenges won’t end with delivery – these first-time and young parents (FT/YP) face unique risks that we must meet to help end preventable child and maternal deaths in a generation.
Here’s what we know: women under age 20 are twice as likely to die in childbirth as women over 20. Early pregnancies limit educational achievement and income-generation potential, and they increase the risk of poor health outcomes for both young mothers and their children.
Pathfinder | Technical Advisor for Health & Rights Education
Young mothers with their children in Burkina Faso. Photo: Célestin Compaore.
In middle- and low-income countries, about 90% of births to adolescents occur within marriage or a union. Many of these young women are under substantial pressure from in-laws and other gatekeepers to begin childbearing immediately and to space their births closely, and service providers often reinforce these assumptions—all resulting in poorer health outcomes and less autonomy for young women. For years, programmatic and policy efforts have focused on preventing early and child marriage, but have paid little attention to adolescents after they marry or have children.
Envision a health system in which quality family planning information and services are accessible to everyone in their local communities. Community-based family planning (CBFP) lessens the burden of having to travel to health facilities while providing valuable and comprehensive care. In countries where CBFP is being implemented, contraceptive methods are being provided to women, men, and couples typically using a combination of three high-impact practices: provision by community health workers, mobile outreach, and drug shops.
If you're a regular visitor to K4Health.org, you'll notice we're in the process of revising the website. I like to think of knowledge products (including websites) as gardens: They need constant tending to adjust to changes in the environment and the needs of the people they serve. This set of changes is like making new paths and building new raised beds—it's more substantial than just planting something new or pruning back old growth.
A mother with her children in Ghana. (Courtesy of Karen Kasmauski/MCSP)
For millions of women worldwide, lack of economic independence can mean more than a life of poverty. Unable to access healthcare without a husband’s or father’s permission, it can be a matter of life or death.
Women in many of the countries where USAID’s flagship Maternal and Child Survival Program (MCSP) works struggle to take control of their lives – both financially and physically. This includes their ability to choose when and if to have another pregnancy. Often there’s a relationship between these two facts, as well: as our staff found in Nigeria, male control over household assets and decision-making has a direct impact on contraceptive prevalence rate.
K4Health shares our favorite family planning resources!
It’s hard to believe this now, given all the information we have available at our fingertips, but when I was a college student in the mid-2000s, the Internet was barely used as a research tool. If I wanted to know which resources in my field of study were the best and most reputable, I asked a librarian, consulted an encyclopedia, or saved clippings of magazine articles by experts. It was a time-consuming process, but I loved it. Why? Because I knew that I could trust my sources.
At the recent Family Planning Summit for Safer, Healthier and Empowered Futures in London in July, representatives from country governments, donors, and civil society organizations reconvened, as many had five years earlier, to make bold commitments in support of reaching 120 million women with contraception by 2020. To achieve these commitments, governments and partners within a country must have a shared vision and must coordinate financing and implementation of aligned and complementary activities. Costed Implementation Plans (CIPs) are one way that countries have articulated and guided the who, what, when, and how much will it cost of achieving their FP2020 commitments. As we pause to reflect on the outcomes of our collective efforts over the past five years, I think it is equally important to reflect on the processes we have employed to achieve those outcomes, including how we implement CIPs.
L-R: Dr. Assefa Seme (Co-PI, PMA2020/Ethiopia), Dr. Linnea Zimmerman (Associate Director for Research, PMA2020), Dr. Ephrem Lemango (Director of Maternal, Child Health and Nutrition Directorate of the Ministry of Health in Ethiopia), Dr. Solomon Shiferaw (PI, PMA2020/Ethiopia).
Data from the fifth and most recent round of the Performance Monitoring and Accountability 2020 (PMA2020) survey in Ethiopia show an increasing proportion of women, married, unmarried, and all, are using highly effective, long-acting forms of contraception, such as implants, intrauterine devices (IUDs), and to a lesser degree sterilization. Over the past three and a half years (since PMA2020’s first survey round in 2014), Ethiopia has made strides in improving family planning access and use among both married and unmarried women. More women are using contraception, they are using contraception at an earlier age, and they are increasingly choosing the most-effective long-acting methods.
Join HIFA for a thematic discussion on how to meet the family planning/contraception (FP/C) information needs of the general public, healthcare providers and policy makers in low- and middle-income countries. Join us!
Photo by Trevor Snapp for IntraHealth International.
Back in the early 1990s, the International Planned Parenthood Federation asked me to research and write about maternal mortality. It was a true eye-opener: the daily tragedy of maternal deaths—in huge numbers. I learned that most of these deaths are preventable, and many are the consequence of unintended pregnancies, due largely to lack of availability of modern contraceptives. Over the following months and years, my sense of injustice was compounded as I began to learn of other global health inequities. I soon found myself leaving the U.K. National Health Service for a (chequered and unconventional) career in global health.