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Title: Expanding access to injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] [2009]. 12 p.
Abstract: A number of technological developments can make injections safer for administration, whether by health personnel, trained community workers or the women themselves: sub-cutaneous injections, which have less complications than intra-muscular injections; non-reusable disposable syringes Distribution by community health workers needs special attention to: the possibility that a woman is already pregnant (or seeking an abortion by using an injectable); the screening of women with pre-existing conditions or on medications; the need for counselling for side-effects (in particular: vaginal bleeding irregularities, amenorrhea, weight gain, delay in return to fertility); the safety of injections to the woman and to the health worker; the possible confusion between different injectables --provided by public and private sectors. To complement pre-service and in-service training, a number of job aids are available to support community workers providing injectables: medical eligibility criteria wheel to screen for eligibility; pregnancy checklist; simplified material for the management of side-effects (bleeding, amenorrhea, weight changes, etc). (Excerpt)
Language: English
Keywords:
GLOBAL | TABLES AND CHARTS | INJECTABLES | DEPO-PROVERA | CONTRACEPTIVE EFFECTIVENESS | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | PROGRAM ACCESSIBILITY | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTIVE SAFETY | MATERNAL MORTALITY | CAUSES OF DEATH | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraceptive Usage | Program Evaluation | Programs | Organization and Administration | Nonclinical Distribution | Distributional Activities | Program Activities | Safety | Public Health | Health | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 331838

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Title: WHO / USAID / FHI Technical Consultation: Expanding Access to Injectable Contraception, 15-17 June 2009, Room M405, WHO, Geneva.
Author: World Health Organization [WHO]; United States. Agency for International Development [USAID]; Family Health International [FHI]
Source: [Unpublished] 2009. 5 p.
Abstract: The agenda for the consultation is presented. The objectives of the consultation were: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely.
Language: English
Keywords:
GLOBAL | TABLES AND CHARTS | CONFERENCES AND CONGRESSES | WHO | USAID | INJECTABLES | CONTRACEPTIVE AVAILABILITY | INTERVENTIONS | NEEDS | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTION CONTINUATION | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Government Agencies | Contraceptive Methods | Contraception | Family Planning | Programs | Organization and Administration | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Contraceptive Usage
Document Number: 331853

Title: The morning-after pill [letter]
Author: Abell S
Source: Clinical Pediatrics. 2009 Apr;48(3):341-2; discussion 342.
Abstract: This is a question from a reader to the journal's Medical Doctor about the morning-after pill. The Dr. clearly confirms that the morning-after pill is not causing abortion. Her description helps us better understand how this pill (usually levonorgestrel), a progestin, works in preventing a pregnancy. This approach, which is now known as Plan B�, has received strong support in the prevention of unplanned pregnancies from both the American College of Obstetrics and Gynecology and the American Academy of Pediatrics in also circumventing the need for abortions in women of all ages, especially in adolescent girls. Some pharmacists have resisted filling these Plan B prescriptions, so it will be important for pediatricians to know which pharmacies in your community will accept your Plan B� prescriptions. Sadly, teenage pregnancies continue to have a major impact on disadvantaged teenagers. This group of individuals also may have limited access to Plan B prescriptions, which requires that they should be taken within 5 days of unprotected intercourse in order for them to be effective in preventing unwanted pregnancies.
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | EVALUATION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE MODE OF ACTION | ABORTION | CONTRACEPTIVE SAFETY | CONTRACEPTIVE AVAILABILITY | PHARMACY DISTRIBUTION | ORAL CONTRACEPTIVES, SIDE EFFECTS | NAUSEA | VOMITING | Developed Countries | North America | Americas | Demographic Factors | Population | Contraception | Family Planning | Fertility Control, Postconception | Safety | Public Health | Health | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Signs and Symptoms | Diseases
Document Number: 331244 Notification

Peer Reviewed

Title: Expanding access to intrauterine contraception.
Author: Allen RH; Goldberg AB; Grimes DA
Source: American Journal of Obstetrics and Gynecology. 2009 Jun 13;
Abstract: The intrauterine device is a safe, highly effective, long-lasting, yet reversible method of contraception. Expanding access to intrauterine contraception is an important measure to reduce the rate of unintended pregnancy in the United States. Clinicians should consider intrauterine contraception in appropriate candidates, including women who are nulliparous, adolescent, immediately postpartum or postabortal, and desiring emergency contraception, and as an alternative to permanent sterilization. Barriers to intrauterine contraception such as requiring cervical cancer screening before insertion, routine testing for gonorrhea and chlamydial infection in low-risk women, or scheduling insertion only during menses are unnecessary.
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | ADOLESCENTS, FEMALE | IUD | CONTRACEPTIVE AVAILABILITY | MISINFORMATION | CONTRAINDICATIONS | INSERTION | PAIN | IUD EXPULSION | NULLIPARITY | Developed Countries | North America | Americas | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Communication | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Diseases | Parity | Fertility Measurements | Fertility | Population Dynamics
Document Number: 341709

Peer Reviewed

Title: Increased access to emergency contraception: why it may fail.
Author: Baecher L; Weaver MA; Raymond EG
Source: Human Reproduction. 2009 Apr;24(4):815-9.
Abstract: BACKGROUND: To explore why increased access to emergency contraception (EC) failed to reduce pregnancies in a recent randomized controlled trial. METHODS: We used multivariable logistic regression to identify risk factors for unintended pregnancy using data from a trial involving sexually active women (n = 1490, aged 14-24 years) randomly assigned to either increased access or standard access to EC. We used predictive modeling to generate estimated pregnancy risk scores for each participant. We then examined EC use among women at low or high baseline risk of pregnancy. RESULTS: Gravidity, recent history of unprotected sex (within 14 days of enrollment to study) and lower aversion to pregnancy predicted unintended pregnancy. Women in the increased access group were more likely than women in the standard access group to use EC repeatedly. This difference was significantly stronger (P = 0.03) among low risk women than high risk women [Relative risk (RR) 10.0, 95% confidence interval (CI) 6.5-15.4 and RR 5.5, 95% CI 3.8-7.9, respectively]. CONCLUSIONS: Increased access to EC had a greater impact on women who were at lower baseline risk of pregnancy. This may explain in part why increased access to EC has had no measurable benefit in clinical trials.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | STATISTICAL REGRESSION | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PREGNANCY, UNPLANNED | INCIDENCE | RISK FACTORS | PSYCHOSOCIAL FACTORS | Developed Countries | North America | Americas | Data Analysis | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Reproductive Behavior | Fertility | Population Dynamics | Measurement | Health | Behavior
Document Number: 341661

Peer Reviewed

Title: Adolescent access to emergency contraception: a comment on the UK context.
Author: Fallon D
Source: European Journal of Contraception and Reproductive Health Care. 2009 Apr;14(2):120-6.
Abstract: The provision of emergency contraception (EC) in the United Kingdom (UK) has been transformed over the past decade through advances in pharmacology and the implementation of governmental measures to reduce teenage pregnancy rates. This paper considers how these issues have developed in the current social and political context with specific reference to adolescent access to EC in the UK. It highlights the concerns caused by increased availability of EC and the tension between adolescent rights to confidential treatment and advice, and professional anxiety about encouraging secrecy or parental deception. It concludes that adolescents, whilst benefiting from increased access to EC may also face a series of challenges as a result.
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | CLINICAL RESEARCH | ADOLESCENTS, FEMALE | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | GOVERNMENT PROGRAMS | ADOLESCENT PREGNANCY | PREVENTION AND CONTROL | POLITICAL FACTORS | CONFIDENTIAL INFORMATION | FAMILY PLANNING EDUCATION | PARENTAL CONSENT | Developed Countries | Europe, Western | Europe | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Programs | Organization and Administration | Reproductive Behavior | Fertility | Population Dynamics | Diseases | Sociocultural Factors | Ethics | Education
Document Number: 330933

Title: Guatemala: Using supply chain modeling and simulation to analyze the Ministry of Health supply chain.
Author: Gibney J; Sanchez A; Lamadrid C
Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2009 Mar. 38 p. (USAID Contract No. GPO-I-01-06-00007-00)
Abstract: This activity analyzed the characteristics of the integrated logistics system in three departments in Guatemala: Solol�, Totonicap�n, and Jutiapa. This paper identifies some of the obstacles to achieving contraceptive availability for the underserved and vulnerable populations; it also offers options for improving equity in access for family planning commodities. The study identifies elements in the Ministry of Public Health and Social Welfare�s (MSPAS) logistics system that could impede the availability and accessibility of contraceptives. By using supply chain simulation and optimization modeling software, with geographic information system tools, the authors propose system-related solutions that could improve the performance of the overall MSPAS.
Language: English
Keywords:
GUATEMALA | RECOMMENDATIONS | GOVERNMENT AGENCIES | LOGISTICS | HEALTH SERVICES EVALUATION | CONTRACEPTIVE AVAILABILITY | OBSTACLES | NEEDS | CONTRACEPTIVE DISTRIBUTION | PERFORMANCE IMPROVEMENT | GEOGRAPHY | INFORMATION RETRIEVAL SYSTEMS | TRANSPORTATION | Central America | Latin America | Americas | Developing Countries | Organizations | Political Factors | Sociocultural Factors | Management | Organization and Administration | Program Evaluation | Programs | Contraception | Family Planning | Economic Factors | Distributional Activities | Program Activities | Social Sciences | Science | Data Storage and Retrieval | Information Processing | Information
Document Number: 331663

Peer Reviewed

Title: The emergency contraceptive pill rescheduled: a focus group study of women's knowledge, attitudes and experiences.
Author: Hobbs M; Taft AJ; Amir LH
Source: Journal of Family Planning and Reproductive Health Care. 2009 Apr;35(2):87-91.
Abstract: BACKGROUND AND METHODOLOGY: The levonorgestrel-containing emergency contraceptive pill (ECP), amongst other strategies, has the potential to assist in reducing unintended pregnancy and abortion rates. Since the rescheduling of the ECP in January 2004 to over-the-counter (OTC) status from pharmacies in Australia, there is little information about Australian women's ECP knowledge, attitudes or practice. The aim of the study was to explore Australian women's knowledge of, attitudes towards and experiences of using the ECP, particularly since it has been available OTC. This paper reports a qualitative study using six focus groups, which were conducted between February and June 2007 in four Australian states with 29 women aged 16-29 years. RESULTS: Participants had a lack of specific knowledge about the ECP. Most were positive about the ECP being available OTC, however some expressed concerns about younger women misusing it. Women's experiences obtaining the ECP from the pharmacy were both positive and negative. Most women said they would use the ECP again if required and would recommend it to a friend. Pharmacists were seen as important suppliers of the ECP but women felt it was not their role to provide advice about contraception or sexually transmitted infections. DISCUSSION AND CONCLUSIONS: The findings from this study confirm views from other studies, which suggest that although women have some concerns in relation to OTC supply of the ECP, they believe that the deregulation of the ECP is a positive step. The data also suggest that women need to be provided with more information and education about the ECP.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | FOCUS GROUPS | WOMEN | EMERGENCY CONTRACEPTION | KNOWLEDGE | ATTITUDES | LEVONORGESTREL | CONTRACEPTIVE USAGE | CONTRACEPTIVE AVAILABILITY | AGE FACTORS | Oceania | Developed Countries | Data Collection | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Sociocultural Factors | Psychological Factors | Behavior | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Population Characteristics
Document Number: 330948

10.
Title: Knowledge of emergency contraception among women of childbearing age at a teaching hospital of Karachi.
Author: Irfan F; Karim SI; Hashmi S; Ali S; Ali SA
Source: JPMA. Journal of the Pakistan Medical Association. 2009 Apr;59(4):235-40.
Abstract: OBJECTIVES: To assess knowledge and attitudes about Emergency Contraception among women of childbearing age in Karachi, Pakistan. METHODS: A questionnaire based survey was conducted on 400 married women, attending the family practice clinics at a teaching hospital in Karachi, Pakistan from July to December 2006. Questionnaire was administered to women at the family practice clinic-seeking level of knowledge of emergency contraception (EC) and attitudes towards its use, Ethical requirements of informed consent and confidentiality were ensured Data was entered into Epi data and analyzed in SPSS. RESULTS: Eighty-eight percent of women were not aware of EC. 83% were housewives. Only a small number (11.5%) ever used EC to prevent pregnancy, out of those, the correct timing of effectiveness of post-coital pill was known to only 40% of women while none of these women were aware of the existence of Intra Uteriune Contraceptive Device (IUCD) insertion as an option for EC About 50% of women identified general practitioners or family medicine clinics as their main sources of knowledge about EC. Increased advertising was considered desirable by 72% while 37% considered over the counter availability of EC pill desirable and only 36% of women were uncomfortable to use EC because of religious reasons. CONCLUSION: EC has a potential to offer women an important option for fertility control. Lack of women's knowledge about EC use and availability may account in part for its limited use. There is a need to improve women's education about EC. The primary health care providers can play a major role in informing their patients about emergency contraception.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | KAP SURVEYS | WOMEN IN DEVELOPMENT | KNOWLEDGE | EMERGENCY CONTRACEPTION | ATTITUDES | TIME FACTORS | CONTRACEPTIVE USAGE | IUD | ADVERTISING | PHARMACY DISTRIBUTION | CONTRACEPTIVE AVAILABILITY | RELIGION | Developing Countries | Asia, Southern | Asia | Surveys | Sampling Studies | Studies | Research Methodology | Economic Development | Economic Factors | Sociocultural Factors | Contraception | Family Planning | Psychological Factors | Behavior | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Promotion | Marketing | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 331281

11.

Title: Emergency contraception services for adolescents: a National Survey of Children's Hospital Emergency Department Directors.
Author: Kavanaugh ML; Saladino RA; Gold MA
Source: Journal of Pediatric and Adolescent Gynecology. 2009 Apr;22(2):111-9.
Abstract: STUDY OBJECTIVE: To assess emergency contraception (EC) counseling and prescribing practices of children's hospital emergency department (ED) directors and the use of EC protocols in these settings. DESIGN: Cross-sectional study of children's hospital ED directors responding to a 15-minute 44-item semi-structured survey during telephone interviews. PARTICIPANTS: 50 of 96 eligible directors of children's hospital EDs in the United States. MAIN OUTCOME MEASURES: EC protocols, EC counseling processes, EC prescribing practices. RESULTS: Most (80%) ED directors reported always offering EC as part of sexual assault care; 66% were more likely to provide onsite EC in these situations. Only 52% identified the progestin-only regimen as the EC dispensed in their ED, and most (96%) limited provision to fewer than 120 hours after sex. Although 58% of ED directors reported ever prescribing ongoing contraception when providing EC, none had prescribed EC for future use. Written ED protocols for providing EC were more common for sexual assault care (76%) than for non-sexual assault care (14%). Directors who worked at hospitals with a sexual assault program were less likely to discuss all the recommended topics for EC counseling. CONCLUSIONS: The recommended standard of care for providing EC to adolescents in children's hospital EDs is not being met. Although risk of pregnancy following sexual assault and consensual unprotected sex is identical, discrepant practices emerged from this survey of pediatric ED directors. Increased education and policy initiatives within children's hospital EDs are needed to standardize EC services for adolescents in this setting.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | CROSS SECTIONAL ANALYSIS | ADMINISTRATIVE PERSONNEL | HEALTH PERSONNEL | ADOLESCENTS, FEMALE | EMERGENCY CONTRACEPTION | HOSPITALS | EMERGENCY SERVICES | COUNSELING | PRESCRIPTIONS | RAPE | CONTRACEPTIVE AVAILABILITY | TIME FACTORS | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Organization and Administration | Delivery of Health Care | Health | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Contraception | Family Planning | Health Facilities | Health Services | Clinic Activities | Program Activities | Programs | Distributional Activities | Crime | Social Problems | Sociocultural Factors | Population Dynamics
Document Number: 330952

12.

Title: Ethics in family planning FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health.
Author: Milliez J
Source: International Journal of Gynaecology and Obstetrics. 2009 Apr 16;
Abstract: The FIGO Committee for the Ethical Aspects of Human Reproduction and Women's Health considers the ethical aspects of issues that impact the discipline of obstetrics, gynecology, and women's health. The following document represents the result of that carefully researched and considered discussion. This material is intended to provide material for consideration and debate about these ethical aspects of our discipline for member organizations and their constituent membership.
Language: English
Keywords:
DEVELOPING COUNTRIES | RECOMMENDATIONS | EVALUATION | WOMEN IN DEVELOPMENT | POLICYMAKERS | FAMILY PLANNING PERSONNEL | HEALTH PERSONNEL | ETHICS | FAMILY PLANNING | CONTRACEPTIVE AVAILABILITY | ABORTION | HUMAN RIGHTS | MALE ROLE | REFERRAL AND CONSULTATION | Economic Development | Economic Factors | Administrative Personnel | Organization and Administration | Family Planning Programs | Delivery of Health Care | Health | Sociocultural Factors | Contraception | Fertility Control, Postconception | Political Factors | Social Behavior | Behavior | Program Activities | Programs
Document Number: 331125 Notification

13.

Title: Knowledge of emergency contraception amongst tertiary students in far North Queensland.
Author: Mohoric-Stare D; DE Costa C
Source: Australian and New Zealand Journal of Obstetrics and Gynaecology. 2009 Jun;49(3):307-11.
Abstract: BACKGROUND: Emergency contraception (EC) has been available in Australia without prescription since 2003. However, there has been little research into the extent of knowledge of the actions, effectiveness and availability of EC among the general population. AIMS: To determine the extent of knowledge of EC among tertiary students in Far North Queensland, and their ability to access EC in the region. METHODS: A questionnaire was distributed to tertiary students in Cairns asking about their knowledge of EC, its effectiveness and its availability over-the-counter in pharmacies, as well as their willingness to access EC themselves if indicated, in settings in which they may be known, and in those where they would be unknown. RESULTS: Of 500 questionnaires 460 were returned; 29% of participants had used EC in the past. Only 20% understood the correct timeframe in which EC can be used; 40% were not aware of its availability over-the-counter in pharmacies, and more than 20% felt unable to purchase EC in a pharmacy where they could be recognised. Only 44% of participants were aware of the cost of EC. CONCLUSION: A significant lack of information regarding the availability, methods of action and limitations of EC was noted in this well-educated population. There was also a high proportion of participants who felt unable to access EC in a pharmacy where they might be known, a factor limiting accessibility of the method in small town and community settings.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | STUDENTS | EMERGENCY CONTRACEPTION | KNOWLEDGE | QUESTIONNAIRES | CONTRACEPTIVE AVAILABILITY | CONTRACEPTIVE EFFECTIVENESS | AWARENESS | Oceania | Developed Countries | Education | Contraception | Family Planning | Sociocultural Factors
Document Number: 341798

14.

Title: Preparing daughters: the context of rurality on mothers' role in contraception.
Author: Noone J; Young HM
Source: Journal of Rural Health. 2009 Summer;25(3):282-9.
Abstract: CONTEXT: The United States continues to have the highest rate of adolescent childbearing among developed countries. Lack of access and disadvantage contribute to this problem, which disproportionately impacts rural women. Given the increased difficulty rural young women face regarding contraceptive access, parental communication and support play an even more vital role in assisting them to navigate decisions about and access to contraception. PURPOSE: To examine rural women's perspectives on how living in a rural area impacts issues surrounding pregnancy prevention for their daughters and parent-child communication regarding pregnancy prevention. METHODS: Open-ended interviews were conducted with 30 mothers of adolescent women in 3 rural counties in southern Oregon. Thematic analysis within and across interviews using constant comparative analysis was used to explore barriers, facilitators and strategies mothers identified in talking with their daughters about contraception. FINDINGS: Specific themes found that related to the rural environment included (1) conservatism, (2) isolation, (3) lack of privacy, (4) stigma, (5) the paradox of the rural environment, and (6) the uniqueness of rural life. CONCLUSIONS: The context of living in a rural environment may present unique barriers to facilitate parent-child communication when discussing intimate topics. The design of interventions needs to take into consideration these issues, particularly when attempting to serve hard-to-reach populations.
Language: English
Keywords:
UNITED STATES OF AMERICA | OREGON | RESEARCH REPORT | RURAL POPULATION | MOTHERS | ADOLESCENT PREGNANCY | CONTRACEPTIVE AVAILABILITY | PARENTAL INVOLVEMENT | INTERPERSONAL COMMUNICATION | INTERVIEWS | PRIVACY | STIGMA | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | Reproductive Behavior | Fertility | Population Dynamics | Contraception | Family Planning | Child Rearing | Behavior | Communication | Data Collection | Research Methodology | Social Problems
Document Number: 341797

15.

Peer Reviewed

Title: Does readily available emergency contraception increase women's awareness and use?
Author: Novikova N; Weisberg E; Fraser IS
Source: European Journal of Contraception and Reproductive Health Care. 2009 Feb;14(1):39-45.
Abstract: BACKGROUND: In Australia just over half of all women of reproductive age have experienced an unplanned pregnancy, many of which could have been avoided by use of emergency contraception. A dedicated emergency contraceptive pill (ECP) pack became available on prescription in Australia in 2002, and over the counter in 2004. OBJECTIVES: To determine if availability of a dedicated over the counter ECP pack in Australia increased knowledge and use of emergency contraception (EC). MATERIAL AND METHODS: Women attending three free-standing abortion clinics in Sydney answered an anonymous questionnaire on their knowledge and use of the ECP. Group 1 (208 women) was recruited prior to a dedicated ECP pack being available, group 2 (308) after it was available on prescription, and group 3 (202) after it became available over the counter. RESULTS: Women who had heard about EC were significantly younger (p < 0.005). The mean age of women who had never heard about EC was 29.8 years compared to 26.3 for women who had heard about EC. More women expressed awareness of the ECP after it became available over the counter. Women in group 2 attained a higher educational level than women in the other groups (p < 0.005). There was a significant trend to increased use of the ECP in women of higher educational level (p < 0.005). The use of EC did not increase significantly with improved availability and access. CONCLUSIONS: Among women seeking termination of pregnancy wider availability of the ECP has increased women's awareness of EC but not use.
Language: English
Keywords:
AUSTRALIA | RESEARCH REPORT | KAP SURVEYS | WOMEN | CONTRACEPTIVE USAGE | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PHARMACY DISTRIBUTION | CONTRACEPTIVE DISTRIBUTION | KNOWLEDGE | CONTRACEPTIVE PREVALENCE | AGE FACTORS | EDUCATIONAL STATUS | Developed Countries | Oceania | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Contraception | Family Planning | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Sociocultural Factors | Population Characteristics | Socioeconomic Status | Socioeconomic Factors | Economic Factors
Document Number: 330346

16.

Title: High rate of unintended pregnancy among pregnant women in a maternity hospital in Cordoba, Argentina: a pilot study.
Author: Palena C; Bahamondes MV; Schenk V; Bahamondes L; Fernandez-Funes J
Source: Reproductive Health. 2009 Jul 20;6(1):11.
Abstract: ABSTRACT: BACKGROUND: Although Argentina has a new law of Reproductive Health, many barriers continue existing to the provision of contraceptive methods at public healthcare facilities. Methods: This exploratory, descriptive pilot study evaluated 212 pregnant women selected at random at the Maternity and Neonatal Hospital, Cordoba, Argentina, who completed a structured questionnaire. The objectives were to determine the rate of unintended pregnancies, reasons for not using contraception, past history of contraceptive use, and intended future use. Results: Two hundred women responded the questionnaire. Forty percent of the participants stated that they had never used contraception and pregnancy was declared unintended by 65% of the interviewed women. In the unintended pregnancy group, almost 50% of women said that they had not been using a contraceptive method because they were "unaware about contraception", and 25% stated that their contraceptive method had failed. Almost 85% of the women stated that they intended to use a contraceptive method after delivery. Conclusions: Approximately two-thirds of all pregnancies in this sample were unintended. Although the data is limited by the small sample size, our findings suggest that government needs to invest in counseling and in improving the availability and access to contraceptive methods.
Language: English
Keywords:
ARGENTINA | RESEARCH REPORT | SAMPLING STUDIES | PREGNANT WOMEN | PREGNANCY, UNPLANNED | CONTRACEPTIVE USAGE | CONTRACEPTIVE USAGE DETERMINANTS | QUESTIONNAIRES | FAMILY PLANNING POLICY | CONTRACEPTIVE AVAILABILITY | LEGISLATION | South America, Southern | South America | Latin America | Americas | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Contraception | Family Planning | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors
Document Number: 342283

17.

Title: Making family planning accessible in resource-poor settings.
Author: Prata N
Source: Philosophical Transactions of the Royal Society of London. Series B, Biological Sciences. 2009 Oct 27;364(1532):3093-9.
Abstract: It is imperative to make family planning more accessible in low resource settings. The poorest couples have the highest fertility, the lowest contraceptive use and the highest unmet need for contraception. It is also in the low resource settings where maternal and child mortality is the highest. Family planning can contribute to improvements in maternal and child health, especially in low resource settings where overall access to health services is limited. Four critical steps should be taken to increase access to family planning in resource-poor settings: (i) increase knowledge about the safety of family planning methods; (ii) ensure contraception is genuinely affordable to the poorest families; (iii) ensure supply of contraceptives by making family planning a permanent line item in healthcare system's budgets and (iv) take immediate action to remove barriers hindering access to family planning methods. In Africa, there are more women with an unmet need for family planning than women currently using modern methods. Making family planning accessible in low resource settings will help decrease the existing inequities in achieving desired fertility at individual and country level. In addition, it could help slow population growth within a human rights framework. The United Nations Population Division projections for the year 2050 vary between a high of 10.6 and a low of 7.4 billion. Given that most of the growth is expected to come from today's resource-poor settings, easy access to family planning could make a difference of billions in the world in 2050.
Language: English
Keywords:
DEVELOPING COUNTRIES | CRITIQUE | FAMILY PLANNING PROGRAMS | PROGRAM ACCESSIBILITY | NEEDS | OBSTACLES | POVERTY | INEQUALITIES | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | POPULATION GROWTH | MATERNAL MORTALITY | Family Planning | Program Evaluation | Programs | Organization and Administration | Economic Factors | Socioeconomic Factors | Contraceptive Usage | Contraception | Population Dynamics | Demographic Factors | Population | Mortality
Document Number: 342846

18.

Title: Contraceptive projections and the donor gap: Meeting the challenge.
Author: Ross J; Weissman E; Stover J
Source: Arlington, Virginia, JSI, DELIVER, 2009 Feb. 44 p.
Abstract: This report looks at just one component of reproductive health commodities: contraceptives: A follow-up report of the same title published in 2001, the report starts with an overview of current demand for contraceptives in 88 developing countries that depend on supplies from donors. Future needs for contraceptive commodities are projected for two scenarios: one assuming that all unmet need for family planning will be satisfied by 2015 as specified in the ICPD and the MDGs, and the other one based on the medium variant projections of the United Nations Population Division-projections that assume a more gradual contraceptive prevalence increase that is based on historical trends. The proportion of future needs that will require donor funding is estimated on the basis of historical funding trends. Those future needs are compared with current donor funding to highlight the ?donor gap,? the expected shortfall in commodity funding unless resources for commodities are increased substantially.
Language: English
Keywords:
DEVELOPING COUNTRIES | DEVELOPED COUNTRIES | RESEARCH REPORT | EVALUATION | POLICYMAKERS | FOREIGN AID | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE AVAILABILITY | NEEDS ASSESSMENT | PROGRAM ACCESSIBILITY | FAMILY PLANNING POLICY | CONTRACEPTIVE DISTRIBUTION | GOVERNMENT FINANCING | Administrative Personnel | Organization and Administration | Financial Activities | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Contraception | Family Planning | Program Evaluation | Programs | Population Policy | Social Policy | Policy | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities
Document Number: 341071

19.

Peer Reviewed

Title: Attitude and behavior effects in a randomized trial of increased access to emergency contraception.
Author: Weaver MA; Raymond EG; Baecher L
Source: Obstetrics and Gynecology. 2009 Jan;113(1):107-16.
Abstract: OBJECTIVE: To explore the effects of providing unrestricted access to emergency contraception in advance of need on various psychosocial outcomes and pregnancy. METHODS: In the trial, women were randomly assigned to either increased access to emergency contraception (two free packs at enrollment with unlimited free resupply) or standard access. Participants were evaluated for 1 year for pregnancy and other outcomes. Psychosocial data were collected at enrollment and at 6 and 12 months. We applied exploratory factor analysis for data reduction. We compared the resulting psychosocial factors (including factors related to "aversion to pregnancy" and to the perceived "relative benefit" and "accessibility" of emergency contraception), two items directly assessing substitution, and pregnancy between randomization groups over time. RESULTS: On average, women in the increased access group had significantly stronger perceptions of both the "relative benefit" and "accessibility" of emergency contraception (P<.001 for each). Women in the increased access group were significantly more likely to report that they had ever used emergency contraception because they did not want to use either condoms or another contraceptive method (P<.001). Regarding pregnancy, we noted a significant interaction between randomization group and "aversion to pregnancy" (P=.010): among the least "averse" women, increased access had a protective effect (hazard ratio 0.64, 95% confidence interval 0.39-1.04); among the most "averse" women, increased access had a deleterious effect (hazard ratio 1.73, 95% confidence interval 1.01-2.98). CONCLUSION: As a result of having unrestricted access, some women substituted emergency contraception for their usual contraceptive methods. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00060463 LEVEL OF EVIDENCE: I.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | KAP SURVEYS | CLINICAL TRIALS | FACTOR ANALYSIS | WOMEN | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | PSYCHOSOCIAL FACTORS | PERCEPTION | CONDOM USE | CONTRACEPTIVE USAGE | PREGNANCY RATE | ATTITUDES | CONTRACEPTIVE METHODS CHOSEN | Developed Countries | North America | Americas | Surveys | Sampling Studies | Studies | Research Methodology | Clinical Research | Data Analysis | Demographic Factors | Population | Contraception | Family Planning | Behavior | Psychological Factors | Risk Reduction Behavior | Fertility Measurements | Fertility | Population Dynamics
Document Number: 330375

20.

Title: Rights to emergency contraception.
Author: Weisberg E; Fraser IS
Source: International Journal of Gynaecology and Obstetrics. 2009 Jun 17;
Abstract: Emergency contraception (EC) provides women with a safe means of preventing pregnancy following unprotected sexual intercourse or potential contraceptive failure, and is accepted as a legitimate method of fertility control. The right of women to access EC, along with other contraceptive methods, needs to be affirmed. The consequences of unintended pregnancy are serious, imposing appreciable burdens on children, women, men, and families. Every child has the right to be a wanted child and not enter this world because its mother was denied access to EC. For maximum effectiveness, barriers to access must be removed. It is essential that EC pills are available over-the-counter with no minimum age for access. There is a tension between the rights of women to access EC without medical or legal intervention and the rights of providers who have a conscientious objection to provision on religious or moral grounds. The principles of autonomy, non-maleficence, and beneficence all weigh in favor of the rights of a woman faced with the possibility of an unintended pregnancy to unrestricted access to EC against providers whose religious views are opposed to this.
Language: English
Keywords:
AUSTRALIA | CRITIQUE | PROVIDERS WITH CLIENTS | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | OBSTACLES | REPRODUCTIVE RIGHTS | CONTRACEPTIVE MODE OF ACTION | CONTRACEPTIVE SAFETY | LEGISLATION | RELIGIOUS ASPECTS | Oceania | Developed Countries | Health Services | Delivery of Health Care | Health | Contraception | Family Planning | Organization and Administration | Human Rights | Political Factors | Sociocultural Factors | Safety | Public Health | Religion
Document Number: 341749

21.

Peer Reviewed

Title: Young women and limits to the normalisation of condom use: a qualitative study.
Author: Williamson LM; Buston K; Sweeting H
Source: AIDS Care. 2009 May;21(5):561-6.
Abstract: Encouraging condom use among young women is a major focus of HIV/STI prevention efforts but the degree to which they see themselves as being at risk limits their use of the method. In this paper, we examine the extent to which condom use has become normalised among young women. In-depth interviews were conducted with 20 year old women from eastern Scotland (N=20). Purposive sampling was used to select a heterogeneous group with different levels of sexual experience and from different social backgrounds. All of the interviewees had used (male) condoms but only three reported consistent use. The rest had changed to other methods, most often the pill, though they typically went back to using condoms occasionally. Condoms were talked about as the most readily available contraceptive method, and were most often the first contraceptive method used. The young women had ingrained expectations of use, but for most, these norms centred only on their new or casual partners, with whom not using condoms was thought to be irresponsible. Many reported negative experiences with condoms, and condom dislike and failure were common, lessening trust in the method. Although the sexually transmitted infection (STI) prevention provided by condoms was important, this was seen as additional, and secondary, to pregnancy prevention. As the perceived risks of STIs lessened in relationships with boyfriends, so did condom use. The promotion of condoms for STI prevention alone fails to consider the wider influences of partners and young women's negative experiences of the method. Focusing on the development of condom negotiation skills alone will not address these issues. Interventions to counter dislike, method failure, and the limits of the normalisation of condom use should be included in STI prevention efforts.
Language: English
Keywords:
SCOTLAND | RESEARCH REPORT | KAP SURVEYS | WOMEN | YOUTH | CONDOM USE | ORAL CONTRACEPTIVES | CONTRACEPTIVE METHOD SWITCHING | CONTRACEPTIVE AVAILABILITY | PERCEPTION | CONDOM FAILURE | RISK ASSESSMENT | PARTNER COMMUNICATION | United Kingdom | Europe, Western | Europe | Developed Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Factors | Population | Age Factors | Population Characteristics | Risk Reduction Behavior | Behavior | Contraceptive Methods | Contraception | Family Planning | Contraceptive Usage | Psychological Factors | Condoms | Barrier Methods | Evaluation | Interpersonal Relations
Document Number: 341100

22.

23.

Title: Expanding access to contraception: IUD fees and subsidies in Egypt.
Author: Abt Associates. Private Sector Partnerships One [PSP-One]
Source: Bethesda, Maryland, Abt Associates, PSP-One, [2008]. 2 p. (Global Research Brief. LAPM Brief 3USAID Contract No. GPO-I-00-04-00007-00)
Abstract: One way for developing countries to afford the costs of family planning is to reduce the number of women with high ability to pay from obtaining subsidized (public) services. Various papers have pointed out that wealthy women receive a subsidy when they use the public sector. This brief describes the first attempt, as far as we know, to calculate this subsidy. The brief focuses specifically on Egypt and on IUDs. We estimated that direct costs of IUD provision in the public and NGO sectors in Egypt totaled $3.08 ($1.25 for insertion by the doctor, $0.95 for counseling by the nurse, $0.58 for the IUD, and $0.30 for other supplies required for insertion). Prices women pay vary substantially by sector, and are highest in the commercial sector and lowest in the public sector. The price varies with wealth within the commercial and NGO sectors but not within the public sector. The average price paid by IUD users in the commercial sector increases substantially with wealth. In fact, women in the highest quintile pay a price about twice that brief of women in the lowest quintile. The wealthiest IUD users also pay the highest prices in the NGO sector, while those in the third and fourth quintile pay somewhat less, and users in the lowest two quintiles pay the lowest prices. Users who access the public and NGO sectors, regardless of ability to pay, always paid an average price lower than did women accessing the commercial sector. (Excerpts)
Language: English
Keywords:
EGYPT | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | CURRENTLY MARRIED | WOMEN | CONTRACEPTIVE AVAILABILITY | IUD | FEES | SOCIOECONOMIC STATUS | COMMERCIAL SECTOR | PUBLIC SECTOR | RESOURCE ALLOCATION | Developing Countries | Africa, North | Africa | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Marital Status | Nuptiality | Contraception | Family Planning | Contraceptive Methods | Financial Activities | Economic Factors | Socioeconomic Factors | Commerce | Macroeconomic Factors
Document Number: 331619

24.

Title: Analysis of the operational policy barriers to financing and procuring contraceptives in Malawi.
Author: Constella Futures. Health Policy Initiative; John Snow [JSI]. DELIVER
Source: Washington, D.C., Health Policy Initiative, Constella Futures, 2008 Jun. :viii, 23 p.. viii, 23 p. (USAID Contract No. GPO-I-01-05-00040-00USAID Contract No. GPO-I-01-06-00007-00)
Abstract: Contraceptive security exists when every person can choose, obtain, and use high-quality contraceptives whenever they need them. Two of the most important factors in achieving contraceptive security are adequate financing and efficient contraceptive procurement mechanisms. The USAID | Health Policy Initiative and USAID | DELIVER Project are working together to develop a methodology for identifying operational policy barriers in the financing and procurement of family planning (FP) products. The goal is to help national governments, donors, and other key stakeholders improve the policy environment for contraceptive security. This report presents the findings from a pilot study the two projects conducted in Malawi to test this methodology.
Language: English
Keywords:
MALAWI | METHODOLOGICAL STUDIES | OPERATIONS RESEARCH | PILOT PROJECTS | DEMOGRAPHIC AND HEALTH SURVEYS | PRIVATE SECTOR | USAID | GOVERNMENT FINANCING | FINANCIAL ACTIVITIES | CONTRACEPTIVE AVAILABILITY | EQUIPMENT AND SUPPLIES | LOGISTICS | CONTRACEPTIVE PREVALENCE | DECENTRALIZATION | CAPACITY BUILDING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Program Evaluation | Programs | Organization and Administration | Research Methodology | Studies | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Macroeconomic Factors | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Contraception | Family Planning | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Management | Contraceptive Usage | Program Sustainability
Document Number: 308944

25.

26.

Title: Factors that degrade the quality of family planning services.
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, [2008]. [2] p. (Research Briefs on Family Planning Service Delivery)
Abstract: A USAID-supported study from Uganda has identified some of the factors that prevent health care providers from offering high-quality family planning services. Scientists from Makerere University and Family Health International used focus group discussions and in-depth interviews with 63 providers and managers of family planning services to examine the organizational and societal barriers to high-quality services. The organizational barriers they identified include lack of supplies, overworked providers, and insufficient knowledge and skills on the part of the providers. The societal barriers include a lack of male participation in family planning, financial constraints on the part of potential clients, public misconceptions about contraceptive use, and unsupportive community leadership. Previous studies have focused on the client's perspective of quality of care. This study looked instead at how system-wide issues have profound effects on a provider's ability to deliver high-quality care. To improve the quality of family planning services that providers offer, the authors suggest that future interventions address weaknesses at the organizational and societal levels. (Full Text)
Language: English
Keywords:
UGANDA | SUMMARY REPORT | FOCUS GROUPS | FAMILY PLANNING PERSONNEL | FAMILY PLANNING PROGRAMS | QUALITY OF HEALTH CARE | OBSTACLES | KNOWLEDGE | CONTRACEPTIVE AVAILABILITY | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Data Collection | Research Methodology | Family Planning | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Sociocultural Factors | Contraception
Document Number: 331699

27.

Title: A strong supply chain responds to increased demand for contraceptives in Rwanda.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2008. 4 p. (USAID Deliver Project, Task Order 1)
Abstract: Contraceptive security is achieved when individuals have the ability to choose, obtain, and use quality contraceptives whenever they need them. The success story, "A Strong Supply Chain Responds to Increased Demand for Contraceptives in Rwanda," highlights how, during the last 10 years, the many changes made by the Rwandan Ministry of Health and its partners (including the USAID | DELIVER PROJECT) led to an increased demand for family planning at the local level. As a result, Rwanda made impressive gains in its contraceptive prevalence rate (CPR)-a sevenfold increase in the use of modern methods-from 4 percent in 2000, post-conflict, to 27 percent in 2008.
Language: English
Keywords:
RWANDA | PROGRESS REPORT | EVALUATION | GOVERNMENT AGENCIES | LOGISTICS | EQUIPMENT AND SUPPLIES | CONTRACEPTIVE DISTRIBUTION | CONTRACEPTIVE AVAILABILITY | FAMILY PLANNING PROGRAM EVALUATION | POLITICAL FACTORS | STORAGE AND WAREHOUSES | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Organizations | Sociocultural Factors | Management | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Distributional Activities | Program Activities | Programs | Contraception | Family Planning | Family Planning Programs
Document Number: 329564

28.

29.

Title: Central Asia (2008): Family planning TRaC study evaluating use of modern contraceptive methods among women of reproductive age in rural areas of Tajikistan and Kyrgyzstan. First round.
Author: Population Services International [PSI]. Research and Metrics
Source: Washington, D.C., PSI, 2008. 27 p. (Social Marketing Research SeriesPSI Dashboard)
Abstract: PSI / Central Asia is implementing a 2-year USAID-funded program to improve maternal health among underserved, low-income women in rural Tajikistan and Kyrgyzstan. The program aims to address the lack of access to affordable family planning products, insufficient knowledge of modern contraceptives, and misconceptions about the safety and effectiveness of modern contraceptive methods. Follow-up studies are planned for 2008. The main objectives of this study are: 1. To obtain and provide both comprehensive and detailed data to support PSI�s interventions with women of reproductive age (WRA) in rural areas. 2. To obtain information for monitoring the key indicators, behavior change, and OAM determinants associated with use of modern contraceptives. A multi-stage probability sampling strategy was used to recruit 2007 women of reproductive age, 15-49 years old living in target sites (small villages) of Kyrgyzstan and Tajikistan. The questionnaire collected information on background characteristics, opinions about sexual behavior, oral and injectable contraceptives, intrauterine devices, and condoms, beliefs and knowledge about modern contraceptive methods and exposure to maternal health improvement intervention. Multivariate analyses were performed to identify significant factors associated with current use of modern contraceptive method and use of modern contraceptive methods (oral and injectable contraceptives, intra uterine device, and condoms) during last 6 months. Simple frequencies were run on descriptive data to permit monitoring of project indicators. Less than half of respondents were current users of modern contraceptives (47% in Kyrgyzstan and 37% in Tajikistan), and only a slightly higher proportion reported using any modern contraceptives in the past 6 months. (Excerpts)
Language: English
Keywords:
TAJIKISTAN | KYRGYZSTAN | RURAL AREAS | RESEARCH REPORT | SAMPLING STUDIES | LOW INCOME POPULATION | CONTRACEPTIVE USAGE | CONTRACEPTIVE USAGE DETERMINANTS | CONTRACEPTIVE AVAILABILITY | KNOWLEDGE | MOTIVATION | BELIEFS | Asia, Central | Asia | Developing Countries | Geographic Factors | Population | Studies | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Contraception | Family Planning | Sociocultural Factors | Psychological Factors | Behavior | Culture
Document Number: 331650

30.

Title: Make a case for supplies. Leading voices in securing reproductive health supplies: An advocacy guide and toolkit.
Author: Reproductive Health Supplies Coalition
Source: [Brussels, Belgium], Reproductive Health Supplies Coalition, [2008]. 99 p.
Abstract: This guide and toolkit offers general information and guidance on advocacy communication that has been useful to many groups interested in advocating for improved RH policy environments. The information is complemented by examples and templates of advocacy tools targeted specifically to the aims the Reproductive Health Supplies Coalition has set forth for securing long-term availability of high-quality reproductive health supplies. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | SUMMARY REPORT | CONTRACEPTIVE PREVALENCE | CONTRACEPTIVE AVAILABILITY | ADVOCACY | FAMILY PLANNING | REPRODUCTIVE HEALTH | CONTRACEPTIVE SECURITY | MANUAL | LOGISTICS | NEEDS | Contraceptive Usage | Contraception | Communication | Health | Management | Organization and Administration | Economic Factors
Document Number: 331555


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